title: Professionals' perception of circuits of care for hypertensive or diabetic patients between primary and secondary care.
abstract: OBJECTIVE
  To determine the flow of care for patients with type 2 diabetes mellitus (T2DM) and hypertension between primary care (PC) and specialized care (SC) in clinical practice, and the criteria used for referral and follow-up within the Spanish National Health System (NHS).
  
  
  METHODS
  A descriptive, cross-sectional, multicenter study.
  
  
  METHODS
  A probability convenience sampling stratified by number of physicians participating in each Spanish autonomous community was performed. Nine hundred and ninety-nine physicians were surveyed, of whom 78.1% (n=780) were primary care physicians (PCPs), while 11.9% (n=119) and 10.0% (n=100) respectively were specialists in hypertension and diabetes. KEY MEASUREMENTS: was conducted using two self administered online surveys.
  
  
  RESULTS
  A majority of PCPs (63.7% and 55.5%) and specialists (79.8% and 45.0%) reported the lack of a protocol to coordinate the primary and specialized settings for both hypertension and T2DM respectively. The most widely used method for communication between specialists was the referral sheet (94.6% in PC and 92.4% in SC). The main reasons for referral to a specialist were refractory hypertension (80.9%) and suspected secondary hypertension (75.6%) in hypertensive patients, and suspicion of a specific diabetes (71.9%) and pregnancy (71.7%) in T2DM patients.
  
  
  CONCLUSIONS
  Although results showed some common characteristics between PCPs and specialists in disease management procedures, the main finding was a poor coordination between PC and SC.
authors.affiliation: Centro de Salud Sillería, Toledo, España. Electronic address: falonsom@semergen.es.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Alonso-Moreno
authors.affiliation: Unidad de Hipertensión, Hospital Clínico San Carlos, Madrid, España.
authors.forename: Nieves
authors.initials: N
authors.lastname: Martell-Claros
authors.affiliation: CAP Sardenya, Barcelona, España.
authors.forename: Mariano
authors.initials: M
authors.lastname: de la Figuera
authors.affiliation: Departamento de Endocrinología y Nutrición, Clínica Universidad de Pamplona, Pamplona, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Escalada
authors.affiliation: Mylan EPD, Madrid, España.
authors.forename: Marta
authors.initials: M
authors.lastname: Rodríguez
authors.affiliation: Mylan EPD, Madrid, España.
authors.forename: Luisa
authors.initials: L
authors.lastname: Orera
mesh_terms: D003142:Communication; D003266:Continuity of Patient Care; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D058007:Physicians, Primary Care; D011320:Primary Health Care; D063127:Secondary Health Care; D013038:Specialization
keywords: Atención primaria; Diabetes mellitus tipo 2; Health care levels; Hipertensión; Hypertension; Niveles de atención de salud; Primary care; Type 2 diabetes mellitus