Referrals from general practice in Denmark - a one-day registration Anders Munck 1, Kjeld Møller Pedersen 2, Jens Damsgaard 3, Lars Poulsen 1, Peter Vedsted 4 and Dorte Gilså Hansen 1 1 Audit Project Odense, Research Unit for General Practice, University of Southern Denmark, 2 Institute of Public Health, Health Economics, University of Southern Denmark, 3 General practice in Hvalsø, 4 Research Unit for General Practice, University of Aarhus

Objectives To analyse general practitioners’ (GPs’) referral patterns in relation to –the patient’s disease –organisational factors.

Methods all Danish GPs (n=3588) were invited 1097 GPs (30.6%) accepted participation the participants registered all their referrals made during one day the registration was made on a simple APO chart in addition, a short questionnaire on practice characteristics was filled in

Læge: Henvisninger fra almen praksis - en endagsregistrering 2008 Dato:_________ M K Pt. fødsels år Køn Forebyggelse Andet Kræft/mistanke om kræft Hjerte-karsygdom BevægeapparatsygdomEndokrin sygdom Psykisk sygdom Andet Anden instans Hjemmesygeplejen Psykolog Ikke akut Praktiserende speciallæge Sygehus ambulantSygehusindlæggelse BilleddiagnostikPraktiserende fysioterapeut Patientønske ”Kørt fast i problemet” Defensiv medicin/for at sikre mig Kort ventetid Kort afstand til henvisningssted Ingen af førnævnte Absolut indikation Lungesygdom Rehabilitering/genoptræning Henvises til Hvorfor henvisnings- sted Din faglige vurdering mindst 1x1x mindst 1x ®Copyright: Audit Projekt Odense, J.B. Winsløws Vej 9A, Odense C 34 Sygdomskategori Hast kun 1x Behandling/kontrol af sygdom Udredning/mistanke om sygdom Akut (< 24 timer) Second opinion Hovedformål med henvisning 35 Rimelig indikation Tvivlsom indikation kun 1x Registrer alle henvisninger en hel arbejdsdag Du skal ikke registrere blodprøver samt materiale til patologi og mikrobiologi, men alle øvrige henvisninger inklusive henvisninger til kommunale tilbud som fx hjemmesygepleje og fysioterapi. Læs venligst den medsendte vejledning grundigt igennem Kontakt- art Konsultation TK Besøg Ingen af førnævnte Socialt problem Andre kommunale tilbud Gode erfaringer 1x Medvirkende faktorer til henvisning Antal konsultationer i dag: Konsultationer ____ TK____ Besøg____ Mave-tarm/gyn/urinveje Hudsygdom 40 41

Main results The GPs recorded a total of 4671 referrals corresponding to 4.3 referrals per doctor per day 9.7 referrals per 100 contacts

Sex Male 38% Female 61%

Reasons for referral Diagnose 52% Treatment 32% Rehabilitation 7% Prevention 4%

Other reasons for referral Patients wish33% Second opinion 7% Tired doctor 10% Defensive medicine 3%

Percentage distribution of referrals to various types of treatment/care, n=4671 referrals

Percentage distribution of disease category for all types of referrals

The doctors own evaluation Absolutely indicated50% Fairly indicated45% Dubious 4%

Female GPs referred more frequently than male GPs

There were no differences with regard to practice size number of patients listed geography nurses employed age of the GP ( the results were not adjusted for differences in patient composition)

Conclusions A Danish GP made on average four referrals per day, which means that the referral rate is 10% of contacts. No organisational factors seem to play an important role in the referral pattern.

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