Mohaghegh Bahram, Seyedin Hesam, Rashidian Arash, Ravaghi Hamid, Khalesi Nader, Kazemeini Hossein
School of Health Management and Information Sciences, Iran University of Medical Sciences, Iranian Ministry of Health and Medical Education, Tehran, IR Iran.
Health Management and Economic Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Iranian Ministry of Health and Medical Education, Tehran, IR Iran.
Iran Red Crescent Med J. 2014 Apr;16(4):e13395. doi: 10.5812/ircmj.13395. Epub 2014 Apr 5.
The recently developed policy of the family practice program in rural regions of Iran faced some challenges such as inefficient referral system. The health insurance organizations (purchaser) and health policy makers are concerned about the high rate of patient referrals from family physicians to specialists due to imposing unnecessary services and costs.
This study examined utility of the theory of planned behavior to explain intention of Iranian family physicians to reduce referral rate of patients with respiratory diseases to medical specialist.
An exploratory cross-sectional study, employing a correlational design directed by the theory of planned behavior was conducted. A questionnaire was developed based on an eliciting study and review of literature. One hundred and seventy-four family physicians working at primary care centers in two provinces of Iran completed the questionnaire (response rate of 86%).
The finding revealed that intention of family physicians to reduce referral rate of patients to specialists was significantly related to two theory-based variables of subjective norms (r = 0.38, P < 0.001) and perceived behavioral control (r = 0.43, P < 0.001), and not to attitudes. A stepwise regression entering direct measures of the theory variables explained 35% of the variance on the intention, with perceived behavioral control being the strongest predictor. Adding background variables to the model achieved further 5% by variables of practice size and past referral rate behavior.
The results indicated that psychological variables of the theory of planned behavior could explain a noticeable proportion of variance in family physician's intention to decrease the rate of referring patients with respiratory diseases to medical specialists. The intention is primarily influenced by normative and control considerations. These findings contribute to a better understanding of referral decisions by family physicians and are of great value in developing interventions to reduce the variation in referral rate of patients to medical specialists at primary care health centers.
伊朗农村地区最近制定的家庭医生项目政策面临一些挑战，比如转诊系统效率低下。健康保险组织（购买方）和卫生政策制定者担心，由于提供了不必要的服务和成本，家庭医生将患者转诊给专科医生的比例过高。
本研究检验了计划行为理论在解释伊朗家庭医生降低呼吸系统疾病患者转诊至医学专科医生比例意愿方面的效用。
开展了一项探索性横断面研究，采用计划行为理论指导的相关性设计。基于一项启发式研究和文献综述编制了一份问卷。伊朗两个省份基层医疗中心的174名家庭医生完成了问卷（回复率为86%）。
研究结果显示，家庭医生降低患者转诊至专科医生比例的意愿与计划行为理论的两个变量显著相关，即主观规范（r = 0.38，P < 0.001）和感知行为控制（r = 0.43，P < 0.001），而与态度无关。逐步回归纳入理论变量的直接测量指标，解释了意愿方差的35%，其中感知行为控制是最强的预测因素。在模型中加入背景变量后，诊所规模和过去转诊率行为变量又进一步解释了5%的方差。
结果表明，计划行为理论的心理变量可以解释家庭医生降低呼吸系统疾病患者转诊至医学专科医生比例意愿中相当一部分的方差。该意愿主要受规范和控制因素的影响。这些发现有助于更好地理解家庭医生的转诊决策，对于制定干预措施以减少基层医疗中心患者转诊至医学专科医生比例的差异具有重要价值。
