Abstract
Background:The referral system constitutes a key element of health system. Effective referral system between different levels of health care delivery represents a cornerstone in addressing patients’ health needs.
 Objectives:To assess the referral system Baghdad/ Al-Rusafa Health Directorate by evaluation the referral pattern and identify the quality of the referral letters and feedback reports.
 Type of the study: This cross-sectional study .
 Methodology : It was conducted in5PHCC in from 1st July 2015 - 31st December 2015 at Bagdad/Al-Rusafa health directorate. The study population (sampled population) included all referrals in six months. Data were entered and analyzed by using the statistical package for social science (SPSS) software version 17 for windows .
 Results: The referral rate was 2.85% .The variables of the referral letter (such as age, gender of the referred patient)were present, while the indication for referral(3.3%), result of investigation done in PHCC (4.67%), initial diagnosis (5.86%), however, the name of physician and signature were not mentioned or specified in 70% of the referral letters. The rate of feedback reports received by PHCCs was 19% of total number of referrals to the hospitals. The referral rate was (2.8%) from total number of patients seen in PHCCs.However, the quality of referral letters and feedback reports was poor in 69.5% and 78.5% respectively.
 Conclusion: In this study there was a low referral percentage and low feedback report in five PHCCs of Baghdad/ Al-Rusafa health directorate compared to international literature.The quality of referral letters and feedback reports is poor and contained inadequate information and lacking important and relevant items in majority of referral needs to be improved
 Key words: Referral ,Feedback report , primary health care centers(PHCCs)
 
 Background:The referral system constitutes a key element of health system. Effective referral system between different levels of health care delivery represents a cornerstone in addressing patients’ health needs.
 Objectives:To assess the referral system Baghdad/ Al-Rusafa Health Directorate by evaluation the referral pattern and identify the quality of the referral letters and feedback reports.
 Type of the study: This cross-sectional study .
 Methodology : It was conducted in5PHCC in from 1st July 2015 - 31st December 2015 at Bagdad/Al-Rusafa health directorate. The study population (sampled population) included all referrals in six months. Data were entered and analyzed by using the statistical package for social science (SPSS) software version 17 for windows .
 Results: The referral rate was 2.85% .The variables of the referral letter (such as age, gender of the referred patient)were present, while the indication for referral(3.3%), result of investigation done in PHCC (4.67%), initial diagnosis (5.86%), however, the name of physician and signature were not mentioned or specified in 70% of the referral letters. The rate of feedback reports received by PHCCs was 19% of total number of referrals to the hospitals. The referral rate was (2.8%) from total number of patients seen in PHCCs.However, the quality of referral letters and feedback reports was poor in 69.5% and 78.5% respectively.
 Conclusion: In this study there was a low referral percentage and low feedback report in five PHCCs of Baghdad/ Al-Rusafa health directorate compared to international literature.The quality of referral letters and feedback reports is poor and contained inadequate information and lacking important and relevant items in majority of referral needs to be improved
 
Highlights
The referral system constitutes a key element of health system
The referral rate was 2.85% .The variables of the referral letterwere present, while the indication for referral(3.3%), result of investigation done in PHCC (4.67%), initial diagnosis (5.86%), the name of physician and signature were not mentioned or specified in 70% of the referral letters
Data source: Data were obtained from a referral form which was adapted by the Iraqi ministry of health at primary & secondary health level,the form consists of three copies carbonated the1st and the 2nd form given to the patient for receiving facility, the 3rd form are kept in the health center for the purpose of registration and followup as if the client have the family health file kept in the file; and if it is outside the geographic area kept in the archives of the primary health center
Summary
The referral system constitutes a key element of health system. Objectives:To assess the referral system Baghdad/ AlRusafa Health Directorate by evaluation the referral pattern and identify the quality of the referral letters and feedback reports. Methodology : It was conducted in5PHCC in from 1st July 2015 - 31st December 2015 at Bagdad/Al-Rusafa health directorate. Results: The referral rate was 2.85% .The variables of the referral letter (such as age, gender of the referred patient)were present, while the indication for referral(3.3%), result of investigation done in PHCC (4.67%), initial diagnosis (5.86%), the name of physician and signature were not mentioned or specified in 70% of the referral letters. The rate of feedback reports received by PHCCs was 19% of total number of referrals to the hospitals.
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