[The consulting of internal medicine in primare care improves the efficacy of medical care].
OBJECTIVE
Our aim was to evaluate the efficacy of the consulting of internal medicine (CIM) in primary care (PC) on the resolution of medical processes.


METHODS
Prospective case-control study of a population of 87,016 inhabitants during a 1-year period. Patients (2,167) jointly attended by family physicians (FP) and consulting internists (CI) who go weekly to the primary care center (PCC) to attend patients who otherwise would have been referred to specialized consultation (SC). As the control group 1,470 patients were randomly and simultaneously chosen among the total of 14.687 first medical referrals during the period of the study.


RESULTS
We observed a significant reduction in: referrals to SC (22%; CI 95%, 18-26%); mean time for SC (23.6 days; CI 95%, 17.3-29.9 days); mean number of tests per patient ordered by FP (0.53; CI 95%, 0.31-0.75) or by CIM (1.22; CI 95%, 1.02-1.40); mean time for patient information on those tests ordered by CIM (21.2 days; CI 95%, 8.5-33.9 days); mean time for the resolution of processes (39.4 days; CI 95%, 35.5-43.3 days); crossed SC rate (23.7%; CI 95%, 20.3-27.1%); and specialized follow-up visits (28.8%; CI 95%, 24.5-33.1%) (p < 0.005 in all cases). The resolution rate of processes (15%; CI 95%, 11-19%) and the discharge rate (41.6%; CI 95%, 35.5-47.7%) were significantly higher for the CIM (p < 0.01 in both cases). The referral rate to SC showed a negative correlation (r = 0.81; p < 0.01) with the management quality, and it related to type of training, age and years of medical practice of the general practitioner (GP). The satisfaction of patients and GPs with the CIM was very high.


CONCLUSIONS
CIM in PC improves the efficacy of specialized outpatient medical care.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000592:standards*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013030:Spain