Referral from primary care to hospitals in Saudi Arabia: 1) quality of referral letters and feedback reports

Abstract

Background: Referral between primary care and hospitals is of great importance for patient care and follow-up. This study was conducted because of the importance of the quality of referral letters and feedback reports. Objectives: To evaluate the quality of referrals from primary health care (PHC) centers to general hospital in four regions in Saudi Arabia. Methods: This was a cross-sectional study of a random sample of referrals from the PHC centers. The first sampling unit was the general hospitals to which the health centers refer. A random sample of health centers was then selected based on their distance from the hospitals. This was followed by randomly selecting 30 referrals from each health center. The referral letters and the corresponding feedback reports were then studied for quality by scoring the components of each. The data was entered in a personal computer using the Stat Pack Gold Statistical Package. The chi-square was used to compare the different scores across the regions and T-test was used to compare the cumulative scores. Main outcome measures: The quality of referral letters and feedback reports was defined according to the standardized components using a scoring system. Results: The most frequently mentioned items in the referrals were demographic data (100%), specialty referred to (93.3%) and reason for referral (82.7%). Other important items in the feedback reports including the name of the treating physician (81.8%), diagnosis (86.0%), and decision on follow-up (80%) were missing. The quality of referral letters was poor in 23%, with 81% as the corresponding figure for the feedback reports with some variation between the different regions. Conclusions: The quality of referral letters and feedback reports is poor and needs to be improved. This can be achieved through implementing the quality assurance programme.