title: Communication between primary care and physician specialist: is it improving?
abstract: OBJECTIVE
  Efforts have recently been made in Spain to improve the communication model between primary care and specialized care. The aim of our study was to analyze the impact of a change in the communication model between the two areas when comparing a traditional system to a consulting system in terms of satisfaction of general practitioners and the number of patient referrals.
  
  
  METHODS
  A questionnaire was used to assess the point of view on the relations with the endocrinologist team of 20 general practitioners from one primary care center at baseline and 18 months after the implementation of the new method of communication. In addition, we counted the number of referrals during the two periods.
  
  
  RESULTS
  We analyzed 30 questionnaires; 13 before and 17 after the consulting system was established. Consulting system was preferred to other alternatives as a way of communication with endocrinologists. After the consulting system was implemented, general practitioners were more confident in treating hypothyroidism and diabetes. There was a decrease in the number of patient referrals to specialized care from 93.8 to 34.6 per month after implementation of the consultant system.
  
  
  CONCLUSIONS
  The consultant system was more efficient in resolving problems and responding to general practitioners than the traditional system. General practitioners were more confident in self-management of hypothyroidism and diabetes. A very large decrease in the number of patient referrals was observed after implementation of the consultant system.
authors.affiliation: Department of Endocrinology and Metabolism, Vall d'Hebron Hospital, Universidad Autónoma de Barcelona, Barcelona, Spain. Electronic address: bbiagetti@vhebron.net.
authors.forename: B
authors.initials: B
authors.lastname: Biagetti
authors.affiliation: Department of Endocrinology and Metabolism, Vall d'Hebron Hospital, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Aulinas
authors.affiliation: Department of Endocrinology and Metabolism, Vall d'Hebron Hospital, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Dalama
authors.affiliation: General Practitioners, San Rafael Primary Care, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Nogués
authors.affiliation: Department of Endocrinology and Metabolism, Vall d'Hebron Hospital, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Zafón
authors.affiliation: Department of Endocrinology and Metabolism, Vall d'Hebron Hospital, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Mesa
mesh_terms: D001291:Attitude of Health Personnel; D003144:Communication Barriers; D003920:Diabetes Mellitus / Q000628:therapy; D019468:Disease Management; D004704:Endocrinology; D006801:Humans; D007037:Hypothyroidism / Q000628:therapy; D033183:Interdisciplinary Communication; D007400:Interprofessional Relations; D008511:Medicine; D010549:Personal Satisfaction; D010820:Physicians / Q000523:psychology; D058007:Physicians, Primary Care / Q000523:psychology; D011320:Primary Health Care; D012017:Referral and Consultation / Q000458:organization & administration* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
keywords: Atención primaria; Communication; Comunicación; Consultant; Consultor; Derivaciones; Diabetes; Medicina especializada; Primary care; Referral; Specialist care