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 :
• 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.