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

  • Robert Mash Stellenbosch University
  • Herma Steyn Department of Health
  • Muideen Bello Stellenbosch University
  • Klaus Von Pressentin Stellenbosch University
  • Liezel Rossouw Department of Health
  • Gavin Hendricks Stellenbosch University
  • Germarie Fouche Department of Health
  • Dusica Stapar Stellenbosch University
Keywords: communication, coordination, primary health care/standards, physician–patient relations, referral, secondary care/standards

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.

The full article is available at https://doi.org/10.1080/20786190.2019.1676021

Author Biographies

Robert Mash, Stellenbosch University

Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa

Herma Steyn, Department of Health

Department of Health, Western Cape, South Africa

Muideen Bello, Stellenbosch University

Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town and Department of Health, Western Cape, South Africa

Klaus Von Pressentin, Stellenbosch University

Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town and Department of Health, Western Cape, South Africa

Liezel Rossouw, Department of Health

Department of Health, Western Cape, South Africa

Gavin Hendricks, Stellenbosch University

Division of Family Medicine and Primary Care, Stellenbosch University, Cape Tow and Department of Health, Western Cape, South Africa

Germarie Fouche, Department of Health

Department of Health, Western Cape, South Africa

Dusica Stapar, Stellenbosch University

Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town and Department of Health, Western Cape, South Africa

Published
2019-12-09
Section
Original Research