RESUMO
Letters between hospital clinicians and general practitioners following an outpatient clinic (OPD) consultation have generally not been shared with patients. Recent guidelines from the Academy of Medical Royal Colleges recommend that all OPD letters should be written directly to the patient. While the benefits of this approach are recognised, additional attention is required to ensure readability, accuracy and acceptability. Our aim was to improve urology OPD letters in a university teaching hospital to ensure suitability for sharing with patients over a 3-month period as measured by patient feedback. In one OPD, 71% of patients stated that they wished to receive a copy of their letter. We designed, tested and implemented two paper-based, self-explanatory prompts to ensure doctors used paragraphs and a structured letter format when dictating OPD letters. This was achieved using a 90-day improvement cycle supported by a quality improvement learning collaborative and evaluated by measurement of Flesch Reading Ease Score, use of paragraphs, use of letter structure and patient feedback. Following the implementation of the intervention, letters were sent to 120 patients and feedback was obtained from 63 patients with either a feedback postcard or telephone interview. Of the 53 patients who agreed to participate in the telephone feedback, 39 (74%) found the letter easy to understand, 49 (92%) reported it was accurate and summarised the consultation as they remembered it and 38 (72%) reported that reading the letter improved their understanding of their OPD visit. All patients said they would like to receive similar letters from future OPD consultations. This improvement report describes the implementation of an intervention to improve the quality of OPD letters and the acceptability and value of these letters to patients.
RESUMO
Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic debilitating condition that is characterised by suprapubic pain and urinary symptoms such as urgency, nocturia and urinary frequency. The prevalence of the condition is increasing due to more inclusive diagnostic criteria. Herein, we review the evolving epidemiology of IC/PBS and investigate health seeking behaviour for the condition through Internet search activity. Study selection was performed in accordance with PRISMA. In addition, global search trends for the terms 'Interstitial Cystitis' and 'Painful Bladder Syndrome' from 2005 to 2015 were also evaluated using the 'Google Trends' search application. The mean search activity per month was recorded and mean activity at annual intervals calculated. Regional search activity by country and city was also measured. Prevalence rates for IC/PBS vary according to diagnostic criteria and range from 2% to 17.3% among the general population. Increased prevalence is associated with female gender and females with one first-degree relative affected. There has been an increase in global mean search activity for IC/PBS on an annual basis since 2005. The greatest increase in search activity was in USA, Canada, United Kingdom, Australia, Ireland and India respectively. The top five cities for search activity for IC/PBS were in the USA. As diagnostic criteria for IC/PBS continues to become more inclusive it is likely that the prevalence will continue to increase. This is particularly true for the USA and Canada as these regions have demonstrated the greatest increase in Internet search activity for IC/ PBS.
