BACKGROUND : Primary care practitioners depend on the feedback from hospitals in order to care for returning patients effectively.
Lack of such feedback from the hospitals leads to frustration, poor efficiency and care that it is not cost effective. This study examined
the presence and adequacy of written feedback from first referral hospitals to primary health clinics (PHC) in the Metsweding
district, Tshwane, South Africa.
METHODS : A retrospective descriptive stratified cluster study was done by reviewing 863 patient records selected randomly from
referred patients between 1 January 2010 and 31 December 2011 in 6 of the 11 clinics. The clinics were stratified according to
type of setting and 6 clinics sampled proportionately.
RESULTS : Of the 858 referrals only 5.4% (n = 46) had feedback letters. Details of the patient were listed in 35 (76.0%) of the feedback
letters. There were no contact details for the referring institution or practitioner in almost half of the feedback letters (41.8%;
n = 19). Most did not mention the symptoms (87%; n = 40) or signs (89.2%; n = 41) but the majority (58.6%; n = 27) recorded the
condition or diagnosis of the patient. The follow-up instructions were documented in 30 letters (65.2%).
CONCLUSIONS : The low rate of return feedback letters appears to be a commonplace experience and this study both quantifies
the extent of this problem and highlights the weaknesses in the letters themselves. The findings reinforce the experiences of
practitioners in PHCs and have practical implications for hospital doctors and district hospital managers who wish to strengthen
the health system.