Referrals from general practitioners to medical specialist outpatient clinics: Effect of feedback and letter templates

Abstract

Objective: To determine whether providing feedback and educating doctors about referral guidelines will help to improve the quality of referral letters and referral rates. Design: Prospective study. Subjects: Patients referred from Shatin region's general outpatient clinics (GOPCs) to medical specialist outpatient clinic at Prince of Wales Hospital between 1st October 2004 and 31st June 2005. Main outcome measures: Number of non-routine appointments, number of letters containing 1st priority and 2nd priority (P1/P2) criteria for early appointments, number of standard components included in referral letters. Results: The number of early appointments (within eight weeks) was significantly increased (2.18, 95% Cl 1.70-2.80). Doctors who have not received their specialist qualifications were the main subgroups who showed improvement after intervention [non-fellows/non-trainees: 2.70 (1.75-4.18); FM trainees: 1.78 (1.01-3.17)]. FM fellows have the highest but non-significant baseline and post-intervention early appointment rates (26.2% and 40.7%). No significant changes were noted in the number of components included in letters after intervention. Significant increase in inclusion of P1/P2 criteria was noted overall and for certain disease subgroups (blood pressure, cardiac related conditions, gastrointestinal problems and thyroid problems). In general, letters including P1/P2 criteria would result in early appointment booking (2.03, 95% Cl 1.52-2.71), although this was not the case for certain disease subgroups. Conclusion: Providing feedback and information on referral guidelines to doctors in GOPCs helps to increase the quality of referral letters.