OUTCOMES OF REFERRALS TO GYNECOLOGY OUTPATIENT CLINICS FOR MENSTRUAL PROBLEMS - AN AUDIT OF GENERAL-PRACTICE RECORDS

Objective-To determine referral rates and intermediate and long-term outcomes for patients consulting for menstrual disorders and referred by their general practitioner to gynaecology outpatient clinics. Design-General practitioners' records of referrals to outpatient clinics and retrospective audit of general practice notes to determine outcomes. Setting-General practices in the Oxford Regional Health Authority area referring to 19 gynaecology outpatient clinics. Subjects-205 patients aged 15-59, referred in 1983/4 and follow up in 1988/9. Main outcome measures-Immediate outcomes: the initiation by hospital specialists on investigation, treatment or advice. Five year outcomes: general practice consultation rates and symptom prevalence. Results-Of 18 754 index referrals recorded by 33 practices over a period of 6 months, 2513 (13%) went to gynaecology clinics. Menstrual disorders constituted 21% (n = 539) of the gynaecology referrals; there was more than three-fold variation between the practices in referral rates. In the 5 years following the index referral, of the 205 audited patients 167 (81%) had been admitted to hospital, 91 (44%) had had a hysterectomy (including 87 (60%) of the 145 patients referred for menorrhagia), 98 (48%) had dilatation and curettage; 25 (12%) received only drug therapy; and 10 (5%) had no active treatment for these symptoms from either the specialist or the general practitioner. Only 29 (14%) had consulted their general practitioners about menstrual problems in the 12 months preceding the audit. Conclusions-Guidelines are needed to assist referral decision-making. If audit is to be used to promote good practice these guidelines should consider the patients' anxieties and preferences, as well as the most appropriate use of investigations and treatments.