P-44 Assessing the quality of patient referrals from primary care physicians at the South-West Regional Health Authority, Trinidad, 2019

Design and Methods: Descriptive, retrospective, crosssectional. In 2019, 1366 patient referrals from PCPs working at 23 centers, obtained via consecutive convenient sampling were audited. Parameters of the referral were assessed using the ‘SWRHA Tool for Assessing the Adequacy of Outgoing Referrals from Primary Health Care,’ by senior PCPs. Descriptive Statistics were used to calculate the proportions of degree of adequacy and completeness of referral parameters and the distribution of referral scores; referral rates; proportion of referrals to specialized care services and proportion of justified and unjustified referrals.

Results: The referral rate was 5.28%. In terms of adequacy and completeness: Demographics – 77.96% – partially adequately completed; Diagnoses – 91.65% adequately completed; History – 83.82% partially adequately completed; Examination findings – 43.70% – adequately completed. In 57.54% of referrals the treatment given was not completed. In most referrals, sections that were adequately completed include: recent labs – 57.54%; current medications – 48.83%; footer – 55.20%. The scores ranged from 5 to 21; Median – 15; Mode – 16. Based on the senior PCPs’ perception, 94.36% of the outgoing referrals were justified. Most patients, 63.84%, were referred to the out-patient clinics and 33.89% to Emergency Department.

Conclusion: Most referrals were justified. The adequacy can further be assessed by an expert panel of end-users. Addressing gaps identified in the referral system should enable cost-effective use of specialized and primary health care services.