CHILDREN REFERRED FOR SPECIALIST CARE - A NATIONWIDE STUDY IN DUTCH GENERAL-PRACTICE

Background. Insight into referral patterns provides general practition ers (GPs) and specialists with a frame of reference for Their own work and enables assessment of the need for secondary care. Only approxima te information is available. Aim. To determine how often, to which spe cialties and for what conditions children in different age groups are referred, as well as how often a condition is referred given the incid ence in general practice. Method. From data of the Dutch National Surv ey of Morbidity and Interventions in General Practice, 63 753 new refe rrals (acute and non-acute) were analysed for children (0-14 years) fr om 103 participating practices (161 GPs) who registered. Practices wer e divided into four groups. Each group of practices participated for t hree consecutive months covering a whole year altogether. We calculate d referral rates per 1000 children per year and referability rates per 100 episodes, which quantifies the a priori chance of a condition bei ng referred for specialist care. Results. The referral rare varied by age from 231 for children under 1 year old to 119 for those aged 10-14 years (mean 159). The specialties mainly involved were ENT, paediatri cs, surgery, ophthalmology, dermatology and orthopaedics. Referrals in the first year of life were most frequently to paediatricians (123); among older children the referral rate to paediatricians decreased (me an 36). Referrals to ENT specialists were seen particularly in the age groups 1-4 (71) and 5-9 (53). For surgery, the referral rate increase d by age from 19 to 34. Differences between boys and girls were small, except for surgery. The highest referral rates were for problems in t he International Classification of Primary Care (ICPC) chapters: respi ratory (28); musculoskeletal (25); ear (24) and eye (21). Referability rates were, in general, low for conditions referred to paediatrics an d dermatology and high for surgery and ophthalmology. The variation in problems presented to each specialty is indicated by the proportion o f all referrals constituted by the 10 most frequently referred diagnos es: from 35% for paediatrics to 81% for ENT for ophthalmology, five di agnoses accounted for 83% of all referrals. Conclusions. The need for specialist care in childhood is clarified with detailed information fo r different age categories, specialties involved and variation in morb idity presented to specialists, as well as the proneness of conditions to be referred.