An Assessment of Referral Letters to a Specialist Diabetes Outpatient Service in Ibadan

BACKGROUND: Diabetes is a complex, chronic illness which requires continuous medical care. Requests for specialist consultation is a regular occurrence, and the referral process is most commonly initiated by a referral letter. The ability to effectively formulate an appropriate management plan for a patient at the time of specialist consultation largely depends on the quality of clinical information provided in the referral letter. AIM: The aim of the study was to assess the information provided in referral letters to the specialist diabetes clinic in tertiary hospital in Nigeria. METHODS: This was a cross-sectional study conducted between August and December 2017. All referral letters presented to the diabetes clinic on selected clinic days were evaluated using a data extraction tool designed by the investigators. RESULTS: The majority of referral letters provided information on patient identifiers. However, the provision of clinical information deemed vital for effective patient triage and good quality review in the specialist diabetes clinic was generally unsatisfactory. Less than a quarter of the referral letters provided information on key parameters such as physical examination findings, patients medication and glycated hemoglobin (HbA1c) level. Short term measures of glycemic control, blood pressure status, serum creatinine and serum lipid profiles were reported in just 51.3%, 35%, 6.7% and 2.5% of referral letters respectively. CONCLUSION: We have observed that referral letters to our specialist diabetes clinic often do not contain adequate information considered essential for a good quality consultation. Identifying the root causes of the inadequacies observed and the institution of intervention measures to address the problems identified could help improve the delivery of specialist review services for patients with diabetes. Interventions such as the use of standardized formats for referral letters, provision of referral guidelines and physician education programmes might help improve the quality of information provided at the time of referral.