Structure and interrelations between different levels of care]

This is a descriptive study of the degree of interrelation between the primary and secondary levels of care in the Spanish health system. The referrals to the specialized milieu are analyzed and the magnitude and quality of the information received by the primary care physician is evaluated. The referrals from the Santoña outpatient clinic during 33 days are evaluated. Out of 5692 consultations, 259 patients were referred (4.55%). 16.2% of the referrals were made on an emergency basis. The most common specialties to which patients were referred were ophthalmology, traumatology, hospital, oto-rhino-laryngology, gynecology and dermatology. In 54.44% of referrals no response from the specialized milieu was obtained. In 41.6% of referrals with a response the quality of the information was poor. In 70% of the responses there was a mention of a diagnosis and in 66.1% a therapy was prescribed. The severe deficiencies in the interrelation between the different levels of care are shown; we propose as solutions the creation of internal pathways of communication and the unification of criteria between specialists and primary care physicians.