title: The quality and relationship of referral and reply letters. The effect of introducing a pro forma letter.
abstract: OBJECTIVE
  An intervention study was conducted to assess the effect of a pro forma letter on the quality of referral letters from general practitioners at a rural hospital in KwaZulu-Natal, and on the quality and rate of replies received.
  
  
  METHODS
  254 referral letters and 111 replies were evaluated.
  
  
  RESULTS
  The quality of referral letters improved after the introduction of the pro forma letter, but the quality of replies did not. The reply rate (43.5%) did not change, and the quality of replies showed a low correlation with the quality of referral letters, indicating that improvements in the quality of referral letters will not necessarily bring about improvements in the quality of replies. Instead, the reply rate was found to be influenced mainly by the hospital to which the patient was referred. Replies were also observed to function poorly as a means of continuing medical education.
  
  
  CONCLUSIONS
  Pro forma letters improve the quality of referral letters, but on their own do not improve the rate and quality of replies. Personal contact between referring doctors and consultants would seem to be an important factor in respect of the latter.
authors.affiliation: Department of Family Medicine, Medical University of Southern Africa.
authors.forename: I D
authors.initials: ID
authors.lastname: Couper
authors.forename: R J
authors.initials: RJ
authors.lastname: Henbest
mesh_terms: D003142:Communication; D015709:Correspondence as Topic; D005194:Family Practice; D006801:Humans; D007400:Interprofessional Relations; D011446:Prospective Studies; D011786:Quality Control; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data; D013019:South Africa