Referral letter with an attached structured reply form: Is it a solution for not getting replies

Ramanayake, R.P.J.C.; Perera, D.P.; Silva, A. H. W. de; Sumanasekera, R.D.N.; Jayasinghe, LR; Fernando, K.A.T.; Athukorala, L.A.C.L.

doi:10.4103/2249-4863.123777

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…PH2 scored 0% and Referral / Counter referral form 3.9%. Similar results were obtained in the study that was conducted in Sri Lanka showing that only 7.5% of the referral feedback was received [ 37 ]. Contrary, an improvement was observed regarding referral feedback in the updated formats with 53.9% for ANC, delivery and PNC external transfer letter, and 42.6% for the external transfer form.…”

Section: Discussionsupporting

confidence: 86%

Assessment of formats and completeness of paper-based referral letters among urban hospitals in Rwanda: a retrospective baseline study

Kalume

Jansen

Nyssen

et al. 2022

BMC Health Serv Res

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Background Patient referral is a process in which a healthcare provider decides to seek assistance due to the limitations of available skills, resources and services offered locally. Paper-based referrals predominantly used in low-income countries hardly follow any procedure. This causes a major gap in communication, coordination, and continuity of care between primary and specialized levels, leading to poor access, delay, duplication and unnecessary costs. The goal of this study is to assess the formats and completeness of existing paper-based referral letters in order to improve health information exchange, coordination, and continuity of care. Methods A retrospective exploratory research was conducted in eight public and three private healthcare facilities in the city of Kigali from May to October 2021. A purposive sampling method was used to select hospitals and referral letters from patients’ files. A data capture sheet was designed according to the contents of the referral letters and the resulting responses were analyzed descriptively. Results In public hospitals, five types of updated referral letters were available, in total agreement with World Health Organization (WHO) standards of which two (neonatal transfer form and patient monitoring transfer form) were not used. There was also one old format that was used by most hospitals and another format designed and used by a district hospital (DH) separately. Three formats were designed and used by private hospitals (PH) individually. A total of 2,304 referral letters were perused and the results show that “external transfer” forms were completed at 58.8%; “antenatal, delivery, and postnatal external transfer” forms at 47.5%; “internal transfer” forms at 46.6%; “Referral/counter referral” forms at 46.0%; district hospital referrals (DH2) at 73.4%. Referrals by private hospitals (PH1, PH2 and PH3) were completed at 97.7%, 70.7%, and 0.0% respectively. The major completeness deficit was observed in counter referral information for all hospitals. Conclusion We observed inconsistencies in the format of the available referral letters used by public hospitals, moreover some of them were incompatible with WHO standards. Additionally, there were deficits in the completeness of all types of paper-based referral letters in use. There is a need for standardization and to disseminate the national patient referral guideline in public hospitals with emphasis on referral feedback, referral registry, triage, archiving and a need for regular training in all organizations.

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Section: Discussionsupporting

confidence: 86%

Assessment of formats and completeness of paper-based referral letters among urban hospitals in Rwanda: a retrospective baseline study

Kalume

Jansen

Nyssen

et al. 2022

BMC Health Serv Res

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“…Although 70% of the specialists admitted that they reply to referral letters always or most of the time, this is contrary to the views of general practitioners. (12,13,14) This interactive process should be balanced and mutual and this will result only if both primary care doctors and specialists respect each other. (6) Several studies have revealed lack of respect for GPs by specialists (8,15,16) and the Canadian RESPECT study (15) suggested that this could be improved by creating better relationships between GPs and specialists, enhancing profile of family medicine in Universities and teaching hospitals and by changing negative attitudes by promoting the expertise and role of family medicine.…”

Section: Discussionmentioning

confidence: 99%

Referral Communications : Bridging the Gap between Primary Care Doctors and Specialists

Ramanayake¹,

Silva²,

Perera³

et al. 2014

ME-JFM

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Introduction: In the Sri Lankan health system there is no system for registering a patient under any health care provider and there is no established referral and back referral system in practice. Still there is communication between primary care doctors and specialists mostly through conventional letters. This study was conducted to explore views of specialists on the referral process of the country. Methodology: This was a descriptive cross sectional study. A self administered questionnaire based on the data gathered in earlier qualitative, explorative research was prepared to gather data. A postal survey was conducted among Specialists island wide. Results: 1100 specialists were included in the study and the response rate was 20%. Although specialists expect a referral letter from general practitioners they receive one only around 50% of the occasions. They were not happy with the quality of letters and expected a comprehensive referral letter. They were keen to reply but time constraints (50%), lack of secretarial support (36%) and perception that reply will not reach the sender (31%) were obstacles in replying. Continuous medical education, use of structured referral forms and strengthening training programs were suggested to improve communications. Conclusions and recommendations: Specialists have a positive attitude towards their professional relationship with GPs and they should be made aware of this and try to enhance their communication with specialists. There should be rectifiable measures in the systems which facilitate coordination and communication between the two parties and then the referral process will become meaningful and beneficial to all the stakeholders.

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“…A referral process that is practiced efficiently, can contribute to high standards of care, improving patient's outcomes and assists in making cost-effective use of hospitals and primary health care services through optimal use of medical services. (5)(6)(7). It can also support health centers and outreach services by experienced staff from the hospital and helps build capacity and enhance access to better quality care (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Practice and Opinion of Doctors in Primary Health Care Centers Toward Referral System: Samples from Nine Governorates in Iraq

Al-Shatari¹,

Hasan²,

Shwaish

et al. 2021

Al-Kindy Col. Med. J

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Background: Most primary Health Care Centers (PHCCs) in Iraq have a referral system records; however, this mechanism does not function well because of the lack of other requirements for an efficient referral system. Objective: To assess the practice & opinion of doctors in PHCs toward the referral system, and to determine the doctors in PHC's commitment to referral system instructions and guidelines. Subjects and methods: A cross-sectional study with analytic elements was conducted in nine health directorates in Iraq, from the 1st October 2018 – 30th June 2019.One PHC was selected randomly form each sector in every governorate, A questionnaire was used to collect the required information. SPSS version 24 analysis was used for the statistical analysis. Results: sixty-three doctors were working in PHCs had participated in the current study, the mean age (40.03 ±10.24), 58.7%were female, 46% were general practitioner, 30.2% of the participated doctors had 300 and less patient/month; 31.7% of doctors had ≤10 Patients referred/month, emergencies was the main cause for referral (46.03%), and 37(58.37%) of doctors announced that the referred-form not retrained to the PHC, and ever retrained-forms had no feedback 29(46%), 28(44%)of the participated doctors agreed that the current referral-system was effective and seven of them strongly agreed, 59(93.7%) believe in the importance of hospital-feedback, with a significant relationship between their attitude about the effective-current-referral system & Refer cases Percentage, while no significant-relation with their Patients examined/month. Loaded crowded and hospital doctors shortage as possible causes and suggest to referral-system activation especially the hospital -part". Conclusions: there was inadequate knowledge of referral-policies and lack of coordination or/and clear feedback-expectations and PHCs-hospitals collaboration and lack of referral-system integrated within an electronic-health-record.

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Referral letter with an attached structured reply form: Is it a solution for not getting replies

Cited by 5 publications

References 16 publications

Assessment of formats and completeness of paper-based referral letters among urban hospitals in Rwanda: a retrospective baseline study

Assessment of formats and completeness of paper-based referral letters among urban hospitals in Rwanda: a retrospective baseline study

Referral Communications : Bridging the Gap between Primary Care Doctors and Specialists

Practice and Opinion of Doctors in Primary Health Care Centers Toward Referral System: Samples from Nine Governorates in Iraq

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