ORIGINAL CONTRIBUTION & CLINICAL INVESTIGATIONSaudi Ministry <strong>of</strong> Health in 1992 .The designed Scheme contained the following points:Administrative section:This section covers the following points:Name <strong>of</strong> the PHC center, Patient name, <strong>Family</strong> medicalrecord number, Direction <strong>of</strong> the referral, Date <strong>of</strong> thereferral and Name with signature <strong>of</strong> the physicianThe Medical section covers the following points:1. Personal history: (name, age and sex)2. Chief complaints3. Medical history: (present illness, relevant past historyeither medical or surgical, family history, socialhistory, diet history, physical activity history, drughistory and reproductive history)4. Investigation: (recent investigations, previous 3fasting blood glucose tests results or previous HbA1cresults if available, history <strong>of</strong> previous abnormalinvestigations - dates and action taken)5. Examinations include recent examinations related todiabetes, previous positive examinations related todiabetes.Performance on each part was calculated using homepersonal computer statistical s<strong>of</strong>tware.RESULTSTwo hundred and fifteen (215) referral forms werereviewed (89 male, 126 female), the administrative partwas filled in 94.18% <strong>of</strong> the sample while only 22.48%<strong>of</strong> the sample filled the components <strong>of</strong> the medical part[table 5&6). None <strong>of</strong> the selected sample contained dataabout history <strong>of</strong> physical practices or foot examination(Table 2).Diet history and its pattern were found only in 0.01% <strong>of</strong> thesample (3 patients). None <strong>of</strong> the referral forms includedthe height <strong>of</strong> the patient (0%) ,while only 8 referral formsincluded weight <strong>of</strong> the patient (0.037%) (Table 3).While blood pressure was an important variable onthe diabetic patient referral forms, blood pressure wasrecorded in 157forms only (73.02%) (Table 4).Only twelve patients (0.05%) were referred urgentlywhile 177 patients (82.32%) were electively referred and26 patients (12.09%) were not titled (Table 5).DISCUSSIONA referral form is the mirror which reflects the picture <strong>of</strong>the diabetic patient at the level <strong>of</strong> primary health care.Usually the PHC medical team has social interactionswith the patients. This distinct relation if organizedand utilized in a proper manner will provide great helpand facilitate the patient referral process to a specialistconsultation (1) .In our study, we planned to answer the followingquestions:Did the referral forms reflect the state <strong>of</strong> the diabeticpatient at the moment <strong>of</strong> referral?Is the information (administrative and medical) clearand complete?Analysis <strong>of</strong> the information included in the referralforms proved that the administrative part is sufficientlyperformed (94.18%) while the medical part is notperformed properly (22.48%).The great difference between the administrative andmedical performance was very obvious (71.7%). Thisdifference related to different causes, some related to theperson filling out the referral form; others to the patient;and others were varied reasons.The skill <strong>of</strong> history taking was decreased in somephysicians due to different reasons. Little chance forattending training workshops or courses greatly affectsphysicians, particularly those who work in remote areas.Only 21.39% succeeded in take the medical history in aproper manner while only 36.74% succeeded in writingthe chief complaints <strong>of</strong> the patient, properly (2) .Only 63.26% wrote the diagnosis instead <strong>of</strong> the patientcomplaints, in the place where they should have writtenthe complaints (2) .Variability <strong>of</strong> health programs at the level the PHCs,limit the time given to the care <strong>of</strong> chronic diseases, so themedical care team may forget /neglect important cluesin the patient history or examination (1) . Both history <strong>of</strong>physical activity and foot examination were not includedin any referral form reviewed, while only 3 formscontained data about diet (3,4) .The term <strong>of</strong> body mass index (BMI) was not used inany referral form, even height was not recorded in anyreferral form while weight was recorded in only 8 forms.The body mass index is an indicator for obesity which isa very important risk for the development <strong>of</strong> diabetes, orit can affect the degree <strong>of</strong> control or even facilitate thedeveloping <strong>of</strong> chronic complications <strong>of</strong> diabetes (5) .Deficiency <strong>of</strong> medical equipment may be taken as a cause<strong>of</strong> decreased medical performance, but in our study, wefound that lack <strong>of</strong> interest is stronger explanation.28MEJFM - Volume 5 Issue 1 - January 2007
ORIGINAL CONTRIBUTION & CLINICAL INVESTIGATIONSome components <strong>of</strong> the medical performance doesnot need special investigation, like foot examination.Diabetic foot problem are a preventable condition as longas foot care is continuously encouraged. Annual footexamination should be performed by PHCs physicians,or by trained staff and trained patients at home (3, 4) . Poorinterpretation <strong>of</strong> the type <strong>of</strong> referral and contrast betweenthe contents <strong>of</strong> the referral form was noticed in 0.03% <strong>of</strong>our sample (data included in the referral form was notcorrelated with the type <strong>of</strong> referral).Of our sample, 82.32% were electively referred. Thesepatients can be managed easily at the level <strong>of</strong> PHCs. In40% <strong>of</strong> the electively referred patients physicians statedclearly that the referral was made upon request <strong>of</strong> thepatient (the manual <strong>of</strong> Quality Assurance <strong>of</strong> PHC allowonly =
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