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Rate of referral from primary health care to secondary health care among governmental hospitals in Taif governorate, KSA

Osama MohammadAlGhamdi, BasimMatar AL-Malki, Ammar EidNahhas, Adel Dakhilallah AL-Malki.


Background: Referral system is facing difficulties worldwide. In Saudi Arabia, particularly, our doctors always complain of referral system.

Objective: To measure the referral rate from primary- to secondary health-care services, evaluate secondary health-care opinion regarding referral from primary care, and measure the feedback rate from secondary health-care physicians.

Materials and Methods: A cross-sectional approach was carried out, which included currently working doctors in a governmental secondary health-care hospital who received referral from primary-care centers in Taif, in addition to a manager of each primary health care center (PHCC) inside the Taif area. Data were collected by using two forms. The first form was a questionnaire that collected data from physicians. It included personal data of the doctors and doctorsÂ’ judgment regarding referral process in PHCC and what can improve the quality of referral system and make it more useful to the patients. The second form was a checklist used to collect data from managers of involved PHCC inside the Taif area.

Result: The study included 112 physicians working in secondary health-care governmental hospitals in Taif. Their age ranged between 25 and 60 years with a mean of 40.4 years and standard deviation of 9.2 years. Men represented 70.5% of them. The commonest reported reasons for referral from PHCCs were seeking specialized treatment (42.9%), more assessment of patients (40.1%), and diagnosis of difficult cases (21.4%). Almost three quarters of them (77.7%) considered referring notes to be more informative if the referring doctor was a family physician. More than half of the physicians (52.5%) reported that they never issued feedback notes to PHCCs regarding referred cases, whereas 20.8% of them reported that they always issued such notes. Older physicians (>50 years) provided feedback referral notes either always or sometimes at a significantly higher rate than younger physicians (76.5% versus 50% among those aged between 41 and 50 years and 30.8% among those aged 40 years or younger). The difference was statistically significant.

Conclusion: This study highlighted some of the inadequacies in the effectiveness of the referral system in a PHCC from the perspective of physicians working in governmental secondary-care hospitals in Taif and suggested various ways of dealing with them.

Key words: Referral, primary health care, secondary health care, government hospitals, Saudi Arabia

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