PCP referral letters for rheumatology care lack basic, key information
Basic, key pieces of information, including descriptions of symptoms and relevant history, as well as investigation results, are often lacking from referral letters filled out by primary care providers for rheumatology care, according to findings published in BMC Rheumatology.
“In many countries, patients require a referral from a family physician to a rheumatologist in order to obtain a rheumatology consultation,” Jessica Widdifield, PhD, of the Sunnybrook Research Institute, in Toronto, told Healio Rheumatology. “Deficits in communication and information transfer between care providers can have implications for patient safety and continuity of care. For example, the presence of comprehensive and easily accessible information in referrals letters is likely to impact on the decision-making process for scheduling patient appointments.”
To analyze the quality of referral information from primary care physicians (PCPs) to rheumatologists, as well as the timeliness of consultation letters from rheumatologists back to PCPs, Widdifield and colleagues conducted a retrospective chart abstraction study of patients with first-time rheumatology referrals in Ontario, Canada. The researchers used the Electronic Medical Record Administrative Data Linked Database (EMERALD) to search records from PCPs throughout Ontario between 2000 and 2013.
Their study included 168 PCPs, as well as 2,430 patients who had been referred to 146 rheumatologists. The researchers determined the completeness and timeliness of the referral and consultation letters using standardized data abstraction, performed by three trained medical abstractors. The most common reasons for referral to a rheumatologist were osteoarthritis, which represented 32% of letters, and systemic inflammatory rheumatic diseases, with 31%.
According to the researchers, just 55% of referral letters summarized the patient’s medical history. In addition, there was a distinct underreporting of details from diagnostic tests on referral letters, with 51% providing information on labs and 34% on imaging.
“We found that basic items necessary for appropriate appointment triage – including a detailed description of symptoms or other relevant medical history and results of investigations – were often lacking in referral letters,” Widdifield said.
Although 92% of referral letters included at least one patient symptom — the most common being joint pain — only half provided information on symptom duration. Only 9% of patients were pressed by their PCP for an urgent consultation. Regarding rheumatologists’ consultation letters to PCPs, 69% of such letters were returned to PCPs within 30 days of the consultation visit.
“The under reporting of key information within rheumatology referral letters highlights consensus needs for standardizing the content of referral letters so that rheumatologists can appropriately determine patients needing priority consultations,” Widdifield said. “Additionally, the delay of rheumatologists providing a copy of the consultation letter to the family physician may further represent a lost opportunity for coordination and continuity of care, and may affect the quality of care patients receive.” – by Jason Laday
Disclosures: The researchers report no relevant financial disclosures.