Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Views of specialists on referral communications - a qualitative study from Sri Lanka(mediWORLD International, 2014) Ramanayake, R.P.J.C.; Perera, D.P.; de Silva, A.H.W.; Sumanasekera, R.D.N.; Jayasinghe, L.R.; Fernando, K.A.T.; Athukorala, L.A.C.L.INTRODUCTION: The referral letter is the interface between the primary and secondary/tertiary levels of care. It facilitates the referral process and is beneficial for optimizing patient care. In Sri Lanka a referral letter is not essential to consult a Specialist. In this scenario, the quality as well as the number of referral letters encountered in practice needed to be explored. OBJECTIVES: To describe Specialists’ views on the quality of referral letters received, perceived advantages of referral letters and to identify other modes of communication between General Practitioners and Specialists. METHODS: Conducted in 2013, this study consisted of in-depth interviews using a semi-structured format, with 21 purposively selected Specialists representing a range of specialties. They included clinicians and university academics from both the government and the private sector. Analysis was by generating a thematic framework based on the recurrent themes and issues which was then applied to the textual data. RESULTS: Most patients consulted Specialists without a referral letter and also the few letters received were of poor clarity, lacking important information and scribbled in illegible hand. Main themes identified as advantages of referral letters were: impart important information about the patient, clear description of the initial condition and treatment given, reduced consultation time, prevents delays in diagnosis and reduced healthcare costs by reducing polypharmacy and repetition of investigations. Some of the other modes of communication suggested by Specialists were via telephone, SMS, fax and email. CONCLUSIONS: The general belief amongst Specialists is that referral letters are an important part of the patient care system. This has not been adequately utilized by the primary care providers in Sri Lanka, despite the numerous advantages described. Also consideration needs to be given to newer modes of emerging information communication technology.Item Why are specialists reluctant to reply to referral letters-exploring the views of specialists in Sri Lanka(Lahore Institute of Public Health(liphealth), 2014) Ramanayake, R.P.J.C.; Perera, D.P.; de Silva, A.H.W.; Sumanasekera, R.D.N.; Fernando, K.A.T.; Jayasinghe, L.R.; Athukorala, L.A.C.L.BACKGROUND: The referral letter from General Practitioner and the reply from the Specialist is the interface between the primary and secondary/tertiary levels of care. It facilitates the referral process and is beneficial for optimizing patient care. In Sri Lanka there is no established referral/back referral system. Not receiving a response to their referrals is a common grievance made by most primary care doctors. In this scenario, the views of Specialists were explored on the importance of reply letters and measures to improve communication. METHOD: Conducted in 2013, this study consisted of in-depth interviews using a semi-structured format, with 21 purposively selected Specialists representing a range of specialties. They included clinicians and university academics from both the government and the private sector. Specialists rarely contacting a GP, such as anesthesiologists and microbiologists, were not invited to participate. Analysis was by generating a thematic framework based on the recurrent themes and issues which was then applied to the textual data. RESULTS: Most Specialists identify that it is important to reply to referrals. These reply letters provide the Primary care doctors with a further management plan, enhance continuity of care and is a source of education to the General Practitioner. Despite the above benefits, the practice of writing a reply is dependent on the following factors: time constraints, lack of clerical assistance, known General Practitioner, patient’s condition and the quality of the referral letter. As methods of improving communication between primary and secondary care it was suggested that referrals be made mandatory to be seen by a Specialist, improving informal communication between Specialists and GPs via regional clinical meetings and introducing a structured referral letter with an attached reply form. CONCLUSIONS: Specialists acknowledge the importance of reply letters in the referral process. Further steps need to be taken to improve the reply rates. This includes changes that need to occur in the referring General Practitioners, Specialists and the practicing institutions creating an environment that is conducive to the referral process.Item Referral Communications in Sri Lanka; Views of General Practitioners(SciRJ, 2014) Ramanayake, R.P.J.C.; de Silva, A.H.W.; Perera, D.P.; Sumanasekera, R.D.N.; Athukorala, L.A.C.L.; Fernando, K.A.T.INTRODUCTION: Referral of patients to specialists and hospitals is an essential and inevitable aspect of primary health care. Maintain good communication is essential during the process in order to provide quality care without delays and unnecessary expenses. In Sri Lanka referral letter from a general practitioner (GP) is not essential to get admitted to a hospital or to consult a specialist and there is no registered population for a particular practitioner. This study was conducted to look at the views of general practitioners on referral communications. METHODOLOGY: This was a descriptive cross sectional study and postal survey was conducted among members of the college of general practitioners of Sri Lanka using a self administered structured questionnaire. RESULTS: Response rate was 28.7%. Only less than 60% wrote a referral letter always when referring a patient to a hospital/ specialist and the main reasons were; Patients insistence on referral without an indication, No feedback from specialists and lack of ownership to non regular patients. Information related to the disease and administrative details were the items of information mainly included in letters while socio psychological items were given lesser importance. Reply rate was very poor irrespective of the referral destination and main items of information expected in a reply letter were; Diagnosis, plan of management and instructions to the GP. DISCUSSION: There should be better communication and coordination between GPs and specialists/hospital doctors. Ways and means should be explored and rectifying measures should be undertaken which will benefit patients, GPs, specialists/hospital doctors and the health care system.Item Structured Referral Form; Is it a solution for problems of referral communication in Sri Lanka(Center for Enhancing Knowledge (CEK), UK., 2014) Ramanayake, R.P.J.C.; de Silva, A.H.W.; Perera, D.P.; Sumanasekera, R.D.N.; Athukorala, L.A.C.L.; Fernando, K.A.T.INTRODUCTION: Referral letters convey information required for continuity of care when patients are referred to a hospital or a specialist. In Sri Lankan conventional, hand written letters are used for patient referrals and there is no standard format or a widely accepted guideline for referral communications. A structured referral form was designed to as a guide for the information to be included, as a solution to the problems in producing a good referral letter (time constrains, competence in language) and to prevent key problemsidentified in letters (omission of vital information, poor legibility and unsatisfactory format). This study was conducted to explore the acceptability, advantages and limitations of the structured referral form for GPs. METHODOLOGY: Referral form was designed based on the guidelines and literature reviews. 20 GPs were purposely selected to represent different backgrounds. Printed referral forms were provided to them and requested to use those for patient referrals for a period of 3 months. Telephone Interviews were conducted at the end of the study period to obtain their viewon the format. Themes expressed by participants were identified. RESULTS: It has improved the comprehensiveness of letters and saved time. Overall quality of letters has improved and participants were of the view that it could be used in any instance, competence in language was immaterial and retrieval of information would be easier. Inadequate space under a few subheadings was a limitation. There was no increase in reply letters after introducing this letter. They were willing to use that format in the future as well. Conclusions: This is a useful and acceptable tool to improve information transfer and it will also be a guide for doctors. It could be a solution to the problems of communication in patient referral in Sri LankaItem Training medical students in general practice : a qualitative study among general practitioner trainers in Sri Lanka(Medknow, 2015) Ramanayake, R.P.J.C.; de Silva, A.H.W.; Perera, D.P.; Sumanasekera, R.D.N.; Athukorala, L.A.C.L.; Fernando, K.A.T.INTRODUCTION: Worldwide Family Medicine has gained an important place in the undergraduate medical curriculum over the last few decades and general practices have become training centers for students. Exposure to patients early in the disease process, out patient management of common problems, follow up of chronic diseases and psychosocial aspects of health and disease are educational advantages of community based training but such training could have varying impact on patients, students and trainers. This study explored the views of General Practitioner (GP) trainers on their experience in training students. METHODOLOGY: This qualitative study was conducted among GP trainers of the faculty of medicine, University of Kelaniya, Sri Lanka, to explore their experience on wide range of issues related to their role as GP trainers. The interviews were recorded and transcribed verbatim. Themes expressed were identified. RESULTS: Altruistic reasons, self-satisfaction, self-esteem and opportunity to improve their knowledge were the motivations for their involvement in teaching. Teachers were confident of their clinical and teaching skills. They perceived that patients were willing participants of the process and benefited from it. There was a positive impact on consultation dynamics. Time pressure was the major problem and ideal number of trainees per session was two. They were willing to attend teacher training workshops to update their knowledge. CONCLUSIONS: GP trainers driven by altruistic reasons were willing participants of student training process. The perceived advantages of involvement of teaching for trainers and patients were an encouragement for potential trainers. University should organize training sessions for trainers which will boost their knowledge, confidence and teaching skills which will eventually benefit students.