Referrals from Primary Care to Tertiary Care in the University Hospital

Abstract

Objective: To assess the situation and cause of referral of outpatients who are covered by Siriraj universal coverage (UC) scheme from primary care unit (PCU) to tertiary care (TC) hospital (both PCU and TC hospital are a part of Siriraj Hospital).

Methods: This study used the 2008-2011 computerized data to explore the financial situation of the hospital in influencing the use of universal coverage scheme and the cause of referral situation from the PCU to the TC hospital.

Results: The top ten diseases which were the important causes of referral of UC patients from the PCU to the TC hospital were cataract, diabetes, hypertension, cancer, abnormal joint, osteoarthritis, infection, allergic rhinitis, depression, and wound complication. Inadequate essential drug list, unsupportable workloads, lack of specific equipment, and lack of specific physicians at the PCU have tended to refer the chronic or complicated patients to TC.

Conclusion: The trends of UC patients at the PCU were continuously increasing and more than half of patients were referred to the TC. Referral from PCU to TC was the important reason for high expenditure of the registered contractors’ units. This is the challenging situation which the administrators have to manage in the limited resource.

Keywords: Referral, primary care, tertiary care, university hospital

Siriraj Med J 2014;66:91-96