A blank page: feedback from first referral hospitals to primary health care clinics

Abstract

Background: Primary care practitioners depend on the feedback from hospitals in order to care for returning patients effectively. Lack of such feedback from the hospitals leads to frustration, poor efficiency and care that it is not cost effective. This study examined the presence and adequacy of written feedback from first referral hospitals to primary health clinics (PHC) in the Metsweding district, Tshwane, South Africa. Methods: A retrospective descriptive stratified cluster study was done by reviewing 863 patient records selected randomly from referred patients between 1 January 2010 and 31 December 2011 in 6 of the 11 clinics. The clinics were stratified according to type of setting and 6 clinics sampled proportionately. Results: Of the 858 referrals only 5.4% (n = 46) had feedback letters. Details of the patient were listed in 35 (76.0%) of the feedback letters. There were no contact details for the referring institution or practitioner in almost half of the feedback letters (41.8%; n = 19). Most did not mention the symptoms (87%; n = 40) or signs (89.2%; n = 41) but the majority (58.6%; n = 27) recorded the condition or diagnosis of the patient. The follow-up instructions were documented in 30 letters (65.2%). Conclusions:The low rate of return feedback letters appears to be a commonplace experience and this study both quantifies the extent of this problem and highlights the weaknesses in the letters themselves. The findings reinforce the experiences of practitioners in PHCs and have practical implications for hospital doctors and district hospital managers who wish to strengthen the health system.

Quality of Primary Care Center Referral Letters and Feedback Reports among Sample of PHCCs in Baghdad /Al-Rusafa Health Directorate During2015

“…(30) In this study, we found that name& signiture of specialist recorded in (40%)feedback reports which similar to the result reported in Qassim region,were recorded in (41.8%), (30) and lower than those obtained in Southeastern Saudi Arabia, and study done in South Africa, were name & sign of specialist recorded in 89.2%,60.8% of feedback reports respectively]. (38,27) In this study we found 53% mention the plan of management; only 7% record the treatment while the remaining 46% mention (It has been making the necessary).Which is lower than the result done in South Africa, [where treatment recommendations recorded in63%]. (27) The reasons behind skipping the referral feedback notes might be related to either the doctors were overloaded or they thought it was of no use, and some did not re-send the patient to the PHCCs at all.…”

“…Despite this, the final diagnosis was specified in (62%) of feedback reports; This assessment was near those obtained in South Africa and in Southeastern Saudi Arabia (58.6, 66.7% respectively) . (27,38) While less than the result reported by study done in Qassim region ,were diagnosis present in (77.9%) of feedback reports. (30) In this study the investigations done at the hospitals were only recorded in (14%)of the feedback letters, and clinical finding recorded in only (4%) which were near those obtained in Asir region, Saudi Arabia,were the result obtained (21.5% ,5.9% of feedback reports, respectively), (28) In 85% of the feedback reports there were no clear recommendations from the specialists.…”

“…Regarding feedback in this study, we found low percentage (16.5%) of hospital feedback reports, These results are higher than those found in a study done in Egypt, 2015 were only 13% of referred patients returned back with feedback reports, (26) poor feedback rate of 5.4% also was shown in a study done in South Africa 2015. (27) On the other hand there was higher percentages of feedback reports in Asir region, Saudi Arabia,were hospitals sent feedback reports for only (22-39%) , (28) comparing with higher rates in some western countries (55-88%). (29) Approximately most of the hospital feedback reports (85.15%) were received from the AL-Nu 'man General Hospital, while the rest (14.85%) were received from the Al -Elwiyah Maternity hospital, the high rate answers to referral letters from the Al -Nu 'man General Hospital may be related to influence of the method of communication, by electronic feedback on answers.The reason for such a low rate of feedback reports, somemight be pertained to the work situation at the hospital, could be the lack of awareness on the part of hospital consultants of the importance of communication with PHCCsin maintaining the continuity of care and patient satisfaction.…”

“…(38,27) In this study we found 53% mention the plan of management; only 7% record the treatment while the remaining 46% mention (It has been making the necessary).Which is lower than the result done in South Africa, [where treatment recommendations recorded in63%]. (27) The reasons behind skipping the referral feedback notes might be related to either the doctors were overloaded or they thought it was of no use, and some did not re-send the patient to the PHCCs at all.…”

Data management for early hearing detection and intervention in South Africa

“…Within the South African public healthcare context, such a system would be essential to the success of a universal newborn hearing screening (UNHS) programme because of the hierarchical nature (Legodi & Wolvaardt 2015) of our three-tier public health referral system. An online data management system would allow for interdisciplinary tracking along the referral pathway, where paediatric hearing screening occurs at the primary healthcare facility with referral to a secondary or tertiary healthcare facility if advanced diagnostic testing and confirmation of hearing loss is required.…”