[Hospital referrals from the general practitioner's perspective - a descriptive analysis based on the CONTENT morbidity register].
BACKGROUND
Hospital referrals cause high costs in the health-care system. Information on hospital referrals from general practices in Germany is sparse. As a starting point for further research we describe the characteristics of hospital referrals and referred patients.


METHODS
In the CONTENT project (CONTinuous morbidity registration Epidemiologic NeTwork) the data sets of the patients of 23 general practices were gathered with the help of a modified electronic patient record system. The data of 49,423 patients (yearly contact group 2007) were analysed.


RESULTS
Approximately 4% of the patients were referred to a hospital. Most frequent diagnoses (International Classification of Primary Care) were: D75 "malignant neoplasm colon/rectum", K74 "ischaemic heart disease with angina" and L90 "osteoarthrosis of knee". Patients referred to hospital had a higher comorbidity (p<0.0001), higher contact frequencies (p<0.0001), higher prescribing rates (p<0.0001) and were older (p<0.0001) than patients not referred to hospitals. Variations of the referral rates over the year and the week were dependent on parallel variations of the contact frequencies between doctors and patients.


CONCLUSIONS
Patients referred to hospital from general practice are older and have a higher morbidity than patients not referred. Hospital referrals to rule out diseases with a potentially dangerous course as a means of managing uncertainty seem to be the most effective field under control of general practitioners to reduce hospital referrals.
Kühlein
T
T
Abteilung für Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg. thomas.kuehlein@med.uni-heidelberg.de
Laux
G
G
Hermann
K
K
Gutscher
A
A
Szecsenyi
J
J
D058006:General Practice / Q000706:statistics & numerical data*; D058005:General Practitioners / Q000706:statistics & numerical data*; D005858:Germany / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012042:Registries