title: [Reasons and determining factors for referrals between primary and specialised care].
abstract: OBJECTIVE
  To determine the reasons and characteristics of referrals from Primary to Specialised Care in the Health Area of Toledo (Spain).
  
  
  METHODS
  A descriptive, cross-sectional study was conducted by reviewing a sample of the referrals to specialists made by 26 general practitioners from eight Teaching Health Centres during February 2011. All of them completed a questionnaire which recorded patient data, and reason and characteristics of the referral.
  
  
  RESULTS
  A total of 332 referrals were recorded; the mean age of the patients was 51.3 years (SD; 17.9); 60.1% females; 30.7% pensioners; 54.8% had a chronic disease; 85.8% were from an urban environment. The most consulted specialists were: Traumatology (63), Gynaecology (53), and Ophthalmology (41). More than three-quarters (78.9%) were by the normal route, and 47.4% were first consultations. Around 12.7% were scheduled reviews, with a majority (51.4%) by a hospital specialist. More than two thirds (69.8%, 95% CI; 64.5-74.7%) required follow-up or treatment by the specialist. More than half (57.7%, 95% CI; 52.3-63.1%) required special diagnostic tests, and in 29.8% (95% CI; 25.0-35.1%) there was no clear diagnosis. There was a history of a repeated consultation for the same symptomatology in 28.9% of the referrals. Around 38.4% (95% CI; 33.0-43.7%) were requested specifically by the family or patient. Around 5.4% had a poor relationship with the patient.
  
  
  CONCLUSIONS
  The majority of referrals are made by the normal route, and to surgical specialities. The need for hospital specialist follow-up and/or treatment, or the impossibility to request specific tests from Primary Care were the main reasons for requesting care from a second health care level. There were a high percentage of referrals requested by the family/patient.
authors: Centro de Salud Santa María de Benquerencia, Toledo, España. juliabaez2001@hotmail.com
authors: J M
authors: JM
authors: Báez Montilla
authors: A
authors: A
authors: Sánchez Oropesa
authors: G
authors: G
authors: Garcés Redondo
authors: R
authors: R
authors: González Carnero
authors: L
authors: L
authors: Santos Béjar
authors: F
authors: F
authors: López de Castro
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008511:Medicine; D008875:Middle Aged; D011320:Primary Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*