Abstract:
Introduction
Referral is one of the core competencies of general practitioners (GP). In 1992, the European study
of referrals from Primary to Secondary care indicated a referral rate (RR) of 5,56% to Portugal. In
2003, the RR related to a health centre in the north of Portugal was 10,11 % and the higher
percentage of referrals was to Otolaryngology, Gynecology and Surgery.
Objectives
To study the trend of referral to Secondary care, in a Centre of Portugal Health Care Unit, with
standardized population indicators, between 2007 and 2010.
Material and Methods
Observational, retrospective, descriptive study using a statistical program to study the informatics
generated data of referral in a health centre with 11 doctors and 5 trainees. Calculation of the RR, (n
referral/n total consultations) * 100, and the number of referral by day adjusted to population at the
middle of each year (CRA), (n referral*1000/ population at the middle of the year*365). We
characterized the six specialties with more referrals, for each year.
Results
In 2007, 2067 referrals were registered (14,7% of patients with consultation (PC)); in 2008, 2639
(17% of PC); in 2009, 3125 (18,6% of PC); in 2010, 3100 (18% of PC). The RR and the CRA were
3,93% and 0,34‰ in 2007; 4,77% and 0,42‰ in 2008; 5,51% and 0,48‰ in 2009; 5,64% and 0,46‰
in 2010. In decrescent order of volume, the specialties with most referrals were Orthopedics,
Dermatology, Stomatology, Gynecology, Otolaryngology, Surgery and in 2009 Ophthalmology, in
detriment to Gynecology.
Discussion
During the time considered there is growth of RR, to values similar to those of 1992, and of CRA, an
indicator of comparability with other contexts. The three specialties with the higher percentage of
referrals suggest the need for technical response (orthopedics and stomatology) and clarification /
clinical orientation (dermatology). The reduction in referral to Gynecology and the increase to
Ophthalmology might reflect technical and scientific options in General Practice performing skills.
The volume of referrals and its characterization may improve our knowledge in these areas and about
the need for continuing professional development
