Quality of Referrals from Family Medicine to Secondary Care in a University Hospital: Communication and Continuity of Care
Keywords:
Referral, Quality, Communication, Continuity of care, Family physician, Secondary careAbstract
Objective: To study the quality of referrals made from Family Medicine Department to Secondary Care Medicine atRamathibodi Hospital, Bangkok.
Methods: Cross-sectional descriptive study. Of 2,714 patients who were referred between 1 January and 31 December 2010, 483 patients were sampled and reviewed.
Results: About 80% of the referrals were made to 6 subspecialties: gastroenterology (21.95%), cardiology (17.18%), neurology (13.87%), pulmonology (11.59%), endocrinology (8.7%) and nephrology (7.87%). Consultations were done in 87.78% of the referrals. The mean waiting time was 18.27 days. 82.23% did not record a reason for referral and 13.22% did not make the referring problem clear. About 20 percent of referrals were made too early. Feedback from a specialist was provided in only 14.08% of cases. And only 3.73% of patients were sent back to family physicians. The retrospective review suggested that 23.6% of cases could have been managed by family physicians.
Conclusions: Several problems regarding quality of referrals were identified. Referral form and structured feedback from specialists should be introduced. One in four referrals could potentially be avoided by developing guidelines for managing commonly referred problems and by strengthening the knowledge of family physicians and residents through training programs.
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Copyright (c) 2015 By the authors. Licensee RMJ, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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