Browsing by Author "Perera, D.P."

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Dealing with medically unexplained symptoms in primary care
(College of General Practitioners of Sri Lanka, 2017) Kumaran, S.; Perera, D.P.
No abstract available
Evaluation of teaching and learning in family medicine by students: a Sri Lankan experience
(Medknow, 2015) Ramanayake, R.P.J.C.; de Silva, A.H.W.; Perera, D.P.; Sumanasekera, R.D.N.; Gunasekara, R.; Chandrasiri, P.
BACKGROUND: Family Medicine occupies a prominent place in the undergraduate curriculum of the Faculty of Medicine, University of Kelaniya, SriLanka. The one month clinical attachment during the fourth year utilizes a variety of teaching methods. This study evaluates teaching learning methods and learning environment of this attachment. METHODOLOGY: A descriptive cross sectional study was carried out among consenting students over a period of six months on completion of the clinical attachment using a pretested self administered questionnaire. RESULTS: Completed questionnaires were returned by 114(99%) students. 90.2% were satisfied with the teaching methods in general while direct observation and feed back from teachers was the most popular(95.1%) followed by learning from patients(91.2%), debate(87.6%), seminar(87.5%) and small group discussions(71.9%). They were highly satisfied with the opportunity they had to develop communication skills (95.5%) and presentation skills (92.9%). Lesser learning opportunity was experienced for history taking (89.9%), problem solving (78.8%) and clinical examination (59.8%) skills. Student satisfaction regarding space within consultation rooms was 80% while space for history taking and examination (62%) and availability of clinical equipment (53%) were less. 90% thought the programme was well organized and adequate understanding on family medicine concepts and practice organization gained by 94% and 95% of the students respectively. CONCLUSIONS: Overall student satisfaction was high. Students prefer learning methods which actively involve them. It is important to provide adequate infrastructure facilities for student activities to make it a positive learning experience for them.
Evaluation of the undergraduate family medicine programme of Faculty of Medicine, University of Kelaniya: quantitative and qualitative student feedback.
(BioMed Central, 2019) Perera, D.P.; Withana, S.S.; Mendis, K.; Kasunjith, D.V.T.; Jayathilaka, W.T.S.; Wickramasuriya, S.
BACKGROUND:Worldwide there is an increasing emphasis on the importance of primary care. The ministry of health Sri Lanka issued a directive in 2016 that training of doctors in primary care should be strengthened. Medical students of the Faculty of Medicine, University of Kelaniya follow a 1 month long clinical appointment in family medicine in their fourth year of study. METHODS:Feedback is taken from students on completion of the appointment. Half the students from each group complete a pre tested structured feedback questionnaire that consists of answers to questions based on a likert scale with a space for free comments. The other half provide qualitative feedback. In this evaluation data were gathered from 185 (98%) students from all eight clinical groups throughout the year 2016. Quantitative data were analysed using SPSS version 22. Inductive thematic analysis was used to analyse the qualitative data from the Round Robin activity and free comments from the questionnaire. RESULTS:The qualitative feedback provided a richer indepth overview of student ideas on the appointment compared to the quantitative data. In reflection of a desire for learning to be of relevance students wanted clinically oriented teaching focused on management. They preferred active teaching learning methods such as the opportunity to conduct consultations and receive immediate feedback. Students had a high regard for the teaching sessions by general practitioners at their clinics. The appointment had created an interest in the discipline of family medicine which could have an impact on future choice of career. There were indications to suggest that student attitudes towards patients may have evolved to be more patient centred. Students appreciated the inclusive and low stress ambience of the learning environment. CONCLUSIONS AND RECOMMENDATIONS:Regular evaluation of teaching programmes helps maintain accountability of faculty and paves the way for more student centred teaching through the incorporation of students' views in devising teaching methods. This evaluation found that qualitative feedback provided more descriptive material to reflect on and therefore improve teaching on the programme. It is recommended that more use should be made of qualitative methodologies in programme evaluations.
General practice is "different": a qualitative study of adaptation experiences of East Staffordshire general practice speciality trainees
(Taylor & Francis-Radcliffe Medical Press, 2021) Perera, D.P.; Mohanna, K.
ABSTRACT: Undergraduate medical education and foundation training are still largely hospital based. General practice trainees also spend nearly half of their speciality training in hospitals. Aims: To explore adaptation experiences of general practice speciality trainees throughout the training. Method: Semi-structured participant-observer interviews with 18 purposively selected trainees on the East Staffordshire vocational training scheme, observation, stakeholder discussions and concurrent inductive thematic analysis. Results: Undergraduate and early general practice experience during speciality training, general practice trainer role modelling and mastering core general practice skills, facilitated transition. An inclusive and supportive general practice environment, facilitating engagement with a community of practice involving peers, general practice trainers and vocational training programme fostered belongingness. A reduced sense of belongingness during hospital rotations impacted on training and work. Building bridging social connections, personal agency initiatives to bring general practice relevance into hospital training, signposting to general practice relevant duties and mastery of secondary care relevant competencies helped gain belongingness in hospital. While some international graduates required assistance in specific areas; overall, general practice trainees had optimistic views of their future. Conclusion: The main contribution of this study was to relate the adaptation experiences of trainees to learning and practice based on Wenger's communities of practice to enable a better understanding of how they can be influenced to enhance training. ABBREVIATIONS: CoP: Community of practice; GP: General practice; GPST: General practice speciality trainee; M: Male; F: Female; ST1: First-year GPST; ST2: Second-year GPST; ST3: Third-year GPST; UKG: UK-based primary medical qualification; IMG: Non-UK primary medical qualification. KEYWORDS: General practice training; belongingness; community of practice; transition.
General practitioners requesting radiological investigations: a qualitative study of the perceptions of radiologists
(College of General Practitioners of Sri Lanka, 2017) Ramanayake, R.P.J.C.; Perera, D.P.; Basnayake, B.M.T.K.
BACKGROUND: General practice provides person centred, continuing, comprehensive and coordi- nated whole person care to individuals and families in their communities. Patients present with early nonspecific symptoms of disease and general practitioners need to be very discrimi- nating when deciding on investigations. Indiscri- minate or inappropriate use of radiological investi- gations could expose patients to unnecessary harm and is a waste of resources. Failure to refer for necessary investigations may lead to inefficient patient management.This study was carried out to identify the various aspects of the process of general practitioners requesting radiological tests and radiologists’ perceptions of this process in Sri Lankan settings. METHODOLOGY: Person to person telephone interviews were conducted by one of the investi- gators with ten consultant radiologists working in different areas of Sri Lanka. A semi structured questionnaire regarding general practitioner requests for radiological investigations was used as a study instrument. Recorded information was studied in depth and then coded. Codes were then combined into themes and analysis was done independently by two investigators and reviewed together with discussion on any disagreements leading to a consensus view.RESULTS: The main findings of the study were that the majority of radiologists thought that most of the requests for radiological investigations were appropriate, however they were disappointed with the provision of background information with the requests such as basic data, clinical history, previous investigations and tentative diagnosis. It was generally thought that a structured referral form would improve the quality of the process of requesting investigations. Radiologists appreciated that a clear pathway of communication with general practitioners was important especially regarding the follow up of the patient.CONCLUSION: There is a need to improve specific aspects of general practitioner knowledge to facilitate efficient utilisation of radiological investi- gations and ensure patient safety. General practitioners need to be more diligent regarding provision of adequate clinical information regarding the patient to the radiologist in order to make optimum use of the investigation and the time of the radiologists. Good communication between the referring general practitioner and radiologist will improve the quality of care for the patient.
Knowledge of diabetes among type 2 diabetes patients attending a primary health care clinic in Sri Lanka
(Eastern Mediterranean Regional Office of the World Health Organization, 2013) Perera, D.P.; de Silva, R.E.E.; Perera, W.L.S.P.
Patients’ knowledge about their illness is considered important in controlling diabetes and preventing complications. A descriptive, cross-sectional study was conducted among patients attending the diabetes clinic of a primary care level hospital in Moratuwa, Sri Lanka. During a 1-month period in 2009 all consenting patients diagnosed with type 2 diabetes who had been attending the clinic for more than 3 months were included in the study. Using an interviewer administered, structured questionnaire 150 patients (135 females, 15 males) answered 25 questions about diabetes knowledge (scored ×4 to give score range 0–100). A majority of patients (70.0%) had a good score (> 65) on the knowledge test but critical gaps in knowledge were revealed, especially regarding knowledge about symptoms of poor control and importance of regular follow-up. Although patients with longer duration of diabetes had higher mean knowledge scores, they also had higher fasting blood glucose levels. Education programmes are needed to address critical gaps in patients’ knowledge.
Knowledge on HIV prevention amongst a group of post war re-settlers in Sri Lanka
(Sri Lanka College of Venereologits, 2015) de Silva, A.H.W.; Rizwaan, M.S.A.; Ramanayake, P.J.C.; Perera, D.P.; Sumanasekara, R.D.N.
BACKGROUND: The war that prevailed for the past three decades in the North and East of Sri Lanka impeded HIV prevention activities in these areas. The purpose of this study is to assess knowledge on HIV prevention amongst post war re-settlers in Thallavadi-Elephant Pass; Northern Province, Sri Lanka. OBJECTIVE: This study assesses the knowledge on HIV prevention amongst post war re-settlers attending a health awareness programme in the community.METHODS: Descriptive cross sectional study was carried out on 27th January 2012, using a pretested selfadministrated questionnaire amongst all consenting participants before commencement of the educational activities. All questions were close ended and replies were based on three answers-Yes/No/Don't know. No details of identification were included in the questionnaire and responders were requested to place the filled questionnaire in a sealed box to ensure anonymity. Responders who have never heard of HIV were excluded on analysing knowledge on HIV.RESULTS: One hundred and twelve post war re-settlers took part in the health awareness programme and 81(54% males) submitted the filled questionnaire. Seventy one (87%) respondents had heard of HIV. Only 14% identified that a HIV infected person may look healthy. fylajority 70% knew that treatment can improve quality of life of infected persons. 94% recognized condoms as a HIV prevention method.CONCLUSION: 17% of participants answered c01Tectly to all four variables of the UN GASS indicator 13: knowledge on HIV. The knowledge on HIV prevention amongst this group of post war re-settlers is very low.
Knowledge on HIV prevention amongst a group of post war re-settlers in Sri Lanka
(Sri Lanka College of Venereologists, 2014) de Silva, A.H.W.; Rizwaan, M.S.A.; Ramanayake, R.P.J.C.; Perera, D.P.; Sumanasekara, R.D.N.
BACKGROUND: The war that prevailed for the past three decades in the North and East of Sri Lanka impeded HIV prevention activities in these areas. The purpose of this study is to assess knowledge on HIV prevention amongst post war re-settlers in Thallavadi-Elephant Pass; Northern Province, Sri Lanka. OBJECTIVE: This study assesses the knowledge on HIV prevention amongst post war re-settlers attending a health awareness programme in the community. METHODS: Descriptive cross sectional study was carried out on 27th January 2012, using a pretested selfadministrated questionnaire amongst all consenting participants before commencement of the educational activities. All questions were close ended and replies were based on three answers-Yes/No/Don't know. No details of identification were included in the questionnaire and responders were requested to place the filled questionnaire in a sealed box to ensure anonymity. Responders who have never heard of HIV were excluded on analysing knowledge on HIV. Results: One hundred and twelve post war re-settlers took part in the health awareness programme and 81(54% males) submitted the filled questionnaire. Seventy one (87%) respondents had heard of HIV. Only 14% identified that a HIV infected person may look healthy. fylajority 70% knew that treatment can improve quality of life of infected persons. 94% recognized condoms as a HIV prevention method. CONCLUSION: 17% of participants answered c01Tectly to all four variables of the UN GASS indicator 13: knowledge on HIV. The knowledge on HIV prevention amongst this group of post war re-settlers is very low.
Morbidity pattern and process of care at a teaching hospital outpatient department in Sri Lanka
(Sri Lanka Medical Association, 2017) Mendis, K.; de Silva, A.H.W.; Perera, D.P.; Withana, S.S.; Premasiri, B.H.S.; Jayakodi, S.
INTRODUCTION & OBJECTIVES: There is paucity of published data regarding outpatient department (OPD) morbidity in spite of 55 million OPD visits to government hospitals in 2014. OPD morbidity has been assumed to be similar to indoor morbidity for two decades. The recent Ministry of Health focus to strengthen primary care skills of medical graduates, requires reliable data from primary care to align medical curricula towards this goal. This is an initial step to identify the primary care morbidity profile. METHODS: In a cross-sectional pilot study doctors trained as data collectors observed a representative sample of doctor patient encounters and recorded the reason for encounters (RFE) and process of care. The problem definition (PD) was provided by the consulting doctor. RFEs and PDs were later coded using International Classification of Primary Care (ICPC2). Analysis was done using ‘R Ver3.2.3’ programming language. RESULTS: A total of 2923 clinical encounters resulted in 5626 RFEs and 3051 health problems. Patients mean age was 39.1(±22) with 64.5% females. Top ranking PDs were (n=3051): acute upper respiratory infection (11.3%), other respiratory infection (8.1%), viral fever (4.7%), lower respiratory tract infection (4.7%), muscle symptoms and complaints (3.8%), gastritis (3.3%), bronchial asthma (2.6%), dermatitis (2.5%), fungal infections (1.6%) back pain (1.5%), sinusitis (1.4%), joint pains (1.2%) and tonsillitis (1.2%). Psychological problems accounted for 0.4% and no social problems were recorded. During 2923 encounters, 540 (18%) were referred to clinics and 66 (2.3%) admitted to hospital. Prescriptions were issued for 2349 (80%), examination carried out in 2322 (79%), advice given to 946 (32%) and investigations ordered for 348 (12%). CONCLUSION: The morbidity pattern of OPD patients is different from inpatients - almost two thirds were females and more than 30% were respiratory problems.
Patient held medical record: solution to fragmented health care in Sri Lanka.
(Lahore Institute of Public Health (LIPhealth), 2013) Ramanayake, R.P.J.C.; Perera, D.P.; de Silva, A.H.W.; Sumanasekera, R.D.N.
Sri Lanka has an extensive network of health care institutions, but there is no registered population for any particular health care institution. Patients are free to select which doctor to consult and which hospital to get admitted. Also there is no established referral and back referral system in practice. This free movement of patients within and between the primary, secondary and tertiary levels of care by patient's choice has given rise to a situation where each episode of an illness or disease process is managed by different doctors in differing specialties. As in most care settings, the patient's medical or health record is held by the health service or doctor that is providing care to the patient for a specific ailment. This leads to a gap in communication between multiple caregivers leading to poor co-ordination of care. These difficulties faced and lessons learnt suggest the use of a medical record that is kept with the patient. Patient Held Medical Records (PHMR) are formal and structured records that are given to patients to enable the continuity and quality of care which he takes with him when he goes for medical consultations. PHMRs aim to improve communication between patients and the multiple clinicians and health care workers who are involved in patient management. The PHMR we propose comprises of a folder, clinical notes, problem list, flow sheet and other optional items. The PHMR can be used as a tool to empower and educate the patients. It will improve transparency and trust and facilitate continuity of care. Increased work load, cost, restriction of freedom in writing notes, confidentiality and retention of records by patients are the disadvantages which need consideration.
Peer feedback for examiner quality assurance on MRCGP International South Asia: a mixed methods study
(BioMed Central, 2017) Perera, D.P.; Andrades, M.; Wass, V.
BACKGROUND: The International Membership Examination (MRCGP[INT]) of the Royal College of General Practitioners UK is a unique collaboration between four South Asian countries with diverse cultures, epidemiology, clinical facilities and resources. In this setting good quality assurance is imperative to achieve acceptable standards of inter rater reliability. This study aims to explore the process of peer feedback for examiner quality assurance with regard to factors affecting the implementation and acceptance of the method. METHODS: A sequential mixed methods approach was used based on focus group discussions with examiners (n = 12) and clinical examination convenors who acted as peer reviewers (n = 4). A questionnaire based on emerging themes and literature review was then completed by 20 examiners at the subsequent OSCE exam. Qualitative data were analysed using an iterative reflexive process. Quantitative data were integrated by interpretive analysis looking for convergence, complementarity or dissonance. The qualitative data helped understand the issues and informed the process of developing the questionnaire. The quantitative data allowed for further refining of issues, wider sampling of examiners and giving voice to different perspectives. RESULTS: Examiners stated specifically that peer feedback gave an opportunity for discussion, standardisation of judgments and improved discriminatory abilities. Interpersonal dynamics, hierarchy and perception of validity of feedback were major factors influencing acceptance of feedback. Examiners desired increased transparency, accountability and the opportunity for equal partnership within the process. The process was stressful for examiners and reviewers; however acceptance increased with increasing exposure to receiving feedback. The process could be refined to improve acceptability through scrupulous attention to training and selection of those giving feedback to improve the perceived validity of feedback and improved reviewer feedback skills to enable better interpersonal dynamics and a more equitable feedback process. It is important to highlight the role of quality assurance and peer feedback as a tool for continuous improvement and maintenance of standards to examiners during training. CONCLUSION: Examiner quality assurance using peer feedback was generally a successful and accepted process. The findings highlight areas for improvement and guide the path towards a model of feedback that is responsive to examiner views and cultural sensibilities.
A Pilot Study on Antibiotic Prescription by General Practitioners in Ragama Medical Officer of Health (MOH) area, Western Province, Sri Lanka
(19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Wijesooriya, L.I.; Perera, D.P.; Dissanayake, D.M.D.P.; Wijenayake, D.L.C.D.; Siriwardana, S.R.
Introduction: Antibiotic usage in healthcare has increased dramatically over past few decades. In parallel, bacteria have developed antibiotics resistance (AR) making a great challenge in healthcare. However, antibiotic misuse is a key behind AR. Therefore, strict regulation of antibiotic use is mandatory to minimize the development of AR. Hence, antibiotics are color-coded as red (Circular No. 01-56/2016, Ministry of Health, Sri Lanka), orange and green light antibiotics according to the level of authorization. However, these circulars and national antibiotic guidelines are mainly focusedinhospital practice. Hence, it is important to understand the current antibiotic prescription at general practitioner (GP) level. Objective: To study antibiotic prescription patterns of GPs in Ragama MOH area, Western Province, Sri Lanka. Methods: A cross-sectional, descriptive study was piloted involving 100 antibiotic prescribing encounters. (Total sample number was six hundred according to the WHO manual on “how to investigate drug use in health facilities”). Six randomly selected general practitioners, registered in general practitioners’ registry, published by College of General Practitioners of Sri Lanka, and practicing in Ragama MOH area were involved for the study which was conducted from May – August 2017. Data were collected from patients, using a pre-tested, interviewer-administered questionnaire. Demographic and clinical data of patients &details of antibiotic prescription as type, dose, frequency and duration were analyzed. Results: Of 100 antibiotic prescriptions, 23% for children (<12-65 years), 64% for adults (12-65 years) and 13% for elderly (>65 years) patients. Antibiotic prescription; 69% for respiratory tract infections (RTI), 12% skin infections 7% digestive tract infections, 2% urinary tract infections (UTI) and 10% for other infections. Common antibiotics prescribed for RTIs were amoxicillin (27.5%), Cephalexin (24.6%), followed by amoxiclav (17.4%), azithromycin (14.5%), clarithromycin (11.6%) cefixime (2.9%) & levofloxacin (1.4%). Ciprofloxacin was prescribed for digestive tract infections, UTI& sinusitis. All antibiotics were prescribed as per recommended doses and frequencies. Duration of antibiotics prescribed for RTI ranged from 3-15 days; in 29.4%, it was for 5 days, in 25% and 17.5% it was for 3 & 4 days respectively. In 33.8% prescriptions, duration of antibiotic therapy was more than 5 days. Conclusion: RTIs were the commonest condition for which antibiotics were prescribed. The most common antibiotics prescribed for RTIs were amoxicillin & cephalexin. A considerable number of prescriptions for RTIs was less than the minimum treatment duration recommended in the national guideline for empirical and prophylactic use of antimicrobials. Use of ciprofloxacin, (orange light antibiotic) and levofloxacin (red light antibiotic) has been noted in general practice.
Public sector primary care services in Sri Lanka and the specialist family physician: A qualitative study
(Medknow, 2022) Ramanayake, R.P.J.C.; Perera, D.P.; Jayasinghe, J.A.P.H.; Munasinghe, M.M.E.M.; de Soyza, E.C.E.S.; Jayawardana, M.A.V.S.
INTRODUCTION: In the background of a rising burden of non-communicable disease (NCD) Sri Lanka has prioritised reorganising primary care based on a family medicine approach. AIMS: This study explored the integration of a relatively new specialist family physician (SFP) role into the state public health sector of Sri Lanka. Methods: In-depth qualitative interviews were conducted with 11 SFPs attached to the Ministry of Health. Data were analysed using inductive thematic analysis. RESULTS: SFPs had faced initial challenges related to recognition and collaboration within the state health sector. They provided comprehensive primary care in a variety of roles; most importantly in care of NCD and elderly care, and focused on professional development of medical officers and support staff in the settings where they worked. Challenges were insufficient laboratory facilities, medication availability, primary care trained manpower and linkages with secondary care. These barriers hindered the ability of the SFPs to provide a full range of family practice-oriented health services. CONCLUSION: SFPs have integrated well into the public health sector of Sri Lanka providing comprehensive primary care services. The findings identify areas that need strengthening to further improve primary care services in the country and operationalise proposed new primary care service models.
Qualitative study of motivators and outcomes of Sri Lankan doctors achieving MRCGP International
(Radcliffe Medical Press, 2013) Pettigrew, L.M.; Perera, D.P.; Wass, V.
BACKGROUND: The UK's Royal College of General Practitioners accredits overseas examinations in family medicine through MRCGP[INT] rather than exporting MRCGP UK. There is limited research on the motivating factors and outcomes of this practice on candidates. AIM: To explore factors motivating Sri Lankan doctors to pursue the South Asian MRCGP[INT] and their perceived benefits and barriers to sitting the examination. METHODS: Qualitative semi-structured 1:1 interviews with 14 successful past MRCGP[INT]SA candidates were undertaken in Sri Lanka. Findings were analysed with N-Vivo software. A phenomenological approach was used. Interpretive dimensions were applied drawing on information from interviews, informal conversations and observations. RESULTS: Motivators to sit the examination included a desire to improve patient care and seeking recognition as a family doctor. Younger doctors had hopes of increased future income and there was some expectation that the examination may improve overseas employment prospects. The examination conferred greater confidence, new patient-centred communication skills, introduced the use of evidence-based guidelines and increased awareness of the UK health system to most participants. There were examples of diffusion of knowledge through different teaching channels. Relative to Sri Lankan examinations, formal training opportunities were limited and value for money of annual membership fees were questioned. Financial and geographical barriers to the examination were noted. CONCLUSION: Currently MRCGP[INT]SA offers additional value for successful candidates in Sri Lanka who perceive accreditation by a UK college favourably. Improvement of pre- and post-exam support linked to MRCGP[INT]SA in Sri Lanka is needed. Further research into the long-term impact is necessary, in particular regarding equity of access, migration and local training development.
Rate of stunting among a sample of postwar resettled families in the Vanni region: a study from the Mullativu District
(Sri Lanka Medical Association, 2013) Ramanayake, R.P.J.C.; Sumanasekera, R.D.N.; de Silva, A.H.W.; Perera, D.P.; Chandrasiri, P.; Gunasekera, R.; Jayasinghe, L.R.
The Department of Family Medicine, University of Kelaniya conducted a health camp in Puthukudiyiruppu in March 2011. Height and weight measurements were carried out and data of 303 participants were analysed. The rate of stunting among children below six years in this population was 62% compared to 19.3% nationally. Thirty four percent of children and adolescents (6-18yrs) were underweight and 21.4% of adults had a BMI less than 18.5kg/m2.
Referral Communications in Sri Lanka; Views of General Practitioners
(SciRJ, 2014) Ramanayake, R.P.J.C.; de Silva, A.H.W.; Perera, D.P.; Sumanasekera, R.D.N.; Athukorala, L.A.C.L.; Fernando, K.A.T.
INTRODUCTION: Referral of patients to specialists and hospitals is an essential and inevitable aspect of primary health care. Maintain good communication is essential during the process in order to provide quality care without delays and unnecessary expenses. In Sri Lanka referral letter from a general practitioner (GP) is not essential to get admitted to a hospital or to consult a specialist and there is no registered population for a particular practitioner. This study was conducted to look at the views of general practitioners on referral communications. METHODOLOGY: This was a descriptive cross sectional study and postal survey was conducted among members of the college of general practitioners of Sri Lanka using a self administered structured questionnaire. RESULTS: Response rate was 28.7%. Only less than 60% wrote a referral letter always when referring a patient to a hospital/ specialist and the main reasons were; Patients insistence on referral without an indication, No feedback from specialists and lack of ownership to non regular patients. Information related to the disease and administrative details were the items of information mainly included in letters while socio psychological items were given lesser importance. Reply rate was very poor irrespective of the referral destination and main items of information expected in a reply letter were; Diagnosis, plan of management and instructions to the GP. DISCUSSION: There should be better communication and coordination between GPs and specialists/hospital doctors. Ways and means should be explored and rectifying measures should be undertaken which will benefit patients, GPs, specialists/hospital doctors and the health care system.
Referral communications: Bridging the gap between primary care doctors and specialists
(Lesley Pocock medi+WORLD International, 2014) Ramanayake, R.P.J.C.; de Silva, A.H.W.; Perera, D.P.; Sumanasekera, R.D.N.; Lakmini, K.M.S.; Ranasinghe, B.L.S.
INTRODUCTION: In the Sri Lankan health system there is no system for registering a patient under any health care provider and there is no established referral and back referral system in practice. Still there is communication between primary care doctors and specialists mostly through conventional letters. This study was conducted to explore views of specialists on the referral process of the country. METHODOLOGY: This was a descriptive cross sectional study. A self-administered questionnaire based on the data gathered in earlier qualitative, explorative research was prepared to gather data. A postal survey was conducted among Specialists Island wide. RESULTS: 1100 specialists were included in the study and the response rate was 20%. Although specialists expect a referral letter from general practitioners they receive one only around 50% of the occasions. They were not happy with the quality of letters and expected a comprehensive referral letter. They were keen to reply but time constraints (50%), lack of secretarial support (36%) and perception that reply will not reach the sender (31%) were obstacles in replying. Continuous medical education, use of structured referral forms and strengthening training programs were suggested to improve communications. CONCLUSIONS AND RECOMMENDATIONS: Specialists have a positive attitude towards their professional relationship with GPs and they should be made aware of this and try to enhance their communication with specialists. There should be rectifiable measures in the systems which facilitate coordination and communication between the two parties and then the referral process will become meaningful and beneficial to all the stakeholders.
Referral letter with an attached structured reply form: Is it a solution for not getting replies
(Mumbai : Medknow, 2013) Ramanayake, R.P.J.C.; Perera, D.P.; de Silva, A.H.W.; Sumanasekera, R.D.N.; Jayasinghe, L.R.; Fernando, K.A.T.; Athukorala, L.A.C.L.
Background: Communication between primary care doctors and specialists/hospital doctors is vital for smooth functioning of a health care system. In many instances referral and reply letters are the sole means of communication between general practitioners and hospital doctors/specialists. Despite the obvious benefits to patient care, answers to referral letters are the exception worldwide. In Sri Lanka hand written conventional letters are used to refer patients and replies are scarce. Materials and Methods: This interventional study was designed to assess if attaching a structured reply form with the referral letter would increase the rate of replies/back-referrals. It was conducted at the Family Medicine Clinic of the Faculty of Medicine, University of Kelaniya. A structured referral letter (form) was designed based on guide lines and literature and it was used for referral of patients for a period of six months. Similarly a structured reply form was also designed and both the referral letter and the reply letter were printed on A4 papers side by side and these were used for the next six months for referrals. Both letters had headings and space underneath to write details pertaining to the patient. A register was maintained to document the number of referrals and replies received during both phases. Patents were asked to return the reply letters if specialists/hospital doctors obliged to reply. Results: Total of 90 patients were referred using the structured referral form during 1st phase. 80 letters (with reply form attached) were issued during the next six months. Patients were referred to eight different specialties. Not a single reply during the 1 st phase and there were six 6 (7.5%) replies during the 2 nd phase. Discussion: This was an attempt to improve communication between specialists/hospital doctors and primary care doctors. Even though there was some improvement it was not satisfactory. A multicenter island wide study should be conducted to assess the acceptability of the format to primary care doctors and specialists and its impact on reply rate
Referral letters from general practitioners to hospitals in Sri Lanka; lack information and clarity
(mediWORLD International, 2013) Ramanayake, R. P. J. C.; Perera, D.P.; de Silva, A.H.W.; Sumanasekera, R. D. N.; Jayasinghe, L.R.; Fernando, K. A. T.; Athukorala, L. A. C. L.
BACKGROUND: Referral of patients to hospitals, specialists and other institutions is an essential part of primary health care. In many instances the referral letter is the sole means of communication between general practitioners (GPs) and specialists/hospital doctors. This study was planned to assess the quality of referral letters sent by general practitioners to out patient departments (OPD) of hospitals. METHODOLOGY: This descriptive cross sectional study was conducted in four hospitals of different levels of care provision in Sri Lanka. Referral letters received by the OPDs during a period of 2 weeks were analyzed. A check list to extract data was developed based on the items of information expected in a referral letter and legibility. Each item was assigned a score. This scoring system was validated using a panel of experts by means of Delphi method. Maximum score possible for a letter was 30. RESULTS: A total of 461 letters were analyzed. Items of information most often present were; to whom referred (96.7%), symptoms (91.5%), reason for referral (90.2%) and date (88.9%). The least often present items were; family history (0.2%), history of allergy (1.1%) and social history (1.7%). Most of the words were not legible in 42.3% of the letters. Median score of the sample was 16 (mean=15.69) Mean score of structured form letters was 18.61 (n=33) and in conventional letters it was 15.53 (n=428). The observed difference was statistically significant (z=-3.544, p<0.01). DISCUSSION: Most of the letters did not have the required information and legibility was also poor. Expected benefits of a referral letter to the patient, recipient and the referring doctor will not be achieved due to these short comings. Form letters were comparatively better. Measures should be taken to improve the content and clarity of referral letters.
Structured Referral Form: is it a solution for problems of referral communication in Sri Lanka
(Sri Lanka Medical Association, 2014) Ramanayake, R.P.J.C.; Sumanasekera, R.D.N.; de Silva, A.H.W.; Perera, D.P.
INTRODUCTION AND OBJECTIVES: Referral letters convey information required for continuity of care when patients are referred to a hospital or a specialist. In Sri Lanka conventional, hand written letters are used for patient referrals and there is no standard format or widely accepted guidelines. This study was conducted to explore the acceptability, advantages and limitations of a structured referral form for General Practitioners. METHODS: A referral form was designed based on literature review and guidelines. Printed referral forms were provided to 20 general practices representing different background. Telephone interviews were conducted at the end of 3 months to obtain their views on the format. Interviews were recorded, transcribed and themes identified. RESULTS: It has improved the comprehensiveness of letters and saved time. Overall quality of letters improved and participants were of the view that it could be used in any instance, language competency was immaterial and retrieval of information would be easier. Inadequate space under a few subheadings was a limitation. There was no increase in reply letters after introducing this letter. Participants were willing to use the format in the future as well. CONCLUSIONS: This is a useful and acceptable tool to improve information transfer and it will also be a reminder and guide for doctors to include all information. It could be a solution to the problems of communication in patient relevant in Sri Lanka.