Referrals from Primary to Secondary Care

Introduction: Referrals of patients from primary to secondary or tertiary care are an important activity in any healthcare system. German national data suggest that the number of referrals from primary care physicians has increased since 2004, but detailed insight into the experiences of patients, GPs and consultants regarding referrals is still very limited. Methods: This study took place in Marbach, a rural region in the south of Germany. 26 GPs and 76 consultants participated. All adult patients referred to consultants after consulting these GPs in a period of five weeks were eligible for this study. GPs, consultants and patients completed short structured forms to document factual characteristics of each referral and their experiences with the referral. GPs and patients completed forms before and after the referral was made, while the consultants completed forms after the patient had consulted them. Results: Overall, consultants were positive about appropriateness of the referral (90.6 %), but somewhat more critical regarding the information provided on the patients' medical history (60.7 %) and prescriptions (48.3 %). In 258 referrals (62.8 %) primary care physicians perceived clear diagnostic benefits, while in 202 referrals (49.1 %) they perceived clear treatment benefits. Patients' expectations of the referrals mostly referred to diagnosis, including increased diagnostic certainty (79.8 %), detailed information about the illness (65.9 %) and exclusion of serious illness (61.7 %). They were overall satisfied with the referral (83.2 %). Conclusions: Patients, primary care physicians and consultants have positive views on the value of referrals from primary care to consultants. Interdisciplinary quality discussion fora could help to increase efficiency of communication. Dtsch Arztebl 2006; 103(37): A 2387–92. Key words: referral, specialist, primary care physician, health care