Performance trend of the family physician referral system before and after the Covid-19 pandemic: A study in northern Iran

Abstract Background: Considering the challenges of the referral system in the family physician program and the impact of Covid-19 pandemic on the performance of the relevant ministry's programs, it is necessary to assess the performance of the referral system. This study was conducted with the aim of investigating the performance of the family physician referral system before and after Covid-19 in Golestan province. Objective: The present descriptive-analytical study was conducted on secondary data (including information on physicians' and midwives' visits, percentage of prescriptions and other information) in Golestan province from 2017 to 2022 in a census and retrospective manner. Data were collected using the reference ratio checklist and analyzed with SPSS 23 software at a significance level of less than 0.05. Results: The highest and lowest percentages of referrals by family physicians were belonged to the surgical and infectious specialists before Covid-19, and internal medicine and urology specialists after Covid-19, respectively. Referral due to physician's diagnosis and target group increased compared to before Covid-19 and care and reverse referral decreased compared to before Covid-19. The amount of changes in the population covered by rural insurance, the amount of referrals to midwives, the percentage of electronic appointments after Covid-19 were significant compared to before it (P-Value<0.05). Conclusion: The present study showed that the Covid-19 pandemic had a significant impact on family physician referral indicators, such as the process of referral to specialists, drug prescriptions, insurance coverage, one-time service population, and patient care.