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Objective (s): One of the recent reforms in the health system, rural insurance with a focus on family physician and is the referral system.This study was carried out in order to investigate the quality of the referra system in the national family physician plan in Shahroud.
Methods: This applied study was carried out in a cross-sectional procedure in 2010. In this study, all the health care centers where the family physician plan was implemented were studied and 800 referred patients were investigated and the checklists and questionnaires were completed by observing the documents and interviewing the patients. The data were analyzed using SPSS, and the results were displayed in frequency distribution tables.
Results: In 56.2% of the patients, the necessity of the reference was recognized by the physician, and in 43.8% of the cases, the patients had asked to be referred. In 66% of the cases, the level two physicians had been selected by the patients, and in 34% of the cases, they had been selected by the physician. 53% of the patients had been referred to private surgeries and clinics in level two. One-third of the patients had been referred by health houses and about one fifth of the references had led to patients’ admission to hospitals. Only in 12.5% of the cases were there copies of the references from the family physicians to the health houses. Internists had received the largest number of the referred patients (16%) from level one. The quality of the feedback was desirable only in 8.4% of the patients. There was a significant relationship between the place of reference in level two and the feedback (P=0.002).
Conclusion: Although one of the aims of the national family physician plan has been and sill is the improvement of the reference system, the results show that there are serious problems in levels one and two and the removal of these problems will lead to the improvement of the services and consequently to patient satisfaction.

Keywords: Family physician, Reference system, Health-care centers

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