Alharbi Abdullah A, Aljerian Nawfal A, Binhotan Meshary S, Alghamdi Hani A, AlOmar Reem S, Alsultan Ali K, Arafat Mohammed S, Aldhabib Abdulrahman, Aloqayli Ahmed I, Alwahbi Eid B, Alabdulaali Mohammed K
Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia.
Saudi Medical Appointment and Referrals Center, Ministry of Health, Riyadh, Saudi Arabia.
Front Public Health. 2024 Jul 17;12:1337138. doi: 10.3389/fpubh.2024.1337138. eCollection 2024.
An effective referral system is necessary to ensure quality and an optimum continuum of care. In the Kingdom of Saudi Arabia, an e-referral system known as the Saudi Medical Appointments and Referrals Centre (SMARC), has been fully functioning since 2019. This study aims to explore the rate of medical e-referral request acceptance in the KSA, and to study the factors associated with acceptance.
This period cross-sectional study utilised secondary collected data from the SMARC e-referral system. The data spans both 2020 and 2021 and covers the entirety of the KSA. Bivariate analyses and binary logistic regression analyses were performed to compute adjusted Odds Ratios (aORs) and 95% confidence intervals.
Of the total 632,763 referral requests across the 2 years, 469,073 requests (74.13%) were accepted. Absence of available machinery was a significant predictor for referral acceptance compared to other reasons. Acceptance was highest for children under 14 with 28,956 (75.48%) and 63,979 (75.48%) accepted referrals, respectively. Patients requiring critical care from all age groups also had the highest acceptance including 6,237 referrals for paediatric intensive care unit (83.54%) and 34,126 referrals for intensive care unit (79.65%). All lifesaving referrals, 42,087 referrals, were accepted (100.00%). Psychiatric patients were observed to have the highest proportion for accepted referrals with 8,170 requests (82.50%) followed by organ transplantations with 1,005 requests (80.92%). Sex was seen to be a significant predictor for referrals, where the odds of acceptances for females increased by 2% compared to their male counterparts (95% CI = 1.01-1.04). Also, proportion of acceptance was highest for the Eastern business unit compared to all other units. External referrals were 32% less likely to be accepted than internal referrals (95% CI = 0.67-0.69).
The current findings indicate that the e-referral system is mostly able to cater to the health services of the most vulnerable of patients. However, there remains areas for health policy improvement, especially in terms of resource allocation.
有效的转诊系统对于确保医疗质量和最佳的连续护理至关重要。在沙特阿拉伯王国，一个名为沙特医疗预约与转诊中心（SMARC）的电子转诊系统自2019年起全面运行。本研究旨在探讨沙特阿拉伯王国医疗电子转诊请求的接受率，并研究与接受相关的因素。
本时期横断面研究利用了从SMARC电子转诊系统收集的二手数据。数据涵盖2020年和2021年，覆盖沙特阿拉伯王国全境。进行了双变量分析和二元逻辑回归分析，以计算调整后的比值比（aORs）和95%置信区间。
在这两年的632,763份转诊请求中，469,073份请求（74.13%）被接受。与其他原因相比，没有可用设备是转诊接受的一个重要预测因素。14岁以下儿童的接受率最高，分别有28,956份（75.48%）和63,979份（75.48%）转诊被接受。所有年龄组中需要重症监护的患者接受率也最高，包括6,237份儿科重症监护病房转诊（83.54%）和34,126份重症监护病房转诊（79.65%）。所有救命转诊，共42,087份转诊，均被接受（100.00%）。观察到精神科患者的转诊接受比例最高，有8,170份请求（82.50%），其次是器官移植，有1,005份请求（80.92%）。性别被视为转诊的一个重要预测因素，女性接受转诊的几率比男性高2%（95%CI = 1.01 - 1.04）。此外，东部业务部门的接受比例高于所有其他部门。外部转诊被接受的可能性比内部转诊低32%（95%CI = 0.67 - 0.69）。
目前的研究结果表明，电子转诊系统大多能够满足最脆弱患者的医疗服务需求。然而，在卫生政策改进方面仍有空间，特别是在资源分配方面。
