Browsing by Author "Ramanayake, R.P.J.C."

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Domain-Specific learning among medical students
(Basic Medical Scientists Association, 2012) Perera, D.; Ramanayake, R.P.J.C.; de Silva, A.H.W.; Sumanasekara, R.D.N.; Jayasinghe, L.R.; Gunasekara, R.; Chandrasiri, P.
Background: The aim of this study was to investigate undergraduate medical student’s domain-specific learning. Method: The research tool was a structured essay question formulated to assess factual and affective knowledge and application and synthesis of knowledge .The question was administered to 151 students. Results: Mean score on the recall question was significantly higher than the other two domains. Total scores of female students were significantly higher than male students (P<0.05). Gender-wise difference in scores was not significant in any specific domain area. There was no significant relationship between factual knowledge and total scores. However, there was a significant linear relationship between total scores and the two areas of affective knowledge (r=0.78) and application and synthesis of knowledge (r=0.6). Findings indicate that affective knowledge and application of knowledge are closely related to overall acquisition of knowledge (P<0.0005). Conclusion: Teaching and assessment in higher-order knowledge domains and affective knowledge needs to be developed. Questions dealing with affective knowledge and testing higher-order cognitive abilities are more discriminatory than questions testing at the recall level.
Evaluation of red flags minimizes missing serious diseases in primary care
(Medknow, 2018) Ramanayake, R.P.J.C.; Basnayake, B.M.T.K.
Primary care physicians encounter a broad range of problems and therefore require a broad knowledge to manage patients. They encounter patients at early undifferentiated stage of a disease and most of the presentations are due to non sinister problems but in minority of patients same presentations could be due to serious conditions. One of the main tasks of a primary care doctor is to marginalize the risk of missing these serious illnesses. To achieve this they can look for red flags which are clinical indicators of possible serious underlying condition. Red flags are signs and symptoms found in the patient's history and clinical examination. Evaluation of red flags is of paramount important as decision making is mainly dependent on history and examination with the availability of minimal investigatory facilities at primary care level. Some Red flags like loss of weight and loss of appetite are general in nature and could be due to many pathologies while hematemesis and melena are specific red flags which indicate GIT bleeding. All red flags, whether highly diagnostic or not, general or specific, warn us the possibility of life-threatening disorders. The term 'red flag' was originally associated with back pain and now lists of red flags are available for other common presentations such as headache, red eye and dyspepsia as well. Identification of red flags warrant investigations and or referral and is an integral part of primary care and of immense value to primary care doctors.
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.
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.
Health care needs and services available for elders in the Batticaloa district.
(College of general practitioners of Sri Lanka, 2018) Arulanandem, K.; Jayawickramaraja, P.T.; Hettige, S.; Ramanayake, R.P.J.C.; Kisokanth, G.
The global and national ageing population led to much health, social and economic concerns. Thus, present study aimed at addressing the health care needs of Elders and assessing the availability of health, social services in Batticaloa district. This community based cross sectional descriptive study was conducted in Batticaloa district with 845 elders who were selected by proportionate random sampling and .interviewer admini~trated questionnaire was used as a major, component.Most of the elders (78%) were in the young old category and majority of them (56.6%) were females and most of elders (77%) were in poor socio economic status. The identified long standing medical problems amongst elders were hypertension (39%), muscular skeletal problems (32%) and bronchialasthma (18%) were also identified. Most of the elders (88%) sought medical treatment in outpatient department as first contact at government hospitals while around half of them had followed clinics for chronic conditions. This study also showed that the health system in Batticaloa district lacked geriatric services and elders were not treated as a special group. In the context of social services, most of the elders were unaware and thus were not benefited by the currently existing social security. Health seeking behavior and accessibility of health and social services were not adequately met for elders. Thus, there is a need to improve their well• being by strengthening primary care in national health system.
Health seeking behavior of elders in Batticaloa district, Sri Lanka: Descriptive cross sectional study
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Arulanandem, K.; Jayawickramarajah, P.T.; Ramanayake, R.P.J.C.; Hettige, S.; Kisokanth, G.
BACKGROUND: Global population of elderly would increase by 15% in year 2025. The change in age structure affects the society in social, cultural and economic aspects of life. The provision of health care to elderly varies across most of the developing countries. Health care is an important issue for ageing population and living with chronic illnesses become a challenge. Health care services are essential for the population it serves. The health seeking behavior of elders depends on the availability of services, health problems and socio economic status. OBJECTIVE: To describe the health seeking behavior of elders in Batticaloa district, Sri Lanka METHODS: A cross sectional descriptive study was carried out in Batticaloa district on a sample of 845 elders selected by simple random sampling method. Interviewer administrated questionnaire was used to collect data and descriptive statistical analysis was done. RESULTS: Study population consisted of 78% of elders in young old category of whom 57% were females. Most (93%) attended outpatient departments of government hospitals and 8%, general practitioners as their first contact care for acute illnesses. 48% attended clinics for chronic illnesses at government hospitals. Approximately half of them used public transport to access the health facility. 50% of their health expenditure was managed by their children. Frequency of health seeking behavior for acute illness was higher among females and the difference between the two sexes was statistically significant (p<0.05). CONCLUSIONS: First contact care for acute and chronic disease conditions for more than 90% of elders in Batticaloa district was government hospitals.
Historical evolution and present status of family medicine in Sri Lanka
(Mumbai : Medknow, 2013) Ramanayake, R.P.J.C.
Sri Lankan health system consists of Allopathic, Ayurvedic, Unani, and several other systems of medicine and allopathic medicine is catering to the majority of the health needs of the people. As in many other countries, Sri Lankan health system consists of both the state and the private sector General practitioners, MOs in OPDs of hospitals and MOs of central dispensaries, provide primary medical care in Sri Lanka. Most of the general practices are solo practices. One does not need postgraduate qualification or training in general practice to start a general practice. There is no registered population for any particular health care institution in the state sector or in the private sector and there is no strict referral procedure from primary care to secondary or tertiary care. Family doctors have been practicing in Sri Lanka for well over 150 years. The first national organization of general practitioners was Independent Medical Practitioner (IMPA)'s organization which was founded in 1929 and the College of General Practitioners of Sri Lanka was founded in 1974. College conducts its own Membership Course and Examination (MCGP) since 1999. Family Medicine was introduced to undergraduate curriculum in Sri Lanka in early 1980s and now almost all the medical faculties in the country have included Family Medicine in their curricula. In 1979, General Practice/Family Medicine was recognized as a specialty in Sri Lanka by the postgraduate institute of Medicine. Diploma in Family Medicine (DFM) and MD Family Medicine are the pathways for postgraduate training in Sri Lanka. At present 50 to 60 doctors enroll for DFM every year and the country has about 20 specialists (with MD) in Family Medicine. The author's vision for the future is that all the primary care doctors to have a postgraduate qualification in Family Medicine either DFM, MD, or MCGP which is a far cry from the present status.
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.
Lifestyle correlates of cardiovascular risk factors in a Sri Lankan population
(Sri Lanka Medical Association, 2008) Pinidiyapathirage, M.J.; Kasturiratne, A.; de Silva, B.A.; Perera, D.M.; Ramanayake, R.P.J.C.; Sumathipala, W.L.A.H.; Mizoue, T.; Makaya, M.
OBJECTIVES: To determine the association between selected lifestyle risk behaviours (physical activity-PA, smoking and fruit, vegetable and alcohol consumption) and cardiovascular risk factors in an urban Sri Lankan population. DESIGN, SETTING AND METHODS: A random sample of 3650 individuals between 35-64 years resident in the Ragama MOH area were selected from the electoral list. A validated, interviewer-administered, food frequency questionnaire and a physical activity questionnaire were used to collect data. Blood samples were analysed for serum lipid and fasting blood glucose (FBG) concentrations. RESULTS: Of the 2602 participants (males:46%), 47% reported low physical activity (PA), 51% sub-optimal fruit consumption, 13% sub-optimal vegetable consumption, 6% excess alcohol consumption and 16% were current smokers. A significantly higher percentage of males reported moderate to high physical activity, had a lower BMI, consumed more alcohol, smoked currently and consumed less fruits. Vegetable consumption was similar between sexes. In females, risk behaviours were not associated with serum lipid and FBG concentrations. Among males, those reporting a low PA had a significantly higher percentage with serum triglyceride concentrations >150mg/dl and FBG >110mg/dl. A significantly higher percentage of male smokers had a serum total cholesterol concentration >200mg/dl and serum LDL concentration >100mg/dl. Excessive alcohol consumption in males was associated with high triglyceride concentrations (>150mg/dl). Serum lipid and FBG levels were similar among those with different fruit and vegetable consumption patterns, CONCLUSION: Low physical activity, smoking and excessive alcohol consumption were associated with serum lipid and FBG concentrations in males. Fruit and vegetable consumption was not correlated with risk factors.
Management of emergencies in general practice: role of general practitioners
(Mumbai : Medknow, 2014) Ramanayake, R.P.J.C.; Ranasingha, S.; Lakmini, S.
INTRODUCTION: Management of emergencies is an integral part of primary care. Being first contact care providers general practitioners may encounter any type of emergency. Acute attacks of asthma, myocardial infarction, anaphylactic shock, hypoglycemic coma, convulsions, head injuries and trauma are some of the common emergencies encountered by GPs. Updated knowledge, communication and procedural skills, trained paramedical staff, necessary equipment and medications and appropriate practice organization are vital to provide optimum care which may even save lives of patients. The wide range of problems and the rarity of the problems make it difficult for primary care doctors to be updated and competent in providing emergency care. ROLE OF GP: Some of the emergencies can be managed completely at a general practice while others should be referred to hospital after initial management. The extent to which a patient should be managed may be determined by the degree of severity of the condition, expertise of the doctor and distance to the nearest hospital. Apart from pharmacological management, explanation about the condition and the need for admission and appropriate advice on care prior to admission are also vital components of management. Writing an appropriate referral, arranging transport facilities, informing the hospital about the referral are also important steps in the process as these measures could prevent crucial delays. CONCLUSION: Emergency care is a responsibility of primary care doctors and they should be knowledgeable and skilled and organize their practices to provide prompt and effective management whenever the need arises.
Palliative care; role of family physicians
(Mumbai : Medknow, 2016) Ramanayake, R.P.J.C.; Dilanka, G.V.; Premasiri, L.W.
Palliative care is the holistic approach to provide relief to patients suffering from life threatening diseases and their families throughout the disease. This is mainly through the prevention and relief of suffering by means of early identification, comprehensive assessment and management of physical, psychosocial and spiritual problems. With the rise of elderly population in the world patients needing palliative care will also increase. Family physicians who are closest to the community and easily accessible has a major role to play in providing palliative care. Their broad knowledge, long standing relationship with patients and their families, ability to carry out home visits and communicate and coordinate with other health care resources place them in an ideal position to address complex issues faced by patients. Keeping up to date with knowledge, acquiring counseling skills, non availability of guide lines and medications, lack of support from team and time constraints are the challenges faced by family physicians in providing palliative care. With the aging population, demand on palliative care resources will increase markedly in the next few decades. Developing palliative care models, improving the skills and opportunities for doctors to learn sound palliative care principles have to be initiated without a delay in order to meet the challenges of the future.
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.
Perceptions regarding obesity amongst obese females attending an urban primary healthcare center
(Sri Lanka Medical Association, 2014) Sumanasekera, R.D.N.; Ramanayake, R.P.J.C.; Pathmeswaran, A.
INTRODUCTION AND OBJECTIVES: Sri Lanka is seeing a rise in the obesity epidemic. Middle class females living in urban areas are one of the affected groups. To explore the beliefs and expectations regarding bodyweight of middle class females attending an urban primary healthcare centre in Sri Lanka. METHODS: Baseline data from an intervention study was used for this analysis. Fifty participants were selected randomly from obese females (BMI between 27.5 -40 kg/iVi2) registered with the University Family Medicine Clinic in Ragama and volunteered to participate in a lifestyle modification programme for weight reduction. Their demographic data.and baseline anthropometric measurements were obtained and a focus group discussion conducted on perceptions regarding obesity. RESULTS: Participants were aged 21 -58 years, majority were married housewives with 2 or more children, Weights ranged from 55-92.9 kg, BMIs 27.6-39.7 kg/m2 and waist circumference 90-112 cm. On average the participants wished to lose 11 kg (ranging from 2-30 kg) over a 6 month period. Focus group discussion revealed that participants accepted the norm of putting on weight after childbirth and as part of aging. Knowledge regarding food values was poor and myths regarding diet and exercise were identified. CONCLUSIONS: Unrealistically high targets for weight loss were common among participants. Putting on weight after childbirth with aging was perceived as the norm. Many mistakenly perceived that they had put on weight in spite of sensible eating and adequate levels of physical activity.
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.
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
Structured printed referral letter (form letter); saves time and improves communication
(Mumbai : Medknow, 2013) Ramanayake, R.P.J.C.
Referral of patients to hospitals, specialists and other institutions is an essential part of primary health care. Patients are referred to specialists when investigation or therapeutic options are exhausted in primary care or when opinion or advice is needed from them. Referral has considerable implications for patients, health care system and health care costs. Good communication between primary and secondary care is essential for the smooth running of any health care system. Referral and reply letters are the sole means of communication between doctors most of the time and breakdown in communication could lead to poor continuity of care, delayed diagnoses, polypharmacy, increased litigation risk and unnecessary testing. A referral letter also helps to avoid patient dissatisfaction and loss of confidence in family physician. Studies of referral letters have reported that specialists are dissatisfied with their quality and content. Inclusion of letter writing skills in the medical curriculum, peer assessment and feedback have shown to improve the quality of referral letters. Form letters have shown to enhance information content and communication in referral process. In Sri Lanka referral letters are usually hand written and frequent complaints are that these letters do not contain adequate information and retrieval of information is a problem due to poor legibility and clarity. Sometimes Primary care doctors refer patients to hospitals and specialists with only verbal instructions. To address these short comings this form letter was introduced. Based on the guidelines and systematic review of published articles, items of information to be included were decided. Printed forms of the letter are kept in the practice and the doctor has to just fill up relevant information under each heading. The objectives of introducing this structured referral letter was to improve the quality and standard of referral letters and save time for both general practitioners and specialists
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.