PDF(Pubmed)
Abstract：
BACKGROUND: Considering the challenges of the referral system in the family physician program and the impact of COVID-19 pandemic on the performance of the relevant ministry\'s programs, it is necessary to assess the performance of the referral system. This study was conducted with the aim of investigating the performance of the family physician referral system before and during COVID-19 in Golestan province.
METHODS: The present repeated cross-sectional study was conducted on secondary data Recorded of 786,603 cases referred and cared by family physicians (including information on physicians\' and midwives\' visits, percentage of prescriptions and other information) in Golestan province from 2017 to 2022 in a census and retrospective manner. Data were collected using the reference ratio checklist and analyzed with SPSS 23 software at a significance level of less than 0.05.
RESULTS: Referral to 10 types of medical specialties and 10 indicators of family physicians referral before and during COVID-19 were investigated. The highest and lowest percentages of referrals by family physicians were belonged to the surgical (17.6%) and infectious (2%) specialists before COVID-19, and internal medicine (15.07%) and urology (3%) specialists during COVID-19, respectively. Referral due to physician\'s diagnosis increased by 19.3% compared to before Covid-19, target group increased by 0.86%, care decreased by 2.69% and reverse referral decreased by 36.1%. The amount of population covered by rural insurance, the amount of visits to midwives, the percentage of electronic appointments in the post-Covid-19 years have changed significantly compared to before.it (P-Value < 0.05).
CONCLUSIONS: The present study showed that the COVID-19 pandemic had a significant impact on family physician referral indicators, such as the process of referral to specialists, drug prescriptions, insurance coverage, one-time service population, and patient care, which can be used to eliminate the weaknesses and Strengthening the strengths of the programs being implemented in the face of possible pandemics is very useful and effective and can be used in the country. Finally, the results obtained from this research provide evidence to discuss the importance of the family physicians care and referral system in the face of special conditions for quality control in health policies.
METHODS: The present repeated cross-sectional study was conducted on secondary data Recorded of 786,603 cases referred and cared by family physicians (including information on physicians\' and midwives\' visits, percentage of prescriptions and other information) in Golestan province from 2017 to 2022 in a census and retrospective manner. Data were collected using the reference ratio checklist and analyzed with SPSS 23 software at a significance level of less than 0.05.
RESULTS: Referral to 10 types of medical specialties and 10 indicators of family physicians referral before and during COVID-19 were investigated. The highest and lowest percentages of referrals by family physicians were belonged to the surgical (17.6%) and infectious (2%) specialists before COVID-19, and internal medicine (15.07%) and urology (3%) specialists during COVID-19, respectively. Referral due to physician\'s diagnosis increased by 19.3% compared to before Covid-19, target group increased by 0.86%, care decreased by 2.69% and reverse referral decreased by 36.1%. The amount of population covered by rural insurance, the amount of visits to midwives, the percentage of electronic appointments in the post-Covid-19 years have changed significantly compared to before.it (P-Value < 0.05).
CONCLUSIONS: The present study showed that the COVID-19 pandemic had a significant impact on family physician referral indicators, such as the process of referral to specialists, drug prescriptions, insurance coverage, one-time service population, and patient care, which can be used to eliminate the weaknesses and Strengthening the strengths of the programs being implemented in the face of possible pandemics is very useful and effective and can be used in the country. Finally, the results obtained from this research provide evidence to discuss the importance of the family physicians care and referral system in the face of special conditions for quality control in health policies.
摘要：
背景：考虑到家庭医生计划中转诊系统的挑战以及COVID-19大流行对相关部计划绩效的影响，有必要评估转介系统的性能。这项研究的目的是调查Golestan省在COVID-19之前和期间家庭医生转诊系统的表现。
方法：本重复横断面研究是针对次要数据进行的，记录了由家庭医生转诊和照顾的786,603例病例（包括有关医生和助产士就诊的信息，2017年至2022年Golestan省的处方百分比和其他信息）以人口普查和回顾性方式进行。使用参考比率检查表收集数据，并用SPSS23软件以小于0.05的显著性水平进行分析。
结果：调查了COVID-19前后10种医学专业的转诊情况和10项家庭医生转诊指标。家庭医生转诊比例最高和最低的分别是COVID-19之前的外科（17.6%）和感染性（2%）专家，以及COVID-19期间的内科（15.07%）和泌尿外科（3%）专家。与Covid-19之前相比，由于医生的诊断而转诊增加了19.3%，目标群体增加了0.86%，护理减少2.69%，反向转诊减少36.1%。农村保险覆盖的人口数量，去助产士的次数,后Covid-19年的电子预约比例与以前相比发生了显著变化。它（P值<0.05）。
结论：本研究表明，COVID-19大流行对家庭医生转诊指标有重大影响，例如转诊给专家的过程，药物处方,保险范围，一次性服务人群，和病人护理，它可以用来消除弱点和加强在可能的流行病面前正在实施的方案的优势是非常有用和有效的，可以在国内使用。最后,从这项研究中获得的结果提供了证据，以讨论面对卫生政策中质量控制的特殊条件，家庭医生护理和转诊系统的重要性。
方法：本重复横断面研究是针对次要数据进行的，记录了由家庭医生转诊和照顾的786,603例病例（包括有关医生和助产士就诊的信息，2017年至2022年Golestan省的处方百分比和其他信息）以人口普查和回顾性方式进行。使用参考比率检查表收集数据，并用SPSS23软件以小于0.05的显著性水平进行分析。
结果：调查了COVID-19前后10种医学专业的转诊情况和10项家庭医生转诊指标。家庭医生转诊比例最高和最低的分别是COVID-19之前的外科（17.6%）和感染性（2%）专家，以及COVID-19期间的内科（15.07%）和泌尿外科（3%）专家。与Covid-19之前相比，由于医生的诊断而转诊增加了19.3%，目标群体增加了0.86%，护理减少2.69%，反向转诊减少36.1%。农村保险覆盖的人口数量，去助产士的次数,后Covid-19年的电子预约比例与以前相比发生了显著变化。它（P值<0.05）。
结论：本研究表明，COVID-19大流行对家庭医生转诊指标有重大影响，例如转诊给专家的过程，药物处方,保险范围，一次性服务人群，和病人护理，它可以用来消除弱点和加强在可能的流行病面前正在实施的方案的优势是非常有用和有效的，可以在国内使用。最后,从这项研究中获得的结果提供了证据，以讨论面对卫生政策中质量控制的特殊条件，家庭医生护理和转诊系统的重要性。
