Referral and responses at Kukot Primary Care Center: A case study for development

Abstract

Objective: To analyze referral letters from Kukot primary care center and response-letters from Thammasat University Hospital.

Method: An action research, referral letters and their responses were collected with team actions at an interval of 9 months. Descriptive statistics and a qualitative analysis of the lettersû contents were used. Qualitative data collected from related personnel interview were presented.

Results: In February 2009, 105 referral letters (10% of monthly total) were randomly selected and their 49 back-referral letters with 39 responses were analyzed. After a team action, in November 2009, 65 consecutive first-time referral letters (6.5% of total) and their 45 back-referral letters with 28 responses were analyzed. Response rate was at 43%. Time of receiving response was 1 week to ≥ 3 months. The average response from major specialties was 50-60% except from the Ob-Gyn. The referral letters had 90% completion of almost all content topics while the response letters had 36.9-40% completion in the final diagnosis heading and 32-34% in the follow-up date. Other headings in the response letters were mentioned <30% especially the co management plan was at <10%. Sixty percent of referred patients understood about the process and the forms while 86% perceived the diagnosis and the treatment they received from the specialists. Interview results showed drawbacks in essential communication skills especially the verbal and the writing among health personnel and patients.

Conclusion: The study showed analytic results of referral letters from Kukot primary care center and responselettersfrom Thammasat University Hospital during February›November 2009. The referral response rate, the completion of referral letter contents and understanding of the referred patients regarding the reasons of referral, the referral process and the final results of the consultation were shown. The expressed concerns of related health personnel were also quoted. We recommended that the referral system should be computerized via electronic mails or other intranet systems.

Key words: referral and response, primary care, development