A descriptive study of referral letters in three rural primary health care centres in Al Qassim Region, Kingdom of Saudi Arabia

Objective: It has been reported that a proper referral system from primary health care sources to the higher health care delivery hospitals is coupled with tremendous improvements in diagnostic, therapeutic, and research services meant globally for the benefits of patients and the community at large. This study was carried out to evaluate the effectiveness and efficiency of the referral system and a detailed description of referral letters in three randomly selected rural primary health care centres.Material and Method: During the 6-month period, 630 patients from three randomly selected primary health care centres were referred to secondary care centres which included general hospitals, and in response 505 feedback letters from different consultants were recieved at those centres. The main sources of data were referral letters and feedback responses.Results: The computer analysis of relevant data abstracted from these two sources showed that patients were referred to different specialists due to five main reasons. Specific data were not found in 15% of referral letters filled by primary health care physicians and likewise in 23.5% of feedback letters from consultants. Correct referral was found in 91% of referrals (n=573) while diagnostic consistency was revealed in 80% (n=504) of cases. On average a success rate of 85.3% was achieved through the referral system. The attrition rate for not consulting specialists was 5.5%.Conclusions and Recommendations: Primary health care physicians should include the specific and detailed data about each patient who needs referral to other specialities on secondary care level. Likewise the consultants reviewing the referred patients should provide the accurate diagnosis supported by definite clinical and laboratory diagnostic criteria and also provide the distinctive treatment guidelines to primary care physicians within a proper feedback mechanism. The rural primary health care centres should have basic essential laboratory and radiological diagnostic facilities. These multiple aspects of the referral system, moreover, underscore the significance of health education and training, especially through organizing effective workshops in which clinicians and primary health care doctors should actively participate in order to devise the ways and means of achieving a maximum success rate in the referral system and hence the best quality of health care to all patients.