Improving patient follow-up in incidental screening through referral letters

Area of Science:

• Cardiovascular Medicine
• Health Services Research
• Patient Adherence

Background:

• Hypertension management requires consistent follow-up assessments.
• Administrative barriers can impede patient access to longitudinal care, particularly within systems like the Veterans Administration.
• Effective communication strategies are crucial for ensuring patients attend necessary medical appointments.

Purpose of the Study:

• To evaluate the impact of different types of referral letters on patient follow-up for hypertension assessments.
• To determine if patient-directed versus physician-directed letters are more effective in increasing appointment attendance.
• To assess the combined effect of patient and physician letters.

Main Methods:

• A randomized controlled trial involving 74 patients with elevated diastolic blood pressure (95-120 mm Hg).
• Patients were assigned to four groups: patient letter only, physician letter only, both letters, or no letter (control).
• Follow-up attendance for hypertension evaluation was the primary outcome measure.

Main Results:

• Patients receiving a patient-directed letter were nearly twice as likely (63%) to return for a hypertension evaluation compared to those not receiving one (33%).
• No significant difference in follow-up rates was observed between the physician letter and no physician letter conditions.
• No interaction effect was found between patient and physician letters.

Conclusions:

• Patient-directed referral letters are an effective strategy for increasing follow-up rates for hypertension evaluations.
• Physician-directed letters alone did not demonstrate a significant impact on patient follow-up in this study.
• These findings support the use of patient-focused communication to improve adherence to essential medical care, including for newly detected hypertension cases.