Assessing the Quality of Patient Referrals from Primary Care Physicians at the South-West Regional Health Authority, Trinidad, 2019

Aim: To assess the adequacy and justification of referrals from primary care physicians (PCPs) to specialized care services. Methods: Descriptive, retrospective, and cross-sectional. In 2019, 1810 patient referrals from over 46 PCPs working at 23 centers, obtained through consecutive convenient sampling were reviewed. Parameters of the referral were assessed using the “South-West Regional Health Authority Tool for Assessing the Adequacy of Outgoing Referrals from Primary Health Care (PHC),” by senior PCPs. Descriptive statistics were used to calculate the proportions of the degree of adequacy and completeness of referral parameters and the distribution of referral scores; referral rates; proportion of referrals to specialized care services and proportion of justified and unjustified referrals. Results: The referral rate was 5.28%. In terms of adequacy and completeness: Demographics - 77.96% - partially adequately completed; diagnoses - 91.65% adequately completed; History - 83.82% partially adequately completed; Examination findings - 43.70% - adequately completed. In 57.54% of referrals, the treatment given was not completed. In most referrals, sections that were adequately completed include recent labs - 57.54%; current medications - 48.83%; footer - 55.20%. The scores ranged from 5 to 21; median - 15 and mode - 16. Based on the senior PCPs’ perception, 94.36% of the outgoing referrals were justified. Most patients, 63.84%, were referred to the outpatient clinics and 33.89% to the emergency department. Conclusions: Most referrals were justified. The adequacy can further be assessed by an expert panel of end-users. Addressing gaps identified in the referral system should enable cost-effective use of specialized and PHC services.