Abstract

FRANQUELO MORALES, Pablo et al. Influence of the primary care physician in the quantity and quality of referrals to Specialist Services. Rev Clin Med Fam [online]. 2008, vol.2, n.5, pp.199-205. ISSN 2386-8201.

Objective. To analyze the relationship between the quantity and quality of referrals and factors related to the family physician (FP). To determine their distribution by specialities. Design. Descriptive, cross study. Setting. Primary care centre in Cuenca city. Subjects. We analyzed a total of 1,214 referrals, using the software package (TURRIANO), made by 7 family physicians during the last quarter of 2005. Main measurements. Referral forms were analysed retrospectively. We compiled variables associated with the family physician (figure 1) and with the referral itself (speciality to which it is addressed, date and quality). Three categories were established to assess the quality of referrals. Poor quality referrals met at least one of the 2 following criteria "lack of consultation reason (MC) and current history of the disease (AD)" and/or "lack of physical (PE) and/or complementary tests (CT)". In acceptable referrals, the two previous criteria were present simultaneously. Finally, a referral was evaluated as good if it fulfilled all the criteria for being acceptable plus the presence of at least one of the following: Family history, personal history, routine treatment, diagnosis. Results. We analyzed 1,214 referrals. The quality of the referrals was poor in 68.2%, acceptable in 11.4% and good in 20.3%. The services that most referrals were made to were Traumatology 14.7%, Ophthalmology 11.8%, Gyneacology 11%, and Dermatology 10.1%. The proportion of good/acceptable referrals in the most popular specialities were: Dermatology 66.7%, Traumatology 29.1%, Otolaryngology 23.3%, Gyneacology 19.5% and Ophthalmology 16,8%. With regard to the acceptable /good quality of the referral only the variable training (MIR) presented a statistically significant difference (p = 0, 03). Of the doctors considered, 28. 6% had MIR training, 57.1% were tutors and 57.1% were male. Conclusions. The number of referrals made by a Primary Health Care team (PC) to Specialist care (SC) is related to correct performance of this team and their ability to solve problems in their daily work. In our study there was a great variability in the number of referrals made by different doctors, which does not appear to be justified by the number of cards and workload. Having specialist training and tutoring residents appears to be associated with a greater capacity and quality completion of referrals.

Keywords : Referral and Consultation; Primary Health Care.

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