Quality of dementia referrals to later life psychiatry service

Optimal care of patients is dependent on accurate and appropriate communication between primary and secondary care. This is particularly important in disorders of cognition where patients may forget their medical history and other important information. With this in mind, we examined 91 consecutive referrals from general practitioners of patients with possible dementia. The reasons for referral included diagnosis (62.6%), management (36.3%) and long-term care (1%). The referral letter was typed in 70% of letters; up to 30% of handwritten letters were illegible. There was no mention of next of kin in 83.5% of letters, despite the fact that patients could not be relied on to attend clinical appointments due to their memory problems. The telephone number was unmentioned in 56% of letters, which made setting up initial appointment more difficult. Current medications and medical history was stated in 75.8% and 76.9% of the letters respectively. The past psychiatric history and family history was only stated in 28.6% and 6.6% of the letters, despite being of obvious importance. Social circumstances were mentioned in 53.8% of the letters. The Mini-Mental State Examination results and blood tests were recorded in only 13.2% of referral letters. The letters showed that in 90% of patients no X-rays were done, with only 6.6% of patients having computed tomography brain scan and 3.3% of patients having magnetic resonance imaging completed.

This audit showed that many general practice referral letters are missing basic information that can compromise the initial assessment of the patients. The letters should contain enough information to ensure that patients are managed safely and effectively.