[The referral system: a study on relations between general practitioners and specialists].

Background: To describe the general practitioners referral patterns. There is special emphasis in the delay between the referral and the first consultation with the specialist. Also we consider other aspects of the coordination between both levels of care.

Methods: Cross-sectional study upon 8.095 referrals from 242 spanish doctors.

Results: The referral rate was 6.63%, higher in the 15-44 age group and also for men. We find a huge variability in the referral rates among doctors. The referral rates are higher to surgical specialties. The mean delay between referral and specialist appointment was 11 days. The general practitioners didn't receive communication from the specialists in 23.5 of the referrals.

Conclusions: A considerable range of referral rates has been identified. There is a poor continuity and coordination in the patient care.