title: [Referrals to an emergency department--are there differences between self-referrals and referrals from general practitioners?].
abstract: The Israeli health system has been undergoing major changes in recent years. Considerations of cost containment have led sick funds to open new out-of-hours services in the community to reduce visits to hospital emergency departments. Referred and self-referred visits to our emergency department during a 1-month period were studied. Patients after trauma or whose visits resulted in hospitalization were excluded. Of the 505 encounters 56.3% were of women; the average age was 52.5 +/- 19.3 years (range 18-96). 57.4% visits were during working hours of primary care clinics ("working hours"), while the others were "out-of-hours" visits. Only 52.7% had a referral letter, 75% of them from the family physician. The quality of the handwriting in 46% was good, in 44% fair and the remaining 10% were illegible. A specific clinical question was asked in only 16% of the letters. A third of "working-hours" visits were self-referrals, rising to 64% in "out-of-hours" visits (p < 0.001). The most common diagnoses in discharge letters were: chest or abdominal pain, asthma, back pain, headache, nephrolithiasis and upper respiratory tract infection. The rate of self-referrals was relatively high throughout the day. Cost-containment efforts did not seem to eliminate self-referrals with "primary care" problems. The quality of referral letters should be improved both with regard to format and content.
authors.affiliation: Central District of General Sick Fund, Sackler Faculty of Medicine, Tel Aviv University.
authors.forename: S
authors.initials: S
authors.lastname: Nakar
authors.forename: S
authors.initials: S
authors.lastname: Vinker
authors.forename: Y
authors.initials: Y
authors.lastname: Or
authors.forename: M
authors.initials: M
authors.lastname: Schadel
authors.forename: Y
authors.initials: Y
authors.lastname: Niego
authors.forename: G
authors.initials: G
authors.lastname: Plotkin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005194:Family Practice; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family; D012017:Referral and Consultation / Q000145:classification*