Referral system
The referral system is a system based on
generalists with the general practitioners as
gatekeepers to secondary care,
institutionalizing the separation of primary
and secondary care , including the referral of
patients from primary care for specialist
opinion in secondary care and containing cost
while improving the quality of care.
Referral is one of the basic health care components
as well as a complete and sustainable system
with two directions to connect between the
primary care units and hospital treating patients .
The primary health care centers form a network
closely linked to general hospitals , which in turn
are linked to tertiary care services by a referral
and feed back system , allowing primary health
care physicians to refer patients for second
opinion , hospitalization , and / or sophisticated
diagnostic tests.
Patients must be able to easily access primary healthcare
center (PHCC) in their own community. In the first contact
with a health care practitioner if the initial problem can not
be managed , the decision will be made to refer the patient
to a specialist. Except in emergency , all patients should be
seen first by a primary health care physician who decides
whether a referral to a secondary care is necessary. The
efficacy of this process depends on an effective
communication across the primary – secondary care
interface. The cost of specialty care is a principle concern .
Specialists are more expensive not only because they
charge more , but also because they use more health
resources than generalists for comparable clinical
conditions.
The referral system enhances patient access
within medical care system and that :
. Services provided are medically necessary .
. Care is given by providers with necessary
expertise.
. Care provided in appropriate setting.
. Referral data can be collected to understand
the needs of each provider.
The referral system can provide cost – effective
medical services and ensure appropriate levels
of quality care. Such referral process must
support the primary physician without being
overly burdensome, or resulting in
micromanagement of the providers.
Due to their limited medical knowledge , people are often not
in a position to select an appropriate health care provider
on their own. Primary care should be made available as an
acceptable substitute for specialist care by educating
people that to avail of a comprehensive yet cost – effective
care for most of their health problems. The best place for
them to start is their primary care physician . The primary
care provider can offer basic health care for a broad range
of general diseases , and act as a health manager for
patients by guiding them through the health care system .
This will not only cut costs but also lead to a less
fragmented , more organized , and better integrated care
for the patients.
Types of referral
1.From PHCC to hospital , due to better resources at the
hospital .
2. From the hospital to the health center to follow up the
prolonged treatment of cases of chronic diseases.
3. Within the hospital from a specialist to another.
4. From a primary health care center to another where
diagnostic facilities are available (x-ray or laboratory).
Direct reporting to hospital will lead to overcrowding in hospitals,
unnecessary waste of resources, lack of continuity of care, less time
for inpatients , and being seen by a house officer in the hospital .
Benefits of referral system according to WHO reference :
1)
The patient would avoid long waiting only to be seen at the end
by a hospital general practitioner, and would draw faster attention
, upon referral , from specialist leading to timely management.
2) The hospital consultant can plan appointments , gather better
information from the referring formats, leading to improved
quality in management.
3) The PHCC physician would learn with an opportunity for self
evaluation , gain self- confidence , help in organizing follow – up
service, establish credibility of the PHCC.