Enhancing continuity of information: essential components of consultation reports.

OBJECTIVE To identify elements of data that have been shown to contribute to continuity of information between primary care providers and medical specialists providing care to adult asthma patients. DESIGN Systematic review of the literature followed by a 2-round modified Delphi consensus process. SETTING Province of Ontario. PARTICIPANTS Eight expert panelists, including 3 practising family physicians, a medical specialist knowledgeable in the treatment of asthma, a family physician previously involved in provincial initiatives related to primary care reform, an e-health technologist, a developer of evidence-based guidelines, and an operations and programs specialist. METHODS We completed a systematic literature review to identify important components of consultation reports. We then engaged an 8-member panel in a 2-round modified Delphi consensus process, which led to the identification of components deemed essential to good continuity of information. MAIN FINDINGS After 2 rounds, expert panelists reached consensus on 15 components, referred to here as minimum essential elements, of consultation reports generated by medical specialists in response to referring primary care providers' consultation requests. CONCLUSION The expert panelists considered inclusion of the minimum essential elements in consultation reports essential to achieving good continuity of information. We assembled these elements in a suggested format for a consultation report. The format can be easily modified by practitioners caring for patients with other chronic diseases.

[1]  Aniruddha M. Deshpande,et al.  Standardized Reporting of Clinical Practice Guidelines: A Proposal from the Conference on Guideline Standardization , 2003, Annals of Internal Medicine.

[2]  A. Rodger Improving doctors' letters , 2003, The Medical journal of Australia.

[3]  J. Emery,et al.  Barriers to effective communication across the primary/secondary interface: examples from the ovarian cancer patient journey (a qualitative study). , 2005, European journal of cancer care.

[4]  R B D'Agostino,et al.  Measuring effectiveness. What to expect without a randomized control group. , 1995, Medical care.

[5]  L. Leape,et al.  Measuring the Necessity of Medical Procedures , 1994, Medical care.

[6]  I. Scott,et al.  Audit of consultant physicians’ reply letters for referrals to clinics in a tertiary teaching hospital , 2004, Internal medicine journal.

[7]  David W. Bates,et al.  Communication breakdown in the outpatient referral process , 2000, Journal of General Internal Medicine.

[8]  C. Adair,et al.  Continuity of care: a multidisciplinary review , 2003, BMJ : British Medical Journal.

[9]  J. Barnsley,et al.  Enhancing continuity of information: essential components of a referral document. , 2008, Canadian family physician Medecin de famille canadien.

[10]  J. Lavis,et al.  Appropriateness in health care delivery: definitions, measurement and policy implications. , 1996, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[11]  C. Counsell,et al.  Non-completion of changes to prescribed medications in people with Parkinson's disease. , 2007, Age and ageing.

[12]  John Campbell,et al.  Views of doctors on clinical correspondence: questionnaire survey and audit of content of letters , 2004, BMJ : British Medical Journal.

[13]  Whitney Berta,et al.  Identifying performance indicators for family practice: assessing levels of consensus. , 2005, Canadian family physician Medecin de famille canadien.

[14]  J. Munro,et al.  Medical Clinic Referral Letters Do They Say What They Mean? Do They Mean What They Say? , 1992, Scottish medical journal.

[15]  Specialist management and coordination of "out-of-domain care". , 2004, Family medicine.

[16]  B. Hickey,et al.  Oncology service correspondence: do we communicate? , 2003, Australasian radiology.

[17]  Ragnhild Hellesø,et al.  Challenging the information gap - the patients transfer from hospital to home health care , 2004, Int. J. Medical Informatics.

[18]  O. Jolobe Quality of referral letters , 2002, The Lancet.