• Sundaran Kada, Harald A Nygaard, Rajendiran Kada, Toralv Laura, Unni Billsback, and Jonn T Geitung.
• Faculty of Health and Social Science, Bergen University College, Bergen, Norway. sundaran.kada@hib.no
• Qual Prim Care. 2008 Jan 1;16(3):165-70.

ObjectiveThe exchange of information between specialists and general practitioners (GPs) is an important aspect of the referral process at the stage of diagnosis. Comprehensive and satisfactory information from specialists guides GPs in choosing the best possible management. The objective of this study was to assess the quality of information in reply letters with regard to the GPs' problem as presented, and the level of GP satisfaction, and to determine if there is any relation between the quality of the referrals and the reply letters.DesignA retrospective review of reply letters from the Department of Geriatric Medicine to primary health care. A data sheet was developed using the existing literature. Three GPs assessed the quality of the reply letters and GP satisfaction.SettingPatient records in the geriatric department were collected, registered and examined according to pre-defined criteria.SubjectsA total of 135 first-time replies from January 2002 to December 2002 were evaluated. All patients and relatives were informed that participation was voluntary and anonymity was guaranteed.Main OutcomesAssessment of the quality of replies and GP satisfaction.ResultsThe mean age of all referred patients was 78.7 years (standard deviation (SD) 7.3, range: 42 to 90 years) and 61.5% were female. Multi-rater agreement analysis showed that 86% of the replies were classified as very good/good quality, 10% as fair, and 4% as poor quality. The mean agreement was 85% (kappa 0.37; 95% confidence interval (CI) 0.29-0.45; P < 0.0001); 89% of the replies were classified as very satisfactory/satisfactory, 9% as less satisfactory and 2% as unsatisfactory. The mean agreement was 86% (kappa 0.34; 95% CI 0.25-0.42; P < 0.0001).ConclusionThe reply letters were overall of good quality and GPs were generally satisfied with the reply letters. No association between the quality of referral and reply letters was found.

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