Abstract
BACKGROUND: Referrals are a two-way communication between healthcare facilities to enable information transfer for the continuity of patient care. The Enhanced Primary Healthcare (EnPHC) initiative, a complex intervention package to improve non-communicable disease (NCD) management, introduced improvements to the NCD’s referral mechanism from primary healthcare clinics to the hospital. This study explores the communication process between the Malaysian public primary healthcare and hospital for chronic care management.  
 
 METHOD: A qualitative exploratory study using purposive sampling was done in all twenty EnPHC intervention clinics. In-depth interviews and focus group discussions were carried out among all healthcare providers working in EnPHC clinics. The 47 interview sessions were audio-recorded, transcribed verbatim, and analyzed thematically.
 
 RESULTS: A total of 97 healthcare providers participated. Three main themes of the communication process between the primary health care and hospital during the implementation of EnPHC intervention emerged from the analysis. These are; (1) structured information relay, (2) no show appointment tracking via various communication devices has strengthened the mechanism to monitor the referred patient appointment scheduling and their adherence to the appointment, and (3) inter-facility networking facilitated the implementation of EnPHC’s referral mechanism.
 
 CONCLUSION: The EnPHC referral mechanism created a platform for PHC clinics and hospitals to communicate and build rapport to help ensure care continuity for NCD patients. The traditional method of communication between healthcare facilities should change and instead start using the newest or most current, advanced technology.
Highlights
A smooth referral process between primary healthcare providers in clinics and specialists in hospitals is fundamental for patient care management
This study explores the communication process between the Malaysian public primary healthcare and hospital for chronic care management
Three main themes of the communication process between the primary health care and hospital during the implementation of Enhanced Primary Healthcare (EnPHC) intervention emerged from the analysis
Summary
A smooth referral process between primary healthcare providers in clinics and specialists in hospitals is fundamental for patient care management. It is a two-way communication where both doctors are responsible to communicate clearly with the patient on the need(s) and reason(s) for the referral (Jarallah, 1998) and deliver feedback on his/her evaluation of the patient's condition. Vol 12, No 13; 2020 information or discharge summaries regarding the patients they were referred (Bodenheimer, 2008; Gandhi et al, 2000) This shows that a lack of effective communication between referring physicians can result in poor and inappropriate information transfer that can impact patient management and cause dissatisfaction amongst health care providers (Ang et al, 2014; Wong et al, 2019). This study explores the communication process between the Malaysian public primary healthcare and hospital for chronic care management
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