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The quality of communication about older patients between hospital physicians and general practitioners: a panel study assessment

Garåsen, Helge; Johnsen, Roar
Journal article, Peer reviewed
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URI
http://hdl.handle.net/11250/2357300
Date
2007
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  • Institutt for samfunnsmedisin og sykepleie [1724]
  • Publikasjoner fra CRIStin - NTNU [19961]
Original version
BMC Health Services Research 2007, 7(1):133   10.1186/1472-6963-7-133
Abstract
Background: Optimal care of patients is dependent on good professional interaction between

general practitioners and general hospital physicians. In Norway this is mainly based upon referral

and discharge letters. The main objectives of this study were to assess the quality of the written

communication between physicians and to estimate the number of patients that could have been

treated at primary care level instead of at a general hospital.

Methods: This study comprised referral and discharge letters for 100 patients above 75 years of

age admitted to orthopaedic, pulmonary and cardiological departments at the city general hospital

in Trondheim, Norway. The assessments were done using a Delphi technique with two expert

panels, each with one general hospital specialist, one general practitioner and one public health

nurse using a standardised evaluation protocol with a visual analogue scale (VAS). The panels

assessed the quality of the description of the patient's actual medical condition, former medical

history, signs, medication, Activity of Daily Living (ADL), social network, need of home care and

the benefit of general hospital care.

Results: While information in the referral letters on actual medical situation, medical history,

symptoms, signs and medications was assessed to be of high quality in 84%, 39%, 56%, 56% and 39%,

respectively, the corresponding information assessed to be of high quality in discharge letters was

for actual medical situation 96%, medical history 92%, symptoms 60%, signs 55% and medications

82%. Only half of the discharge letters had satisfactory information on ADL. Some two-thirds of

the patients were assessed to have had large health benefits from the general hospital care in

question. One of six patients could have been treated without a general hospital admission. The

specialists assessed that 77% of the patients had had a large benefit from the general hospital care;

however, the general practitioners assessment was only 59%. One of four of the discharge letters

did not describe who was responsible for follow-up care.

Conclusion: In this study from one general hospital both referral and discharge letters were

missing vital medical information, and referral letters to such an extent that it might represent a

health hazard for older patients. There was also low consensus between health professionals at

primary and secondary level of what was high benefit of care for older patients at a general hospital.
Publisher
BioMed Central
Journal
BMC Health Services Research

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