[Referrals to specialists: evaluation of general practitioners' need for assistance from specialists in other fields.].
OBJECTIVE
To examine prospectively the longterm pattern of referrals of one family practitioner.


METHODS
Over a period of 8.5 years (1989-1998), the referral process of one general practitioner (GP) during his daytime practice in the Akureyri district (inhabitants around 17,000), Iceland, was examined. In this area there were 11 GPs working at the Community Health Centre, and 40 specialists, most of whom were based at the Community Hospital or working as consultants in their pri-vate practice.


RESULTS
In the 8.5 year period one GP (one of the authors, HThornS) had 40,634 patient encounters with 8,463 persons (4.7 encounters per person). Of those, 24,952 (61%) were office visits by 7,208 persons (3.5 visits per person). A total of 1672 patients were referred to a specialist, of whom 215 were emergency cases. The number of referrals was 41 per 1000 total encounters, and 67 of 1000 office encounters. There were 1613 (96.5%) completed written responses from the specialists. Most were referred to internists (28%), orthopaedists (16%), general surgeons (12%), ear, nose and throat specialists (11%), paediatrists (8%) and gynaecologists (8%). Of those referred to internists, 43% were referred to gastroenterologists and 25% to cardiologists. There were 339 referrals for patients younger than 16 years (54% boys). Of those, 41% were referred to paediatrists, 26% to an ear, nose and throat specialists, 9% to orthopaedists and 7% to surgeons.


CONCLUSIONS
The use of a written referral works well in Akureyri. Information on the number and types of referrals could be useful for determining the appropriateness for allocations and future development of speciality resources in each area. It could also serve as a method to help family practitioners choose areas of their continuous medical education.
H T
HT
Sigurdsson
J A
JA
Sigurdsson