NEW ORLEANS A simple form could be all that you need to help ease the flow of communication with your primary care referrers, Wake Forest University researchers wrote in a poster presented at the annual meeting of the American Academy of Dermatology.
Steven R. Feldman, M.D., a professor of dermatology, pathology, and public health sciences at the university in Winston-Salem, N.C., helped to design the form. Dr. Feldman, who is also a solo dermatologist in Mount Airy, N.C., understands firsthand the difficulties in communicating information to the primary care physicians who refer patients to him.
It can take 7-10 days in some cases before the primary care doctor receives a report from the dermatologist. In the meantime, many patients have returned to their primary care physician's office before the report on their visit, he said.
This information lag compromises patient care, according to Dr. Feldman. The patient is unable to be treated because the referring physician doesn't know the patient's diagnosis, treatment plan, and health status.
He and his colleagues at Wake Forest set out to design a form that would include the most important information. Their study was supported by Galderma Laboratories.
The form includes a section for the diagnosis and a silhouette for marking the location of skin lesions or eruptions. It also includes a section for listing the most frequently prescribed medications as well as the dosage, frequency, and duration of treatment.
The one-page form is designed to be filled out at the point of care and can be faxed to the referring physician.
To make the process more efficient from the dermatologist's standpoint, he tracked his most frequently prescribed medications and added them to the form with a check box next to each one.
The multilayered form also doubles as a prescription pad, he said.
Dr. Feldman told this newspaper that he plans to use the form in his practice and to continue to improve it based on feedback from referring physicians. He has no plans to commercialize the form but said he is happy to share it with other physicians.
The researchers measured the effectiveness of the form by surveying five primary care physicians or their office staff about their experiences using the tool. They also interviewed another eight primary care physicians.
In general, the primary care physicians who were interviewed about the form said that reporting delays are a common problem, and the form is a potential way to eliminate those delays.
Michael Shea, M.D., a family physician in Greensboro, N.C., who reviewed the form as part of the study agrees. "The concept of the form is fantastic," he told this newspaper.
In his experience, it can take up to 3 weeks to get information from specialists, and when the information arrives, it's usually in the form of several pages of office notes. Having the diagnosis and treatment plan in hand allows the primary care physician to treat the other facets of the condition, Dr. Shea said. It also allows the opportunity to look for drug-drug interactions with the patient's other medications.
But there's not just one way to streamline the communication between primary care physicians and specialists, said Rosemarie Nelson, a consultant for the Medical Group Management Association.
For example, some practices are having their transcription service save each patient's note in a separate electronic file and are sending that to the referring physician by fax. This doesn't need to be done using an electronic medical record, Ms. Nelson told this newspaper. Instead, it can be done with more basic technology like a fax modem or fax server.
In his office, Joseph S. Eastern, M.D., a dermatologist in Belleville, N.J., uses a simple computer template to record the diagnosis and treatment information for the referring physician. He makes a point of filling out the template the same day and sending it off to the referrer in the morning. "They want it fast," Dr. Eastern told this newspaper. "That's the No. 1 thing for them."
The dermatology referral form can be accessed at http://www.wfubmc.edu/dermatology/files/consultation_form.doc
COURTESY DR. STEVEN R. FELDMAN