Journal of
Public Health and Epidemiology

  • Abbreviation: J. Public Health Epidemiol.
  • Language: English
  • ISSN: 2141-2316
  • DOI: 10.5897/JPHE
  • Start Year: 2009
  • Published Articles: 652

Full Length Research Paper

Quality of General Practitioner Referral Letters to a South African Tertiary Hospital: Determinants of Quality Content and Good Practice

Mabuza Langalibalele1*, Maduna Patrick M. H2, Mhlongo Samuel W. P1, Ndimande John V1 and Longo-Mbenza Benjamin3
1Department of Family Medicine and Primary Health Care, University of Limpopo (Medunsa Campus), South Africa. 2Gauteng Department of Health, South Africa. 3Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa.
Email: [email protected]

  •  Accepted: 12 October 2011
  •  Published: 30 November 2011


The aim of this paper is to describe the essential elements of information, to assess the quality of content, to audit the referral practice and to identify the determinants of both good referral and practice from the general practitioners’ referral letters received at a tertiary hospital. A cross-sectional descriptive and evaluative study was conducted at theOutpatient Department of the Dr. George Mukhari Hospital in Pretoria. A sample of 303 general practitioner (GP) referral letters was collected from 25 May to 25 June 2004. Univariate (chi-square test) and multivariate (logistic regression model) identified potential and independent determinants of Good referral and Good practice, respectively. The reason for the referral was reflected in 267 (88%) of the letters. 186 (61.3%) of the referral letters were entirely legible. Proportions of optimal referral letter and good practice were 24.9 (n=77) and 6.5% (n=20), respectively. Presence of past medical history (OR=4.2 95% CI 1.9 – 9.2; P<0.001), systemic examination (OR=13 95% CI 5.8-29.2; P<0.0001), involved system (OR=7 95% CI 3.2- 15.3; P<0.0001) and differential diagnosis (OR=11.7 95% CI 3.6 – 38.5; P<0.001) were the independent determinants of Good referral. Systemic examination (OR=4.8 95% CI 1.9 – 12.3; P<0.001) and side-room tests (OR=4.1 95% CI 1.2 – 14.6; P= 0.008) were the independent determinants of Good practice. There is an urgent need for improvement in the deficient areas to optimise patient care in Pretoria Region.


Key words: General practitioners. Dr George Mukhari Hospital, referral letters, quality, legibility.