title: [Evaluation of referral process of the hypertensive patient in Spain: DERIVA study].
abstract: BACKGROUND
  An adequate communication between levels of medical attention is the key point for optimal treatment and outcomes of the hypertensive population.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the adequacy of the hypertensive patients' derivation from Primary Care to Specialized Care. As secondary objectives, the information registered on the derivation report was assessed and concordance between derivation reason and final diagnosis was analysed.
  
  
  METHODS
  This is an observational, descriptive, multicentre study. SITE: Study conducted at the national level.
  
  
  METHODS
  Specialty Care Physicians receiving hypertensive patients referred from primary care.
  
  
  METHODS
  On the baseline visit, the specialist physicians assessed the quality of the derivation records and attended the patient. After the study, final diagnosis and treatment is suggested on the final visit.
  
  
  RESULTS
  1769 subjects were included, mean aged 62,4 (13,6) years, 45% female. Time of diagnosis of hypertension was 8,0 (7,7) years. More than the half of the derivation records contained very good information (5,4%; CI4,3-6,5) or sufficient (50,7%; CI48,4-53,0). In 7,1% (IC5,9-8,3) derivation cause was not specified. 74,7% of the derivations were considered as appropriate, though 30% were late. Concordance between derivation reasons and final diagnosis was low (kappa index 0,208).
  
  
  CONCLUSIONS
  A quarter of the hypertensive population is unnecessary derived to Secondary Care and 30% of the appropriately derived was late. We should improve the interrelation of attention in the hypertension and cardiovascular area between the both attention levels.
authors.affiliation: Unidad de Hipertensión, Servico de Medicina Interna, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, UCM, Madrid, España. Electronic address: nieves.martell@salud.madrid.org.
authors.forename: Nieves
authors.initials: N
authors.lastname: Martell-Claros
authors.affiliation: Unidad de Hipertensión, Servico de Medicina Interna, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, UCM, Madrid, España.
authors.forename: María
authors.initials: M
authors.lastname: Abad-Cardiel
authors.affiliation: Centro de Salud Andrés Mellado, Madrid, España.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Álvarez-Álvarez
authors.affiliation: Unidad de Hipertensión, Servico de Medicina Interna, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, UCM, Madrid, España.
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: García-Donaire
authors.affiliation: Centro de Salud Espronceda, Madrid, España.
authors.forename: Alberto
authors.initials: A
authors.lastname: Galgo-Nafría
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012017:Referral and Consultation; D013030:Spain; D013038:Specialization
keywords: Atención primaria de salud; Health care levels; Hipertensión; Hypertension; Niveles de atención de salud; Primary health care; Referral and consultation; Remisión y consulta