Psychological Factors Explaining the Referral Behavior of Iranian Family Physicians

Abstract

Background:The recently developed policy of the family practice program in rural regions of Iran faced some challenges such as inefficient referral system. The health insurance organizations (purchaser) and health policy makers are concerned about the high rate of patient referrals from family physicians to specialists due to imposing unnecessary services and costs.Objectives:This study examined utility of the theory of planned behavior to explain intention of Iranian family physicians to reduce referral rate of patients with respiratory diseases to medical specialist.Patients and Methods:An exploratory cross-sectional study, employing a correlational design directed by the theory of planned behavior was conducted. A questionnaire was developed based on an eliciting study and review of literature. One hundred and seventy-four family physicians working at primary care centers in two provinces of Iran completed the questionnaire (response rate of 86%).Results:The finding revealed that intention of family physicians to reduce referral rate of patients to specialists was significantly related to two theory-based variables of subjective norms (r = 0.38, P < 0.001) and perceived behavioral control (r = 0.43, P < 0.001), and not to attitudes. A stepwise regression entering direct measures of the theory variables explained 35% of the variance on the intention, with perceived behavioral control being the strongest predictor. Adding background variables to the model achieved further 5% by variables of practice size and past referral rate behavior.Conclusions:The results indicated that psychological variables of the theory of planned behavior could explain a noticeable proportion of variance in family physician's intention to decrease the rate of referring patients with respiratory diseases to medical specialists. The intention is primarily influenced by normative and control considerations. These findings contribute to a better understanding of referral decisions by family physicians and are of great value in developing interventions to reduce the variation in referral rate of patients to medical specialists at primary care health centers.

Challenges and strengths of implementing urban family physician program in Fars Province, Iran

“…reported that some FPs feel that they have low control on referral decisions due to the social pressure. [ 10 ] In the current study, the participants argued how this issue was also solved through the instructions approved by these executive meetings which limited the referrals up to 20% of total FP visits.…”

“…[ 8 9 ] Gradually, health system failed to respond to the emerging needs of the population because of high burden of noncommunicable diseases, public expectation to access qualified physicians, and fast-growing technologies. [ 10 11 ] Therefore, the Ministry of Health and Medical Education (MOHME) initiated a series of health sector reforms, including the pilot phase of FP program as a basic health plan in rural areas based on the fourth 5-year national development plan in 2005. [ 12 13 14 ] These reforms in rural areas and small cities with populations under 20,000 individuals made very sharp improvements, especially in major health indicators, such as maternal mortality, life expectancy, and the control of infectious diseases.…”