OUTCOMES OF REFERRALS FROM GENERAL-PRACTICE

Objective - To investigate hospital referrals by general practitioners, subsequent hospital events, and discharge letters. Design - Audit of 340 referrals written by 29 general practitioners, hospital case records, discharge letters, and primary care case records. Setting - Sale Area Health Authority in southern Finland (population 43 000). Main outcome measures - Referral rates, reasons for referrals, distribution according to speciality, number of hospital days, visits to outpatient-departments, laboratory and radiological examinations, therapeutic procedures, changes in medication and/or diagnosis and availability of discharge Letters. Results - The mean referral rate was 4.5% and varied from 1.6-10.0 per cent. The referring physician's age, sex, and workload did not significantly explain the variation of referral rates between individual general practitioners. A third of all hospital referrals from general practitioners led to a single visit at the hospital outpatient department. Discharge letters were received for 33% of all referrals. A change in medication or diagnosis did not substantially affect the rate of discharge information supplied by the hospital. Conclusions - The variation of the referral rates between the individual general practitioners was large. The small number of participating general practitioners (n=29) did not permit valid explanations for this variation. The referring general practitioner rarely receives discharge letters from secondary care providers.