Sources of clinical referrals to an urban coloproctology unit in Italy

Prompt and appropriate referrals to colorectal surgeons result in better clinical and more cost-effective outcome: The question that then arises is how patients with large bowel diseases get in contact with the specialist. The aim of the present research was to investigate the sources of clinical referrals of 1000 patients attending a dedicated coloproctology unit. One thousand consecutive new patients attending the private Coloproctology Unit of Rome were prospectively evaluated from May 1995 through December 1999. For each patient, the following data were collected: age, gender, source of referral, and disease classified as benign anal diseases, neoplasms, functional disorders or inflammatory bowel disease (IBD). There were 569 patients with benign anal disease, 334 with functional disorders, 57 with neoplasms, and 40 with IBD. Sources of referrals were: surgeons (32.6%), previous patients (23.6%), other specialists (22.8%), general practitioners (11.8) and others (9.2%). Overall, referrals from non-medical sources were 32.8%, whereas 67.2% of the cases were referred by other colleagues. Most of the referring specialists were surgeons or gastroenterologists, who sent 304 patients, whereas 9.4% of the cases were referred by other colorectal surgeons. Previous patients who were satisfactorily cured sent 23.6% of the cases. Only 1.1% of patients were referred by health insurance companies and 0.2% found the Unit through Internet. Colleagues who referred patients to the coloproctologist sent mainly cases with benign anal diseases and functional disorders. Few patients were referred for colorectal cancer and IBD as these diseases are routinely treated by general surgeons and their management is expensive in a private hospital for patients without insurance coverage. In conclusion, GPs, media, health insurance and Internet may be the most valuable targets of an information campaign, as their role as sources of referral was lower than expected. © Springer-Verlag 2001.