Referral and communication between primary and secondary care

Abstract

Objectives: To describe some aspects of the articulation between primary and secondary care in a restricted population of general practitioners. Method: Observational, descriptive and cross-sectional study, with the participation of 24 general practitioners working in public medical centres in the region of Lisbon and Almada. The physicians registered their re f e rrals for 8 weeks, and the replies from secondary care were collected for a total period of nine months. Results: From 415 re f e rrals, 57 were to Hospital Casualty and 358 to regular secondary care appointments. For the latter, and in the nine months duration of the study, 2/3 of the appointments re q u i red by the family physicians took place, and 1 in 3 obtained a reply with clinical information. The destination defined as "others" (private and public-private conventions) received the best rates, both in the number of appointments, and in the answers received. The average time for the delay in obtaining an appointment was 58.2 days, and half the patients were seen in the first 39 days. Half the answers were received by the general practitioners in the first 6 days after they were written down. A large majority of general practitioners ignores the reasons for not having any clinical answers at all. Conclusions: The results obtained cannot be extrapolated for all the general practitioners, the second care physicians or the re f e rred institutions. However, comparing these results with previous studies, we can see that the results are very similar, which leads us to believe that the actual situation nationwide does not differ fundamentally from the observations in this sample.