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Quality and appropriateness of referrals for dementia patients

Sundaran Kada, Harald A Nygaard, Jonn T Geitung, Bickol N Mukesh, Mala Naik, Grete Wold, Dag H Soevik

Objective To evaluate the quality and appropriateness of referrals from general practitioners (GPs) to geriatricians of patients with suspected dementia.Design A retrospective review of referrals from primary health care to a department of geriatric medicine. A data sheet was developed froma reviewof previous literature. Two GPs and two geriatricians assessed the quality and appropriateness of the referrals.Setting Patient records in the geriatric department were collected, registered and scrutinised.Subjects A total of 135 first-time referrals from January 2002 to December 2002 were evaluated. All patients and relatives were informed that participation was voluntary and anonymity was guaranteed. Main outcomes Assessment of the appropriateness of referrals.Results The mean age of all referred patients was 78.7 years (standard deviation (SD) 7.3; range 42–90 years) and 61.5% were female; 81 (60.0%)referrals were initiated by GPs, 33 (24.4%) by family members, three (2.2%) by community nurses, nine (6.7%) by the patients themselves and referral initiation was not specified for nine (6.7%). The agreement on appropriateness of referrals between the geriatricians was 83.7% (kappa 0.67; 95% confidence interval (CI) 0.55– 0.79; P = 0.03) and the GPs was 71.1% (kappa 0.21; 95% CI 0.07–35.3; P < 0.001). After consensus, theagreement between the geriatricians and GPs was 57.8%(kappa 0.08; 95% CI 0–0.23). This difference was statistically significant (P < 0.001).Conclusion There was disagreement between geriatricians and GPs regarding the appropriateness of referrals. It was found that time-consuming tests were infrequently performed or reported, and key medical information was absent from the referral letters.