Patient referral patterns by family doctors and to selected specialists in Tajikistan

Referral rates are a key measure for the functioning of a healthcare system. The objective of this study was to assess referral patterns from family doctors (FD) and selected specialists to other specialists and hospitals in two rayons (districts) of Tajikistan. Quantitative data on referral decisions and self-referral was collected among FDs and selected specialists over a 10-workday period in 2008. For comparison, the collected information was contrasted to routinely recorded data and figures from the national health information system (HIS). The mean referral rate of FDs was 20.0% while the referral rate according to the HIS was 4.5%. In one rayon, the majority of the referred patients were sent to hospitals (65.6%) while in the other rayon, 65.9% were advised to see a specialist. Technical diagnostic tests not available at the primary healthcare level triggered the majority of all referrals. A need for diagnosis and treatment by specialists accounted for 19.2% of the referrals. Self-referral was common among patients seen by ophthalmologists and otorhinolaryngologists (76.0%). We conclude that referral rates among Tajik FD patients are high and self-referral of patients to a specialist is the norm. The routine HIS fails to provide accurate data.