title: They call it stormy Monday--reasons for referral from primary to secondary care according to the days of the week.
abstract: Previous studies of specialist care have shown that the onset of acute myocardial infarction occurs most frequently on Mondays; however, the septadian pattern in the reasons for referrals from primary care to secondary care has not been examined previously. We examined daily variations in rates of referral from primary to secondary care in central and northern Finland, using International Classification of Primary Care codes, during two weeks (30 November to 6 December 1992, and 28 November to 4 December 1994) before and after the introduction of a reform in the system of financing health care. Monday peaks were observed in the occurrence of angina pectoris, fractures of the tibia/fibula, lumbar disc lesions, and infections of the eye. Tuesday peaks were found in the occurrence of headache. Two peaks (on Tuesday and Thursday) were observed for patients with suspected appendicitis. Many problems of primary health care leading to referral to secondary care are not random events but occur in a weekly pattern. Further investigation is needed within these subgroups of patients to identify the causes of this variation.
authors.affiliation: Department of Community Health and General Practice, University of Kuopio, Finland. Arto.Vehvilainen@uku.fi
authors.forename: A T
authors.initials: AT
authors.lastname: Vehviläinen
authors.forename: E A
authors.initials: EA
authors.lastname: Kumpusalo
authors.forename: J K
authors.initials: JK
authors.lastname: Takala
mesh_terms: D005387:Finland / Q000453:epidemiology; D006801:Humans; D010507:Periodicity; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires