Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, 08022 Barcelona, Spain.
Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Cra 24 No. 63C-69, Quinta Mutis, 11001 Bogotá, Colombia.
Health Policy Plan. 2018 May 1;33(4):494-504. doi: 10.1093/heapol/czy016.
An adequate use of referral and reply letters-the main form of communication between primary care (PC) and out-patient secondary care (SC)-helps to avoid medical errors, test duplications and delays in diagnosis. However, it has been little studied to date in Latin America. The aim is to determine the level and characteristics of PC and SC doctors' use of referral and reply letters and to explore influencing factors in public healthcare networks of Argentina, Brazil, Chile, Colombia, Mexico and Uruguay. A cross-sectional study was conducted through a survey of PC and SC doctors working in public healthcare networks (348 doctors per country). The COORDENA questionnaire was applied to measure the frequency of use and receipt of referral and reply letters, quality of contents, timeliness and difficulties in using them. Descriptive analyses were conducted and a multivariate logistic regression model was generated to assess the relationship between frequent use and associated factors. The great majority of doctors claim that they send referral letters to the other level. However, only half of SC doctors (a higher proportion in Chile and Mexico) report that they receive referral letters and <20% of PC doctors receive a reply from specialists. Insufficient recording of data is reported in terms of medical history, tests and medication and the reason for referral. The factor associated with frequent use of the referral letter is doctors' age, while the use of reply letters is associated with identifying PC doctors as care coordinators, knowing them and trusting in their clinical skills, and receiving referral letters. Significant problems are revealed in the use of referral and reply letters which may affect quality of care. Multifaceted strategies are required that foster a direct contact between doctors and a better understanding of the PC-based model.
转诊和回复信函的合理使用——这是初级保健（PC）和门诊二级保健（SC）之间主要的沟通形式——有助于避免医疗错误、重复检查和诊断延误。然而，迄今为止，拉丁美洲对这方面的研究还很少。本研究旨在确定阿根廷、巴西、智利、哥伦比亚、墨西哥和乌拉圭的公共医疗保健网络中 PC 和 SC 医生使用转诊和回复信函的水平和特征，并探讨其影响因素。本研究通过对在公共医疗保健网络中工作的 PC 和 SC 医生（每个国家 348 名医生）进行横断面调查开展了一项研究。采用 COORDENA 问卷来衡量使用和接收转诊和回复信函的频率、内容质量、及时性以及使用时遇到的困难。进行了描述性分析，并生成了多变量逻辑回归模型来评估频繁使用与相关因素之间的关系。绝大多数医生声称他们会向另一级别的医生发送转诊信。然而，只有一半的 SC 医生（智利和墨西哥的比例更高）报告收到转诊信，而<20%的 PC 医生收到专家的回复。报告称，在病历、检查和药物以及转诊原因方面，数据记录不足。与频繁使用转诊信相关的因素是医生的年龄，而回复信的使用与将 PC 医生视为医疗协调员、了解他们并信任他们的临床技能以及收到转诊信有关。转诊和回复信函的使用存在显著问题，可能会影响医疗服务质量。需要采取多方面的策略，促进医生之间的直接联系，并更好地了解基于 PC 的模式。
