Department of General Practice/Family Medicine, University of Marburg, Marburg, Germany.
Scand J Public Health. 2012 Aug;40(6):571-8. doi: 10.1177/1403494812455113. Epub 2012 Aug 7.
Referrals from primary to secondary care may differ regarding motivation and initiative. Previous research on the frequency and variation of referrals has mostly treated referrals as homogeneous. We intended to develop a taxonomy regarding referrals from primary to secondary care in Germany that could support decision making on a macro level.
We analyzed 3,988 referrals by 29 German general practitioners (GPs). GPs were asked to document all referrals during one week; in subsequent audits they stated the reasons and initiative for any referral. We postulated the following five referral types: clinical problem, shared care, administrative, patient initiated and shared cost. The data were analyzed with k-means cluster analysis.
We identified three of our five postulated referral types with cluster analytic techniques: shared care, clinical problem, and patient initiated. This solution accounted for 11.7% of total variance. The majority of referrals in German primary care practices were initiated by the GP, or they were part of a shared decision with patients.
We suggest a taxonomy of referrals that might offer insights regarding the allocation of resources within the German health system. Referrals might be reduced by improved training of primary care physicians and by giving them more competencies in routine care of chronic patients.
初级保健向二级保健的转诊可能因动机和主动性而异。以前关于转诊频率和变化的研究大多将转诊视为同质的。我们旨在为德国初级保健向二级保健的转诊制定一个分类法，以支持宏观层面的决策。
我们分析了 29 名德国全科医生（GP）的 3988 份转诊。要求全科医生在一周内记录所有转诊；在随后的审计中，他们说明了任何转诊的原因和主动性。我们假设了以下五种转诊类型：临床问题、共同护理、行政、患者发起和共同费用。使用 k-均值聚类分析对数据进行了分析。
我们使用聚类分析技术确定了我们提出的五种转诊类型中的三种：共同护理、临床问题和患者发起。该解决方案解释了总方差的 11.7%。德国初级保健实践中的大多数转诊是由全科医生发起的，或者是与患者共同决策的一部分。
我们建议一种转诊分类法，可能为德国卫生系统内的资源分配提供一些见解。通过提高初级保健医生的培训水平，并赋予他们在慢性病常规护理方面更多的能力，可能会减少转诊。
