Verwijzing van kinderen naar de specialist: Een vergelijking tussen 1987 en 2001

Background: Although GPs regularly refer children to a medical specialist, there is little detailed information available on the pattern of referrals and still less on developments over time. Aim: To uncover the pattern of referrals of children aged from 0 to 17 years and to compare the pattern in 2001 with that in 1987. Study design: An analysis of data from the First and Second Dutch National Surveys of General Practice, the studies carried out in 1987 (103 practices) and 2001 (91 practices) respectively. Method: In 2001 we recorded all new referrals to medical specialists as regards age and gender of the patient, the referral indication (ICPC code) and the medical specialty. We compared the data from that year to the data recorded for 1987. Outcome measurements were the number of new referrals per 1000 person-years and the number of new referrals per 100 new episodes. The latter measurement illustrates the possibility of a child with a specific diagnosis being referred. Results The number of referrals per 1000 person-years dropped from 138 in 1987 to 84 in 2001. The pattern as regards age was comparable in both years, but in 2001 there were relatively more referrals of boys than in 1987. The chances of referral dropped from 8.0 per 100 episodes in 1987 to 6.5 in 2001. The indications for referral also changed, particularly in the case of those to the ENT specialist and the eye specialist: the number of referrals for acute middle ear infection, refractive errors and problems with sight was 50 to 75% lower in 2001 than in 1987. Conclusion: In 2001 GPs themselves dealt with more children's problems and made fewer referrals in comparison to 1987