Practice and Opinion of Doctors in Primary Health Care Centers Toward Referral System: Samples from Nine Governorates in Iraq

Abstract

Background: Most primary Health Care Centers (PHCCs) in Iraq have a referral system records; however, this mechanism does not function well because of the lack of other requirements for an efficient referral system.
 Objective: To assess the practice & opinion of doctors in PHCs toward the referral system, and to determine the doctors in PHC's commitment to referral system instructions and guidelines.
 Subjects and methods: A cross-sectional study with analytic elements was conducted in nine health directorates in Iraq, from the 1st October 2018 – 30th June 2019.One PHC was selected randomly form each sector in every governorate, A questionnaire was used to collect the required information. SPSS version 24 analysis was used for the statistical analysis.
 Results: sixty-three doctors were working in PHCs had participated in the current study, the mean age (40.03 ±10.24), 58.7%were female, 46% were general practitioner, 30.2% of the participated doctors had 300 and less patient/month; 31.7% of doctors had ≤10 Patients referred/month, emergencies was the main cause for referral (46.03%), and 37(58.37%) of doctors announced that the referred-form not retrained to the PHC, and ever retrained-forms had no feedback 29(46%), 28(44%)of the participated doctors agreed that the current referral-system was effective and seven of them strongly agreed, 59(93.7%) believe in the importance of hospital-feedback, with a significant relationship between their attitude about the effective-current-referral system & Refer cases Percentage, while no significant-relation with their Patients examined/month. Loaded crowded and hospital doctors shortage as possible causes and suggest to referral-system activation especially the hospital -part".
 Conclusions: there was inadequate knowledge of referral-policies and lack of coordination or/and clear feedback-expectations and PHCs-hospitals collaboration and lack of referral-system integrated within an electronic-health-record.

Assessment of Primary Care Physicians’ Expertise of Common Dermatological Conditions in the Jouf Region, Saudi Arabia: A Mixed Methods Study

“…For instance, several studies investigating PCPs’ knowledge and practice in dermatology have been carried out on various objectives, including eczema [ 12 ], topical corticosteroids [ 24 ], suspicious pigmented skin lesions [ 20 , 22 ], atopic dermatitis [ 25 ], and psoriasis [ 21 ]. At the same time, other studies evaluated the prevalence of DCs in PHC settings [ 1 , 4 , 7 , 15 , 16 , 17 ], PCPs’ knowledge [ 2 , 11 , 19 , 20 ], different approaches to management [ 18 , 21 , 22 , 23 , 24 ], and referral strategies [ 26 , 27 , 28 , 29 , 30 , 31 , 32 ].…”

Barriers to the Utilization of Primary Health Centers (PHCs) in Iraq

“…Health policies at the national level should set the minimum standard of care at PHCs and launch PHC accreditation programs [ 77 , 78 ]. Establishing and reinforcing a referral system is essential as it has advantages such as avoiding the wasteful use of limited resources, streamlining the continuity of care, and improving the quality of care [ 79 , 80 ]. Public–private partnerships to support PHCs should also be considered.…”

Practice & Opinion of Doctors in Hospitals toward Referral System in Iraq

“…(1,6) While the presence of the PHC-hospital doctor's coordination; had no significant association with their specialty degree, and their response to PHCCs referred forms, which does not go with other studies done in Beijing, The PHC doctors recommended creating a distinct organization that coordinates referral to the hospital because a referral system is not adequately established. (27)(28)(29).…”