URGENT SELF-REFERRALS TO AMBULATORY CONSULTANT - A PROSPECTIVE EVALUATION OF TRIAGE BY A QUALIFIED FAMILY PHYSICIAN

Direct self-referral to a consultant, especially on an urgent basis, h as not been widely explored before. The health insurance system in Isr ael permits elective direct self-referrals to various specialists, but the range and reasons of urgent self-referrals has not yet been evalu ated. Our aim was to evaluate urgent self-referrals to ambulatory cons ultants and to see to what extent a qualified family physician can tri age and treat those patients. The setting was an urban ambulatory mult i-disciplinary consultation center in the city of Ashdod in central Is rael, serving a population of approximately 150,000. Over a three-mont h period, all patients who made urgent self-referrals for an ambulator y consultant in Ophthalmology, Ear, Nose and Throat (ENT) and Dermatol ogy were triaged by an on-duty qualified family physician. The physici an was instructed to take care of the patient in one of three ways: 1) immediate referral to a specialist; 2) begin treatment and schedule t he patient for a specialist consultation; 3) administration of definit ive treatment. Eight hundred and ninety-eight patients aged 46+/-22 ye ars were treated by the triaging family physician. Forty-six percent h ad ophthalmological symptoms, 26% had dermatological symptoms and 20% had ENT-related symptoms. A symptom duration of less than 24 hours was reported by 36% of the patients. Eye problems were more commonly of s hort duration (p<0.001). Sixty percent of the patients were given a de finitive treatment, another 19% were given immediate treatment and sch eduled for elective consultation with a specialist and 21% were referr ed for an immediate specialist consultation. Of the immediate consulta tions, 73% were ophthalmological and 27% came from a range of other co mplaints (p<0.001). Our conclusion was that a family physician can tre at most of the urgent self-referrals to ambulatory consultations in th e three domains that were evaluated. A triage system is particularly s uitable for urgent self-referrals to ENT as well as dermatological pro blems.