A qualitative study on the contents of referral letters from primary care physicians to psychiatrists

Primary care physicians (PCPs) are required to collaborate with psychiatrists to provide mental health care, and referral letters are used as a basic form of communication between them. However, studies on what should be included in referral letters remain insufficient. Therefore, this study aimed to reveal what PCPs and psychiatrists believe should be included in referral letters and their attitudes toward writing them. A semi-structured focus group study was conducted from October 2024 to March 2025. Each group consisted of 4 to 6 psychiatrists or PCPs, who were recruited by purposive sampling. The interviews were conducted by two PCPs, and then transcribed and analyzed using framework analysis. In total, 17 PCPs and 15 psychiatrists participated. Three groups included only PCPs and three included only psychiatrists. We identified 18 items that are expected to be included in referral letters and 7 themes regarding the attitudes towards writing them. The following are the expected referral letter contents: “Patient’s profile”; “Physical information to facilitate psychiatrists’ practice”; “Family composition, relationship, and dynamics”; “Assessment and diagnosis”; “Description of symptoms by describing a concrete episode or quoting patient’s words”; “Reason for referral”; “Intention to involve the patient after referral”; and “Medication history.” Several differences regarding content emerged. PCPs were concerned that their description of the assessment and diagnosis might influence the psychiatrist’s practice, but this was not the case. Psychiatrists wanted to receive more details regarding prescription histories, but PCPs did not provide them. The PCP’s attitudes toward writing referral letters involved “PCP’s initiatives within the scope of their medical practice” and “making adjustments and considerations to ensure a brief but clear description of the referral purpose and intention.” Information provided by PCPs can benefit psychiatrists. Therefore, stronger communication between PCPs and psychiatrists is needed to ensure referral letters adequately address psychiatrists’ informational needs.