title: [Referrals to a gastroenterology outpatient clinic from primary care: evaluation of two programs].
abstract: OBJECTIVE
  To analyze the effect of implementing a high-resolution clinic (HRC) and an increasing resolution capacity program in primary care (IRCPPC) for referrals to a gastroenterology outpatient clinic from primary care and the resources used.
  
  
  METHODS
  A retrospective and observational study based on a review of referral sheets and databases was performed. We analyzed the number and reason for referrals, delay times and resource consumption in two periods: before (first 4 months of 2007) and after (first 4 months of 2009) the launch of the IRCPPC and HRC.
  
  
  RESULTS
  In the first and second periods, 881 and 1076 patients, respectively, referred from primary health care were evaluated in the gastroenterology clinic, with a decrease in the delay time in the second period (80.8 ± 64.34 days vs 36.1 ± 29.12 days, p < 0.001). The most frequent reasons for referral were dyspepsia (27.7%), high-risk of colorectal cancer (17.1%), disturbance of bowel rhythm (18.2%), abdominal pain (16%), and gastroesophageal reflux (11.2%), with no differences between the two periods. Although delay times until the first visit (10.8 ± 9.03 days vs 42.8 ± 28.67 days, p < 0.001) and until discharge (39.6 ± 80.65 days vs 128.6 ± 135.34 days, p < 0.001) were lower in referrals to the HRC, the number of visits (3.6 ± 2.20 vs 3.2 ± 1.95, p = 0.015) and the cost of referrals (592.7 ± 421.50 € vs 486.0 ± 309.66 €, p < 0.001) was higher.
  
  
  CONCLUSIONS
  In the study period the number of referrals increased, while the delay time decreased. Although the HRC reduces delay times, it is associated with an increase in health resource use.
authors: Servicio de Aparato Digestivo, Complexo Hospitalario de Ourense, Ourense, España.
authors: Paola
authors: P
authors: Quintas Lorenzo
authors: Andrés
authors: A
authors: Dacal Rivas
authors: María Francisco
authors: MF
authors: González
authors: Joaquín
authors: J
authors: Cubiella Fernández
authors: Luis
authors: L
authors: López Sánchez
authors: María Jesús
authors: MJ
authors: García García
authors: Javier
authors: J
authors: Fernández Seara
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D016208:Databases, Factual; D003953:Diagnosis-Related Groups; D003938:Diagnostic Techniques, Digestive System / Q000191:economics / Q000706:statistics & numerical data; D016099:Endoscopy, Gastrointestinal / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005762:Gastroenterology / Q000458:organization & administration*; D019983:Guideline Adherence; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D012017:Referral and Consultation / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013030:Spain; D013997:Time Factors