RESUMO
Referral rate varies widely, even among family physicians within the same practice. No body can deny the increasing cost of the health care. Health care costs are tried to be cut by family physicians/general practitioners. This could be achieved partly by treating patients on an ambulatory care basis rather than hospitalizing them through appropriate shared consultation with other specialties in addition to rational use of available resources through use of the referral system appropriately. The present study aimed at identifying the rate of referral and hospital feedback at family practice centers affiliated to faculty of medicine-Suez Canal University [FOM-SCU] an that belonging to Ministry of Health and Population [MOHP]. Also, the quality of referral letters was assessed. This study was conducted in four family practice centers in EL Mahsama and Abou Khalifa villages in Ismailia Governorate, two centers belonging to the Faculty of Medicine of Suez Canal University, while the other two centers belonging to Ministry of Health and Population. Over a period of 6 months, the medical records in these centers were examined to identify the total number of patients attending these health facilities through reviewing the daily sheet of the clinics. Over the period of study a duplicate forms of the referral letter with hospital feedback were dept in the family practice centers in the referral register. Data obtained from medical records were evaluated to identify rate of referral and hospital feedback. The quality of referral letter was evaluated for the presence or absence of predetermined items for both identification and clinical data that recommended by WHO. Results showed that, the rate of referral from these family practice centers is low compared to other studies [2.27%] also, there was statistically significant difference in referral rate between family practice centers of FOM-SCU and MOHP [X2 =4.02, p<0.05]. it was found that, although the referral rate among qualified physicians [2%] was lower than noon-qualified physicians [2.3%], there was no significant difference [X=0.94, p=0.3324]. referral for further investigations and unavailable treatment modalities came at the top of reasons for referral with rate of 34.29% and 26.81% respectively. Referral for shared consultation represented only 15.38%. surgery, laboratory and obstetric and gynecology departments come at the top of the list [20.44%, 16.7% and 14.72% respectively. The study revealed the absence of adequate, efficient hospital feedback and the connection between the family physicians in family practice centers and specialists in hospitals is nearly lost [very low rate of hospital feedback [0.8%]]. It was found that 47.4% of referral letters were poor [score <13 items]. Understanding and awareness among primary health care physicians [PHCs] and specialists regarding the organization of the referral system is needed to deliver a better health are to the patients. This study highlighted some of the inadequacies that may hinder the effectiveness of the referral system in the family practice centers as the absence of feedback report by the hospital to which these patients are referred. Such problems will affect the continuity of care of patients negatively and may result in lack of patient satisfaction. In addition, lack of facilities in family practice centers make the highest referral rate by the physicians is for doing laboratory investigation to reach the final diagnosis