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Background and purpose: Health care system is organized at three levels in order to increase efficacy and effectiveness and create justice and also people availability. Considering the three levels of primary health care, access of people to specialized services through referral system is possible. With regard to the importance of referral system in family physician program, this study was performed to evaluate the function of referral system and network system in Northern provinces of Iran. Material and methods: This analytic study was performed in autumn and winter of 2012. Twenty five percent of health centers (139 centers from 552) which implement the family physician program and rural insurance coverage by medical universities of Golestan, Mazandaran, Babol and Guilan were randomly selected. In each center, 7-8 patients who were referred to level 2 by their family physician and received necessary services were evaluated. They were at their homes at inquiry time. Results: From 963 patients who received the level 2 services, 687 cases (71%) were females and 276 (29%) were males. Three hundred and twenty cases (33%) had referral form from health house. Only 299 (31%) persons referred to the centers because of diagnosis of family physician and in 161 (17%) of cases, the family physician had a role to choose a specialist of level 2. For 155 (16.1%) of cases, the specialists wrote the results of their evaluation in feedback form. Only 149 (15.5%) of patients returned to their family physicians. Six hundred ninety-seven (79.6%) of patients did not return to their family physician because of lack of knowledge. Conclusion: The results of this study showed that many principles for referral system from level 1 to higher levels and vice versa are not considered that require education, reformation and intervention in this field.

Keywords: Referral system, Family physician, Health care center, Health levels

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