title: Smoothing the passage of patients from primary care to specialist respiratory opinion.
abstract: OBJECTIVE
  To assess whether information in general practitioner (GP) referral letters provides a basis for selection of diagnostic tests in patients referred for specialist respiratory advice.
  
  
  METHODS
  We undertook a prospective study within a respiratory outpatients department to compare the diagnostic tests planned at three stages of the referral/specialist consultation process: i) using the GP referral letter alone; ii) using the referral letter and patient history; iii) using the referral letter, patient history, and clinical examination.
  
  
  RESULTS
  Analysis of the content of GP referral letters revealed wide variations in referral information. A high proportion of tests selected using the referral letter alone were altered after specialist history-taking and examination. Far fewer changes were recorded between history-taking and examination.
  
  
  CONCLUSIONS
  Neither literature review nor our study support a system which bases diagnostic test selection on GP referral letters alone. However, our findings suggest that approaches which include specialist history-taking in advance of face-to-face consultation merit further investigation.
authors.affiliation: Imperial College London, NHLI Division at Charing Cross Hospital, London, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: O'Byrne
authors.forename: Camilla
authors.initials: C
authors.lastname: Darlow
authors.forename: Nicola
authors.initials: N
authors.lastname: Roberts
authors.forename: Graeme
authors.initials: G
authors.lastname: Wilson
authors.forename: Martyn R
authors.initials: MR
authors.lastname: Partridge
mesh_terms: D003266:Continuity of Patient Care / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008487:Medical History Taking; D010808:Physical Examination; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data; D015272:Pulmonary Medicine / Q000592:standards / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data; D012140:Respiratory Tract Diseases / Q000175:diagnosis; D006113:United Kingdom