Objectives The referral letter is a key tool for information exchange between physicians. This study aims to evaluate the quality of referral letters received by a rheumatology department and to examine the correlation between the characteristics of referring physicians and the referral quality. Methods This cross-sectional study was conducted in the rheumatology outpatient clinic of a university hospital. We included new patients referred with a legible letter and for whom a final diagnosis was established by a rheumatologist. Each referral letter was evaluated for its format, administrative details, information about the referring physician, and clinical content. Results Out of 1468 new patients, we included 478 (35.6%). Referral letters were handwritten in 99.2% of cases. The presence of a date on the referral letter was correlated with the referring physician’s specialty, with higher rates among primary care physicians (p < 0.001); by professional title, favoring specialists and senior physicians (p = 0.001); and by practice setting, with higher rates in the public sector, particularly primary healthcare centers and secondary hospitals (p < 0.001). The patient’s age and medical history were not specified in 11.1% and 30.5% of the letters, respectively, and were more often specified by specialist physicians compared to primary care physicians and those practicing in university hospitals. Osteoarticular examination findings were mentioned in 10.9% of letters. Diagnostic tests were requested by 32.4% of doctors, particularly those practicing in regional hospitals (p = 0.016). A diagnosis was suspected in 34.9% of cases. Conclusion The analysis of letters addressed in rheumatology revealed several shortcomings essentially associated with the profile of the referring doctor. <Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> Key Points • Referral letters lacked essential information. • The quality of referral letters is associated with the characteristics of the referring physician. • Suspected diagnoses were often omitted. </entry> </row> </tbody> </tgroup> </Table>

Quality of referral letters to the rheumatology department of a tertiary care center: room for improvement

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发表日期：

2025年12月23日

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Safa Rahmouni,
Ines Mahouachi,
Khaoula Zouaoui,
Maissa Abess,
Sonia Rekik,
Soumaya Boussaid,
Hela Sahli

摘要

Objectives

The referral letter is a key tool for information exchange between physicians. This study aims to evaluate the quality of referral letters received by a rheumatology department and to examine the correlation between the characteristics of referring physicians and the referral quality.

Methods

This cross-sectional study was conducted in the rheumatology outpatient clinic of a university hospital. We included new patients referred with a legible letter and for whom a final diagnosis was established by a rheumatologist. Each referral letter was evaluated for its format, administrative details, information about the referring physician, and clinical content.

Results

Out of 1468 new patients, we included 478 (35.6%). Referral letters were handwritten in 99.2% of cases. The presence of a date on the referral letter was correlated with the referring physician’s specialty, with higher rates among primary care physicians (p < 0.001); by professional title, favoring specialists and senior physicians (p = 0.001); and by practice setting, with higher rates in the public sector, particularly primary healthcare centers and secondary hospitals (p < 0.001). The patient’s age and medical history were not specified in 11.1% and 30.5% of the letters, respectively, and were more often specified by specialist physicians compared to primary care physicians and those practicing in university hospitals. Osteoarticular examination findings were mentioned in 10.9% of letters. Diagnostic tests were requested by 32.4% of doctors, particularly those practicing in regional hospitals (p = 0.016). A diagnosis was suspected in 34.9% of cases.

Conclusion

The analysis of letters addressed in rheumatology revealed several shortcomings essentially associated with the profile of the referring doctor.

Key Points

• Referral letters lacked essential information.

• The quality of referral letters is associated with the characteristics of the referring physician.

• Suspected diagnoses were often omitted.