Original Article

Design of a Model for Management of Referral System in the Iranian Urban Family Physician Program


Background: The purpose of this research was to identify the main dimensions of management of referral systems in family physician program and then introduce them to policymakers of the country primary health care.

Methods: This descriptive-correlation study was designed in Mazandaran Province, northern Iran (2017). The participants were employees of health centers of Mazandaran and Fars Provinces, Iran. The dimensions influencing on the referral system were identified systematically in the selected countries by using researcher-made questionnaire according to a statistical method called Factor Analysis. The data sufficiency was evaluated by the Bartlett's and Kaiser-Meyer-Olkin’s tests. Reliability of test was calculated and confirmed according to Cronbach's Alpha and Combined Reliability tests. Validity of the test was calculated and confirmed based on the average variance extracted (AVE).

Results: In confirmatory factor analysis, coefficient of effect of Electronic Health Record on referral system (as the most important dimension), coefficient of Family Physician, coefficient of structure of insurance, coefficient of policymaking in health care system, coefficient of proper stewardship of health system, and basic health care services, were 0.887, 0.877, 0.860, 0.804, 0.568, and 0.522, respectively.

Conclusion: Six effective dimensions including Electronic Health Record (as the most important dimension), family physician, structure of insurance, policymaking in health care system, proper stewardship of health system, and basic health care services were identified. According to six effective dimensions on management model of the referral system in the Iranian urban family physician program, the health system authorities pay serious attention to the six identified dimensions of the current study to improve the health of the urban community.

Mosadeghrad AM. Factors influencing healthcare service quality. International journal of health policy and management. 2014;3(2):77.

Senitan M, Alhaiti AH, Gillespie J, Alotaibi BF, Lenon GB. The Referral System between Primary and Secondary Health Care in Saudi Arabia for Patients with Type 2 Diabetes: A Systematic Review. Journal of diabetes research. 2017;2017.

Eskawati MY, Murti B, Tamtomo D. Implementation of the Referral System Policy in the National Health Insurance Scheme at Community Health Centers, Ngawi District, East Java. Journal of Health Policy and Management. 2017;2(2):102-11.

Nasrollahpour Shirvani D, Ashrafian Amiri H, Motlagh M, Kabir M, Maleki MR, Shabestani Monfared A, et al. Evaluation of the function of referral system in family physician program in Northern provinces of Iran. Journal of Babol University of Medical Sciences. 2010;11(6):46-52.

O'Donnell CA. Variation in GP referral rates: what can we learn from the literature? Family practice. 2000;17(6):462-71.

Habibzade s. Family physician and referral system, challenges and hopes. Journal of Mashhad University of Medical Sciences. 2011.

Steinmann P, Baimatova M, Wyss K. Patient referral patterns by family doctors and to selected specialists in Tajikistan. International health. 2012;4(4):268-76.

Ferdosi M, Vatankhah S, Khalesi N, Ayoobian A. Designing a referral system management model for direct treatment in social security organization. Journal Mil Med. 2012;14(2):129-35.

MA I. A study of Refferal System from the view of physicians correspondent. Emam Khomeini Aid Committee Tamin-E-Ejtemaee Journal of medicine. 2003.

Morris CG, Lesko SE, Andrilla HA, Chen FM. Family medicine residency training in community health centers: A national survey. Academic Medicine. 2010;85(10):1640-4.

Bagley P, Lin V. Public health systems research: the state of the field. Australian Health Review. 2008;32(4):721-32.

Doshmangir L DP, Abbasi M, A R Infrastructures for Implementation of Urban Family Medicine in Iran: a Qualitative Document Analysis. Hakim Health Sys Res 2015.

Bagley BA. The New Model of Care in Family Medicine: What's In It For You? Family practice management. 2005;12(5):59.

Khayyati F, Motlagh ME, Kabir M, Kazemeini H. The role of family physician in case finding, referral, and insurance coverage in the rural areas. Iranian journal of public health. 2011;40(3):136.

Sørensen TH, Olsen KR, Vedsted P. Association between general practice referral rates and patients’ socioeconomic status and access to specialised health care: A population-based nationwide study. Health policy. 2009;92(2):180-6.

Jaturapatporn D, Dellow A. Does Family Medicine training in Thailand affect patient satisfaction with primary care doctors? BMC family practice. 2007;8(1):14.

Tavakloi F ea. The Effect of Health Policy and Structure of Health Insurance on Referral System in the Urban Family Physician Program in Iran. Jornal of health care Managemenat. 2017;8( 3):85-93.

Cohidon C, Wild P, Senn N. Coping better with health problems after a visit to the family physician: associations with patients and physicians characteristics. BMC family practice. 2018;19(1):27.

Mehrolhassani MH, Sirizi MJ, Poorhoseini SS, Feyzabadi VY. The Challenges of Implementing Family Physician and Rural Insurance Policies in Kerman Province, Iran: A Qualitative Study. Journal of Health and Development. 2012;1(3):193-206.

Nuwer MR. Public policy and healthcare systems. Handbook of clinical neurology. 118: Elsevier; 2013. p. 277-87.

Arunanondchai J, Fink C. Trade in health services in the ASEAN region. Health Promotion International. 2006;21(suppl_1):59-66.

Shadpour K. Health sector reform in Islamic Republic of Iran. Hakim Research Journal. 2006;9(3):1-18.

Ayé R, Wyss K, Abdualimova H, Saidaliev S. Household costs of illness during different phases of tuberculosis treatment in Central Asia: a patient survey in Tajikistan. BMC Public Health. 2010;10(1):18.

IssueVol 49 No 11 (2020) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v49i11.4732
Management of referral system Urban family physician Factor analysis Primary health care

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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
TAVAKOLI F, NASIRIPOUR AA, RIAHI L, MAHMOUDI M. Design of a Model for Management of Referral System in the Iranian Urban Family Physician Program. Iran J Public Health. 2020;49(11):2144-2151.