The impact of the quality of communication from nephrologists to primary care practitioners : a literature review

Objective: This review of the literature aims to explore two research questions: (1) what is the evidence that patients benefit from sound communication between primary care physicians (PCPs) and nephrologists; and (2) what information is required in primary care to meet the needs of patients who have attended a renal unit? Research design and methods: 57 citations were independently reviewed by the four authors. The inclusion criteria were: (1) the article focused on information flow from nephrologists and or specialists to general practitioners; (2) it includes the involvement of PCPs in nephrology, including registrars and PCPs with special interests or specialists in any medical field; (3) it was published from 1990 onwards (inclusive) and (4) the study was conducted in the United Kingdom, Canada, The Netherlands, Australia, United States or New Zealand. Selected articles were then reviewed by a different author as a measure of inter-rater reliability. Results: 18 papers in four categories were identified: six audits or observational studies, one meta-analysis; one randomised control trial, six qualitative studies; four position statements or quality improvement tools. Published audits involving feedback to clinicians using validated tools demonstrate the scope for substantial improvement in the amount of information relayed to PCPs. Specialists may not prioritise the letter to the PCP but there is some evidence that there is a direct impact from this limited or inadequate communication on outcomes to patient care. Only two studies focused on patients attending nephrology clinics. Conclusions: There is some evidence that improving the quality of letters from specialists to PCPs may be beneficial to patient care. This review suggests a need for research on communication from nephrologists about patients who have received care at a renal unit regardless of whether or not the patient continues to attend.