Introduction: The family physician referral system has been determined as a major goal to
economic, social, and cultural development in the field of health in Iran. The necessity of
implementing this system has been explicitly stated in high-level documents. Hence, the aim
of this study was to evaluate the overall performance of the referral system in Fars Province
in 2015.
Methods: In this cross-sectional study, 20% of family physicians (75 doctors) were randomly
selected; then, all patients of these physicians (1289 patients) in one work shift were studied.
The data were collected in three parts containing the questions related to the physician and
patients using data collection forms. Finally, data analysis was performed through SPSS,
version16, using descriptive statistics and Chi-square test.
Results: The results showed that 70.3% of the patients (906 patients) had used the referral
system to visit specialists. Most of the referral forms had been completed correctly (63.6%).
Most of the referrals (820 cases) were recognized as necessary (59.4%) and from the first level
of referral, i.e. by the family physician (96.3%: 1241 cases). The patients aged 70 and over had
the minimum self-referrals, whereas young people aged lower than 20 had the maximum selfreferrals
(P=0.03). Also, more self-referrals were observed among highly educated patients
(P=0.001).
Conclusion: Based on the findings, the most important problems of the referral system
included self-referrals, incomplete referral forms, and unnecessary referrals. Self-referral
could be solved through education, establishment of an electronic referral system, and legal
measures. Also, educating doctors, making an electronic referral system, and using auxiliary
staff and incentive measures can reduce the incompleteness of the referral forms. To reduce
the patients’ unnecessary referrals, development of referral guidelines might be very effective
