Specialists' perception of referrals from general doctors and family physicians working as primary care doctors in Thailand

• Main Authors: Darin Jaturapatporn, Saipin Hathirat
• Other Authors: Mahidol University
• Format: Article
• Published: 2018
• Subjects: Medicine; Nursing
• Online Access: https://repository.li.mahidol.ac.th/handle/123456789/23719

Background: Following recent national healthcare reform in Thailand, newly trained family physicians (FPs) as well as untrained general doctors (GDs) are now working in primary care. Objective: To compare th e referral patterns of FPs and GDs from a primary care clinic to specialty clinics. Methods: A cross-sectional analytic study of 3300 newly designed referral letters from primary care doctors to specialists in Ramathibodi Hospital Medical School from November 2003 to February 2004. The appropriateness of each referral was evaluated by specialists. Outcome measures: Rate, reason, purpose and appropriateness of referral. Results: Of 16 500 visits at the primary care clinic, different referral rates were found between the 16 FPs (14.02%) and 16 GDs (24.30%). Referrals were judged as inappropriate more often in the GD group. For referrals to internal medicine, GDs provided more incorrect diagnoses and unreasonable referrals. For orthopaedic referrals, GDs provided more incorrect diagnoses and inadequate investigations before referral. The most common comments on inappropriate referral were non-specific diagnosis, non-comprehensive case approach, too early referral, and inadequate investigation. There was no difference for reason or for purpose of referral between FPs and GDs (therapeutic (81.14%), diagnostic (55.56%), patient request (6.73%), transferred management (70.71%), shared management (29.29%)). Conclusion: Compared with GDs, FPs tended to have lower referral rates and these referrals were judged by specialists as being more appropriate in terms of diagnoses, investigations, and reasons for referral. © 2006 Radcliffe Publishing.