Background: The issue of missed appointments at maternal healthcare clinics in primary healthcare centers (PHCCs) has received increasing attention in recent years. The significant relationship between missed appointments and access to maternal healthcare has been recognized around the world. Missed appointments have serious health and economic consequences for women seeking maternal healthcare at PHCCs. Objectives:The objectives of this research were 1) to critically explore the reasons for and socio-demographic factors associated with missed appointments at maternal healthcare clinics at PHCCs; and 2) to provide recommendations for health policy that might help to eliminate the problem of "no-show" maternal patients. Methods:Descriptive statistics were used to analyze the responses of 250 women regarding demographics, as well as their reasons for missing appointments and their preferences regarding appointment confirmation at maternal healthcare clinics at five PHCCs in Riyadh, Saudi Arabia. Results:The most frequent reasons associated with missed appointments reported by women included a lack of supplies and medical equipment, such as ultrasound machines, the unavailability of transportation and a lack of respect from PHCC staff. Conclusion:Developing easily accessible, flexible, interactive appointment systems with reminder/recall, providing means of transportation, providing training courses to PHCC employees on how to address these women and the provision of necessary medical equipment and facilities, such as ultrasound machines to all PHCCs are highly recommended to reduce the occurrence of missed appointments at maternal healthcare clinics at PHCCs in Riyadh, Saudi Arabia.

Among important daily activity that ensure providing adequate medical care to patients is the referral from primary care to hospitals. In order to improve the quality of patient care, building and improving a sound referral system should be the main objective. [1] Referral is a two-way communication process between primary-care physicians and specialists in hospitals, both of

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