The Finnish national asthma programme: communication in asthma care – quality assessment of asthma referral letters

Tuomisto, Leena E.; Erhola, Marina; Kaila, Minna; Brander, Pirkko; Kauppinen, Ritva; Puolijoki, Hannu; Kekki, Pertti

doi:10.1111/j.1365-2753.2006.00645.x

Cited by 11 publications

(15 citation statements)

References 10 publications

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“…Figure 2 shows the origin of these spirometry reports. In our previous study, 14 all non-emergency referral letters (n=3176) to three Finnish pulmonary outpatient units sent during 2001 were scrutinised. The referrals originated from health care centres and private practices.…”

Section: O P Y R I G H T G E N E R a L P R A C T I C E A I R W A Y mentioning

confidence: 99%

Asthma Programme in Finland: the quality of primary care spirometry is good

Tuomisto

Järvinen

Laitinen³

et al. 2008

Primary Care Respiratory Journal

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Aims: To assess the quality of primary care spirometry by visual inspection of the flow-volume expiratory curve and to study the quantity of clinical information provided on the spirometry report sheets.Methods: Retrospective audit of 868 expiratory flow-volume curves referred to three pulmonary clinics assessed against five predefined quality criteria. Clinical information included on the spirometry report sheets was also collected.Results: Quality was good in 78% of pre-bronchodilation curves and in 80% of post-bronchodilation curves. Obtaining a sharp PEF value and full vital capacity exhalation seemed to be the critical points of measurement. Inter-rater reliability of the curve assessment was mainly good. Data on where the spirometry took place, and comments on the use of respiratory medication and patient co-operation were often lacking.Conclusions: The quality of primary care spirometry was good. Adequate clinical information on the report sheets would further improve the quality of this diagnostic process.

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Section: O P Y R I G H T G E N E R a L P R A C T I C E A I R W A Y mentioning

confidence: 99%

Asthma Programme in Finland: the quality of primary care spirometry is good

Tuomisto

Järvinen

Laitinen³

et al. 2008

Primary Care Respiratory Journal

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“…The only previous studies of respiratory referral letters relate to patients with asthma, and show similar omissions to those in other specialty areas with, for example, only 50% of referral letters recording the results of necessary investigations, 20 and 41% recording current medications. 21 Our study has obvious limitations in that the number of patient referral letters evaluated was small and the setting was limited to one NHS respiratory outpatients department. However, we have shown clearly that the tests ordered on the basis of a referral letter were substantially fewer than those ordered at the end of the consultation.…”

Section: Discussionmentioning

confidence: 99%

“…However, when asthma referral letters were evaluated against objective criteria 31 at several disease centres in Finland following the establishment of a National Asthma Programme, 44-45% were still considered to be of poor quality, and the inclusion of necessary information remained inconsistent despite specific referral recommendations. 20,21 Many specialties have produced and promoted standardised referral letters, guidelines and referral criteria, plus or minus specific education for GPs, 2,14,26,27,32 as a means to improve referral information. There has been some success with the use of structured forms; 15,16 however, the results are equivocal 19 and passive dissemination of guidelines has not been found to be an effective strategy to improve referral information.…”

Section: Discussionmentioning

confidence: 99%

“…However, where this system is in use, studies show that key information is frequently omitted from referral letters and that use of generic templates and guidelines does not optimise this process. Two studies in Finland 20,21 specifically evaluated asthma referrals from primary care to a specialist respiratory outpatients department. However, no 'straight-to-test' systems using information from referral letter alone were identified within a respiratory setting.…”

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confidence: 99%

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Smoothing the passage of patients from primary care to specialist respiratory opinion

O'Byrne

Darlow

Roberts

et al. 2010

Primary Care Respiratory Journal

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Aims: To assess whether information in general practitioner (GP) referral letters provides a basis for selection of diagnostic tests in patients referred for specialist respiratory advice. Methods:We undertook a prospective study within a respiratory outpatients department to compare the diagnostic tests planned at three stages of the referral/specialist consultation process: i) using the GP referral letter alone; ii) using the referral letter and patient history; iii) using the referral letter, patient history, and clinical examination.Results: Analysis of the content of GP referral letters revealed wide variations in referral information. A high proportion of tests selected using the referral letter alone were altered after specialist history-taking and examination. Far fewer changes were recorded between history-taking and examination.Conclusions: Neither literature review nor our study support a system which bases diagnostic test selection on GP referral letters alone. However, our findings suggest that approaches which include specialist history-taking in advance of face-to-face consultation merit further investigation.

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“…Single disease programs have shown that asthma and COPD patients receive better health care, impairment decreases, and fewer hospitalizations occur, provided that access to drugs is secured. ( 32 - 34 ) In addition, this type of programs reduces deaths and health expenditures in asthma and COPD, ( 35 ) which would be included in integrated programs.…”

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confidence: 99%