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dc.contributor.author | Bosch Aparici, Francisco Javier |
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dc.contributor.author | Escoda, Ona |
dc.contributor.author | Nicolás, David |
dc.contributor.author | Coloma, Emmanuel |
dc.contributor.author | Fernández, Sara (Fernández García) |
dc.contributor.author | Coca, Antonio |
dc.contributor.author | López-Soto, Alfonso |
dc.date | 2018-01-16T18:38:32Z |
dc.date | 2018-01-16T18:38:32Z |
dc.date | 2014-04-28 |
dc.date | 2018-01-16T18:38:32Z |
dc.identifier | 1471-2296 |
dc.identifier | 658741 |
dc.identifier | 24775097 |
dc.identifier.uri | http://hdl.handle.net/2445/119057 |
dc.description | BACKGROUND: In Spain, primary healthcare (PHC) referrals for diagnostic procedures are subject to long waiting-times, and physicians and patients often use the emergency department (ED) as a shortcut. We aimed to determine whether patients evaluated at a hospital outpatient quick diagnosis unit (QDU) who were referred to ED from 12 PHC centers could have been directly referred to QDU, thus avoiding ED visits. As a secondary objective, we determined the proportion of QDU patients who might have been evaluated in a less rapid, non-QDU setting. METHODS: We carried out a cross-sectional retrospective cohort study of patients with potentially serious conditions attended by the QDU from December 2007 to December 2012. We established 2 groups of patients: 1) patients referred from PHC to QDU (PHC-QDU group) and 2) patients referred from PHC to ED, then to QDU (PHC-ED-QDU group). Two observers assessed the appropriateness/inappropriateness of each referral using a scoring system. The interobserver agreement was assessed by calculating the kappa index. Multivariate logistic regression analysis was performed to identify the factors associated with the dependent variable 'ED referral'. RESULTS: We evaluated 1186 PHC-QDU and 1004 PHC-ED-QDU patients and estimated that 93.1% of PHC-ED-QDU patients might have been directly referred to QDU. In contrast, 96% of PHC-QDU patients were found to be appropriately referred to QDU first. The agreement for PHC-QDU referrals (PHC-QDU group) was rated as excellent (ϰ=0.81), while it was rated as good for PHC-ED referrals (PHC-ED-QDU group) (ϰ=0.75). The mean waiting-time for the first QDU visit was longer in PHC-QDU (4.8 days) than in PHC-ED-QDU (2.6 days) patients (P=.001). On multivariate analysis, anemia (OR 2.87, 95% CI 1.49-4.55, P<.001), rectorrhagia (OR 2.18, 95% CI 1.10-3.77, P=.01) and febrile syndrome (OR 2.53, 95% CI 1.33-4.12, P=.002) were independent factors associated with ED referral. Nearly one-fifth of all QDU patients were found who might have been evaluated in a less rapid, non-QDU setting. CONCLUSIONS: Most PHC-ED-QDU patients might have been directly referred to QDU from PHC, avoiding the inconvenience of the ED visit. A stricter definition of QDU evaluation criteria may be needed to improve and hasten PHC referrals. |
dc.format | 10 p. |
dc.format | application/pdf |
dc.language | eng |
dc.publisher | BioMed Central |
dc.relation | Reproducció del document publicat a: https://doi.org/10.1186/1471-2296-15-75 |
dc.relation | BMC Family Practice, 2014, vol. 15, num. 75 |
dc.relation | https://doi.org/10.1186/1471-2296-15-75 |
dc.rights | cc-by (c) Bosch Genover, Xavier et al., 2014 |
dc.rights | http://creativecommons.org/licenses/by/3.0/es |
dc.rights | info:eu-repo/semantics/openAccess |
dc.subject | Atenció primària |
dc.subject | Serveis d'urgències hospitalàries |
dc.subject | Càncer |
dc.subject | Anèmia |
dc.subject | Primary health care |
dc.subject | Hospital emergency services |
dc.subject | Cancer |
dc.subject | Anemia |
dc.title | Primary care referrals of patients with potentially serious diseases to the emergency department or a quick diagnosis unit: a cross-sectional retrospective study. |
dc.type | info:eu-repo/semantics/article |
dc.type | info:eu-repo/semantics/publishedVersion |