Rural Healthcare Providers’ Referral Practices: A Survey

INTRODUCTION: In rural areas, where specialty care is less accessible, high-quality referrals from primary care providers are essential. This study explored the factors that influence rural primary care providers in their referral patterns and barriers they experience in the referral process. METHODS: An online, cross-sectional survey was conducted among primary care providers in rural Kansas. Rural represents communities with fewer than 50,000 people. Providers in this study are limited to MDs (doctors of medicine), DOs (doctors of osteopathic medicine), NPs (nurse practitioners), and PAs (physician assistants). RESULTS: The dataset included 56 rural healthcare providers (MD/DO = 36; NP = 9; PA = 11). Of these, 75% reported limited availability of specialists as a significant barrier when referring patients. When deciding on referrals, 96.4% of providers considered the specialist’s distance, while 67.9% also factored in positive feedback from previous patients. A negative patient experience and an unfavorable experience consulting with a specialist were the most influential factors that adversely affected a rural provider’s referral decision. To access the quality of specialist care, 62.5% of providers reviewed patients’ medical records. Providers reported that the most impactful methods of improving rural healthcare referral practices would be increased direct contact with specialists (53.6%) and receiving medical records in a timely manner (53.6%). CONCLUSIONS: Rural primary care providers face numerous barriers which makes referring patients to specialists particularly challenging. A reliable referral process along with access to necessary specialists is imperative to effectively serve rural patients. Further studies could explore specialists’ role in the referral process from rural communities.