Assessing the quality of referral letters written by general practitioners: a cross-sectional study in rural Iran

Janati, Ali; Amini, Amir; Adham, Davoud; Naseriasl, Mansour

doi:10.1590/0102-311x00043016

Cited by 6 publications

(5 citation statements)

References 8 publications

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“…For example, reports from both HCPs and patients revealed that that documented information was often provided in the form of minimal, handwritten notes on papers provided for other purposes (eg, prescription cards). These findings reflect results from other LMIC studies that have evidenced the exchange of poor-quality referral documents 14 37–39. However, the current study also evidenced patient reports of not being provided with any documented information during referrals.…”

Section: Discussionsupporting

confidence: 87%

“…In addition, the implementation of structured documentation, systems and training is urgently required to manage critical care transitions such as referrals, transfers and discharge. Research from both HIC and LMIC settings has proven that such interventions can improve the continuity and safety of care 4 17 37 49. Regarding future steps, during HCP interviews it was reported that public healthcare facilities in Kerala will be transitioning to computerised ‘e-health’ information systems.…”

Section: Discussionmentioning

confidence: 99%

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Patient and healthcare provider knowledge, attitudes and barriers to handover and healthcare communication during chronic disease inpatient care in India: a qualitative exploratory study

et al. 2019

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Objectives1) To investigate patient and healthcare provider (HCP) knowledge, attitudes and barriers to handover and healthcare communication during inpatient care. 2) To explore potential interventions for improving the storage and transfer of healthcare information.DesignQualitative study comprising 41 semi-structured, individual interviews and a thematic analysis using the Framework Method with analyst triangulation.SettingThree public hospitals in Himachal Pradesh and Kerala, India.ParticipantsParticipants included 20 male (n=10) and female (n=10) patients with chronic non-communicable disease (NCD) and 21 male (n=15) and female (n=6) HCPs. Purposive sampling was used to identify patients with chronic NCDs (cardiovascular disease, chronic respiratory disease, diabetes or hypertension) and HCPs.ResultsPatient themes were (1) public healthcare service characteristics, (2) HCP to patient communication and (3) attitudes regarding medical information. HCP themes were (1) system factors, (2) information exchange practices and (3) quality improvement strategies. Both patients and HCPs recognised public healthcare constraints that increased pressure on hospitals and subsequently limited consultation times. Systemic issues reported by HCPs were a lack of formal handover systems, training and accessible hospital-based records. Healthcare management communication during admission was inconsistent and lacked patient-centredness, evidenced by varying reports of patient information received and some dissatisfaction with lifestyle advice. HCPs reported that the duty of writing discharge notes was passed from senior doctors to interns or nurses during busy periods. A nurse reported providing predominantly verbal discharge instructions to patients. Patient-held medical documents facilitated information exchange between HCPs, but doctors reported that they were not always transported. HCPs and patients expressed positive views towards the idea of introducing patient-held booklets to improve the organisation and transfer of medical documents.ConclusionsHandover and healthcare communication during chronic NCD inpatient care is currently suboptimal. Structured information exchange systems and HCP training are required to improve continuity and safety of care during critical transitions such as referral and discharge. Our findings suggest that patient-held booklets may also assist in enhancing handover and patient-centred practices.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Patient and healthcare provider knowledge, attitudes and barriers to handover and healthcare communication during chronic disease inpatient care in India: a qualitative exploratory study

et al. 2019

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“…General practitioners (GP) play a key role in primary healthcare in Iran (1). They act as gatekeepers who identify the needs of their patients and decide on the health services required for the better management of their complications (2).…”

Section: Introductionmentioning

confidence: 99%

Knowledge, Attitude, and Practice of General Practitioners Toward the Rehabilitation Field and Team Experts in Shiraz, Iran, in 2018

et al. 2021

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Background: General practitioners (GP) are the keystones in the process of referring patients in Iran. To refer patients to rehabilitation experts effectively and accurately, GPs need to be equipped with knowledge and understanding of physical medicine and rehabilitation (PMR) and its roles and have a positive attitude toward collaborating with rehabilitation teams. Objectives: The current study aimed at evaluating the knowledge, attitude, and practice (KAP) of GPs in Shiraz, Iran, toward the rehabilitation field and teamwork. Methods: The current cross sectional study assessed the KAP of GPs working in public and private health sectors in Shiraz, Iran, in 2018 via a researcher-made questionnaire. Participants were recruited using the stratified random sampling method. Results: A total of 200 GPs completed the study. The mean score of knowledge was 13.54 ± 2.68 (ranging from 0 to 24), and the mean score of attitude 10.84 ± 2.47 (ranging from 0 to 20). Regarding practice, none of the participants (0%) had a monthly average of more than five referrals to a physiatrist. Thirty-eight (19%) respondents were interested in choosing PMR as a specialty. Conclusions: According to the current study findings, GPs in Shiraz, Iran, are not equipped with adequate knowledge of rehabilitation and have a moderate attitude toward collaborating with a rehabilitation team. GPs rarely use PMR consultations for their patients’ complications. Policymakers should advocate for a higher level of collaboration between GPs and rehabilitation teams and find ways to better familiarize healthcare providers with PMR.

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“…A good referral should include the patient's biography, such as age, gender, tribe, religion, occupation, medical history, the reason for the referral, interventions or treatments received, and the clinical diagnosis [5] [6]. An effective referral system plays a critical role in achieving good and sustainable healthcare delivery in Nigeria.…”

Section: Introductionmentioning

confidence: 99%

Pattern of Referral of Obstetric Patients at a Tertiary Care Hospital in Southern Nigeria

John,

Alegbeleye

2024

ARSci

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Background: Health challenges that are difficult to manage at primary health centres should be referred to secondary health facilities, and if untreated, to the tertiary hospitals. A good referral should include the patient's biography, such as age, gender, tribe, religion, occupation, medical history, the reason for the referral, treatments received, and clinical diagnosis. Objectives: To evaluate the referral patterns, indications for referrals, and feto-maternal outcomes for obstetric patients who were referred to the University of Port Harcourt Teaching Hospital. Materials and Methods: A prospective study of patients admitted to the Obstetric unit from January 1, 2021, to December 31, 2022. Data was collected from patients while on admission or clinic visits and recorded in an excel spread sheet. Data was analyzed with the Statistical Package for Social Sciences (SPSS) version 25. Results: Of the 3469 patients were admitted to the obstetric unit, 1476 and 1993 were admitted in 2021 and 2022, respectively. Most (70.35%) of the patients were in the 20-34 years age group, parity 1-4 was the most frequent (66.49%), while 85.39% of patients were booked. 10.46% of the booked patients were referred from other facilities, whereas 89.54% of patients were booked at our facility from the onset. Most common indications of referrals were previous caesarean section (CS) at term (40.09%) and hypertensive disorders of pregnancy (17.59%). The outcome for 2021 indicated 17 maternal deaths, 132 fetal deaths and 1010 live births, giving maternal mortality ratio (MMR) as 1810.44 per 100,000 live births and perinatal mortality ratio (PMR) of 130.7 per 1000 births respectively. In 2022, there were 17 maternal deaths, 130 fetal deaths and 1297 deliveries, giving a MMR of 1399 per 100,000 live births and a PMR of 100.2 per 1000 births. Conclusion: The pattern of referral among obstetric patients in this study shows that a lot of the patients do not get adequate care at the lower cadre of the referral system, hence adequate facilities should be made available in primary and secondary health centres to tackle obstetric emergencies.

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Assessing the quality of referral letters written by general practitioners: a cross-sectional study in rural Iran

Cited by 6 publications

References 8 publications

Patient and healthcare provider knowledge, attitudes and barriers to handover and healthcare communication during chronic disease inpatient care in India: a qualitative exploratory study

Patient and healthcare provider knowledge, attitudes and barriers to handover and healthcare communication during chronic disease inpatient care in India: a qualitative exploratory study

Knowledge, Attitude, and Practice of General Practitioners Toward the Rehabilitation Field and Team Experts in Shiraz, Iran, in 2018

Pattern of Referral of Obstetric Patients at a Tertiary Care Hospital in Southern Nigeria

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