A study on the referral of outpatient from the department of family medicine to other medical department

ABSTRACT

BACKGROUND: Appropriate referral without failure, one af important health care services provided by primary care physicians, is very helpful not only to patients but also to the referring physiciasn. This study was performed to observe the rate of referral failure and to evaluate the factars related to referral failure. METHODS: From June 10 to October 31, 1997, all referrah made in the department of family practice in the Samsung Medical Center were studied. Structured questionnaires inquiring of referral initiator, pbysicians view af dinical severity and referral necessity, and tbe reason for referral were completed by referring physician whenever each referral was made. On the 60th day after referrals were initiated medical records of the referred patients were reviewed to obtain the information on the demographic characteristics of the patients referred, the contents of referral, and the patient's attendance the specialist clinic after referraL Each referral was audited by five family physicians working at the Samsung Medical Center to examine the appropriateness of the time when the referral was initiated. The patients who did not attend at specialist dinic to which they were referred to were telephoned to ask about the reasons for the referral failure. Chi-square test and multiple logistic regression analysis were used to evalute the factors related to referral failure. RESULTS: During the study period, total of 477 referrals were made among 9,384 encounters and the referral rate was 5.08%. Fifty-eight patients failed to compkte the referral process within predetermined periad and the rate of referral failure was 12.16%. The risk of referral failure was significantly low in cases whose referral time was assessed as appropriate(odds ratio=0.53). Female was a significant increasing the risk of referral failure(odds ratio=1.91). Being too busy(24.14%) was the most common reason for referral failure. Other reasons induded improverment or resolution af syrnptoms (12.06%), information on the referral was not given (6.9%) and too great a distance the between hospital and the patients home (6.9%). Four patients forgot to attend the hospital. CONCLUSIONS: Considerable proportion of patients being referred did not complete the referral process. Timely referral and sufficient discussion between pbysician and patient being referred seems to be necessary to prevent referral failure.