The Finnish national asthma programme: communication in asthma care--quality assessment of asthma referral letters.
OBJECTIVE
The Finnish National Asthma Programme, which was launched in year 1994, considered the management of asthma as a community problem. The role of the primary health care in the management of asthma was emphasized. Optimal asthma management includes good communication between health care professionals. Referral letters are an accepted tool for evaluation of the communication process. The aim of this study was to assess the quality of asthma-related referral letters.


METHODS
All non-acute referral letters (n=3176) to three pulmonary departments were screened in 2001 and all those related to asthma were included (n=1289). The 14 previously derived asthma-specific criteria were applied: occupation, smoking, known allergies, current medication, other diseases, onset of symptoms, wheezing, dyspnoea, specified dyspnoea, cough, specified cough, use of asthma medication, peak-flow follow-up or spirometry with bronchodilatation test as an attachment. The study group was prepared to accept the maximum of 30% of the referral letters to be of poor quality.


RESULTS
Twenty-one per cent of the referral letters were graded good, 34% satisfactory and 45% poor. Information on wheezing, smoking habits and current medication was mentioned in 44%, 42% and 41% of asthma letters respectively.


CONCLUSIONS
The Finnish National Asthma Programme calls for optimizing communication between doctors. The proportion of poor letters was 50% higher than the preset standard and clearly indicates a need for improvement. We found several issues, which need to be better communicated (smoking, lung function tests, wheezing, medication) when referring a patient with suspected asthma.
Tuomisto
Leena E
LE
Central Hospital, Seinäjoki, Filha, and University of Helsinki, Department of General Practice and Primary Health Care, Finland. leena.tuomisto@epshp.fi
Erhola
Marina
M
Marina
Erhola
E
Kaila
Minna
M
Minna
Kaila
K
Brander
Pirkko E
PE
Kauppinen
Ritva
R
Ritva
Kauppinen
K
Puolijoki
Hannu
H
Hannu
Puolijoki
P
Kekki
Pertti
P
Pertti
Kekki
K
D001249:Asthma / Q000628:therapy*; D003142:Communication; D005387:Finland; D006801:Humans; D011785:Quality Assurance, Health Care; D012017:Referral and Consultation / Q000592:standards*