Patients who received a letter summarising their visit to their medical
consultant valued it highly according to a study carried out by
researchers at UCC.
The research study focused on the quality of outpatient care, with
particular reference to the effectiveness of communications between
patients, consultants and referring GPs in the delivery of care.
The study assessed the proposal that consultants in outpatient
departments could give patients a letter summarising their
consultation, with a copy to their GP.
The study was carried out by the Departments of Epidemiology &
Public Health and Applied Social Studies at UCC with collaboration with
clinical colleagues in Limerick (Dr Mary Cahill, Consultant
Haematologist at Limerick Regional Hospital).
The study had two phases. In the first phase, the attitudes
towards this proposal among patients, GPs and consultants in two health
board regions (the HSE - South and HSE Mid-West) were investigated,
using quantitative and qualitative methods. In the second phase,
the proposal was evaluated in a randomised controlled trial of 150
patients in an outpatient setting at the Department of Haematology at
Limerick Regional Hospital.
The intervention group was provided with a personal letter summarising
their outpatient consultation by post within 1-2 days of the
consultation. The letter included reasons for referral, main
problems discussed and decisions made in the consultation, follow-up
arrangements and diagnosis where available. Letters were modified
in style and language and carefully checked by the consultant for
readability. The letter to the patient was copied to the
referring general practitioner. The time taken to dictate each letter
was recorded by the consultant. Control patients received a short
note thanking them for attending the clinic with a standard letter to
the referring general practitioner.
The primary outcome measures were patient recall investigating how many
patients could recall at least 60% of the items discussed in the
intervention and control groups. The secondary outcome measures
were patient and referring clinician satisfaction with the summary
letters.
The effect of the personal letters in terms of recall was not
significant and was determined more by patients' age and educational
status. However patients reported high satisfaction rates with
personal letters, regardless of age, gender and educational
status. A substantial majority (80%) of patients were very
pleased to receive a written summary of their consultation.
Reported use of the personal letters was high: 71% of intervention
patients reported that they read the letter several times and 61%
showed the letter to a family member, mainly a spouse or sibling.
Approximately 75% of patients in the control group indicated that they
would like to receive a personal letter from the consultant following
their visit to the out-patient department and most felt that such
letters should be sent routinely to patients.
The average time it took the consultant to dictate the personal letters
was 6.8 minutes. The substantial majority of referring clinicians
rated the summary letter as a 'very useful' or 'useful' method of
doctor -patient communications.
The researchers believe that despite the negative findings on the major
outcome of patient recall that personal letters are valued and used by
the overwhelming majority of patients. Indeed they suggest that
it may be argued that patients have a right to access relevant
correspondence in a form accessible to them and the effect of personal
letters on satisfaction with the consultation provides adequate
justification for the practice. The study also showed that
personal letters mailed directly to patients (with a copy to the
referring clinician) are acceptable to the overwhelming majority of
referring general practitioners and consultants.
The study was carried out through a HRB health services research
fellowship, awarded to Máire O'Reilly of the Department of Epidemiology
& Public Health and the Department of Applied Social Studies.
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