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Br J Obstet Gynaecol. 1991 Aug;98(8):789-96.

Outcomes of referrals to gynaecology outpatient clinics for menstrual problems: an audit of general practice records.

Author information

1
Unit of Clinical Epidemiology, University of Oxford, Headington.

Abstract

OBJECTIVE:

To determine referral rates and intermediate and long-term outcomes for patients consulting for menstrual disorders and referred by their general practitioner to gynaecology outpatient clinics.

DESIGN:

General practitioners' records of referrals to outpatient clinics and retrospective audit of general practice notes to determine outcomes.

SETTING:

General practices in the Oxford Regional Health Authority area referring to 19 gynaecology outpatient clinics.

SUBJECTS:

205 patients aged 15-59, referred in 1983/4 and follow up in 1988/9.

MAIN OUTCOME MEASURES:

Immediate outcomes: the initiation by hospital specialists of investigation, treatment or advice. Five year outcomes: general practice consultation rates and symptom prevalence.

RESULTS:

Of 18,754 index referrals recorded by 33 practices over a period of 6 months, 2513 (13%) went to gynaecology clinics. Menstrual disorders constituted 21% (n = 539) of the gynaecology referrals; there was more than three-fold variation between the practices in referral rates. In the 5 years following the index referral, of the 205 audited patients 167 (81%) had been admitted to hospital, 91 (44%) had had a hysterectomy (including 87 (60%) of the 145 patients referred for menorrhagia), 98 (48%) had dilatation and curettage; 25 (12%) received only drug therapy; and 10 (5%) had no active treatment for these symptoms from either the specialist or the general practitioner. Only 29 (14%) had consulted their general practitioners about menstrual problems in the 12 months preceding the audit.

CONCLUSIONS:

Guidelines are needed to assist referral decision-making. If audit is to be used to promote good practice these guidelines should consider the patients' anxieties and preferences, as well as the most appropriate use of investigations and treatments.

PMID:
1911587
[Indexed for MEDLINE]

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