Exploring Communication Processes in Referral Pathways for Chronic Disease Management: Malaysian Public Primary Health care Experiences

BACKGROUND- Referrals are a two-way communication between healthcare facilities to enable information transfer for the continuity of patient care. The Enhanced Primary Healthcare (EnPHC) initiative, a complex intervention package to improve non-communicable disease (NCD) management, introduced improvements to the NCD’s referral mechanism from primary healthcare clinics to the hospital. This study explores the communication process between the Malaysian public primary healthcare and hospital for chronic care management. METHOD- A qualitative exploratory study using purposive sampling was done in all twenty EnPHC intervention clinics. In-depth interviews and focus group discussions were carried out among all healthcare providers working in EnPHC clinics. The 47 interview sessions were audio-recorded, transcribed verbatim, and analyzed thematically. RESULTS- A total of 97 healthcare providers participated. Three main themes of the communication process between the primary health care and hospital during the implementation of EnPHC intervention emerged from the analysis. These are; (1) structured information relay, (2) no show appointment tracking via various communication devices has strengthened the mechanism to monitor the referred patient appointment scheduling and their adherence to the appointment, and (3) inter-facility networking facilitated the implementation of EnPHC’s referral mechanism. CONCLUSION- The EnPHC referral mechanism created a platform for PHC clinics and hospitals to communicate and build rapport to help ensure care continuity for NCD patients. The traditional method of communication between healthcare facilities should change and instead start using the newest or most current, advanced technology.