title: [Urgent, unscheduled self-referrals by ambulatory patients].
abstract: Direct self-referral to a consultant is common in the Israeli health system. Yet patients' reasons for their urgent, unscheduled self-referrals for ambulatory consultations (UUSR) have not been explored. We studied such consultations in an urban multi-disciplinary consultation center serving a population of approximately 100,000. Over a 3-month period such consultations in ophthalmology, ear-nose-and-throat and dermatology clinics were treated by a duty family physician (FP). The FP was instructed to focus on the urgent complaint and either to give definitive treatment and schedule a consultation when needed, or refer the patient for immediate specialist consultation. Patients treated by the FP were asked to fill an anonymous questionnaire, which 347/645 (55.4%) did. Among the reasons for UUSR were that the patient thought that his/her complaints should be treated by a consultant (29%), the patient was sent by the FP without a consultation note (13.9%), the FP was not available (10.4%), or the patient wished to see the consultant for a second opinion (8.2%). In only 7.8% had the patient noted that his complaint needed urgent consultation. Duration of complaints, but not prior efforts to schedule a consultation, were associated with different reasons for asking for an UUSR. For various reasons patients preferred an UUSR rather than seeing their own FP. Patients' opinions regarding self-referrals are important in planning primary care facilities and FP training.
authors.affiliation: General Sick Fund, Sackler Faculty of Medicine, Tel Aviv University.
authors.forename: S
authors.initials: S
authors.lastname: Vinker
authors.forename: S
authors.initials: S
authors.lastname: Nakar
authors.forename: Z
authors.initials: Z
authors.lastname: Alon
authors.forename: H
authors.initials: H
authors.lastname: Abu-Amar
authors.forename: G
authors.initials: G
authors.lastname: Sadovsky
authors.forename: E
authors.initials: E
authors.lastname: Hyam
mesh_terms: D003253:Consultants; D004630:Emergencies; D005128:Eye Diseases / Q000628:therapy; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D010038:Otorhinolaryngologic Diseases / Q000628:therapy; D011320:Primary Health Care / Q000458:organization & administration; D012017:Referral and Consultation; D012871:Skin Diseases / Q000628:therapy; D011795:Surveys and Questionnaires