Analysis of criteria for referral of type 2 diabetes patients from primary care to specialized care in spain. A Pathways Study

Objectives: To assess the reasons for referral of type 2 diabetes (T2DM) patients from primary care ( PC) to specialized care (SC) in Spain. To assess the level of compliance with referral criteria established in national recommendations. Methods: Observational, cross-sectional, multi-centre national study, in PC and SC. Each physician provided, using a structured case report form, data on usual practice for T2DM patient referral and data about referral of 6 patients. Recommendations of the Spanish Society for Endocrinology and Nutrition (SEEN) and the National Health System (NHS) were used as reference documents to assess compliance. Data from clinical practice of 143 professionals of SC/641 general practitioners (GPs) and from referrals of 805 patients to PC/3,624 to SC are presented. Results: Almost one-third (31.8%) of GPs and 46.2% of SC professionals reported the existence of a coordination protocol with the other healthcare level. The most frequent communication tool for referrals to SC was a Consultation Report (89.2%), and the Medical History for referrals to PC. The referral criterion to SC most frequently declared was Metabolic Instability (80.5%) and to PC was Goal Achievement (96.5%). The most frequent cause for referral to SC among the patients studied was Reassessment (48.4%) and to PC Goal Achievement (91.6%). Almost half (46.8%) of GPs applied all NHS criteria in usual practice, and 3.9% all SEEN referral criteria. Conclusions: The number of reported coordination protocols is low, and the compliance with national guidelines is poor. (C) 2012 Sociedad Espanola de Diabetes. Published by Elsevier Espana, S.L. All rights reserved.