lunes, 20 de febrero de 2012

Cuando un médico deriva a un paciente a otro médico...



 Es muy frecuente que cuando un paciente acude a un médico, sea derivado a otro.
En los centros de salud tenemos capacidad para resolver el 90% de los problemas de salud que los pacientes presentan. Este porcentaje es muy variable. Depende del médico en cuestión, de su nivel de competencia, de la sobrecarga asistencial a la que esté sometido, la carga de burocracia, la coordinación dentro de la organización sanitaria, etc...

Los datos que presenta el estudio norteamericano del Archives of Internal Medicine dicen que de 1999 a 2009 el porcentaje de derivaciones de un médico a otro subió del 4.8% al 9.3%. No está mal para 10 años. 


Lo que podemos concluir es que este hecho incrementa los costes sanitarios, complica los procesos y seguramente no aporte valor añadido a la salud del paciente. El paciente seguirá siendo rebotado de raqueta en raqueta...






Nosotros seguimos apostando por una atención primaria resolutiva, mucho más barata y segura que derivar al hospital. Y seguimos sin que nos hagan mucho caso.










 Trends in Physician Referrals in the United States, 1999-2009
Michael L. Barnett, MD; Zirui Song, BA; Bruce E. Landon, MD, MBA


Arch Intern Med. 2012;172(2):163-170. doi:10.1001/archinternmed.2011.722
Background  Physician referrals play a central role in ambulatory care in the United States; however, little is known about national trends in physician referrals over time. The objective of this study was to assess changes in the annual rate of referrals to other physicians from physician office visits in the United States from 1999 to 2009.
Methods  We analyzed nationally representative cross-sections of ambulatory patient visits in the United States, using a sample of 845 243 visits from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 1993 to 2009, focusing on the decade from 1999 to 2009. The main outcome measures were survey-weighted estimates of the total number and percentage of visits resulting in a referral to another physician across several patient and physician characteristics.
Results  From 1999 to 2009, the probability that an ambulatory visit to a physician resulted in a referral to another physician increased from 4.8% to 9.3% (P < .001), a 94% increase. The absolute number of visits resulting in a physician referral increased 159% nationally during this time, from 41 million to 105 million. This trend was consistent across all subgroups examined, except for slower growth among physicians with ownership stakes in their practice (P = .02) or those with the majority of income from managed care contracts (P = .007). Changes in referral rates varied according to the principal symptoms accounting for patients' visits, with significant increases noted for visits to primary care physicians from patients with cardiovascular, gastrointestinal, orthopedic, dermatologic, and ear/nose/throat symptoms.
Conclusions  The percentage and absolute number of ambulatory visits resulting in a referral in the United States grew substantially from 1999 to 2009. More research is necessary to understand the contribution of rising referral rates to costs of care.




Datos españoles dan un 7%


foto  Image: 'Gaudio The Best WorldwideTennis Player'
http://www.flickr.com/photos/27971507@N00/465400250