The quality of feedback from outpatient departments at referral hospitals to the primary care providers in the Western Cape: a descriptive survey

Abstract

Background: Coordinating care for patients is a key characteristic of effective primary care. Family physicians in the Western Cape formed a research network to enable them to perform practical research on key questions from clinical practice. The initial question selected by the network focused on evaluating the quality of referrals to and feedback from outpatient departments at referral hospitals to primary care providers in the Western Cape.

Methods: A descriptive survey combined quantitative data collected from the medical records with quantitative and qualitative data collected from the patients by questionnaire. Family physicians collected data on consecutive patients who had attended outpatient appointments in the last three months. Data were analysed using the Statistical Package for the Social Sciences.

Results: Seven family physicians submitted data on 141 patients (41% male, 59% female; 46% metropolitan, 54% rural). Referrals were to district (18%), regional (28%) and tertiary hospitals (51%). Referral letters were predominantly biomedical. Written feedback was available in 39% of patients. In 32% of patients, doctors spent time obtaining feedback; the patient was the main source of information in 53% of cases, although many patients did not know what the hospital doctor thought was wrong (36%). The quality of referrals differed significantly by district and type of practitioner, while feedback differed significantly by level of hospital.

Conclusion: Primary care providers did not obtain reliable feedback on specialist consultations at referral hospital outpatients. Attention must be given to barriers to care as well as communication, coordination and relationships across the primary–secondary interface.

Keywords::

• communication
• coordination
• primary health care/standards
• physician–patient relations
• referral
• secondary care/standards

Acknowledgements

The research question was chosen by the whole Stellenbosch University Family Physician Research Network, who also commented on the initial analysis at a workshop in May 2019. Thanks are extended to Ms Marianna James who captured the data and provided administrative support. Funds were provided by the Division of Family Medicine and Primary Care, Stellenbosch University.

Disclosure statement

No potential conflict of interest was reported by the authors.

Supplemental data

Supplemental data for this article can be accessed at https://doi.org/10.1080/20786190.2019.1676021 description of location.

ORCID

Robert Mash http://orcid.org/0000-0001-7373-0774

Klaus von Pressentin http://orcid.org/0000-0001-5965-9721