71. Managing Oa In General Practice: Can Training Enhance The Oa Consultation?

Abstract

quality letter also facilitates a more efficient use of outpatient appointments. Our study describes referral patterns to our rheumatology department and assesses the content of the referral letters and proposes measures to improve their quality. Methods: A prospective review of consecutive referral letters to the rheumatology department at Cannock Chase Hospital over a 6-week period in April and May 2013 was conducted. Data were collected on age, gender, source of referral, reason for referral, duration of symptoms, investigations documented in referral letter, time from referral to clinic appointment and clinic outcome. Results: A total of 224 referral letters were assessed, of which 195 (87%) were from general practitioners. Mean age of the patients was 52 years (range 9–89 years) and 155 (69.2%) of them were females. Of the 195 GP referral letters, 125 (64.1%) did not indicate the duration of symptoms, 51 (26.3%) either had no investigations in primary care or none was documented, while 32 (16.7%) did not volunteer a provisional diagnosis. Thirty one of the 79 (41.1%) cases referred as suspected inflammatory arthritis turned out to have the diagnosis after clinical assessment. Only 8 (10.1%) of the 79 cases were triaged as urgent based on the information in their referral letters. The overall mean wait time was 11 weeks (range 2–27) while patients who received a clinic outcome of inflammatory arthritis had a mean wait time of 10 weeks (range 2–19). Cases triaged as urgent at referral had a mean wait time of 5 weeks (range 2–11). Conclusion: This study provides further evidence that primary care referral letters to rheumatology services are often lacking in key information needed for an accurate triage of cases. Some cases of suspected inflammatory arthritis may be marked as non-urgent because of inadequate information in the referral letter. Measures to improve the quality of the content of referral letters have often focussed on the use of referral templates, but these have a poor uptake in primary care. Clinical audit may offer an alternative tool for improving letter content and we propose the development of an audit tool containing agreed minimum data sets to be used in primary care for monitoring the quality of referral letters. Disclosure statement: The authors have declared no conflicts of interest.