Trends of Referrals Throughout the Kingdom, A Retrospective Analysis of the Saudi Medical Appointments and Referrals Centre Registry, Saudi Arabia

Abstract

Background: The referral process has a central role within health care systems, acting as a gateway to those requiring certain methods of care and services. The main objective of our study was to assess the trends of referrals across the regions of Saudi Arabia during a four-year period from 2018 to 2021 involving a total of more than 1·6 million referrals. Methods: We conducted a retrospective observational study design of referral data submitted by practitioners from different facilities across all regions within Saudi Arabia. Data was obtained from the Saudi Medical Appointments and Referrals Centre (SMARC) over a four-year timeline from 2018 to 2021, with data including the type of referral, reason for referral, and the required specialty. Results: A total of 1,607,009 referrals across the Kingdom of Saudi Arabia were analyzed. The overall number of referrals have increased dramatically throughout the years with an increase of 55% from the year 2018 to 2021, with most referrals being routine (938,467) (58·3%) composed of inpatient and outpatient types of referrals (Figure 1A). Unavailability of required specialty by the primary provider was the most popular reason for referral (897,461) (55·8%), with General Surgery contributing to the majority of referrals (430,664) (26·7%) (Figures 2A, 3A). Referrals initiated from 2019 to 2021 had an acceptance rate of 55·3% with the remaining being either closed (43·3%) or rejected (0·5%). The nationality of the individual requiring a referral was most likely Saudi, contributing to a total of (1,109,254) (84.8%) referrals from 2019 to 2021 (Tables 4A-4B). Conclusions: Upon assessing trends of referrals across regions of Saudi Arabia, we observed a major increase in referrals starting from the year 2018 to 2021, potentially inflicting harm on the sustainability of high-quality health systems. Further actions should be taken to assess the appropriateness of referrals made, which could aid in identifying areas of inefficiencies and possible rate reduction.

External Vs Internal e-Referrals: Results from a Nationwide Epidemiological Study Utilizing Secondary Collected Data

“…In the Kingdom of Saudi Arabia (KSA), the Saudi Medical Appointments and Referrals Centre (SMARC), formerly known as Ehalati, operates and manages e-referrals across the country. 7 The SMARC system manages both internal and external referrals. Internal referrals represent any referral of patients from one health institution to another within the same administrative area, whereas external referrals represent the referral of patients to healthcare institutions outside of that referring administrative area.…”

“…9 , 10 Thus, to meet the aim of the referral concept, which is to move a patient from a place that has insufficient resources such as equipment and specialized healthcare providers to another facility, external referrals are also available within the SMARC e-referral system. 7 , 11…”

“…9,10 Thus, to meet the aim of the referral concept, which is to move a patient from a place that has insufficient resources such as equipment and specialized healthcare providers to another facility, external referrals are also available within the SMARC e-referral system. 7,11 External referrals are likely to be more complicated to manage and costly than standard internal referrals. The Ministry of Health (MoH) in the KSA provides flight tickets and daily living expenses to patients and their fellows when they are referred externally.…”

Assessing Medical Emergency E-referral Request Acceptance Patterns and Trends: A Comprehensive Analysis of Secondary Data From the Kingdom of Saudi Arabia

“…An effective referral system that encourages effective collaboration through all levels of care is a necessity to provide the highest quality healthcare [1]. An effective referral system bridges the gaps in healthcare infrastructure and provides an integrated channel through which healthcare facilities and regional hospitals can work together to ensure that patients have access to all necessary healthcare resources, including those that may not be available at their original treatment location [2,3]. A variety of factors contribute to the success of a referral system, including barriers to patient access, the overall functioning of the healthcare system, communication systems, human and non-human resources, technology, and patient behavior in response to the referral [4].…”

“…Current available literature indicates a significant variation in the rate of referral requests made by physicians, with a notable increase in referral requests in recent years [2,[10][11][12][13]. This increase in referral requests can be attributed to several factors, including a growing and aging population, and the increased complexity of required care, which requires the involvement of specialized physicians [2,14,15].…”