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Referral Letters (referral + letter)
Selected AbstractsContemporary referral of patients from community care to cardiology lack diagnostic and clinical detailINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2006S. Bodek Summary The quantity of referrals to secondary care is increasing. That the quality of medical referrals is decreasing is a common allegation yet has rarely been assessed. We report a time-limited, cross-sectional survey evaluating cardiological referral information quality. Referral letters (n = 218, excluding direct access pro formas) from GPs to the Cardiology Department at City Hospital, Birmingham, were collated and analysed over 2 months. A subset (n = 49) of these patients completed questionnaires assessing their knowledge and patient communication of the referral. Information quality was poor (length, diagnosis, expectation, prior treatment and investigation) with almost half of all letters containing only outline symptomatic complaints without diagnosis. The majority of patients referred had not been investigated or treated in any way before referral. Despite lack of understanding of the reason for referral, typically the majority of patients expressed themselves as satisfied with the process. Given most referrals are seen as appropriate, information exchange between secondary and primary care is crucial. By contrast, the standard of even basic clinical assessment communicated between primary care and secondary care was severely limited. The reason(s) why medical assessment is lacking are unclear but must be explored to give more support to primary care to complete basic medical task particularly if investment is to flow into this source. [source] How should trainees be taught to open a clinical interview?MEDICAL EDUCATION, Issue 5 2005Alex Walter Aim, To characterise the opening of secondary care consultations. Method, We audio-taped 17 first consultations in medical clinics, transcribed them verbatim, and analysed verbal interactions from when the doctor called the patient into the consulting room to when she or he asked clarifying questions. Results, The interviews did not open with the sequence, reported by previous researchers, of ,doctor's soliciting question, patient's opening statement, interruption by the doctor'. Doctors (1) called the patient to the consultation; (2) greeted them; (3) introduced themselves; (4) made a transition to clinical talk; and (5) framed the consultation. They used a referral letter, the case notes, computer records and their prior knowledge of the patient to help frame the consultation, and did so informally and with humour. Conclusion, These 5 steps could help trainees create a context for active listening that is less prone to interruption. [source] The significance of diabetes and disability: referrals made to a disability servicePRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 6 2006MRCP Specialist Registrar in Rehabilitation Medicine, R Singh MA Abstract Diabetes mellitus is an important cause of disability even after correction for complications. It has been suggested that diabetes may be underestimated in referrals to rehabilitation services. We tested this by assessing how often patients with diabetes had this diagnosis mentioned when referred to a wheelchair clinic. Two hundred consecutive referrals to a wheelchair service were assessed to ascertain whether diabetes was mentioned in the referral letter compared to how many actually had a diagnosis of diabetes. This was then compared to other medical conditions to assess whether diabetes was being under-mentioned in referrals. Only 7/29 (24.1%) patients with diabetes in the cohort had diabetes mentioned in their referral. By comparison, 34/42 (81%) of those with stroke/heart failure/chronic obstructive pulmonary disease were mentioned (,2=22.69, df=1, p<0.001) There was no difference between those with diabetes mentioned or not mentioned in terms of age, gender, type of diabetes, HbA1c or complication rate. We conclude that diabetes is under-mentioned in referrals to a rehabilitation service. It may be the case that health services are yet to appreciate the significance of diabetes as a cause of disability compared to other major conditions that cause disability. There seems to be a need to create an awareness of the importance of diabetes in disability. Copyright © 2006 John Wiley & Sons, Ltd. [source] The accuracy of medical history information in referral lettersAUSTRALIAN DENTAL JOURNAL, Issue 2 2010AF DeAngelis Abstract Background: Accurate medical history information is essential for good patient care and should be notified in the letter of referral. The aim of this study was to investigate the subjective opinion that the medical information in a large number of referrals is either inaccurate or non-existent. Methods: Medical histories from 54 patients with positive medical history findings upon taking the medical history at the initial consultation appointment were compared to the medical information supplied in the referral letter. Results: Overall, medical information was only 58.8% complete with dental referrals being 55.2% complete and medical referrals 62.4%. The majority of referral letters (70.4%) missed at least one relevant finding and only 29.6% of referrals were 100% complete. Conclusions: The results of this study suggest that the standard of referral letters needs to be improved as the received referrals were generally incomplete and contained inaccurate information. This highlights the need for each and every practitioner to take their own detailed medical history and not rely on the information supplied in the referral. [source] Decreased activities of mitochondrial respiratory chain complexes in non-mitochondrial respiratory chain diseasesDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2 2006Joannie Hui MBBS The aim of this study was to illustrate the difficulties in establishing a diagnosis of mitochondrial respiratory chain (MRC) disorders based on clinical grounds in combination with intermediate activities of the MRC enzyme complexes. We reviewed retrospectively all medical and laboratory records of patients initially considered likely to have MRC disorders on clinical grounds, and subsequently diagnosed with other disorders (n=20; 11 males, 9 females). Data were retrieved from hospital records, referral letters, and results of enzymatic analysis at a reference laboratory. Clinical symptoms included developmental delay, epilepsy, hypotonia, movement disorder, spastic quadriplegia, tetany, microcephaly, visual problems, carpopedal spasms, dysmorphism, hearing loss, muscle weakness and rhabdomyolysis, and fulminant hepatitis. Blood and cerebrospinal fluid lactate levels were elevated in 13/20 and 9/20 respectively. One or more MRC complex activities (expressed as ratios relative to citrate synthase and/or complex II activity) were less than 50% of control mean activity in 11/20 patients (including patients with deficiencies of pyruvate dehydrogenase complex, pantothenate kinase, holocarboxylase synthetase, long-chain hydroxy acyl-CoA dehydrogenase, molybdenum co-factor, and neonatal haemochromatosis). One patient had a pattern suggestive of mitochondrial proliferation. We conclude that intermediate results of MRC enzymes should be interpreted with caution and clinicians should be actively looking for other underlying diagnoses. [source] Medication accuracy and general practitioner referral lettersINTERNAL MEDICINE JOURNAL, Issue 2 2006S. L. Carney Abstract Prescriber medication communication is a Quality Use of Medicines barrier. Medication information in General Practice (GP) referral letters to a physician was evaluated. Accuracy of medications taken and drug dose was respectively 63% and 84%, an overall accuracy rate of 58%. Complementary/over-the-counter medication documentation occurred in 26% of the letters. To avoid medical mismanagement, physicians must validate all GP medication lists regardless of their apparent comprehensiveness. [source] Services for erectile dysfunction in the UK , a 12-month review of referrals to a west Midlands NHS clinicINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 7 2010G. Hackett Summary Introduction:, Few studies have addressed the health economics of the provision of services for sexual dysfunction within the National Health Service. Aim:, To evaluate the referral patterns, workload and prescribing costs in secondary care resulting from government guidance on erectile dysfunction (ED). Method:, A review of 324 consecutive referral letters to the Good Hope Hospital Erectile Dysfunction Clinic was conducted to assess the purpose of referral. Prescribing data and costs were assessed over the same 2-year period. Results:, Severe distress was the main reason for referral in 54% of referrals. Long term prescribing according to government guidance doubled the cost of care and created an unsustainable increase in clinic and pharmacy workload. Conclusions:, Existing regulations designed to control costs of ED therapy have created health inequalities, waste of resources and have increased the overall cost of care. [source] The accuracy of medical history information in referral lettersAUSTRALIAN DENTAL JOURNAL, Issue 2 2010AF DeAngelis Abstract Background: Accurate medical history information is essential for good patient care and should be notified in the letter of referral. The aim of this study was to investigate the subjective opinion that the medical information in a large number of referrals is either inaccurate or non-existent. Methods: Medical histories from 54 patients with positive medical history findings upon taking the medical history at the initial consultation appointment were compared to the medical information supplied in the referral letter. Results: Overall, medical information was only 58.8% complete with dental referrals being 55.2% complete and medical referrals 62.4%. The majority of referral letters (70.4%) missed at least one relevant finding and only 29.6% of referrals were 100% complete. Conclusions: The results of this study suggest that the standard of referral letters needs to be improved as the received referrals were generally incomplete and contained inaccurate information. This highlights the need for each and every practitioner to take their own detailed medical history and not rely on the information supplied in the referral. [source] The Vulnerability and sexual abuse of people with learning disabilitiesBRITISH JOURNAL OF LEARNING DISABILITIES, Issue 2 2007Nicholas Guy Peckham Accessible summary ,,People with learning disabilities are more likely to experience sexual things happening to them when they do not want them to. This is called sexual abuse. ,,A group was started to help some women who have been sexually abused. ,,Women who wanted to attend the group were given information about it and asked on three separate occasions if they wanted to attend. Their carers helped them and went to a different group upstairs in the same building. ,,We found that the group helped the women feel less scared and depressed and helped the women's carers understand them better. ,,This research matters because it helped the women move on with their lives and will help others who want to start a group. Summary In his capacity as a Clinical Psychologist the author provides psychological support to people with learning disabilities living in hospital and in the community. Frequently, the problem behaviour highlighted in referral letters (such as sexualized behaviour, anger management or self-harm) is formulated as relating to a past history of abuse and neglect which they had experienced. In view of increasing client referrals and a limited research literature the author established a small team, developed and then piloted a survivors' group for women with a learning disability. The pilot achieved ethical approval and the survivors' group ran concurrently with an educational support group for their carers. For more details about this pilot study see Peckham (2005)Developing, delivering and evaluating a survivors group pilot in Northumberland for women with significant learning disabilities who have been sexually abused. Unpublished DClinPsych Thesis, University of Newcastle, Newcastle upon Tyne; and Peckham et al. (2007). These articles summarize the research literature in the area of sexual abuse and describe, in detail, the problem of delivering and evaluating a survivors' group for women with learning disabilities. [source] | ||||||||||