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

Nawfal A Aljerian; Abdullah A Alharbi; Hani A Alghamdi; Meshary S Binhotan; Reem S AlOmar; Ali K Alsultan; Mohammed S Arafat; Abdulrahman Aldhabib; Mohammed K Alabdulaali

doi:10.2147/RMHP.S453042

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

Risk Manag Healthc Policy. 2024 Mar 28:17:739-751. doi: 10.2147/RMHP.S453042. eCollection 2024.

Authors

Affiliations

¹ Medical Referrals Centre, Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
² Emergency Medicine Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
³ Family and Community Medicine Department, Jazan University, Jazan, Kingdom of Saudi Arabia.
⁴ Department of Family and Community Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
⁵ Emergency Medical Services Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
⁶ King Abdullah International Medical Research Centre, Riyadh, Kingdom of Saudi Arabia.
⁷ Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia.

Abstract

Background: E-referral systems, streamlining patient access to specialists, have gained global recognition yet lacked a comparative study between internal and external referrals in Saudi Arabia (KSA).

Methods: This retrospective study utilized secondary data from the Saudi Medical Appointments and Referrals Centre system. The data covers 2020 and 2021, including socio-demographic data, referral characteristics, and specialties. Logistic regression analysis was used to assess factors associated with external referrals.

Results: Out of 645,425 e-referrals from more than 300 hospitals, 19.87% were external. The northern region led with 48.65%. Males were 55%, and those aged 25-64 were 56.68% of referrals. Outpatient clinic referrals comprised 47%, while 61% of referrals were due to a lack of specialty services. Several significant determinants are associated with higher rates of external referral with (p-value <0.001) and a 95% Confidence interval. Younger individuals under 25 exhibit higher referral rates than those aged 25-64. Geographically, compared to the central region, in descending order, there were increasing trends of external referral in the northern, western, and southern regions, respectively (OR = 19.26, OR = 4.48, OR 3.63). External referrals for outpatient departments (OPD) and dialysis services were higher than for routine admissions (OR = 1.38, OR = 1.26). The rate of external referrals due to the lack of available equipment was more predominant than other causes. Furthermore, in descending order, external referrals for organ transplantation and oncology are more frequent than for medical specialties, respectively (OR = 9.39, OR = 4.50).

Conclusion: The study reveals trends in e-referrals within the KSA, noting regional differences, demographic factors, and types of specialties regarding external referrals, benefiting the New Model of Care for the 2030 Vision. Findings suggest expanding virtual consultations to reduce external referrals. Strengthening primary care and preventive medicine could also decrease future referrals. Future studies should assess resource distribution, including infrastructure and workforce, to further inform healthcare strategy.

Keywords: e-referrals; epidemiology; health policy; public health.

Grants and funding

This research is non-funded.