Pattern of Patient Referrals from Family Healthcare Centers to Tertiary Centers in Erbil City

Abstract

Background: Family medicine provides personal, comprehensive, and ongoing care for individuals within the context of their family and community. There is little information on referral status in Middle Eastern countries. Purpose: In this regard, we aimed to investigate the reasons for patient referrals from family healthcare centers (FHCs) to tertiary health facilities within Erbil City. Methods: A cross-sectional study was conducted in five FHCs in Erbil City from October 1st 2024 to September 1st 2025. This study included patients who attended these FHCs and subsequently received referrals to tertiary health centers. Results: Of the 400 patients, one-third (36.3%) were male, and more than two-thirds (63.7%) were female. The mean age was 33.21 (SD: 18.18 years). More than two-thirds (65.8%) of the referrals were indicated, and 34.3% were self-request referrals with no significant difference in genders (p=0.941). The main reasons for referral were insufficient investigation (44%), non-existence of a specialty in the hospital (34.3%), non-diagnosis (13%), and non-availability of medicine (8.8%). Internal medicine (13.5%), ENT (13.8%), skin (11.8%), and obstetrics and gynecology (10.3%) were the main areas to which patients were referred. Pediatric and orthopedic services had equal representation (8.8%). Conclusions: Research revealed that medical professionals sent a significant number of patients to Family Health Centers (FHCs). Patients frequently self-referred because they perceived family care centers to be inadequate. Such a trend of self-referral could add a strain on the already scarce resources of the specialized healthcare institutions.