From Family Practitioner to Specialist – Actual Data on Referral Behaviour and Motives
DOI: 10.3238/zfa.2011.0371german translation / full article
Background: Referrals between family practitioners (FPs) and specialists are an important area in the light of the introduction of FP centred patient management. This study aimed to describe the referral practice of German FPs.
Method: In a cross sectional study we included 29 FP practices. During a three months period FPs gathered all referrals for one week. We documented all primary informations (patient related basic data, specialist referred to, curative/preventative referral etc.) including the referral direction (to which specialist) and accompanying medical and organisational information. We interviewed FPs about each referral. Referral data were analysed mainly descriptively.
Results: We analysed 3988 referrals. Median age was 52 years. 64% of patients were female. 2138 (53,6%) of all referrals were issued for specific diagnosis and 1006 (25,2%) for specific therapy offered by a specialist. Referrals were predominantly for internal medicine, gynaecology, ophthalmology, orthopaedics, neurology/psychiatry/psychotherapy und dermatology. 71,8% were (partially) initiated by the patient.
Conclusion: Referrals of German FPs are influenced by insufficient information flow and increasingly informed patients. A gate keeper model in combination with increased coordination and a more effective bidirectional information flow could prevent the degeneration of the referral process to a formal act of patient care.