Adequacy of electronic and in-person referrals to endocrinology: a prospective study of primary care and hospital consultations

Juan J. Díez, Macarena Alpañés, Pedro Iglesias, Raquel Mateo

Purpose To assess the adequacy of electronic consultations (e-consults) and in-person referrals to an endocrinology department, to describe patterns and causes of inadequacy, and identify factors associated with inadequacy across different referral pathways. Methods All e-consults and in-person referrals received by the Department of Endocrinology of a tertiary hospital were prospectively recorded over a 52-working-day period. Consultations were classified as primary care e-consults, primary care in-person referrals, or hospital specialist in-person referrals. Each consultation was evaluated for adequacy and, when inadequate, categorized according to clinical or administrative causes. Priority assignment of primary care in-person referrals was also assessed. Univariable and multivariable logistic regression analyses were performed separately for primary care and hospital in-person referrals to identify factors associated with referral inadequacy. Results A total of 1,106 consultations were analyzed (e-consults, 187; primary care in-person referrals, 447; hospital in-person referrals, 472). Overall adequacy was 61.8%, with higher adequacy in primary care e-consults (77.5%) than in primary care (63.1%) and hospital in-person referrals (54.4%). Administrative causes predominated among inadequate e-consults, whereas hospital referrals showed both clinical and administrative causes. Among primary care in-person referrals, 46.3% were assigned priority, of which 58.5% were considered inappropriately prioritized. The association between age and adequacy did not follow a linear pattern, with the 41–64 age group showing the highest proportion of inadequacy in both primary care and hospital referrals. Referral origin outside the hospital catchment area was associated with higher inadequacy in primary care referrals. Conclusion Referral inadequacy to endocrinology services is common and varies by consultation modality, diagnostic category, and organizational factors. Targeted strategies to optimize referral pathways and prioritization may improve efficiency and access to specialist endocrine care.