title: [Prior authorisation to visit the neurologist from primary care may not be necessary: the findings of a prospective, controlled study].
abstract: BACKGROUND
  The system by which approval must be given by the primary care physician before a patient can visit a specialist is known as gatekeeping and is aimed at preventing the mistaken or simple referral of patients to the next stage of health care services. We present a study that compares the final diagnoses of 400 patients who used a direct access model of referral (DAM) with those of 400 patients referred by a primary care physician in a prior authorisation model (PAM).
  
  
  METHODS
  We conducted a prospective analysis of two cohorts of patients who visited the same neurologist in a PAM system versus a DAM system. The 800 patients were evaluated following similar diagnostic criteria. The primary objective of the study was to compare the patients who were referred with a final diagnosis of 'non-neurological pathology' in the PAM and the DAM systems. Secondary aims consisted in conducting an analysis of the diagnoses by different pathologies between the two models.
  
  
  RESULTS
  No significant differences were found between the referrals that were considered to be non-neurological in the PAM and the DAM systems (27.0% versus 26.3%; p = 0.48). A logistic regression model was performed with 'non-neurological pathology' as the dependent variable and age, sex and type of model (PAM or DAM) as the independent variables, similar results being obtained in both cases.
  
  
  CONCLUSIONS
  Our data suggest that the role played by the primary care physician is not effective when it comes to preventing mistaken referrals to the neurologist in our area. A populational study would be needed to evaluate the rate at which resources are used and the spending on health care in the two models.
authors.affiliation: Unidad de Neurología, Hospital Central de la Cruz Roja, Madrid, España. daperezm@yahoo.com
authors.forename: D A
authors.initials: DA
authors.lastname: Pérez-Martínez
authors.forename: A I
authors.initials: AI
authors.lastname: Puente-Muñoz
mesh_terms: D005260:Female; D020793:Gatekeeping / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis*; D009462:Neurology; D011320:Primary Health Care; D011446:Prospective Studies; D013030:Spain