Health Management & Information Science

Health Management & Information Science

A Study of the Performance of Referral System in Urban Family Physician Program in Fars Province, Iran

Document Type : Articles

Authors
Zahra Kavosi
Elham Siavashi
Abstract
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
  1. Mehrolhassani MH, Sirizi MJ, Poorhoseini SS,
  2. Feyzabadi VY. The Challenges of Implementing
  3. Family Physician and Rural Insurance Policies
  4. in Kerman Province, Iran: A Qualitative Study.
  5. Journal of Health and Development. 2012;1(3):193-
  6. Hafezi Z, Asqari R, Momayezi M. Monitoring
  7. performance of family physicians in Yazd. 2009;
  8. (1,2) :1-11
  9. Executive headquarters of Family Physician
  10. Program and referral system. Family Physician
  11. Program and Referral System Instructions in
  12. Urban Areas. Tehran: Ministry of Health and
  13. Medical Education; 2012.
  14. Planning and Strategic Supervision Department
  15. of President [Internet]. Fifth Five-Year
  16. Development Plan of Islamic Republic of Iran.
  17. Available from: http://www.behdasht.
  18. gov.ir/index.jsp?fkeyid=&siteid=1&pageid=130
  19. &newsview=12438. Persian.
  20. Management and Planning Organization
  21. [Internet]. Fourth Five-Year Development Plan
  22. of Islamic Republic of Iran. 2004. Available from:
  23. http://www.behdasht.gov.ir/uploads/1_101_
  24. barname%204%20tosee.pdf. Persian.
  25. Shariati M, Moghimi D, Rahbar M, Kazemini
  26. H, Mir Mohammad Khani M, Emamian MH
  27. [Internet]. Family Physician in health system
  28. map in 2025 of Islamic Republic of Iran. National
  29. Institute for Health Research of Islamic Republic
  30. of Iran. Available from: http://ihm.behdasht.gov.
  31. ir/Images/UserFiles/26/file/family%20doctor.
  32. pdf. Persian.
  33. Majdzadeh R. Family physician implementation
  34. and preventive medicine; opportunities and
  35. challenges. Int J Prev Med. 2012;3(10):665-9.
  36. Eskandari M, Abbaszadeh A, Borhani F. Barriers
  37. of referral system to health care provision in
  38. rural societies in iran. Journal of caring sciences.
  39. ;2(3):229-36. doi: 10.5681/jcs.2013.028.
  40. Golalizadeh E, Moosazadeh M, Amir Esmaeeli
  41. M, Ahangar N. Challenges in second level
  42. of referral system in family physician plan: a
  43. qualitative research. Journal of Medical Council
  44. of Iran. 2011;29(4):309-21.
  45. Xu J, Wang W, Li Y, Zhang J, Pavlova M, Liu H, et
  46. al. Analysis of factors influencing the outpatient
  47. workload at Chinese health centres. BMC Health
  48. Serv Res. 2010;10:151. doi: 10.1186/1472-6963-10-
  49. Afkar A, Pourrza A, Mehrabian F. Family
  50. physician performance from the perspective
  51. of Gilani customers. Journal of Hospital.
  52. ;12(1):39-48.
  53. Matalon A, Nahmani T, Rabin S, Maoz B, Hart J.
  54. A short-term intervention in a multidisciplinary
  55. referral clinic for primary care frequent attenders:
  56. description of the model, patient characteristics
  57. and their use of medical resources. Fam Pract.
  58. ;19(3):251-6.
  59. Nasrollahpour Shirvani S. The implementation of
  60. family physician program in Iran: achievements
  61. and challenges. J Babol Univ Med Sci.
  62. ;16(Suppl 1):15-26.
  63. Honarvar B, Lankarani KB, Ghahramani S,
  64. Akbari M, Tabrizi R, Bagheri Z, et al. Satisfaction
  65. and Dissatisfaction Toward Urban Family
  66. Physician Program: A Population Based Study in
  67. Shiraz, Southern Iran. Int J Prev Med. 2016;7:3.
  68. doi: 10.4103/2008-7802.173793.
  69. Chaman R, Amiri M, Raee M. National survey
  70. of family physician and quality of the referral
  71. system. Payesh Journal. 2012;11(6):785-90.
  72. Bossyns P, Abache R, Abdoulaye MS, Miye H,
  73. Depoorter AM, Van Lerberghe W. Monitoring
  74. the referral system through benchmarking in
  75. rural Niger: an evaluation of the functional
  76. relation between health centres and the district
  77. hospital. BMC Health Serv Res. 2006;6:51. doi:
  78. 1186/1472-6963-6-51.
  79. Forrest CB, Shadmi E, Nutting PA, Starfield B.
  80. Specialty referral completion among primary
  81. care patients: results from the ASPN Referral
  82. Study. Ann Fam Med. 2007;5(4):361-7.
  83. Jiwa M, Coleman M, McKinley RK. Measuring
  84. the quality of referral letters about patients
  85. with upper gastrointestinal symptoms. Postgrad
  86. Med J. 2005;81(957):467-9. doi: 10.1136/
  87. pgmj.2004.027516.
  88. Shabila NP, Al-Tawil NG, Al-Hadithi TS, Sondorp
  89. E, Vaughan K. Iraqi primary care system in
  90. Kurdistan region: providers’ perspectives on
  91. problems and opportunities for improvement.
  92. BMC Int Health Hum Rights. 2012;12:21. doi:
  93. 1186/1472-698X-12-21.
  94. Mehrotra A, Forrest CB, Lin CY. Dropping the
  95. baton: specialty referrals in the United States.
  96. Milbank Q. 2011;89(1):39-68. doi: 10.1111/j.1468-
  97. 2011.00619.x.
  98. Cheng J, Beltran-Agullo L, Trope GE, Buys
  99. YM. Assessment of the quality of glaucoma
  100. referral letters based on a survey of glaucoma
  101. specialists and a glaucoma guideline.
  102. Ophthalmology. 2014;121(1):126-33. doi: 10.1016/j.
  103. ophtha.2013.08.027.
  104. Richards DB, Jacquet GA. Analysis of referral
  105. appropriateness in the Western Cape, South
  106. Africa, and implications for resource allocation.
  107. African Journal of Emergency Medicine.
  108. ;2(2):53-8.
  109. Hashmi FK, Chaudhry TA, Ahmad K. An
  110. evaluation of referral system for retinopathy
  111. of prematurity in leading health centers
  112. across Karachi, Pakistan. J Pak Med Assoc.
  113. ;60(10):840-4.
  114. Zuckerman KE, Perrin JM, Hobrecker K,
  115. Donelan K. Barriers to specialty care and
  116. specialty referral completion in the community
  117. health center setting. J Pediatr. 2013;162(2):409-
  118. e1. doi: 10.1016/j.jpeds.2012.07.022.
  119. Cervantes K, Salgado R, Choi M, Kalter HD.
  120. Rapid assessment of referral care systems: a guide
  121. for program managers. 2003.
  122. Laal N, Shekarriz R, Bahadoram M, Dorestan N.
  123. Evaluation of the Referral System Performance in
  124. the Family Physician Program. Persian Journal of
  125. Medical Sciences (PJMS). 2016;3(1).
  126. Nourafkan O, Yazdanpanah A, Kharazmi E. The
  127. study of urban family physicians performance
  128. and its related factors in the south of Iran.
Health Management & Information Science
Volume 5, Issue 3 - Serial Number 3
31
Summer 2018
Pages 88-95