Management of inappropriate referrals in Wazarat health center, Riyadh, Saudi Arabia

Abstract

Background: Referrals are an essential part of the health care system and have a significant impact on patient services, medical staff, and health care costs. The referral process is a complex one in which the General Practitioner (GP) plays the essential role as a decision maker. However, once the referral initiated, its implementation involves the GP, the patient, the specialist and the health system. Aims & Objective: This study aims to identify the factors related to inappropriate referrals and to suggest the best management approach to improve the quality of referrals in Wazarat Health Center (WHC) in Riyadh, Saudi Arabia. Material and Methods: The study surveyed all the primary care doctors (GPs) who work in the WHC through anonymous, self-completed, web-based questionnaires. A total of 51 GPs were included in the study. The survey obtained the participants’ opinions about 32 different factors that contribute to making inappropriate referrals in WHC. Results: The study results show that 67.44% of surveyed GPs either agree or strongly agree that “poor GP awareness of the available secondary care clinics” is the main GP’s factor for making inappropriate referrals. 83.8% of surveyed doctors agreed or strongly agreed that “patients’ requests and demands for referral” is the main patient’s factor that contributes to making inappropriate referrals, and 86.04%of GPs agreed or strongly agreed that a “lack of specialist referral feedback” is the main specialists’ factor that contributes to making inappropriate referrals. 90.7% of surveyed GP either agreed or strongly agreed that “the lack of continuity of care” in WHC and “difficulty with GP-specialist phone communication” in Riyadh Military Hospital are the two main factors concerning the RMH system that contribute in making inappropriate referrals. Finally, 83.7% of GPs agreed or strongly agreed that the best management approach for improving the referral process from primary care to secondary care in RMH would be to conduct “periodic referral auditing”. Conclusion: The study identified a number of barriers to achieve high-quality referrals in WHC. Effort put towards improving the system to ensure the continuity of care and to facilitate GP-specialist communication are priority recommendations. The study also recommends a review of the hospital policy that obligates specialists to provide referral feedback within a reasonable time frame. Furthermore, the study encourages distributing the GPs in small teams and advocating for team work. Finally, the study recommends establishing a referral audit project as a tool to monitor and improve the quality of referrals in WHC.