Clear communication between a primary care physician and a specialist is key to ensuring quality patient care and satisfaction. Referring physicians must be informed of their patients’ progress in a prompt and efficient manner — prompt reporting is essential for proper communication among the referring doctor, the specialist and the patient.1
However, the multiple steps involved in the reporting process create a high level of paperwork and delays in the process result in uncertainty and confusion for primary care physicians, specialists and patients.2 Miscommunication between these critical players leads to errors that can compromise patient care, such as patients missing critical treatment.3
Maintaining Good Relationships
We know that the key to maintaining a good relationship between specialists and primary care physicians is prompt reporting.4 There is no better way to keep a primary care physician informed on the progress of his or her patient than to have a referral letter back on his or her desk before the patient returns to the practice or before the patient calls the primary care physician about their visit to the dermatologist.
Prompt communication between the specialist and referring doctor is both a necessity and a challenge. The current method requires the report from the specialist to the primary care doctor to be dictated, transcribed and mailed out, which means it can be 7 to 10 days before the primary care doctor receives the report. As a result, the patient frequently will return to the referring physician’s office before the report from the specialist does. Patient care is compromised because the patient is unable to be treated or followed-up with because the primary care doctor is in the dark regarding the patient’s diagnosis, treatment plan and health status.
Furthermore, primary care physicians have to spend more time on administrative work and paperwork (as a result of reporting delay), and less time with their patients.5,6 Streamlining the efficiency of this reporting process between physicians would prevent delays such as this one, and therefore would improve health care quality.7
We designed a study to develop and test a consultation/prescription form to streamline the reporting process between dermatologists and primary care physicians. First, we identified the common treatments prescribed by dermatologists and created a consultation/prescription form that didn’t require dictation, transcription or mailing. The report can be faxed to the referring physician the very same day the patient is seen, helping to keep the referring physicians promptly informed about his or her patient’s diagnosis and treatment. The form can also be used as a prescription form.
We tested the tool in actual use, with follow-up evaluation from primary care providers and pharmacists.
Designing the Form
We compiled medications prescribed from January 2003 to May 2004 in the office of a single dermatologist practicing in a small town in North Carolina. The consultation/prescription form created included a section for listing the diagnosis, a silhouette for marking location of skin lesions/eruptions and a listing of the most frequently prescribed medications, the prescribed amount of medication, frequency of administration, and duration of treatment (see the form below, which you can download as a PDF). The prescribing dermatologist and a primary care doctor both reviewed the form to help assure it met both the consulting and referring physician’s needs. A pharmacist also reviewed the form to assure it could be utilized as a prescription. It was then printed with carbonless copies allowing a copy to be kept for the practice, a copy to be sent to the referring physician and a copy to be taken to the pharmacy as a prescription.
Of the 1,483 prescriptions recorded over the study interval, the top 21 treatments accounted for 85% of all prescribed medications (See Table 1). Topical triamcinolone (Aristocort, Flutex, Kenalog, Triacet) was the most frequently prescribed medication, accounting for 14% of the prescriptions, followed by the topical fluocinonide (Lidex) and topical tacrolimus (Protopic).
Assuring Effectiveness
We qualitatively measured the effectiveness of this consultation/prescription form through feedback from five primary care physicians or their offices regarding their experiences with utilizing this tool and an additional eight primary care physicians in an interview setting. Primary care doctors were called and asked a set of questions to qualitatively assess how they feel the form would affect referral reporting efficiency. The following questions were asked:
1. Have you had any problems or concerns about the dermatology service?
2. Have there been any issues related to not getting back follow-up information in a timely way?
3. Do you find the consultation follow-up form to be helpful?
4. Any suggestions for improving it?
*Human subject research approval was obtained from the local Intramural Review Board.
Physician Feedback
Primary care doctors that were interviewed about the form were enthusiastic about its potential effectiveness in minimizing reporting delay and improving patient care.
All of the doctors interviewed agreed that reporting delay is a problem. This is not only frustrating for the doctor, but immensely frustrating for patients, who feel that the system has failed. The doctors were in strong agreement that the prescription form has the potential to eliminate reporting delay, and the multitude of problems that reporting delay brings. They also found the form to be thorough and to contain the necessary information for them to continue caring for their patients.
Primary care physicians report there are three ingredients of an effective referral letter: the working diagnosis, the medications you have prescribed and the treatment plan. Usually, they are not interested in the depth and detail of the history or the fine nuances and descriptions of the dermatologic lesions that have been detected on the physical examination.
The method described in this project creates a user-friendly referral letter that meets the three necessary criteria and that arrives on the primary care physician’s desk before the patient returns for an office visit. It keeps the primary care physician in control of the patient’s healthcare and enhances dermatologists’ communication with their referring doctors.
Potential Advantages of the Consultation/Prescription Form
Another potential advantage of the form relates to the efficiency of having preprinted prescription information. The ability to check off frequently used drugs allows the form to be used as both a prescription and a means of communicating with referring physicians. Further study may be of value to test the effectiveness of this consultation/prescription form in minimizing prescription errors.
Clear communication between a primary care physician and a specialist is key to ensuring quality patient care and satisfaction. Referring physicians must be informed of their patients’ progress in a prompt and efficient manner — prompt reporting is essential for proper communication among the referring doctor, the specialist and the patient.1
However, the multiple steps involved in the reporting process create a high level of paperwork and delays in the process result in uncertainty and confusion for primary care physicians, specialists and patients.2 Miscommunication between these critical players leads to errors that can compromise patient care, such as patients missing critical treatment.3
Maintaining Good Relationships
We know that the key to maintaining a good relationship between specialists and primary care physicians is prompt reporting.4 There is no better way to keep a primary care physician informed on the progress of his or her patient than to have a referral letter back on his or her desk before the patient returns to the practice or before the patient calls the primary care physician about their visit to the dermatologist.
Prompt communication between the specialist and referring doctor is both a necessity and a challenge. The current method requires the report from the specialist to the primary care doctor to be dictated, transcribed and mailed out, which means it can be 7 to 10 days before the primary care doctor receives the report. As a result, the patient frequently will return to the referring physician’s office before the report from the specialist does. Patient care is compromised because the patient is unable to be treated or followed-up with because the primary care doctor is in the dark regarding the patient’s diagnosis, treatment plan and health status.
Furthermore, primary care physicians have to spend more time on administrative work and paperwork (as a result of reporting delay), and less time with their patients.5,6 Streamlining the efficiency of this reporting process between physicians would prevent delays such as this one, and therefore would improve health care quality.7
We designed a study to develop and test a consultation/prescription form to streamline the reporting process between dermatologists and primary care physicians. First, we identified the common treatments prescribed by dermatologists and created a consultation/prescription form that didn’t require dictation, transcription or mailing. The report can be faxed to the referring physician the very same day the patient is seen, helping to keep the referring physicians promptly informed about his or her patient’s diagnosis and treatment. The form can also be used as a prescription form.
We tested the tool in actual use, with follow-up evaluation from primary care providers and pharmacists.
Designing the Form
We compiled medications prescribed from January 2003 to May 2004 in the office of a single dermatologist practicing in a small town in North Carolina. The consultation/prescription form created included a section for listing the diagnosis, a silhouette for marking location of skin lesions/eruptions and a listing of the most frequently prescribed medications, the prescribed amount of medication, frequency of administration, and duration of treatment (see the form below, which you can download as a PDF). The prescribing dermatologist and a primary care doctor both reviewed the form to help assure it met both the consulting and referring physician’s needs. A pharmacist also reviewed the form to assure it could be utilized as a prescription. It was then printed with carbonless copies allowing a copy to be kept for the practice, a copy to be sent to the referring physician and a copy to be taken to the pharmacy as a prescription.
Of the 1,483 prescriptions recorded over the study interval, the top 21 treatments accounted for 85% of all prescribed medications (See Table 1). Topical triamcinolone (Aristocort, Flutex, Kenalog, Triacet) was the most frequently prescribed medication, accounting for 14% of the prescriptions, followed by the topical fluocinonide (Lidex) and topical tacrolimus (Protopic).
Assuring Effectiveness
We qualitatively measured the effectiveness of this consultation/prescription form through feedback from five primary care physicians or their offices regarding their experiences with utilizing this tool and an additional eight primary care physicians in an interview setting. Primary care doctors were called and asked a set of questions to qualitatively assess how they feel the form would affect referral reporting efficiency. The following questions were asked:
1. Have you had any problems or concerns about the dermatology service?
2. Have there been any issues related to not getting back follow-up information in a timely way?
3. Do you find the consultation follow-up form to be helpful?
4. Any suggestions for improving it?
*Human subject research approval was obtained from the local Intramural Review Board.
Physician Feedback
Primary care doctors that were interviewed about the form were enthusiastic about its potential effectiveness in minimizing reporting delay and improving patient care.
All of the doctors interviewed agreed that reporting delay is a problem. This is not only frustrating for the doctor, but immensely frustrating for patients, who feel that the system has failed. The doctors were in strong agreement that the prescription form has the potential to eliminate reporting delay, and the multitude of problems that reporting delay brings. They also found the form to be thorough and to contain the necessary information for them to continue caring for their patients.
Primary care physicians report there are three ingredients of an effective referral letter: the working diagnosis, the medications you have prescribed and the treatment plan. Usually, they are not interested in the depth and detail of the history or the fine nuances and descriptions of the dermatologic lesions that have been detected on the physical examination.
The method described in this project creates a user-friendly referral letter that meets the three necessary criteria and that arrives on the primary care physician’s desk before the patient returns for an office visit. It keeps the primary care physician in control of the patient’s healthcare and enhances dermatologists’ communication with their referring doctors.
Potential Advantages of the Consultation/Prescription Form
Another potential advantage of the form relates to the efficiency of having preprinted prescription information. The ability to check off frequently used drugs allows the form to be used as both a prescription and a means of communicating with referring physicians. Further study may be of value to test the effectiveness of this consultation/prescription form in minimizing prescription errors.
Clear communication between a primary care physician and a specialist is key to ensuring quality patient care and satisfaction. Referring physicians must be informed of their patients’ progress in a prompt and efficient manner — prompt reporting is essential for proper communication among the referring doctor, the specialist and the patient.1
However, the multiple steps involved in the reporting process create a high level of paperwork and delays in the process result in uncertainty and confusion for primary care physicians, specialists and patients.2 Miscommunication between these critical players leads to errors that can compromise patient care, such as patients missing critical treatment.3
Maintaining Good Relationships
We know that the key to maintaining a good relationship between specialists and primary care physicians is prompt reporting.4 There is no better way to keep a primary care physician informed on the progress of his or her patient than to have a referral letter back on his or her desk before the patient returns to the practice or before the patient calls the primary care physician about their visit to the dermatologist.
Prompt communication between the specialist and referring doctor is both a necessity and a challenge. The current method requires the report from the specialist to the primary care doctor to be dictated, transcribed and mailed out, which means it can be 7 to 10 days before the primary care doctor receives the report. As a result, the patient frequently will return to the referring physician’s office before the report from the specialist does. Patient care is compromised because the patient is unable to be treated or followed-up with because the primary care doctor is in the dark regarding the patient’s diagnosis, treatment plan and health status.
Furthermore, primary care physicians have to spend more time on administrative work and paperwork (as a result of reporting delay), and less time with their patients.5,6 Streamlining the efficiency of this reporting process between physicians would prevent delays such as this one, and therefore would improve health care quality.7
We designed a study to develop and test a consultation/prescription form to streamline the reporting process between dermatologists and primary care physicians. First, we identified the common treatments prescribed by dermatologists and created a consultation/prescription form that didn’t require dictation, transcription or mailing. The report can be faxed to the referring physician the very same day the patient is seen, helping to keep the referring physicians promptly informed about his or her patient’s diagnosis and treatment. The form can also be used as a prescription form.
We tested the tool in actual use, with follow-up evaluation from primary care providers and pharmacists.
Designing the Form
We compiled medications prescribed from January 2003 to May 2004 in the office of a single dermatologist practicing in a small town in North Carolina. The consultation/prescription form created included a section for listing the diagnosis, a silhouette for marking location of skin lesions/eruptions and a listing of the most frequently prescribed medications, the prescribed amount of medication, frequency of administration, and duration of treatment (see the form below, which you can download as a PDF). The prescribing dermatologist and a primary care doctor both reviewed the form to help assure it met both the consulting and referring physician’s needs. A pharmacist also reviewed the form to assure it could be utilized as a prescription. It was then printed with carbonless copies allowing a copy to be kept for the practice, a copy to be sent to the referring physician and a copy to be taken to the pharmacy as a prescription.
Of the 1,483 prescriptions recorded over the study interval, the top 21 treatments accounted for 85% of all prescribed medications (See Table 1). Topical triamcinolone (Aristocort, Flutex, Kenalog, Triacet) was the most frequently prescribed medication, accounting for 14% of the prescriptions, followed by the topical fluocinonide (Lidex) and topical tacrolimus (Protopic).
Assuring Effectiveness
We qualitatively measured the effectiveness of this consultation/prescription form through feedback from five primary care physicians or their offices regarding their experiences with utilizing this tool and an additional eight primary care physicians in an interview setting. Primary care doctors were called and asked a set of questions to qualitatively assess how they feel the form would affect referral reporting efficiency. The following questions were asked:
1. Have you had any problems or concerns about the dermatology service?
2. Have there been any issues related to not getting back follow-up information in a timely way?
3. Do you find the consultation follow-up form to be helpful?
4. Any suggestions for improving it?
*Human subject research approval was obtained from the local Intramural Review Board.
Physician Feedback
Primary care doctors that were interviewed about the form were enthusiastic about its potential effectiveness in minimizing reporting delay and improving patient care.
All of the doctors interviewed agreed that reporting delay is a problem. This is not only frustrating for the doctor, but immensely frustrating for patients, who feel that the system has failed. The doctors were in strong agreement that the prescription form has the potential to eliminate reporting delay, and the multitude of problems that reporting delay brings. They also found the form to be thorough and to contain the necessary information for them to continue caring for their patients.
Primary care physicians report there are three ingredients of an effective referral letter: the working diagnosis, the medications you have prescribed and the treatment plan. Usually, they are not interested in the depth and detail of the history or the fine nuances and descriptions of the dermatologic lesions that have been detected on the physical examination.
The method described in this project creates a user-friendly referral letter that meets the three necessary criteria and that arrives on the primary care physician’s desk before the patient returns for an office visit. It keeps the primary care physician in control of the patient’s healthcare and enhances dermatologists’ communication with their referring doctors.
Potential Advantages of the Consultation/Prescription Form
Another potential advantage of the form relates to the efficiency of having preprinted prescription information. The ability to check off frequently used drugs allows the form to be used as both a prescription and a means of communicating with referring physicians. Further study may be of value to test the effectiveness of this consultation/prescription form in minimizing prescription errors.
