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National Medical Care Statistics 2014
CHAPTER 12: FOLLOW-UPS AND REFERRALS
Depending on the diagnosis and patient needs, primary healthcare providers may schedule follow-up appointments for patients or refer them to other healthcare providers or services. These visit
dispositions follow-ups and referrals and their related diagnoses were documented in NMCS 2014 and are reported here. Note that the classification of follow-ups and referrals followed a different approach
than that used in NMCS 2012.
12.1 NUMBER OF FOLLOW-UPS AND REFERRALS
Table 12.1.1 shows the visit dispositions of primary care patients in 2014. • About one-third 29.7 of the patients presenting to primary care had a referral or follow-up
appointment. • Almost half 49.2 of all encounters in public clinics had a follow-up appointment scheduled,
compared to only 12.9 in private clinics. This finding could be attributed to the fact that the bulk of the public clinic encounters were of patients with chronic diseases see Chapter 8, who were
more likely to require some form of follow-up. • Only 3.4 of all encounters were issued referrals. The referral rate was higher in the public sector
compared to the private sector 5.8 versus 1.8, respectively.
Table 12.1.1: Visit dispositions of primary care patients by sector in 2014
Visit disposition Unweighted
count Weighted
count Percent of encounters
95 CI Overall
Follow-up 8,742
89,641 27.5 24.4–30.8
At least one referral 1,099
11,068 3.4 2.8–4.0
Follow-up or at least one referral 9,425
96,853 29.7 26.4–33.1
Public
Follow-up 7,224
64,737 49.2 45.1–53.3
At least one referral 919
7,681 5.8 4.6–7.1
Follow-up or at least one referral 7,745
68,737 52.2 48.0–56.5
Private
Follow-up 1,518
24,904 12.9 10.7–15.1
At least one referral 180
3,387 1.8 1.4–2.2
Follow-up or at least one referral 1,680
28,116 14.5 12.3–16.7
• •
•
•
• •
115
• •
•
27.5 3.4
29.7 49.2
5.8 52.2
12.9 1.8
14.5
Chapter 12 : Follow-Ups and Referrals
12.2 TYPES OF REFERRALS
Referrals captured in NMCS 2014 included referrals within the primary care sphere which included referrals to family medicine specialists, non-specialist doctors, assistant medical officers, maternal and
child health services, quit smoking clinics and diabetes medical therapy adherence clinics, those to medical specialists other than family medicine specialists, allied health services, hospitals, and other
services which included social welfare services for the public sector and diagnostic imaging services for the private sector. Table 12.2.1 shows the distribution of referrals by type in primary care clinics in
2014. • Out of the 11,068 patients who had at least one referral recorded, 38.2 were referred to medical
specialists 1.3 per 100 encounters and 1.0 per 100 diagnoses. • Referrals to hospitals accounted for 27.6 of all referrals 0.9 per 100 encounters and 0.7 per
100 diagnoses, followed by those within the primary care sphere at 17.2 0.6 per 100 encounters and 0.4 per 100 diagnoses and those to allied health services at 13.9 0.5 per 100 encounters and
0.4 per 100 diagnoses.
Table 12.2.1: Types of referrals in primary care in 2014
Type of referrals Unweighted
count Weighted
count Percent of
total referrals
n = 11,068 Rate per 100
encounters 95 CI
n = 325,818 Rate per 100
diagnoses 95 CI
n = 436,743
Specialist 386
4,229 38.2
1.3 0.9–1.7 1.0 0.7–1.2
Hospital 278
3,052 27.6
0.9 0.7–1.1 0.7 0.6–0.8
Primary care 237
1,900 17.2
0.6 0.3–0.9 0.4 0.2–0.6
Allied health services 173
1,543 13.9
0.5 0.3–0.7 0.4 0.2–0.5
Other services 25
344 3.1
0.1 0.0–0.2 0.1 0.0–0.1
Total 1,099
11,068 100.0
3.4 2.3–4.5 2.5 1.7–3.4
Table 12.2.2 and Table 12.2.3 show the distribution of referrals by type in public and private clinics, respectively.
Public clinics
• Referrals in public clinics were most often to medical specialists 34.0 of referrals in the public sector, recorded at a rate of 2.0 specialist referrals per 100 encounters 1.3 referrals per
100 diagnoses. • Referrals within primary care accounted for 22.4 of all referrals in public clinics, followed closely
by referrals to hospitals at 21.6 and allied health services at 19.3.
Private clinics
• Nearly half 47.7 of all referrals recorded in the private sector were for medical specialists, while hospital referrals constituted most of the other half 41.1 of total referrals.
• Referrals to another primary healthcare centre, the third most common type of referrals made in private clinics, accounted for a smaller proportion of referrals in the private sector than in the
public sector 5.2 versus 22.4, respectively.
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