Article Type

Original Study


Objectives The main aim of this study was to improve the referral system. The specific aims were to determine the referral rate, to study its current status as well as to identify the obstacles at family health facilities in Shebein El-Koum District, Menoufia Governorate, Egypt. Background The referral system is a process that ensures accessibility to higher levels of medical care for patients attending the primary healthcare facility. Referral is usually sought to obtain expert professional advice, undergo a diagnostic technique, seek a therapeutic intervention, or receive inpatient care when these are not available at the referring site. The referral system aims to provide efficient, effective, affordable, and equitable community-based healthcare services. For a successful referral, there must be first and foremost geographical access to referral care facilities, referral staff must be trained to provide high-quality care, services must be affordable, and essential drugs, supplies, and equipment must be available. Participants and methods A cross-sectional study was carried out from 1st of March 2011 to the end of April 2013 in all rural and urban family health units/centers (No. 23 and 4, respectively) of Shebein El-Koum District, which was selected randomly to represent Menoufia Governorate, Egypt. All the managers (No. 25), family physicians (No. 125), and nurses (No. 186) at the site of the study were subjected to a predesigned questionnaire for complete assessment of the current status of the referral system. Results The referral rate was significantly higher in urban versus rural areas (16.2 and 11.2%, respectively). The usage of referral letter is the main means of referral; the highest referral rate was among adults and the lowest was among adolescents. There was no significant difference in the referral rate in terms of sex in either urban or rural facilities. Training of the physicians is considered an important factor for quality assurance of the referral system. Conclusion We found that the highest referral rate was found among adults; however, the lowest referral rate was found among adolescents. The rate was high for ENT and Ophthalmology Clinics. Lack of training and availability of means of transportation and absence of feedback were the most common obstacles for the referral process.