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Waiting for an endocrine OPD appointment: the patient’s and the GP’s dilemma

An article for Health Professionals

by Dr Simon Vanlint, Dr Oliver frank, Dr Colin Godson, Dr Anthony Zimmermann and Dr Parind Vora.

 

Long waiting times for specialist outpatient appointments are a fact of life for many of our patients. This can cause frustration for patients, GPs and specialists, as well as affecting standards of care.

Endocrinologists at the Northern Adelaide Local Health Network (NAHLN) reported to Sonder’s Adelaide GP Council in 2013 that some referrals made by GPs to public hospital diabetes clinics were for patients who could and should receive care within the general practice or elsewhere.  These referrals were increasing already long delays for appointments.

As a result, a project was initiated by local GPs and funded by the RACGP Foundation/ANEDGP Research Grant to develop a method of increasing the proportion of GPs’ referrals to public hospital diabetes clinics that are for appropriate reasons.

The project was to include feedback to GPs about the appropriateness of their referrals, and their responses to that feedback with a view to improving the guidelines for referral.

Two endocrinologists from the Lyell McEwin Health Service and three GPs who work in the NAHLN catchment independently assessed the appropriateness of a sample of 20 de-identified GP referrals to the Lyell McEwin diabetes clinic.

Ten referrals were assessed as appropriate by at least four of the five reviewers, thirteen referrals were assessed as being of adequate quality.  The team agreed that appropriate, high-quality referrals were characterised by a clear question or problem for the specialist to address; a proper assessment of the urgency with which the patient needed to be seen; a succinct but sufficiently detailed description of the background to the question or problem; acknowledgement of pertinent psychosocial factors; clear and contemporary documentation of relevant findings on physical examination and the results of diagnostic testing.

Our finding that half of the numbers of GPs referrals to the public hospital diabetes clinic were for inappropriate reasons suggests that many of these patients might have been able to receive care more appropriately elsewhere, reducing delays for appointments at the diabetes clinic.

Practical implications for referring GPs

In order to reduce appointment waiting times and enhance patient care, we suggest the following guidelines when making a referral to diabetic outpatient clinics. It is likely that the general principles can also be effectively applied to other outpatient referrals.

  1. Ask yourself: does this patient clearly need specialist diabetic input?
  2. As early as possible in your referral, identify the key issue(s)/question(s) that you want the specialist team to address
  3. Give your opinion as to the urgency with which the patient should be seen
  4. Document relevant physical examination findings (BP, vision; feet) where possible
  5. Include relevant social factors (smoking, occupation if that may be impacted by the patient’s diabetes)
  6. Include recent and relevant test results (e.g. HbA1c, renal function, lipids, urine ACR) but try to avoid including test results that are unlikely to be relevant: keep it simple

GPs will generally have most of this information readily available. Setting it out clearly and concisely, having first carefully considered if specialist referral is definitely required, will assist the right patients to be seen within the right time frame, improving their outcomes, while at the same time reducing pressure and frustration for referring GPs and our specialist colleagues. It should be well within our capabilities as competent GPs – can we afford not to follow these simple guidelines in order to improve the care of our diabetic patients?


To provide feedback or questions about this research project, contact Dr Simon Vanlint, General Practitioner & Clinical Senior Lecturer via email simon.vanlint@adelaide.edu.au