Communication between primary care physician and consultants is essential for continuing patient care. Several studies have noted failures of consultants to provide follow-up information to the referring physician. We studied the referral pattern in a family practice clinic, and tried to increase written communication between consultants and primary care physicians. 306 patients referred to medical consultants during a 6-month period received either a routine referral form with the patient's name, age and reason for consultation, or an experimental referral form with a special area for the consultant to fill out and return to the referring family physician via the patient. The overall referral rate was 6.4%, the most frequently consulted specialists being ophthalmologists (27%), followed by surgeons (26.4%), internists (24.7%), otolaryngologists (10%) and gynecologists (8%). Consultation reports were returned to the referring physician in 55% of the cases. The return rate was significantly higher (62.5%) for the experimental form than the standard form (48%), (p < 0.004, X2 = 15.18). This improvement in response rate was seen for all specialists and for the different types of clinics. The proposed referral form is a simple and inexpensive method of improving communication between family practitioners and specialists, thus ensuring continuity of patient care.

Sixteen patients (mean age 68 years) with mild to moderate hypertension were treated with either diltiazem or hydrochlorothiazide for 6 weeks, followed by enalapril for a further 6 weeks. A second group of 40 patients (mean age 71 years) was treated with either hydrochlorothiazide or enalapril for 12 weeks; nonresponders received both drugs for 8 weeks. Treatment with hydrochlorothiazide or enalapril resulted in a lowering of systolic and diastolic blood pressures, but diastolic pressure was lower in patients treated with enalapril (89 ± 2 and 82 ± 2 mm Hg, respectively; p < 0.05). Treatment with diltiazem resulted in a decrease in diastolic pressure only. Treatment with hydrochlorothiazide resulted in a 17% decrease in serum potassium (p < 0.05), which returned to normal when enalapril was substituted. Hydrochlorothiazide also produced a 23% decrease in mononuclear cell sodium content at 4 weeks (p < 0.01), with a further 15% decrease at 12 weeks (p < 0.05). Mononuclear cell potassium and magnesium also decreased at 12 weeks by 18 and 16%, respectively (p < 0.05). All these effects were reversed when enalapril was substituted. A similar pattern of events was seen with diltiazem, which was again reversed with enalapril. Finally, there was no relation between changes in mononuclear cell sodium or other cation content and changes in blood pressure.