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OBJECTIVES: To determine the reasons and characteristics of referrals from Primary to Specialised Care in the Health Area of Toledo (Spain). MATERIAL AND METHODS: A descriptive, cross-sectional study was conducted by reviewing a sample of the referrals to specialists made by 26 general practitioners from eight Teaching Health Centres during February 2011. All of them completed a questionnaire which recorded patient data, and reason and characteristics of the referral. RESULTS: A total of 332 referrals were recorded; the mean age of the patients was 51.3 years (SD; 17.9); 60.1% females; 30.7% pensioners; 54.8% had a chronic disease; 85.8% were from an urban environment. The most consulted specialists were: Traumatology (63), Gynaecology (53), and Ophthalmology (41). More than three-quarters (78.9%) were by the normal route, and 47.4% were first consultations. Around 12.7% were scheduled reviews, with a majority (51.4%) by a hospital specialist. More than two thirds (69.8%, 95% CI; 64.5-74.7%) required follow-up or treatment by the specialist. More than half (57.7%, 95% CI; 52.3-63.1%) required special diagnostic tests, and in 29.8% (95% CI; 25.0-35.1%) there was no clear diagnosis. There was a history of a repeated consultation for the same symptomatology in 28.9% of the referrals. Around 38.4% (95% CI; 33.0-43.7%) were requested specifically by the family or patient. Around 5.4% had a poor relationship with the patient. CONCLUSIONS: The majority of referrals are made by the normal route, and to surgical specialities. The need for hospital specialist follow-up and/or treatment, or the impossibility to request specific tests from Primary Care were the main reasons for requesting care from a second health care level. There were a high percentage of referrals requested by the family/patient.

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Objetivos. Conocer los motivos y características de las derivaciones desde atención primaria a especializada en el área de Salud de Toledo. Material y métodos. Estudio de tipo descriptivo transversal. Se revisó una muestra de las interconsultas a especializada realizadas por 26 médicos de familia, pertenecientes a 8 centros de salud docentes, en febrero de 2011. Por cada una, se cumplimentó un cuestionario que recogía datos del paciente, motivo y características de la derivación. Resultados. Se recogieron 332 interconsultas; la edad media de los pacientes fue de 51,3 años (DE 17,9); el 60,1% mujeres; el 30,7% pensionistas; el 54,8% presentaban patología crónica; el 85,8% procedía del medio urbano. Las especialidades más consultadas fueron: Traumatología (63), Ginecología (53) y Oftalmología (41). El 78,9% fueron vía normal y 47,4% fueron primeras consultas. Un 12,7% eran revisiones programadas, en su mayoría (51,4%) por el especialista hospitalario. El 69,8% (IC95% 64,5–74,7%) precisaba seguimiento o tratamiento por el especialista. El 57,7% (IC95% 52,3–63,1%) requería pruebas diagnósticas especiales. En el 29,8% (IC95% 25,0–35,1%) no estaba claro el diagnóstico. En el 28,9% de las derivaciones había antecedentes de consulta reiterada por esa sintomatología. En el 38,4% (IC95% 33,0–43,7%) hubo solicitud expresa por familia o paciente. El 5,4% tenía mala relación con el paciente. Conclusiones. La mayoría de las derivaciones se hacen por vía normal y a especialidades quirúrgicas. La necesidad de seguimiento y/o tratamiento por parte del especialista hospitalario o la imposibilidad de solicitar determinadas pruebas desde atención primaria fueron los principales motivos para solicitar la atención del segundo nivel asistencial. Existe un alto porcentaje de interconsultas inducidas por la familia/paciente(AU)

Objectives. To determine the reasons and characteristics of referrals from Primary to Specialised Care in the Health Area of Toledo (Spain). Material and methods. A descriptive, cross-sectional study was conducted by reviewing a sample of the referrals to specialists made by 26 general practitioners from eight Teaching Health Centres during February 2011. All of them completed a questionnaire which recorded patient data, and reason and characteristics of the referral. Results. A total of 332 referrals were recorded; the mean age of the patients was 51.3 years (SD; 17.9); 60.1% females; 30.7% pensioners; 54.8% had a chronic disease; 85.8% were from an urban environment. The most consulted specialists were: Traumatology (63), Gynaecology (53), and Ophthalmology (41). More than three-quarters (78.9%) were by the normal route, and 47.4% were first consultations. Around 12.7% were scheduled reviews, with a majority (51.4%) by a hospital specialist. More than two thirds (69.8%, 95% CI; 64.5–74.7%) required follow-up or treatment by the specialist. More than half (57.7%, 95% CI; 52.3–63.1%) required special diagnostic tests, and in 29.8% (95% CI; 25.0-35.1%) there was no clear diagnosis. There was a history of a repeated consultation for the same symptomatology in 28.9% of the referrals. Around 38.4% (95% CI; 33.0–43.7%) were requested specifically by the family or patient. Around 5.4% had a poor relationship with the patient. Conclusions. The majority of referrals are made by the normal route, and to surgical specialities. The need for hospital specialist follow-up and/or treatment, or the impossibility to request specific tests from Primary Care were the main reasons for requesting care from a second health care level. There were a high percentage of referrals requested by the family/patient(AU)

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Las arritmias son, quizá, una de las patologías que más intranquilidad provoca en el médico de atención primaria. Esto es especialmente cierto ante episodios agudos de taquicardia, en las cuales con frecuencia se duda a la hora de decidir qué fármaco utilizar por temor a empeorar el cuadro. Por otro lado, con frecuencia se detectan de forma casual distintos tipos de arritmias asintomáticas en electrocardiogramas rutinarios; las dudas en este caso suelen plantearse respecto a si es necesario tratarlas o no. Saber identificar el tipo de trastorno del ritmo en base al patrón electrocardiográfico es el primer paso indispensable para poder enfrentarnos a estas patologías. En el presente artículo se pretende realizar una revisión de las arritmias más frecuentes, con especial énfasis en su diagnóstico electrocardiográfico, sus causas más frecuentes, su significación pronóstica y su tratamiento (AU)

Arrhythmias are, perhaps, one of the diseases that cause the most concern in the primary care physician. This is especially true when these are acute episodes of tachycardia, in which the physician frequently has doubts about which drug can be used without worsening the clinical picture. On the other hand, different types of asymptomatic arrhythmias are frequently detected on the routine electrocardiograms. In this case, doubt arises regarding whether these should be treated or not. Knowing how to identify the type of rhythm disorder based on the electrocardiographic pattern is the first essential step in order to cope with these conditions. In this article, it has been aimed to make a review on the most frequent arrhythmias, placing special emphasis on their electrocardiographic diagnosis, their most frequent causes, their prognostic significance and treatment (AU)

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