Current referral practices of patients with non-communicable diseases to specialists in the Republic of Moldova

Abstract

Background. In the Republic of Moldova, patients with non-communicable diseases (NCDs) are referred to specialists more frequently than in countries in Western Europe, where the referral rate is only 5–10%. Both over-referrals and self-referrals affect the efficiency and management of primary health care (PHC). Objective(s). The study assessed the referral practices of family doctors and the behaviors of patients with non-communicable diseases regarding access to specialized outpatient medical care. Materials and methods. Between October and November 2022, a cross-sectional, observational study was conducted in 9 primary health care, analyzing 1140 consultations conducted by family doctors and involved interviews with 324 patients. Referral pathways, patient motivations and health staff involvement in specialist appointments were all assessed. Results. Almost 59% of patients with NCDs were referred to specialists, mainly to cardiologist. Self-referral was reported by 9% of respondents and 21% indicated that they would use this option in the future. Scheduling of specialist consultations was predominantly carried out by medical staff. It was found that 59% of the referred patients did not know the appointment date at the time of leaving the PHC institution. And for those who knew it, the appointment was scheduled, in most cases, within 2 weeks. Despite long waiting periods, 91% of the interviewed patients followed the official referral pathway through their family doctor. Conclusion(s). Over-referrals and self-referrals of patients with NCDs to specialists contribute to system overload, fragmented care and higher costs. It is essential to optimize referral pathways and to strengthen the role of the family physician in order to ensure an efficient and equitable health system.