Abstract
Referrals from primary to secondary care reflect a crucial role of primary care physicians (PCPs). Most referral rates are based on the number of consultations, rather than on the number of problems addressed during consultations (reasons for encounter = RFE). The aim of the study was to update data on consultations, RFE and referrals in Swiss primary care and calculate a referral rate based on RFE rather than on the number of consultations. Cross-sectional study in Swiss primary care. PCPs collected data on consultations on 15 different days in three nonconsecutive months in 2012/2013. Demographic data of patients and up to six RFE per consultation were collected. For each RFE the PCP had to indicate whether a referral was initiated. Data were analysed using descriptive statistics. Ninety PCPs (18.9% females) participated and 24 774 consultations with 42 890 RFE (corresponding to 1.73 [standard deviation 1.07] RFE per consultation) were recorded. A total of 2 427 RFE (of 2 341 consultations) led to a referral, corresponding to a referral rate of 9.44% (95% confidence interval [CI] 9.08-9.81%) based on consultations and 5.65% (95% CI 5.43-5.87%) based on the number of RFE. An average of 1.7 RFE per consultation and a broad clinical spectrum of problems were presented in primary care; nevertheless, 94.3% of all problems were solved in primary care, reflecting the crucial role of PCPs as a coordinator of healthcare.
Highlights
There is growing evidence that strong primary care contributes to efficiency and quality in healthcare [1, 2]
QUESTIONS UNDER STUDY: Referrals from primary to secondary care reflect a crucial role of primary care physicians (PCPs)
Most referral rates are based on the number of consultations, rather than on the number of problems addressed during consultations
Summary
There is growing evidence that strong primary care contributes to efficiency and quality in healthcare [1, 2]. A gatekeeping system is not mandatory for health insurance and the role of PCPs as gatekeepers is often challenged. It remains unclear how these changes affected referral rates. Earlier studies reporting referral rates were calculated on the basis of consultations. This does not completely reflect the work of PCPs. Some studies have shown that during a consultation usually more than one problem is discussed between patient and PCP [6,7,8]. The aim of our study was to investigate consultations and to update recordkeeping and the database on referrals of Swiss primary care. We decided to collect prospectively data on consultations; we aimed to calculate a referral rate based on consultations, and based on all problems raised during these consultations
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