The quality of referrals and follow up cares in prenatal care units of health centers in Mashad, 2001

Back ground and Considering the importance of referrals as a significant factor in prenatal care, this research was conducted to determine the quality of referrals and follow-up care in prenatal units of health centers in Mashhad in 2000. In this descriptive research, 325 pregnant women attending at urban health centers programs, were sampled using multi-stage randomized method from 26 health centers. The research instruments were: 2 questionnaires about the available facilities of health centers and characteristics of midwives who work at health centers, an interviewing form on characteristics of pregnant women and their knowledge on the referral processes. guideline for referral and a form for assessing the need to referrals, it’s relevance, kinds and manners of referral, feed back and it’s follow up. Descriptive statistics and Chi-square and student-t tests were used in data analysis. In this study the rate of referrals to inside or outside of health centers were 34.7%, also 53.1 of referred cases had brought feedback of referral to and 60% had been followed up. The manner of referral in 42.8% of cases was verbal recommendation. Only 62% of referrals were appropriate. 66.8% of all subjects needed to referral, and 62.5% of all mothers who needed,it didn’t refer. Poor history tacking and poor clinical examination, lack of recording accurate description about the situation of pregnant mother and lack of attention to health instructions were the main cause of missing the referrals for mothers who needed to it. The results showed that many of pregnant mothers who needed refferals, were not referred, and many of performed referrals were not appropriate. Furthermore, findings indicate inappropriate kinds and manners of referrals in many cases, low rate of receiving feedback and low rate of following referred mother’s problem up. So far, considering the mentioned problems in maternal referrals, providing a clear comprehensive guideline for referrals during pregnancy is necessary. Midwives should be re-instructed about the referral and practice of health centers in this regard should be supervised.