ArticleBMC health services research2022
The impact of referral letter quality on timely access to specialised mental health care: a quantitative study of the reliability of patient triage.
Article in BMC health services research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01374035 (Interface Between Primary Care and Specialist Mental Health Care - the Referral Letters), which is not on this map. Cited by 5 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Interface Between Primary Care and Specialist Mental Health Care - the Referral Letters
Who cites it
5 citing papers in PubMed.
- Generative AI and Clinicians Show Comparable Prognostic Reasoning From Clinical Narratives in Biologic-Treated CRSwNP.World journal of otorhinolaryngology - head and neck surgery · 2026Article
- Hospital triage of general practice referrals: exploring the role of triage in rejected referrals.BMC health services research · 2026Article
- Conveying the need for mental healthcare - a qualitative study of how patients communicate mental health challenges.BMC health services research · 2025Article
- Lack of sex bias in the referral letters for patients with inflammatory bowel disease: a mixed methods evaluation.Journal of the Canadian Association of Gastroenterology · 2025Article
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPatients referred to specialised mental health care are usually triaged based on referral information provided by general practitioners. However, knowledge about this system's ability to ensure timely access to and equity in specialised mental health care is limited. We aimed to investigate to the degree to which patient triage, based on referral letter information, corresponds to triage based on a hospital specialist's consultation with the patient, and whether the degree of correspondence is affected by the quality of the referral letter.
methodsWe gathered information from three specialised mental health centres in Norway regarding patients that were referred and offered health care (N = 264). Data consisted of triage decisions for each patient (i.e., the hospital specialist's assessment of maximum acceptable waiting time), which were determined on the basis of a) referral information and b) meeting the patient. Referral letter quality was evaluated using the Quality of Referral information-Mental Health checklist. The reliability of priority setting and the impact of referral letter quality on this measure were investigated using descriptive analyses, binary logistic regression and Nadaraya-Watson kernel regression.
resultsIn 143 (54%) cases, the triage decision based on referral information corresponded with the decision based on patient consultation. In 70 (27%) cases, the urgency of need for treatment was underestimated when based on referral information compared with that based on information from patient consultation. Referral letter quality could not explain the differences between the two triage decisions. However, when a cut-off value of 7 on the Quality of Referral information-Mental Health scale was used, low-quality letters were found more frequently among patients whose urgency of need was underestimated, compared with those whose need was overestimated.
conclusionsDeciding the urgency of patient need for specialised mental health care based on referral information is a reliable system in many situations. However, the possibility of under- and overestimation is present, implying risks to patient safety and inappropriate use of resources. Improving the content of referral letters does not appear to reduce this risk when the letters are of acceptable quality.
trial registrationNCT01374035 .
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