Appropriateness of hospital referral for hypertension.

OBJECTIVE: To examine the efficiency of referral to an outpatient clinic and particularly the differences between referrals from general practitioners practising in health centres and those from other general practitioners.
DESIGN: Retrospective audit of referral letters and case notes by comparison with externally set standards of appropriateness of referrals over two years.
SETTING: Outpatient hypertension clinic at Western Infirmary, Glasgow. PATIENTS: 306 Consecutive new referrals of patients over two years (1 May 1986 to 30 April 1988), for whom case notes were available in 298. MAIN OUTCOME MEASURES: Congruence of referrals with each of two standards of appropriateness based on published opinion on specialist referral (standard 1 was stricter than standard 2) and completeness of referral letters.
RESULTS: Of the 298 referrals, those from general practitioners accounted for 205, from other hospital departments 68, and from other sources 25. Overall, 84 referrals of the 205 from general practice met the first standard and 134 met the second, more lenient standard. 58 Referral letters from outside the hospital had some item missing. Referrals from general practitioners working in health centres (a fifth of the total) were significantly more likely to meet both standards (p less than 0.01) and to send a complete referral letter (p less than 0.001) than the 145 referred by other general practitioners.
CONCLUSIONS: According to the standards used, general practitioners in health centres made more appropriate referrals, and further investigation is needed to identify the underlying factors responsible.