A Study of the Performance of Referral System in Urban Family Physician Program in Fars Province, Iran
Introduction: The family physician referral system has been determined as a major goal to economic, social, and cultural development in the field of health in Iran. The necessity of implementing this system has been explicitly stated in high-level documents. Hence, the aim of this study was to evaluate the overall performance of the referral system in Fars Province in 2015.
Methods: In this cross-sectional study, 20% of family physicians (75 doctors) were randomly selected; then, all patients of these physicians (1289 patients) in one work shift were studied. The data were collected in three parts containing the questions related to the physician and patients using data collection forms. Finally, data analysis was performed through SPSS, version16, using descriptive statistics and Chi-square test.
Results: The results showed that 70.3% of the patients (906 patients) had used the referral system to visit specialists. Most of the referral forms had been completed correctly (63.6%). Most of the referrals (820 cases) were recognized as necessary (59.4%) and from the first level of referral, i.e. by the family physician (96.3%: 1241 cases). The patients aged 70 and over had the minimum self-referrals, whereas young people aged lower than 20 had the maximum selfreferrals (P=0.03). Also, more self-referrals were observed among highly educated patients (P=0.001).
Conclusion: Based on the findings, the most important problems of the referral system included self-referrals, incomplete referral forms, and unnecessary referrals. Self-referral could be solved through education, establishment of an electronic referral system, and legal measures. Also, educating doctors, making an electronic referral system, and using auxiliary staff and incentive measures can reduce the incompleteness of the referral forms. To reduce the patients’ unnecessary referrals, development of referral guidelines might be very effective.
Keywords: Family physician, Referral, Practice management
Mehrolhassani MH, Sirizi MJ, Poorhoseini SS,
Feyzabadi VY. The Challenges of Implementing
Family Physician and Rural Insurance Policies
in Kerman Province, Iran: A Qualitative Study.
Journal of Health and Development. 2012;1(3):193-
Hafezi Z, Asqari R, Momayezi M. Monitoring
performance of family physicians in Yazd. 2009;
Executive headquarters of Family Physician
Program and referral system. Family Physician
Program and Referral System Instructions in
Urban Areas. Tehran: Ministry of Health and
Medical Education; 2012.
Planning and Strategic Supervision Department
of President [Internet]. Fifth Five-Year
Development Plan of Islamic Republic of Iran.
Available from: http://www.behdasht.
Management and Planning Organization
[Internet]. Fourth Five-Year Development Plan
of Islamic Republic of Iran. 2004. Available from:
Shariati M, Moghimi D, Rahbar M, Kazemini
H, Mir Mohammad Khani M, Emamian MH
[Internet]. Family Physician in health system
map in 2025 of Islamic Republic of Iran. National
Institute for Health Research of Islamic Republic
of Iran. Available from: http://ihm.behdasht.gov.
Majdzadeh R. Family physician implementation
and preventive medicine; opportunities and
challenges. Int J Prev Med. 2012;3(10):665-9.
Eskandari M, Abbaszadeh A, Borhani F. Barriers
of referral system to health care provision in
rural societies in iran. Journal of caring sciences.
;2(3):229-36. doi: 10.5681/jcs.2013.028.
Golalizadeh E, Moosazadeh M, Amir Esmaeeli
M, Ahangar N. Challenges in second level
of referral system in family physician plan: a
qualitative research. Journal of Medical Council
of Iran. 2011;29(4):309-21.
Xu J, Wang W, Li Y, Zhang J, Pavlova M, Liu H, et
al. Analysis of factors influencing the outpatient
workload at Chinese health centres. BMC Health
Serv Res. 2010;10:151. doi: 10.1186/1472-6963-10-
Afkar A, Pourrza A, Mehrabian F. Family
physician performance from the perspective
of Gilani customers. Journal of Hospital.
Matalon A, Nahmani T, Rabin S, Maoz B, Hart J.
A short-term intervention in a multidisciplinary
referral clinic for primary care frequent attenders:
description of the model, patient characteristics
and their use of medical resources. Fam Pract.
Nasrollahpour Shirvani S. The implementation of
family physician program in Iran: achievements
and challenges. J Babol Univ Med Sci.
Honarvar B, Lankarani KB, Ghahramani S,
Akbari M, Tabrizi R, Bagheri Z, et al. Satisfaction
and Dissatisfaction Toward Urban Family
Physician Program: A Population Based Study in
Shiraz, Southern Iran. Int J Prev Med. 2016;7:3.
Chaman R, Amiri M, Raee M. National survey
of family physician and quality of the referral
system. Payesh Journal. 2012;11(6):785-90.
Bossyns P, Abache R, Abdoulaye MS, Miye H,
Depoorter AM, Van Lerberghe W. Monitoring
the referral system through benchmarking in
rural Niger: an evaluation of the functional
relation between health centres and the district
hospital. BMC Health Serv Res. 2006;6:51. doi:
Forrest CB, Shadmi E, Nutting PA, Starfield B.
Specialty referral completion among primary
care patients: results from the ASPN Referral
Study. Ann Fam Med. 2007;5(4):361-7.
Jiwa M, Coleman M, McKinley RK. Measuring
the quality of referral letters about patients
with upper gastrointestinal symptoms. Postgrad
Med J. 2005;81(957):467-9. doi: 10.1136/
Shabila NP, Al-Tawil NG, Al-Hadithi TS, Sondorp
E, Vaughan K. Iraqi primary care system in
Kurdistan region: providers’ perspectives on
problems and opportunities for improvement.
BMC Int Health Hum Rights. 2012;12:21. doi:
Mehrotra A, Forrest CB, Lin CY. Dropping the
baton: specialty referrals in the United States.
Milbank Q. 2011;89(1):39-68. doi: 10.1111/j.1468-
Cheng J, Beltran-Agullo L, Trope GE, Buys
YM. Assessment of the quality of glaucoma
referral letters based on a survey of glaucoma
specialists and a glaucoma guideline.
Ophthalmology. 2014;121(1):126-33. doi: 10.1016/j.
Richards DB, Jacquet GA. Analysis of referral
appropriateness in the Western Cape, South
Africa, and implications for resource allocation.
African Journal of Emergency Medicine.
Hashmi FK, Chaudhry TA, Ahmad K. An
evaluation of referral system for retinopathy
of prematurity in leading health centers
across Karachi, Pakistan. J Pak Med Assoc.
Zuckerman KE, Perrin JM, Hobrecker K,
Donelan K. Barriers to specialty care and
specialty referral completion in the community
health center setting. J Pediatr. 2013;162(2):409-
e1. doi: 10.1016/j.jpeds.2012.07.022.
Cervantes K, Salgado R, Choi M, Kalter HD.
Rapid assessment of referral care systems: a guide
for program managers. 2003.
Laal N, Shekarriz R, Bahadoram M, Dorestan N.
Evaluation of the Referral System Performance in
the Family Physician Program. Persian Journal of
Medical Sciences (PJMS). 2016;3(1).
Nourafkan O, Yazdanpanah A, Kharazmi E. The
study of urban family physicians performance
and its related factors in the south of Iran.
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution 3.0 License.
pISSN: 2322-1097 eISSN: 2423-5857