Dutch general practitioners' referral of children to specialists: a comparison between 1987 and 2001.
BACKGROUND
Although children are frequently referred to specialists, detailed information on referral patterns of them is scarce. Even less information is available on how referral patterns evolve over time.


OBJECTIVE
To examine current referral patterns for children aged 0-17 years and compare these with referral patterns reported for 1987.


METHODS
Data were analysed from two national cross-sectional surveys, performed in 2001 (91 general practices) and in 1987 (103 general practices).


METHODS
Dutch general practice.


METHODS
All new referrals to specialists were assessed by age, sex, International Classification of Primary Care (ICPC) category, specialty referred to, and specific episodes of disease. Referral measures were quantified as new referrals per 1000 person-years and per 100 new episodes, a measure of likelihood of a young person with a specific diagnosis to be referred. Rates in 2001 were compared with those from 1987.


RESULTS
Referral rates decreased from 138 per 1000 person-years in 1987, to 84 per 1000 person-years in 2001. Age differences in referral rates were similar in both surveys. Compared with 1987, more boys than girls were referred to specialists. The overall likelihood of a condition being referred decreased from 8.0 per 100 episodes in 1987 to 6.5 per 100 episodes in 2001. Reasons for referral had also changed by 2001, particularly for the ear, nose, and throat (ENT) specialist and ophthalmologist. Moreover, referral rates for acute otitis media, refractive disorders, and vision problems decreased two- to fourfold in 2001.


CONCLUSIONS
Presently, Dutch general practitioners tend to manage more health problems themselves and refer less young people to specialists.
Otters
Hanneke
H
Department of General Practice, Erasmus MC, University Medical Centre, Rotterdam, Netherlands.
van der Wouden
Johannes C
JC
Schellevis
François G
FG
van Suijlekom-Smit
Lisette W A
LW
Koes
Bart W
BW
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003657:Decision Making; D005194:Family Practice / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009426:Netherlands; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012017:Referral and Consultation / Q000706:statistics & numerical data* / Q000639:trends