Referral system in Iran's health sector and world's leading countries

Referral system is a common and important component of Primary Health Care (PHC) which is usually used for integrating PHC and specialty care settings. This study aimed to identify world's successful referral system's key elements, capabilities and comparison with Iran's existing referral system. We searched electronic data bases including ProQuest, Scopus, Emerald, Web of Knowledge, Springer, Science direct, PubMed and Google Scholar search engines. We also searched Iranian SID, IranMedex, Medlib and IRANDOC data bases. Terms of referral system, referral model, referral project, consultation, health system, health service and medical care were used. We conducted a hand search for reference lists of relevant papers. A predefined inclusion and exclusion criteria were used for assessing the quality of papers which were checked by two reviewers. We identified 5300 initial articles of which 28 articles met the inclusion criteria. Functional and relatively successful referral systems belonged to countries such as UK, Denmark, Finland, Norway, the Netherlands, Australia, New Zealand, Canada, and the United States. Effective referral systems had key functions and capabilities: using clear and agreed upon referral guidelines, structured referral templates, Incorporation of referral process into electronic patient records, centrally referral triage and referral tracking system. Iran's referral system lacks these functionalities. Current referral system of Iran was compared with successful referral evidences in terms of key features and elements. Referral systems have been established as a small and localized manner. Electronic referral system has been emerged in developed countries as a dominant modality. Key features of functional referral systems were severely neglected in Iran's health referral system. Political support and further attention to sociotechnical conditions are recommended.