As an integral part of the duties of a family physician is the referral. Coordinating this referral process and getting aa feedback is important to caring for this patients. This slides gives us an insight to the what referral means in this specialty.

1. REFERRALS IN FAMILY
MEDICINE
DR. MUYIWA OGUNTUNDE
JUNIOR RESIDENT, FAMILY MEDICINE
O.L.A CATHOLIC HOSPITAL,
OLUYORO
29TH MAY, 2023
9/3/2023 1

2. OUTLINE
• INTRODUCTION
• LEVELS OF CARE IN NIGERIA
• TYPES OF REFERRAL
• REASONS FOR REFERRAL
• REFERRAL PROCESS
• COMPONENTS OF A REFERRAL LETTER
• BENEFITS OF REFERRAL
• CHALLENGES IN REFERRAL
• ROLE OF FAMILY PHYSICIAN IN REFERRAL
• CONCLUSION
• REFERENCES
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3. REFERRAL LETTER SAMPLE
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4. REFERRAL LETTER SAMPLE
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5. • FROM THE 2 SAMPLES OF REFERRAL LETTERS,
CAN WE SAY THEY CONTAIN THE NECESSARY
INFORMATIONS NEEDED IN A GOOD
REFERRAL LETTER?
• IF YES, WHAT ARE INCLUDED THAT ARE
SUPPOSED TO BE THERE?
• IF NO, WHAT ARE SUPPOSED TO BE THERE
THAT ARE NOT INCLUDED?
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6. INTRODUCTION
• Referral is the process of sending a patient to
another healthcare professional or specialist for
further evaluation or treatment of a medical or
surgical condition beyond the scope of the
physicians practice.
• There must be an accompanying note / letter
for referral to be effective and coordinated.
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7. • Family physicians are often the first point of
contact for patients seeking medical care and
therefore referrals are integral to family practice
as patients would need to be sent to other
specialists.
• Provide primary medical care services, manage
chronic conditions, and offer preventive care.
• Work closely with healthcare professionals
ensuring that patients receives the appropriate
care and treatment.
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8. • Referral should not be confused with
consultation.
• In consultation, a doctor that is responsible for
the care of a patient seek the opinion or
assistance of a colleague on the patients care
and the patient is at no time under the care of
the physician whose opinion is being sort.
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9. LEVELS OF CARE
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10. TYPES OF REFERRAL
MODERN CLASSIFICATION
• Split referral
• Cross referral
• Interval referral
• Collateral referral
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11. SPLIT REFERRAL
• This is seen in a multi - specialist setting
whereby this responsibilities is shared evenly
among two more physicians in the same
center and on a single patient.
• Seen in HIV patient who require multi –
specialist involvement in their management –
Clinical care, Nutritional care, counseling and
the support group.
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12. CROSS REFERRAL
• Patient is advised to see another physician
and the referring physician takes no
responsibilities on the patient again. Also
known as self – referral .
• Seen when the patient referred him/herself
without prior consent of the clinician.
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13. COLLATERAL REFERRAL
• In this situation, the Physician refers a patient
for secondary or tertiary care and expects a
reverse referral from the secondary or tertiary
consultant for continuity of treatment or
coordinated care.
• A diabetic patient with glaucoma referred to
an ophthalmologist for surgery.
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14. INTERVAL REFERRAL
• Patient is referred for complete care for a
limited period of time.
• The referring physician has no responsibility to
the patient during the period of care under
the consultant.
• A patient with myocardial infarction admitted
in hospital for a period under the care of a
cardiologist then return for continuity after
being discharged.
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15. OTHER TYPES OF REFERRAL
• Internal (Within the same institution)
• External ( From one institution to the other)
• Vertical ( From primary to secondary too
tertiary)
• Horizonal ( From primary to primary,
secondary to secondary , from tertiary to
tertiary)
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16. ACCORDING TO CASE
• MANDATORY
This is seen in a condition in which the patient is
likely to suffer harm if not referred.
• ELECTIVE
Where the patient is not likely to suffer harm if
not referred.
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17. • NB , In referring patients, they must be
involved in decision making, consent, choice
of referral centre, treatment options, need for
referral e.t.c.
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18. REASONS FOR REFERRAL
• DIAGNOSTIC TESTING: Sometimes, family
physicians may need to refer patients for
diagnostic testing such as imaging studies,
laboratory tests, or biopsies to help diagnose a
condition.
• MENTAL HEALTH CONCERNS: Patients with
mental health concerns such as depression,
anxiety, or substance abuse may be referred for
counseling ( psychologist) or psychiatric
evaluation.
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19. • SPECIALIST CONSULTATION: Family physicians
may refer patients to specialists such as
cardiologists, gastroenterologists, or
neurologists for further evaluation and
management of specific condition.
• REHABILITATION: Patients who require
physical therapy or rehabilitation services may
be referred to appropriate providers.
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20. • PALLIATIVE CARE: Patients with serious illness
or advanced disease may be referred to
palliative care providers for symptom
management and end-of-life care.
The decision to refer a patient to another
healthcare provider is made on a case-by-case
basis, taking into account the patient's unique
health needs and circumstances.
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21. REFERRAL PROCESS
The referral may be initiated by either the Physician
or the patient, depending on the circumstances.
The referral process typically involves the following.
• IDENTIFICATION OF THE NEED FOR A REFERRAL:
The Physician may identify a need for a referral
after conducting a thorough evaluation of the
patient's medical history and symptoms.
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22. REFERRAL PROCESS
• SELECTION OF A SPECIALIST: The Physician
will select a specialist based on the patient's
condition, insurance coverage, and other
factors.
• REFERRAL AUTHORIZATION: The Physician
will obtain authorization from the patient's
insurance company for the referral, if
required.
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23. REFERRAL PROCESS
• REFERRAL DOCUMENTATION: The Physician
will prepare a referral document, which
includes the patient's medical history, the
reason for the referral, and any relevant test
results or imaging studies.
• COMMUNICATION WITH THE SPECIALIST: The
Physician will communicate with the specialist
to provide any necessary information and to
coordinate the transfer of care.
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24. REFERRAL PROCESS
• FOLLOW-UP: The PCP will follow up with the
patient to ensure that the specialist has provided
appropriate care and to determine whether
further treatment or referral is necessary.
Overall, the referral process is an important aspect
of family medicine, as it allows patients to receive
specialized care for specific medical conditions
while still maintaining a relationship with their
primary care physician.
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25. COMPONENTS OF A REFERRAL LETTER
A good referral letter must have the following;
• Time and date of referral
• Receiving consultant
• Bio – data
• Hospital number
• Summary of presenting complaints
• Summary of physical findings
• Clinical impression, diagnosis or list of significant
problems
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26. COMPONENTS OF A REFRRAL LETTER
• Results of laboratory or radiological
investigations
• Procedures carried out
• Progress of the disease
• Treatment and medications given
• Reasons for referral
• Request for feedback
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27. COMPONENTS OF A REFERRAL LETTER
• Name and signature of referring physician
• THE USE OF TO WHOM IT MAY CONCERN
SHOULD BE AVOIDED WHILE ADDRESSING THE
LETTER
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28. BENEFIT OF REFERRAL
FOR THE PATIENT
• Prompt diagnosis and management
• Save time, money and effort
• Better outcome
FOR THE FAMILY PHYSICIAN
• Learning and training
• Gaining self confidence
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29. • Increase communication between the health
care staff.
FOR THE CONSULTANT
• Improve the quality of the patients
management.
• Increase the communication between the
health care staff.
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30. CHALLENGES IN REFERRAL
Referrals in family medicine can be challenging
for a number of reasons,
• COMMUNICATION: Communication between
the referring physician and the specialist may
be inadequate, leading to incomplete or
inaccurate information being conveyed. This
can result in delays in diagnosis and
treatment, or even misdiagnosis.
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31. CHALLENGES IN REFERRAL
• COORDINATION OF CARE:
Referrals often involve multiple healthcare
providers, and coordination of care can be
challenging. Patients may need to see several
specialists, and it can be difficult to ensure that
all of their care is well-coordinated.
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32. CHALLENGES IN REFERRAL
• PATIENT FACTORS:
Patients may be reluctant to see a specialist, or
they may have financial or logistical barriers to
accessing care. This can result in delays in
diagnosis and treatment, and can also lead to
unnecessary use of emergency departments.
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33. CHALLENGES IN REFERRAL
• LIMITED ACCESS TO SPECIALISTS:
In some areas, there may be a shortage of
specialists, leading to long wait times for patients
who need to see a specialist. This can result in
delayed diagnosis and treatment, and can also
place a strain on physicians who are managing
complex cases without specialist input.
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34. CHALLENGES IN REFERRAL
• Overall, addressing these challenges requires
collaboration between family physicians,
specialists, and healthcare organizations to
ensure that patients receive timely,
coordinated, and appropriate care.
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35. ROLE OF FAMILY PHYSICIAN IN
REFERRAL
CAREGIVER
• He gives first contact care and serving as a
point of entry for the patient into the health
care system. He makes several referral to
different specialties. Referral is integral to the
caregiver role that a family physician is
playing.
• He would need to make several referrals as
the case demands.
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36. ROLE OF FAMILY PHYSICIAN IN
REFERRAL
COORDINATOR
• He liaise with other specialties in other to give
the patient an holistic care
• He would need to write referrals to those
specialties as the need arises for his patients
• He gives appropriate and timely referrals with
follow up
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37. ROLE OF FAMILY PHYSICIAN IN
REFERRAL
ADVOCATE
• He can advocate for better referral system in the
health care system in other to improve patients
care.
• He can advocate for an incorporation of referral
in the curriculum for medical schools such that
when students become doctors, they can write a
good referral letter with necessary information
that would facilitate the process.
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38. ROLE OF FAMILY PHYSICIAN IN
REFERRAL
• At the government level, a family physician
can advocate to ensure that referrals are given
feedbacks. A lot of referral in this environment
don’t give feedback to the referring physician.
• He can also advocate for processes that will
improve these feedback which will help the
health care system and the patient generally.
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39. ROLE OF FAMILY PHYSICIAN IN
REFERRAL
MANAGER
• A family physician should appropriately make
use of the resources in the health care system
and that of the patient to refer patient to the
specialist needed instead of referring
inappropriately such that there wont be
duplication of efforts.
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40. ROLE OF FAMILY PHYSICIAN IN
REFERRAL
• He is able to utilize and manage
resources(man, money, materials and
minutes)effectively so that he can refer to
appropriate personnel e.g. knowing to refer to
an orthopedic rather than a plastic surgeon.
So that the resources and time are not wasted
and patient can have a good experience as
regards their health.
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41. ROLE OF A FAMILY PHYSICIAN IN
REFERRAL
RESEARCHER
• He should be involved in research as regards
referrals in other to improve on referral
policies, referral processes within the health
care system within the community, state and
the country where he practices.
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42. CONCLUSION
• For effective and efficient healthcare delivery
locally and globally, there must be a holistic,
continuing and coordinated care and these
can only be possible by a good referral system.
• All healthcare facilities locally and globally
must adopt a referral policy taking into
consideration the resources available and the
increasing complexity of disease that are
prevalent in the target locality.
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43. REFERENCES
• Bob Mash, Handbook of Family Medicine,
Oxford University Press South Africa, Third
Edition. 2011;pg 178-181.
• Ita B Okokon. Emergency Referral, Lecture
Presentation during Revision Workshop
organized by WACP, Faculty of Family
Medicine at Ibadan, 2013.
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44. • Obadofin, M.O. Health Facility Management
and Referral System. Lecture presentation
during Joint Update Course organized by
NPMCN, 2019.
• Oxford Handbook of General Practice. Oxford
University Press. 3rd Edition. 2010.
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