The reason why patient admitted to a university hospital skip family health centers and factor affecting this

Objective: Even though it has been 7 years since the family medicine system has been established throughout the country, the referral system could not be implemented and the rate of patients preferring Family Health Centers (FHC) during the first admission is low. The aim of this study is to determine why patients admitted to a university hospital skip FHCs and the factors affecting this. Methods: This is a descriptive study. Qualitative data were also collected. The study was conducted at the Bezmialem Foundation University Hospital between July and August 2017. In reaching the sample size, the number of policlinic patients were weighted and the number of pa-tients was followed up in consecutive days. A questionnaire form prepared by researchers from eight selected outpatient clinics was applied to 522 individuals using the face-to-face interview method. Results were evaluated using number (n), percentage (%), mean and standard deviation. Results: Of the study participants, 304 (58.2%) were female and 218 (41.7%) were male. The mean age was found to be 39.7 ± 14.7 (min: 18 years of age, max: 86 years of age). 72.5% of the participants were admitted for themselves, 27.4% of them were accompanying pediatric pa-tients. The participants' first preferred health institution was generally training research hospitals and universities with 49.4%, and the preference rate of FHCs during the first admission was 18.0%. The participants applied to FHCs for an average of 3.70 ± 1.74 times in the last one year. The distribution of demographic characteristics such as gender, participant's age, educational sta-tus and general health status were similar among participants with ASM and other health institu-tions. 56.3% of those who applied to ASM and 31.5% of those who applied to other health insti-tutions stated that they knew and followed the general health status of the family physician. The awareness of the family physician about the examinations and treatments applied by the specialist physician is 31.9% for the applicants and 16.9% for the applicants for other health institutions. 56.3% of those who applied to ASM and 34.1% of those who applied to other health institutions stated that they benefited from the treatment given by the family physician. Two-thirds of the participants find the technical facilities of ASM insufficient. While 42.5% of those with ASM prefer the first referral system, 24.8% of those who prefer other health institutions are positive. When the reasons why the participants skip FHCs were questioned, the problems with fam-ily physicians, limited availability of tests in FHCs, the presence of conditions hindering to access to the service, the preference of high standard of care in hospitals and negative perspective to FHCs have been indicated. Conclusions: A range of factors associated with skipping family health centres and attend-ing a university hospital as the first point of contact were identified. In order that a referral system is implemented successfully, these factors need to be taken into account and discussed fully.