Mariken Stegmann

preferred regional hospitals because, compared to university hospitals, it was considered  easier to contact specialists (Q12).  Q12: But, talking about [the university hospital]; yes, I prefer not to work with them  […] yes, I often find it difficult to contact them.  Interview with GP1. (Rural general practice, I1)  Discussion  Key findings  We identified 70 items of correspondence between primary and secondary care. Six topics  were identified in almost all referral letters (Box 1), but it was most notable that highly  relevant information was often mixed with less relevant information in the past medical  history, medication list and history of the presenting complaint. By contrast, specialist letters  included nine common topics (Box 2), and although information about actual treatment was  always presented, it was rare for the letters to include information about the intent of the  treatment (curative or palliative), whether there had been any discussion about treatment  alternatives or about how the patient had reacted to the information received.  Comparison with the literature  This study adds to the small body of evidence about written communication between  healthcare providers, especially that concerning patients with cancer. We note two features  that we believe reflect use of the ZorgDomein system. Firstly, in contrast to existing results  in the literature, 14,15  referral letters in our sample typically mentioned the reason for  referral. This could be explained by the fact that most GPs in the Netherlands refer patients  using ZorgDomein, which pre‐specifies the information required. 23  Secondly, the lack of  discrimination between relevant and less relevant information has not been mentioned in  the literature before. This finding can also be explained using the ZorgDomein system that  automatically exports information from the electronic patient file into the referral letter.  Apparently, GPs fail to adjust the exported information.  Concerning specialist letters, and consistent with the existing literature, we found that the  treatment goal and prognosis were seldom mentioned. 16,27  By contrast, current medication  details were almost always mentioned, despite this not being the case in previous  research. 17  Also consistent with previous research, technical information about radiation  therapy was included in all letters, even though only a minority of the GPs wanted the  information. 28  These findings suggest that letters are sometimes meant to provide a means  of storing rather than exchanging information, which may explain why they are poorly  tailored to the needs of the recipient. 16,17 Overall, the findings of our study indicate that both referral and specialist letters were not  always written with the primary aim of mutual communication. This aim could be defined as  providing the information needed to ensure continuity of care, between hospital and  primary care, without giving redundant information. 29  To improve communication, it would  be interesting to explore the information different healthcare providers find essential or  desirable in communication.  74 Chapter 6