Adjusted Clinical Groups use as a measure of the referrals efficiency from primary care to specialized in Spain

Sicras‐Mainar, Antoni; Serrat-Tarrés, Josep; Navarro‐Artieda, Ruth; Llausí-Sellés, Rosa; Ruano-Ruano, I; González-Ares, Josep Antón

doi:10.1093/eurpub/ckm044

Cited by 21 publications

(30 citation statements)

References 19 publications

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“…Forrest et al [20] used the ACG designations to show the much larger percentage of people receiving specialist care (after controlling for differences in morbidity burden) in the US as compared with the UK. Sicras-Mainar et al [21] used ACGs to show that variability in referrals is greatly reduced after taking into account differences in morbidity burden. Aguado et al [22] used groupings of ACGs, known as RUBs (Resource Utilization Bands) to show that the variation in prescription drug use across 5 primary care centers in Spain is greatly reduced after controlling for differences in morbidity burden.…”

Section: Studies Using the Acg System To Understand The Role Of Multimentioning

confidence: 99%

Multimorbidity and its measurement

Starfield

Kinder²

2011

Health Policy

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Section: Studies Using the Acg System To Understand The Role Of Multimentioning

confidence: 99%

Multimorbidity and its measurement

Starfield

Kinder²

2011

Health Policy

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“…In the United States the rate of referral from primary care physicians is twice that in the United Kingdom. 20 The reasons for higher specialist use in the United States 33 are likely to be many, including common self-referral of patients in the United States, fee-for-service payment in the United States as opposed to the salaried arrangements for consultants in many countries, the greater supply of specialists per capita, and the less-comprehensive nature of primary care in the United States. 25,34 Absence of a usual source of care for many patients may account for both self-referral 35,36 and for some of the specialists' failure to share care with other physicians.…”

Section: Referrals and Shared Carementioning

confidence: 99%

Ambulatory Care Provided by Office-Based Specialists in the United States

Valderas¹,

Starfield²,

Forrest³

et al. 2009

The Annals of Family Medicine

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PURPOSE Increasing use of specialist services in the United States is leading to a perception of a specialist shortage. Little is known, however, about the nature of care provided by this secondary level of services. The aim of this study was to examine the content of care provided by specialists in community settings, including visits for which the patient had been referred by another physician.METHODS Nationally representative visit data were obtained from the National Ambulatory Medical Care Survey (NAMCS) for the years 2002 through 2004. To describe the nature of care, we developed a taxonomy of offi ce-based visit types and constructed logistic regression models allowing for adjusted comparisons of specialty types.RESULTS Overall, 46.3% of visits were for routine follow-up and preventive care of patients already known to the specialist. Referrals accounted for only 30.4% of all visits. Specialists were more likely to report sharing care with other physicians for referred, compared with not referred, patients (odds ratio [OR] = 2.99; 95% confi dence interval [CI], 2.52-3.55). Overall, 73.6% of all visits resulted in a return appointment with the same physician, in more than one-half of all cases as a result of a routine or preventive care visit.CONCLUSIONS Ambulatory offi ce-based activity of specialists includes a large share of routine and preventive care for patients already known, not referred, to the physician. It is likely that many of these services could be managed in primary care settings, lessening demand for specialists and improving coordination of care. INTRODUCTIONT here is uncertainty as to whether the United States should be training more specialists. Some argue that demand for specialists is rising and shortages are already apparent, 1-5 while others disagree. 6,7 Better information about the content of and need for care that specialists are providing in the United States would help to inform this debate. 8 The functions of primary care are well established and widely accepted 9 : fi rst-contact care, continuity with the same provider over time, delivery of a comprehensive range of services, and coordination of care.10 These benefi ts, best achieved when provided by a single, regular source of care, 11 form the basis of the recent medical home model. 12,13 Specialist physicians are needed to address conditions too uncommon for primary care physicians to maintain competence 14 and for procedures that require a high level of technical expertise or specialized equipment. 15,16 Theoretically, these activities should be the core functions of specialized care, but whether such is the case in practice or how it is accomplished is unknown.As most specialty care in the United States is clinician-initiated, 17 decisions that specialists make about routine or follow-up care can have important implications for the volume of their work and physician workforce projections. Referrals 18 are also of particular interest, not only because they result from an explicit assessment of need for specialist...

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“…En nuestro medio la TDxV fue 4,9, es decir, similar 10,19,20 o inferior a otros hallazgos 4,6,7,12 . Se ha señalado que los/las MF resuelven en torno al 95% de los problemas de su consulta 20,21 y se observa que los sistemas de salud basados en MF como gatekeeper presentan tasas de derivación similares 22,23 .…”

Section: Discussionunclassified

“…Desde el punto de vista de pacientes se ha observado que el factor más determinante de la derivación es la morbilidad 1,11,12 . También su sexo afecta a la tasa de derivaciones, siendo, según unos estudios más derivadas las mujeres 2,13 , según otros los hombres 10,14 y, por último, hay hallazgos que no muestran diferencias entre ambos 5,7,11 .…”

Section: Introductionunclassified