title: Referral rates in Swiss primary care with a special emphasis on reasons for encounter.
abstract: OBJECTIVE
  Referrals from primary to secondary care reflect a crucial role of primary care physicians (PCPs). Most referral rates are based on the number of consultations, rather than on the number of problems addressed during consultations (reasons for encounter = RFE). The aim of the study was to update data on consultations, RFE and referrals in Swiss primary care and calculate a referral rate based on RFE rather than on the number of consultations.
  
  
  METHODS
  Cross-sectional study in Swiss primary care. PCPs collected data on consultations on 15 different days in three nonconsecutive months in 2012/2013. Demographic data of patients and up to six RFE per consultation were collected. For each RFE the PCP had to indicate whether a referral was initiated. Data were analysed using descriptive statistics.
  
  
  RESULTS
  Ninety PCPs (18.9% females) participated and 24 774 consultations with 42 890 RFE (corresponding to 1.73 [standard deviation 1.07] RFE per consultation) were recorded. A total of 2 427 RFE (of 2 341 consultations) led to a referral, corresponding to a referral rate of 9.44% (95% confidence interval [CI] 9.08-9.81%) based on consultations and 5.65% (95% CI 5.43-5.87%) based on the number of RFE.
  
  
  CONCLUSIONS
  An average of 1.7 RFE per consultation and a broad clinical spectrum of problems were presented in primary care; nevertheless, 94.3% of all problems were solved in primary care, reflecting the crucial role of PCPs as a coordinator of healthcare.
authors.affiliation: Institute of Primary Care, University Hospital and University of Zurich, Switzerland.
authors.forename: Ryan
authors.initials: R
authors.lastname: Tandjung
authors.affiliation: Institute of Primary Care, University Hospital and University of Zurich, Switzerland; Private primary care practice.
authors.forename: Andreas
authors.initials: A
authors.lastname: Hanhart
authors.affiliation: Private primary care practice.
authors.forename: Fredi
authors.initials: F
authors.lastname: Bärtschi
authors.affiliation: Institute of Primary Care, University Hospital and University of Zurich, Switzerland.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Keller
authors.affiliation: Institute of Primary Care, University Hospital and University of Zurich, Switzerland.
authors.forename: Andy
authors.initials: A
authors.lastname: Steinhauer
authors.affiliation: Institute of Primary Care, University Hospital and University of Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosemann
authors.affiliation: Institute of Primary Care, University Hospital and University of Zurich, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Senn
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013557:Switzerland