Analysis of referral letters to rheumatology consultation in Tunisia

Abstract

Aim of the work: Our objective was to analyze the content and quality of referral letters to rheumatology consultation. Patients and methods: This is a cross-sectional study conducted on the rheumatology consultations in a tertiary hospital over six months (April-October 2014). Patients were interviewed and their rheumatology consultation referral letters analyzed. The relevance of referent reasons, suggested diagnosis and additional tests requested prior to recruitment were studied. Results: We studied 302 referral letters for rheumatology consultation. The average age of patients was 55.34 ± 15 years (13–85). The sex ratio M/F was 0.3. All patients consulted for painful symptoms affecting mainly the lumbar spine (20%) and knees (20%). The current clinical problem was appropriately presented in 43% of the referral letters. Only 6 letters (2%) were illegible, 28 letters did not contain the consultation date (9%). General practitioners represented 59% of referring physicians. The age and patient history were more detailed in the letters written by physician specialists (p = 0.002 and p < 0.001 respectively). The complementary investigations were more requested by private sector physicians (p = 0.04) and physician specialists (p = 0.011). Of the 76 doctors who had proposed a diagnosis, 42 (55%) had proposed a correct one. The relevance of diagnoses showed no significant difference between GPs and specialists. Conclusion: Referral letters deserve more attention in order to improve communication between physicians and rheumatologists. Analysis of the quality of referral letters can be part of initial and continuing medical education. The referral letters have several shortcomings. A model referral letter has been proposed in this study