Referrals to psychiatric service in United arab emirates: an analysis of the content of referral letters.

objectivesTo study all psychiatric referrals by General Practitioners (GPs) to the psychiatric service at Al-Ain Hospital for 7 years starting from July 1997 till December 2003. The study examined the appropriateness of referrals and the quality of information presented in the referral document. Also, it studied the outcome of this referral including the response of the psychiatrist.

methodThe case notes of all patients referred from the Primary Health Centres to the psychiatric service of Al-Ain Hospital for the period specified were studied. The data related to the GP referral were obtained from the copy of the referral letter, in the case notes. The information included: identifying data, reason for referral, symptomatology, relevant medical history and investigations, provisional diagnosis, recommended action, and the response of the psychiatrist. The diagnosis in the referral letter was compared to the International Classification of Diseases, 10th edition, Primary Health Care version [ICD-10 (PHC)], and to the final diagnosis in the case notes for agreement.

resultsamong the whole sample of 503 GP referrals there were 309 males (61.4%) and 179 (35.6%) females and 15 (3%) missing data. The mean age was 32.8 years (SD=13.7), with mean age for UAE nationals 31.4 years (SD=15.58) and expatriates as 34.3 years (SD=11.32) with significant difference between the two groups (t=2.253, p=0.03), 74.2% expatriates males with significant difference, and 15 missing data. Analysis of the referral letters showed that Diagnosis was clearly indicated in 380 (77.2%), was not mentioned in 112 (22.8%) of the referral letters, with 11 missed data. Psychiatrists agreed with the GP diagnosis in 205 of them (41.7%), but considered diagnosis inaccurate in 175 (35.6%) of these cases. All the referred patients had been seen by psychiatrists. However, replies of the psychiatrists to the GPs referrals were made only in 29 patients (5.9%); 4 of these replies were written and the 2 copies of the letter were kept in the file. No reply was written in 460 cases and 14 missing data. Also physical examination and investigations were not mentioned in the majority of referrals.

conclusionThere is poor quality of GP referral letters and obvious poor response rate of psychiatrists to the GPs. This is an indication for urgent need for intensive training to GPs advising them to include particular items of information in future referrals.