Referral rates in Swiss primary care with a special emphasis on reasons for encounter

Ryan Tandjung; Andreas Hanhart; Fredi Bärtschi; Rebecca Keller; Andy Steinhauer; Thomas Rosemann; Oliver Senn

doi:10.4414/smw.2015.14244

Original article

Vol. 145 No. 5152 (2015)

Referral rates in Swiss primary care with a special emphasis on reasons for encounter

Ryan Tandjung
Andreas Hanhart
Fredi Bärtschi
Rebecca Keller
Andy Steinhauer
Thomas Rosemann
Oliver Senn

DOI: https://doi.org/10.4414/smw.2015.14244
Cite this as:: Swiss Med Wkly. 2015;145:w14244
Published: 13.12.2015

Summary

QUESTIONS UNDER STUDY: 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.

METHOD: 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.

References

Kringos DS, Boerma W, van der Zee J, Groenewegen P. Europe’s strong primary care systems are linked to better population health but also to higher health spending. Health affairs. 2013;32(4):686–94.
Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. The Milbank quarterly. 2005;83(3):457–502.
The European study of referrals from primary to secondary care. Concerned Action Committee of Health Services Research for the European Community. Occas Pap R Coll Gen Pract. 1992(56):1–75.
Switzerland FOoS. Population of Switzerland 1950–2012 2013 [August 4th 2014]. Available from: http://www.bfs.admin.ch/bfs/portal/de/index/themen/01/02/blank/key/bevoelkerungsstand.html.
FMH SMA. Statistics on physicians in Switzerland [interactive webpage]. Swiss Medical Association; 2013 [updated 2013February 16th 2015]. Available from: http://aerztestatistik.myfmh2.fmh.ch/.
Litschgi L, Fehr F, Zeller A. Die Konsultation beim Hausarzt: Aufbau, Themen und Redeverteilung. Praxis. 2011;100(18):1085–95.
Salisbury C, Procter S, Stewart K, Bowen L, Purdy S, Ridd M, et al. The content of general practice consultations: cross-sectional study based on video recordings. The British journal of general practice: the journal of the Royal College of General Practitioners. 2013;63(616):e751–9.
Beasley JW, Hankey TH, Erickson R, Stange KC, Mundt M, Elliott M, et al. How many problems do family physicians manage at each encounter? A WReN study. Ann Fam Med. 2004;2(5):405–10.
Rosemann T, Marty F, Bhend H, Wagner J, Brunner L, Zoller M. Utilisation of information technologies in ambulatory care in Switzerland. Swiss Medical Wkly. 2010;140:w13088.
Chmiel C, Bhend H, Senn O, Zoller M, Rosemann T. The FIRE project A milestone for research in primary care in Switzerland. Swiss Med Wkly. 2011;141.
Vehvilainen AT, Kumpusalo EA, Takala JK. They call it stormy Monday – reasons for referral from primary to secondary care according to the days of the week. Brit J Gen Pract. 1999;49(448):909–11.
ICPC-2-R. International Classification of Primary Care. Revised Second Edition. Oxford: Oxford University Press; 2005. 2005.
Frese T, Herrmann K, Bungert-Kahl P, Sandholzer H. Inter-rater reliability of the ICPC-2 in a German general practice setting. Swiss Med Wkly. 2012;142:w13621.
Barnett ML, Song Z, Landon BE. Trends in physician referrals in the United States, 1999–2009. Arch Intern Med. 2012;172(2):163–70.
Moth G, Olesen F, Vedsted P. Reasons for encounter and disease patterns in Danish primary care: changes over 16 years. Scand J Prim Health Care. 2012;30(2):70–5.
Ringberg U, Fleten N, Deraas TS, Hasvold T, Forde O. High referral rates to secondary care by general practitioners in Norway are associated with GPs’ gender and specialist qualifications in family medicine, a study of 4350 consultations. BMC Health Serv Res. 2013;13:147.
Forrest CB, Majeed A, Weiner JP, Carroll K, Bindman AB. Comparison of specialty referral rates in the United Kingdom and the United States: retrospective cohort analysis. BMJ. 2002;325(7360):370–1.
Djalali S, Frei A, Rosemann T, Tandjung R. Vocational training for general practitioners-comparing Switzerland with other European countries. Praxis (Bern 1994). 2013;102(6):327–33.
Rizza A, Kaplan V, Senn O, Rosemann T, Bhend H, Tandjung R. Age- and gender-related prevalence of multimorbidity in primary care: the Swiss FIRE project. BMC Fam Pract. 2012;13:113.
Busato A, Bhend H, Chmiel C, Tandjung R, Senn O, Zoller M, et al. Improving the quality of morbidity indicators in electronic health records in Swiss primary care. Swiss Med Wkly. 2012;142:w13611.

How to Cite

1.

Tandjung R, Hanhart A, Bärtschi F, Keller R, Steinhauer A, Rosemann T, Senn O. Referral rates in Swiss primary care with a special emphasis on reasons for encounter. Swiss Med Wkly [Internet]. 2015 Dec. 13 [cited 2024 Nov. 21];145(5152):w14244. Available from: https://smw.ch/index.php/smw/article/view/2121

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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[1] Kringos DS, Boerma W, van der Zee J, Groenewegen P. Europe’s strong primary care systems are linked to better population health but also to higher health spending. Health affairs. 2013;32(4):686–94.

[2] Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. The Milbank quarterly. 2005;83(3):457–502.

[3] The European study of referrals from primary to secondary care. Concerned Action Committee of Health Services Research for the European Community. Occas Pap R Coll Gen Pract. 1992(56):1–75.

[4] Switzerland FOoS. Population of Switzerland 1950–2012 2013 [August 4th 2014]. Available from: http://www.bfs.admin.ch/bfs/portal/de/index/themen/01/02/blank/key/bevoelkerungsstand.html.

[5] FMH SMA. Statistics on physicians in Switzerland [interactive webpage]. Swiss Medical Association; 2013 [updated 2013February 16th 2015]. Available from: http://aerztestatistik.myfmh2.fmh.ch/.

[6] Litschgi L, Fehr F, Zeller A. Die Konsultation beim Hausarzt: Aufbau, Themen und Redeverteilung. Praxis. 2011;100(18):1085–95.

[7] Salisbury C, Procter S, Stewart K, Bowen L, Purdy S, Ridd M, et al. The content of general practice consultations: cross-sectional study based on video recordings. The British journal of general practice: the journal of the Royal College of General Practitioners. 2013;63(616):e751–9.

[8] Beasley JW, Hankey TH, Erickson R, Stange KC, Mundt M, Elliott M, et al. How many problems do family physicians manage at each encounter? A WReN study. Ann Fam Med. 2004;2(5):405–10.

[9] Rosemann T, Marty F, Bhend H, Wagner J, Brunner L, Zoller M. Utilisation of information technologies in ambulatory care in Switzerland. Swiss Medical Wkly. 2010;140:w13088.

[10] Chmiel C, Bhend H, Senn O, Zoller M, Rosemann T. The FIRE project A milestone for research in primary care in Switzerland. Swiss Med Wkly. 2011;141.

[11] Vehvilainen AT, Kumpusalo EA, Takala JK. They call it stormy Monday – reasons for referral from primary to secondary care according to the days of the week. Brit J Gen Pract. 1999;49(448):909–11.

[12] ICPC-2-R. International Classification of Primary Care. Revised Second Edition. Oxford: Oxford University Press; 2005. 2005.

[13] Frese T, Herrmann K, Bungert-Kahl P, Sandholzer H. Inter-rater reliability of the ICPC-2 in a German general practice setting. Swiss Med Wkly. 2012;142:w13621.

[14] Barnett ML, Song Z, Landon BE. Trends in physician referrals in the United States, 1999–2009. Arch Intern Med. 2012;172(2):163–70.

[15] Moth G, Olesen F, Vedsted P. Reasons for encounter and disease patterns in Danish primary care: changes over 16 years. Scand J Prim Health Care. 2012;30(2):70–5.

[16] Ringberg U, Fleten N, Deraas TS, Hasvold T, Forde O. High referral rates to secondary care by general practitioners in Norway are associated with GPs’ gender and specialist qualifications in family medicine, a study of 4350 consultations. BMC Health Serv Res. 2013;13:147.

[17] Forrest CB, Majeed A, Weiner JP, Carroll K, Bindman AB. Comparison of specialty referral rates in the United Kingdom and the United States: retrospective cohort analysis. BMJ. 2002;325(7360):370–1.

[18] Djalali S, Frei A, Rosemann T, Tandjung R. Vocational training for general practitioners-comparing Switzerland with other European countries. Praxis (Bern 1994). 2013;102(6):327–33.

[19] Rizza A, Kaplan V, Senn O, Rosemann T, Bhend H, Tandjung R. Age- and gender-related prevalence of multimorbidity in primary care: the Swiss FIRE project. BMC Fam Pract. 2012;13:113.

[20] Busato A, Bhend H, Chmiel C, Tandjung R, Senn O, Zoller M, et al. Improving the quality of morbidity indicators in electronic health records in Swiss primary care. Swiss Med Wkly. 2012;142:w13611.