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1826, 1841, 1859, 1874, 1893, 1906, 2134, 2162, 2210, 2222, 2387, 2505], 'PHC': [275, 284, 443, 467, 583, 649, 697, 716, 799, 868, 1052, 1082, 1108, 1258, 1550, 1567, 1595, 1759, 1830, 1887, 1900, 2014, 2094, 2125, 2231, 2245, 2255], 'centers,': [276], 'which': [277, 449, 1110, 1686, 2055, 2096, 2117, 2261], 'hinders': [278], 'continuity': [280, 2197, 2520], 'settings.4': [285], 'In': [286, 475, 1024, 2417], 'addition,': [287, 476], 'concern': [288], 'expressed': [291], 'about': [292, 455, 1058, 1773], 'poor': [294], 'letters,': [299, 1099, 1494, 2347, 2499], 'both': [300, 368], 'physicians': [305, 2126, 2431], 'consultants.4': [309], 'Yet': [310], 'another': [311, 1978, 2078], 'study': [312, 334, 345, 437, 512, 528, 1037, 1384, 1910, 1950, 2022, 2140, 2217, 2310, 2378, 2453, 2664], 'Asir': [315, 447, 1942, 2659], 'region': [316], '1993': [318], 'deficiencies': [321, 1919], 'administrative': [324, 664, 900, 1560, 1643], 'structure': [325, 370, 934, 1264, 1922], 'Hospital': [328, 841], 'Coordination': [329, 2668], 'Offices': [330], '(HCOs),5': [331], 'but': [332, 1972, 2355], 'no': [333, 1333, 1436, 1732, 1873, 2357], 'mentioned': [336], 'shortcomings': [338, 1913], 'process': [342, 376, 885, 1122], 'itself.The': [343], 'present': [344, 436, 1909, 2139, 2216, 2240, 2309, 2350, 2377], 'was': [346, 426, 438, 470, 513, 540, 551, 573, 631, 766, 779, 785, 793, 802, 824, 886, 938, 1014, 1033, 1111, 1123, 1130, 1146, 1196, 1268, 1276, 1315, 1332, 1342, 1358, 1474, 1628, 1653, 1731, 1861, 1870, 1951, 1973, 2070, 2106, 2146, 2205, 2398], 'carried': [347], 'out': [348, 1018], 'with': [349, 575, 607, 1054, 1166, 1285, 1320, 2024, 2052, 2150, 2192, 2391, 2485], 'objective': [351], 'studying': [353, 367, 647, 683], 'one': [358, 469, 482, 769, 889, 1858, 1955, 2109], 'family': [359, 397, 473, 488, 1617, 2430, 2448], 'center': [361, 444, 2472], 'city': [364], 'by:': [365], '1)': [366], '(premises': [371], 'facilities)': [373], 'identify': [382], 'obstacles;': [384], '2)': [385], 'determining': [386], 'rate': [388, 403, 1087, 1115, 1462, 1946, 1962, 2064, 2089, 2131, 2160, 2211, 2384], 'letters': [393, 421, 539, 585, 651, 699, 718, 870, 1135, 1155, 1165, 1177, 1221, 1324, 1552, 1569, 1597, 1648, 1663, 1761, 1778, 1799, 1889, 1902, 2247, 2321, 2631, 2715], 'originating': [394], 'center,': [399, 468, 912, 1109], 'also': [401, 1147, 1197, 1816, 2311], 'reports;': [409], '3)': [411], 'testing': [412], 'hypothesis': [414], 'whether': [416], 'related': [427, 1302], 'type': [430, 703, 722, 743, 758], 'clinical': [432, 661, 1558, 1658], 'speciality.PATIENTS': [433], 'AND': [434], 'METHODSThe': [435], 'conducted': [439, 514], 'at': [440, 465, 542, 1084, 1243, 1317, 1439], 'region,': [448], 'catchment': [452], 'area': [453], '15,000': [456], 'inhabitants.': [457], 'Of': [458], 'four': [460, 519, 2551], 'full-time': [461], 'working': [464, 1284], 'qualified': [472], 'physician.': [474], 'there': [477, 1627, 2204, 2332], 'were': [478, 591, 652, 843, 876, 965, 1005, 1044, 1071, 1104, 1136, 1178, 1241, 1288, 1390, 1418, 1435, 1505, 1514, 1528, 1538, 1570, 1687, 1695, 1786, 1807, 1855, 1876, 2047, 2432], 'two': [479, 548, 881, 1635, 2633], 'part-time': [480], 'physicians,': [481], 'them': [484, 1140, 1167, 1224], 'consultant': [486], 'medicine': [489, 1401, 1432], 'other': [492, 1412, 2053, 2268, 2283], 'pediatrician.': [494], 'staff': [496], 'included': [497, 977], 'eight': [498, 945, 963, 2473], 'nurses,': [499], 'inspector,': [502], 'laboratory': [504], 'technician,': [505], 'radiology': [507], 'technician': [508], 'an': [510, 941, 951, 1055, 1112, 1340, 1629, 2825], 'administrator.The': [511], 'over': [515], 'period': [517, 546, 1171], 'months': [520], 'between': [521, 1021, 1469, 1633, 1743, 1964, 2707, 2804], 'May': [522], 'August': [524], '1997.': [525], 'During': [526, 1066], 'period,': [529, 1038, 1068, 1385], 'carbon': [531, 578], 'copy': [532, 579], 'each': [534], "PHC's": [537], 'preserved': [541], 'center.': [544], 'A': [545], "months'": [549], 'follow-up': [550], 'allowed': [552], 'order': [554], 'allow': [556], 'sufficient': [557], 'time': [558], 'receive': [560], 'these': [566, 1176, 2512], 'letters.': [568, 1212, 2233], 'Every': [569], 'report': [572, 823, 1715, 1860, 1929, 2079, 2506, 2542], 'attached': [574], 'corresponding': [577], 'letter.The': [582], 'evaluated': [592, 887, 939], 'for': [593, 629, 640, 646, 682, 763, 989, 996, 1000, 1168, 1187, 1352, 1377, 2057, 2121, 2156], 'presence': [595, 656, 949, 1722], 'absence': [597, 658, 959], '20': [599, 644], '10': [601, 660, 663, 679, 1495], 'predetermined': [602], 'points,': [603], 'respectively,': [604], 'accordance': [606], 'guidelines': [609], 'laid': [610], 'down': [611], 'by': [612, 620, 634, 768, 888, 940, 1046, 1080, 1106, 1253, 1999, 2003, 2249, 2264, 2493, 2507, 2877], 'National': [614, 969], 'Quality': [615, 970, 2683, 2689], 'Assurance': [616, 971, 2684], 'Protocol': [617], '(NQAP)6': [618], 'international': [621, 2269], 'standards.7': [622], 'The': [623, 638, 795, 864, 896, 1273, 1345, 1446, 1594, 1684, 2062, 2154, 2308, 2487, 2679], 'selection': [624, 642], 'important': [627], 'information': [628, 954, 2285, 2492], 'auditing': [630], 'agreed': [632], 'upon': [633], 'team.': [637], 'criteria': [639], 'points': [645], 'based': [653], 'items': [665, 671, 680, 695, 714, 733, 748, 765, 964, 1644, 1659, 1680, 1685, 2260, 2343], 'letter.': [669], 'are': [672, 688, 2224, 2262, 2366, 2514], 'listed': [673, 689], 'Table': [675, 691, 1814], '1': [676, 784, 956, 1544], 'selected': [681], '2.Table': [692], '1.': [693, 712], 'Omitted': [694, 713, 732, 747], 'according': [700, 719, 741, 756, 878], 'specialty': [706, 725], 'inappropriateness': [708, 727, 735, 750], 'letters.Table': [711, 730], '2.': [731, 746], 'specialty.Table': [745], 'specialty.A': [760], 'scoring': [761], 'such': [764, 2157, 2271, 2348], 'developed': [767], 'authors': [772], 'this': [774, 894, 1067, 1229, 1949, 2021], 'study.': [775, 895], 'If': [776], 'item': [778, 952], 'recorded,': [780], 'mark': [782, 790], 'given,': [786], 'if': [787, 805, 813, 827, 835], 'not,': [788], '0': [792], 'given.': [794], 'letter': [801], 'considered': [803, 825], 'appropriate': [804, 826, 986, 1758, 1787, 1808, 1825], 'it': [806, 814, 828, 836, 1185, 1869, 2397], 'scored': [807, 815, 829, 837, 955, 960], '≥70%': [808, 830], '(≥14': [809], 'items),': [810], 'inappropriate': [812, 834, 2386], '<70%': [816, 838], '(≤13': [817], 'items).': [818, 840], 'Similarly,': [819], '(≥7': [831], 'items)': [832], '(≤6': [839], 'departments': [842, 847, 856, 1076, 1394, 1422, 1453, 1467, 1487, 1601, 1636, 1748, 1766, 1781, 1802, 1845, 2041], 'classified': [844], 'into': [845], 'medical': [846, 1518, 1542, 1591, 1624, 1745, 2362], '(medicine,': [848], 'pediatric,': [849], 'dermatology,': [850], 'emergency': [851, 1403, 2035], 'psychiatry)': [853], 'surgical': [855, 1509, 1532, 1600, 1747], '(general': [857], 'surgery,': [858], 'ophthalmology,': [859, 2043], 'otolaryngology,': [860], 'urology': [861, 1806], 'orthopedic).': [863], 'compared': [877, 1622, 1953, 1976, 2076, 2085, 2164, 2390], 'different': [882, 1075, 1451, 1465, 1485, 2213, 2325], 'departments.The': [883, 2215], 'investigators': [892, 2290], 'investigator': [897], 'recorded': [898, 2404], 'steps': [901], 'process,': [905, 1917], 'starting': [906], 'local': [914], 'HCO,': [915, 1925], 'clinics,': [919], 'inpatient': [921], 'departments,': [923, 1625], 'finally': [925], 'center.The': [933], 'HCO': [937, 1158, 1201, 1267, 1287, 1319, 1346], 'observation': [942], 'checklist': [943], 'comprising': [944], 'items,': [946], 'where': [947, 1959], 'its': [958, 2476], 'zero.': [961], 'derived': [966], 'requirements6': [972], 'HCOs,': [975], 'accessible': [978], 'well-organized': [980], 'premises,': [981], 'adequate': [982], 'well-trained': [984], 'staff,': [985, 990], 'job': [987, 1292], 'descriptions': [988, 1293], 'registration': [992, 1313], 'system,': [993], 'telephone': [994, 1335], 'line': [995, 1336], 'appointments': [997], 'facilities': [999], 'typing.Appropriate': [1001], 'tests': [1002], 'significance': [1004], 'performed': [1006], 'analyzing': [1008], 'data.': [1010, 1023], 'Pearson': [1011], 'chi-squared': [1012], 'test': [1013, 1032], 'used': [1015], 'find': [1017], 'difference': [1020, 1478, 1632, 1652, 1734], 'categorical': [1022], 'cases': [1025], 'small': [1027], 'cell': [1028], 'frequencies,': [1029], "Fisher's": [1030], 'exact': [1031], 'used.RESULTSDuring': [1034], 'four-month': [1036], 'total': [1040, 1260], '22,838': [1042], 'visits': [1043, 1061], 'made': [1045, 2368], 'patients': [1048, 1070, 1151, 1575, 1700, 2513, 2524, 2761, 2853], 'average': [1056], '57.7': [1059], 'per': [1062, 1064, 1090, 1118, 1968, 2142, 2173], 'doctor': [1063], 'day.': [1065], '864': [1069, 1097, 1492], 'referred': [1072, 2375], 'doctors,': [1083], '3.8': [1089], '100': [1091, 1119, 1365, 1969, 2143, 2174], 'visits.': [1093], 'Out': [1094], '339': [1100], 'received': [1105, 1529, 1539, 1862, 1877], 'overall': [1113, 1630, 1944, 2011], '39.2': [1117], 'referrals.The': [1120], 'composed': [1124], 'several': [1126, 1912, 2259], 'consecutive': [1127], 'steps.': [1128], 'It': [1129, 1145, 1195, 1213, 1769, 1833, 1980], 'observed': [1131, 1198, 1655, 1771, 1835, 1947, 2019, 2136, 2399], 'that': [1132, 1149, 1161, 1199, 1281, 1360, 1772, 1836, 1984, 2219, 2400], 'still': [1137, 2356], 'handwritten,': [1138], 'making': [1139, 1184], 'sometimes': [1141], 'difficult': [1142, 1186], 'read.': [1144], 'noticed': [1148, 1359], 'some': [1150, 1577, 1678, 2128, 2169, 2456], 'delivered': [1152, 1179], 'themselves': [1159], 'others': [1162], 'had': [1163], 'considerable': [1170], 'time.': [1173], 'Some': [1174], 'crumpled': [1182], 'condition,': [1183], 'doctors': [1189, 2758], 'obtain': [1191], 'full': [1193], 'information.': [1194], 'did': [1202, 1295, 1347, 1497], 'maintain': [1204, 2518], 'any': [1205, 1298, 1350, 2405, 2438], 'record': [1206, 1307], 'incoming': [1208], 'outgoing': [1210], 'registered': [1214], 'only': [1215, 1339], 'appointment': [1217], 'returned': [1223], 'patient,': [1227], 'led': [1230], 'difficulties': [1232], 'monitoring': [1234], 'system.': [1237], 'No': [1238, 1306], 'issued': [1242], 'all': [1244, 1440], 'tertiary': [1247], '(ACH)': [1250], 'unless': [1251], 'requested': [1252], 'doctor.The': [1259], 'score': [1261, 1275], 'found': [1269, 2048, 2071, 2147], 'be': [1271, 1996, 2050, 2073, 2177, 2236], '2/8.': [1272], 'due': [1277, 1674, 2237, 2784], 'fact': [1280], 'personnel': [1283], 'unaware': [1289], 'their': [1291, 1304, 2450, 2497, 2714], 'kind': [1299], 'training': [1301, 2123], 'work.': [1305], 'form': [1310], 'book': [1314], 'maintained': [1316], 'regards': [1321], 'reports.': [1330, 1683], 'There': [1331, 1434, 1473, 1730], 'direct': [1334], 'facility,': [1337], 'extension': [1341], 'operation.': [1344], 'facility': [1351], 'typing': [1353], 'reports.It': [1357], '(per': [1364], 'referrals)': [1366], 'three': [1368, 1931], 'departments—obstetric/gynecology': [1370], '(24.8%),': [1371], 'ophthalmology': [1372], '(17.5%),': [1373], 'dermatology': [1375, 1424, 1785, 1854, 2044], '(13%)—accounted': [1376], 'two-thirds': [1378, 1521], 'referrals': [1381, 1389, 2015], 'during': [1382], 'remaining': [1388], 'directed': [1391, 1506, 1515, 1598, 1762, 2322], 'orthopedics': [1396], '(8.6%),': [1397], 'surgery': [1399, 1429], '(7.9%),': [1400], '(7.8%),': [1402], '(3.7%),': [1404], 'otolaryngology': [1405, 2046], '(9.5%)': [1406], 'psychiatry': [1408, 1804, 2069], '(0.9%).': [1409], 'On': [1410], 'hand,': [1413], 'highest': [1415, 1792, 2059], 'obtained': [1419], '(74.1%),': [1425], 'pediatrics': [1426, 1783, 1852], '(57.1%),': [1427], '(52.9%)': [1430], '(45.1%).': [1433], 'department': [1443, 1865, 1880, 2067, 2829], 'psychiatry.': [1445], 'varied': [1454], '0.9%': [1456], '24.8%,': [1458], 'ranged': [1468, 1963], '0%': [1470], '74%.': [1472], 'statistically': [1476], 'significant': [1477, 1631, 1733, 1752, 1818], '(X2=96.04,': [1488], 'df=9,': [1489], 'P<0.001).Of': [1490], '(1.2%)': [1496], 'mention': [1499], 'specialty,': [1501], '614': [1503], '(71.9%)': [1504], 'specialties,': [1510, 1533], '240': [1512], '(28.1%)': [1513], 'specialties.': [1519], 'Approximately': [1520], '(64.6%)': [1527], 'rest': [1536], '(35.4%)': [1537], 'specialties.Table': [1543], 'shows': [1545, 1666, 1751, 1817, 2379], 'inadequacies': [1547, 1668, 2459], 'terms': [1554], 'recording': [1556, 1609, 1641, 2340, 2360, 2488], 'relevant': [1557, 1679], 'items.': [1561], 'Items': [1562], 'mostly': [1563, 1688], 'omitted': [1564, 1689], 'sociopsychological': [1571, 2284, 2303], 'data': [1572], '(100%),': [1576, 1701], 'demographic': [1578, 2275], 'characteristics': [1579, 2276], '(age,': [1580], 'literacy': [1581], 'status,': [1582, 2278], 'occupation,': [1583, 2279], 'etc.),': [1584], "patients'": [1585, 1611], 'known': [1586, 2371], 'allergies': [1587, 2372], '(94.8%)': [1588], 'past': [1590, 2361], 'history': [1592], '(69.7%).': [1593], 'showed': [1602, 2218, 2312], 'significantly': [1603], 'higher': [1604, 2166, 2227], 'omission': [1607, 1639, 1676], 'age,': [1612], 'date': [1613, 1712], 'registry': [1619], 'number': [1620], '(P<0.05)': [1621], '(P<0.001).': [1649], 'Such': [1650], '(P>0.05).Table': [1664], '2': [1665], 'advice': [1697, 2406, 2439], 'given': [1698, 2407], 'findings': [1703, 2026], 'investigations': [1705], '(21.5%),': [1706], 'final': [1708], 'diagnosis': [1709], '(15.6%),': [1710], '(14.2%),': [1716], 'management': [1718], 'plan': [1719], '(13.3%),': [1720], 'clear': [1724, 2296], 'recommendations': [1725, 2441], '(10.3%).': [1729], 'inadequacy': [1736], 'level': [1737], '(P<0.05).Table': [1749], '3': [1750, 1815], 'differences': [1753, 1819], 'proportion': [1756, 1822], 'various': [1764, 2017, 2481], '(X2=58.60,': [1767], 'P<0.001).': [1768, 1832], 'is': [1770, 1834, 2783], '80%': [1774], 'they': [1789], 'occupied': [1790, 1810], 'rank,': [1793], '<40%': [1795], 'lowest': [1812], 'rank.': [1813], '(X2=62.93,': [1831], '>85%': [1837], 'obstetrics': [1847], 'gynecology,': [1849], 'orthopedics,': [1850], 'medicine,': [1851], 'appropriate.': [1856], 'Only': [1857], 'urology,': [1867], 'inappropriate,': [1871], 'psychiatry.Table': [1882], '3.': [1883, 1896], 'Appropriateness': [1884, 1897], '(RL)': [1890, 1903], '(FR).Table': [1895], '(FR).DISCUSSIONThe': [1908], 'highlights': [1911], 'including': [1918, 2295], 'supports': [1927], 'published': [1930], 'years': [1932, 2474], 'after': [1933, 2475], 'region.5The': [1943], 'group': [1956], 'studies,': [1958, 2054], '4.3': [1965], '6.6': [1967], 'visits,3,4,8': [1971], 'fairly': [1974], 'high': [1975], 'study.8': [1979], 'suggested': [1983, 2480], 'variation': [1987, 2776], 'could': [1995, 2176, 2235], 'explained': [1997], 'partly': [1998, 2002], 'chance10': [2000], 'context': [2005], 'individual': [2007], 'approaches': [2008], 'healthcare.11The': [2010], 'distribution': [2012], 'specialties': [2018], 'agrees': [2023], 'previous': [2029, 2152], 'study.4': [2030, 2153], 'After': [2031], 'excluding': [2032], 'maternity': [2033], 'cases,': [2036], 'comparable': [2051], 'account': [2056], 'rates.3,4': [2061], '(0.9%)': [2075], '(3.9%),3': [2080], 'very': [2082], 'when': [2084], 'prevalence': [2088], 'psychiatric': [2091, 2104, 2822], 'disorders': [2092, 2105, 2823], 'settings,12,13': [2095], 'varies': [2097], '28%': [2099], '46%.': [2101], 'Misdiagnosis': [2102], 'reported': [2107], 'study12': [2110], 'vary': [2112], '36.6%': [2114], '50%,': [2116], 'indicates': [2118], 'need': [2120], 'more': [2122, 2760], 'specialties.The': [2129], '(39.2': [2141], 'letters)': [2145], 'agree': [2149], 'reason': [2155], 'Western': [2170], 'countries': [2171], '(55-88': [2172], 'referrals),4': [2175], 'lack': [2178, 2258], 'awareness': [2180], 'part': [2183], 'consultants': [2186, 2402, 2425], 'importance': [2189, 2293], 'communication': [2191], 'PHCs': [2193, 2495], 'maintaining': [2195], 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