Why Don't Patients Referred by a Family PhysicianVisit a Specialist? A Study in Golestan Province in Northern Iran

Abstract Background Utilizing electronic referral (eReferral) system while enhancing the efficiency and quality of medical services may improve the access level to specialized services and reduce patients' wait times; however, some patients do not follow the the eReferral system guidelines. The present study aims at figuring out why outpatients referred by family physicians to specialists do not visit specialists. Methods The present cross-sectional study was conducted in the hospitals wherein eReferral system was implemented as a pilot plan in the calendar year started on 21 March 2019. The sampling was done in two phases: 1) proportionate stratified sampling method, and 2) systematic random sampling. The first, 429 patients were selected. These patients were referred by a rural family physician (FP) to a specialist in the district hospital, but despite appointment made for them by the relevant FP, they had not visited specialists. Then, data was collected using a self-made questionnaire whose validity and reliability were confirmed (α = 0.90). Descriptive statistical methods were used to describe the data and analytical methods, i.e. Spearman, Mann-Whitney and Croscal Wallis correlation tests were also conducted. Data analysis was performed using SPSS 16 at a significant level of 0.05. Findings : Most of the participants (54.7%) were female, 43.4% were in the age group of 30–60, 81.6% were married, 26.4% had high school diploma, 47.2% were housewives, 81.6% were rural residents. Among the dimensions of the reasons why patients did not visit specialists, the clinic conditions (3.26 ± 0.74), side expenditures (2.51 ± 0.74), admission and queuing system (2.45 ± 0.70) accounted for the highest average score, respectively. There was significant relationship between age groups, marital status, level of education, occupation, place of residence and type of insurance (p < 0.05), but no significant relationship was observed between them and gender (p > 0.05). Conclusion Reducing patient wait times in the clinic, providing patients with appropriate guidance, enhancing patients’ freedom to determine the time to visit specialists, training physicians to communicate with patients properly, reassuring and reducing costs were of great importance to encourage receiving outpatient services within the framework of eReferral system.