Umm Al–Qura University
Faculty of Medicine
Department of Community Medicine and Pilgrims of Health Care
Submitted by:
Leena Baghdadi
Rabab Baghdadi
Supervised by :
Professor Sirag El- Rady
Dr. Mohammad Garout
1428 AH / 2007
Summery
This research has been conducted to see weather the referral system
in Holy Makkah appropriate or not and to know the opinion of the
consultant in the referral system. To fulfill this target a questionnaire
was designed and distributed among doctors working at Al Noor and
Al Sheshah hospitals . The data was collected and analyzed using
SPSS .The most important result is that the PHC centers referral
system need to be improved and availability of a family physician in
all the PHC centers is a must for a better quality of health service.
Introduction
Referral system is facing difficulties world wide. In Saudi Arabia
specially our doctors always complain of referral system.
In order to provide a comprehensive and integrated health service for
the people of Saudi Arabia, the Ministry of Health has introduced a
referral system as one of its strategies to make the best use of hospitals
and primary health care services [1]. In this system, all patients should
first be seen by primary health care physicians who decide whether a
referral to secondary care is necessary. In other words, access to
hospital care is through primary health care centres, except for
emergency cases where patients can access the hospital directly
through the accident and emergency departments [2]. It was thought
that implementing such a referral system would lead to better costeffective utilization of the health services.
The concept of a referral system was initiated in Riyadh region in
1986 but it was not fully implemented until the second half of 1989.
However, there is little published data about its effect on the health
services [3].
Referral letters are the main, if not the only, means of communication
between general practitioners and specialists. Referral was defined as
a process in which the treating physician at a lower level of the health
service, who has inadequate skills by virtue of his qualification and/or
fewer facilities to manage a clinical condition, seeks the assistance of
a better equipped and/or specially trained person, with better resources
at a higher level, to guide him in managing or to take over the
management of a particular episode of a clinical condition in a
beneficiary [1]. Routine referral is usually made to:
• seek expert opinion regarding a patient
• seek admission and management of a patient
• seek facilities for investigation.[1]
Several reports have demonstrated the effectiveness of the referral
system in reducing the workload on the outpatient clinics of the
hospitals, while increasing the workload of the general practice clinics
of the primary health care (PHC) centers. These reports, however,
have not shown the impact on the quality of patient care, either in the
hospitals or in general practice clinics.[4,5] Other studies have
indicated wide variations in the referral rates among general
practitioners in Saudi Arabia,[6] as well as the low rates of hospital
feedback reports to PHC centers, which hinders the continuity of care
in PHC settings.[7] In addition, concern has been expressed about the
poor quality of the referral letters, both from the primary care
physicians and the hospital consultants.[7] Also another study done in
Jeddah in 199 demonestrate the morbidity pattern of referred patients
and the effectiveness of the referral system in PHC centers.[8]
Yet another study from the Asir region in 1993 demonstrated the
deficiencies in the administrative structure of the Hospital
Coordination Offices (HCOs),[9] but no study has mentioned the
shortcomings of the referral process itself.
Another study done in 1994 study of knowledge, attitude and practice
regarding referral system was undertaken among all governmental
primary health care and private dispensary physicians (56 and 50
respectively) in Abha and Kamis, Asir Region.[10]
Also another study done in the asir region 1997 showed low rate of
hospital feed back reports and the hospital feed back are of higher
quality than the PHC center referral letters.[11]
A study was conducted at Wasat Abha PHC center in the Asir region,
publication 8 December 1998. [12] similar to the study that was done
in Asir region in 1993.
Another study studied the Patterns of attendance and referrals in
hospitals and health centres in Riyadh region, Saudi Arabia, studied
before and after implementing a referral system showed a 40.6% total
decrease in patients attending hospital outpatient clinics; an 11.9%
increase in patients attending primary health centres; a 19.2% increase
in referrals; a 33.2% increase in patients attending emergency
departments; and a 17.3% increase in inpatients.[13]
Finally,a study was conducted in Riyadh in 2005 concerned the quality
of primary health care in Saudi Arabia.[14]
The present study was carried out to improve the quality of the referral
system & communication between the PHC and the hospitals, so the
patients can get the best quality of the available health services;
determining the rate and quality of referral letters originating from the
family practice center, and also the rate and quality of hospital
feedback reports; and testing the hypothesis of whether the quality of
referral letters and hospital feedback reports was related to the type of
clinical speciality.
Objectives
To evaluate the referral system from PHC centers to
hospitals .
Literature review
While reviewing the literature we found about 10 studies which
talked about the referral system 4 of them was concerning the quality
of referral system in Saudi Arabia ,while the other 6 was talking about
it in international means .
The first study was done in Jeddah in 1992 by :
 kordy MN ET AL.
it is about ( The morbidity pattern of referred patients and the
effectiveness of the referral system in primary health care centers).
The results demonstrated that 5 per cent of patients were routinely
referred to the secondary health care centers, and the feedback from
these secondary health care facilities was (22.7%). It was also noted
that the majority of referral letters lack commonly accepted standards
of information about the patient. It was concluded that the follow-up
and feed-back system needs to be reinforced. The primary health care
providers need to review the patient referral system and implement
specific criteria for the optimum utilization of this essential service for
the benefit of the community.
The second study was conducted in Abha , Kasim ,and Asir region in
1994 by:
 al-Erian RA,
 Mahfouz AA,
 Alakija W,
al-Khozayem AA.
It was concerning the(Referral system in the Asir Region, Saudi
Arabia: knowledge, attitude, and practice of physicians working
in urban areas--a comparative study of governmental and private
health sectors).
A comparative study of knowledge, attitude and practice regarding
referral system was undertaken among all governmental primary
health care and private dispensary physicians (56 and 50 respectively)
in Abha and Kamis, Asir Region. Results show that knowledge about
referral is adequate in both groups, but the attitudes and practice of
both groups need to be positively modified specially among the
private sector physicians.

The third study was at wasat abha PHC center in the asir region in
1997 by:
 Khattab MS
 Aboalftooh AM
 Alkhaldi YM
 Khan MY
This study was concerning the following (studying the referral system
in one family practice center in Saudi Arabia).
This study showed low rate of hospital feed back reports 39.2 %
referral letters.
The hospital feed back are of higher quality than the PHC center
referral letters. they found the reason is the structured format of the
PHC referral letters recommended by the ministry of health , which
lack several items which are recommended by National Quality
Assurance Protocol ( NQAP) and other international investigators.
The fourth study was conducted in Riyadh in 2005 by :
Al-Ahmadi H,
 Roland M.
It was concerning the ( Quality of primary health care in Saudi
Arabia: a comprehensive review )
They found that the Components of quality were reviewed in terms of
access and effectiveness of both clinical and interpersonal care. Good
access and effective care were reported for certain services including:
immunization, maternal health care, and control of epidemic diseases.
Poor access and effectiveness were reported for chronic disease
management programs, prescribing patterns, health education, referral
patterns, and some aspects of interpersonal care including those
caused by language barriers. Several factors were identified as
determining whether high-quality care was delivered. These included
management and organizational factors, implementation of evidencebased practice, professional development, use of referrals to secondary
care, and organizational culture.

A study was conducting in 1993 by :
 Mimbela Sanchez MM,
 Foradada Baldellou S.
Concerning analysis of the interrelations of primary carespecialized care in patient referral in Zaragoza.
On conclusions. The study identified both a large number of "mislaid"
patients and a low level of information fed back to the Primary Care
doctors, for example reports not containing a diagnosis or the
treatment to be followed. This leads us to think that the absence of a
work-system which facilitates the inter-professional relationship of the
doctors at these two care levels makes the follow-up and treatment of
patients more difficult and in general lowers the standards of health
care.
Another study conducted in 1998 by :




Hongoro C,
Musonza TG,
Macq J,
Anozie A
Under the headen of (A qualitative assessment of the referral
system at district level in Zimbabwe: implications on efficiency
and effective delivery of health services) in zimbabwe.
They found that unnecessary overloading of referral centres negatively
affected the care of referral cases, which actually required hospital
care, due to competition with primary care cases.
In 1998 A Study of a patient referral system in the Republic of
Honduras, done by :
 Ohara K,
 Melendez V,
 Uehara N,
 Ohi G.
Showed that the patient referral system has not developed
satisfactorily in Honduras. The main problems were: 1) low referral
rate at all levels of institution, 2) evident by-pass phenomenon at
intermediate hospitals, 3) inadequate health information system for
patient referral, and 4) misunderstanding of the terminology of referral
by health personnel.
In 2000 a study done under the title of (Patient referral by
telemedicine: effectiveness and cost analysis of an Intranet system)
was done by :
 Harno K,
 Paavola T,
 Carlson C,
 Viikinkoski P.
In Vantaa in finland conclude that the wide interactive use of the
intranet referral system between secondary and primary care improved
clinical effectiveness, lowered direct costs, increased productivity and
was cost-effective.
In 2001 another study done by :
 Siddiqi S,
 Kielmann A,
 Khan M,
 Ali N,
 Ghaffar A,
 Sheikh U,
 Mumtaz Z.
And it was studying the effectiveness of patient referral in
Pakistan.
Of the households experiencing serious illnesses less than half were
taken to a nearest first-level care facility (FLCF). Major reasons
included dissatisfaction with quality of care offered, non-availability
of physician, and patients being too ill to be taken to the FLCF.
In 2005 research concerning the interventions to improve outpatient
referrals from primary care to secondary care. Done by :
 Grimshaw JM,
 Winkens RA,
 Shirran L,
 Cunningham C,
 Mayhew A,
 Thomas R,
 Fraser C.
In Canada showed that modest reductions in referral rates of uncertain
significance were observed following the introduction of the general
practice fund holding scheme in the United Kingdom (UK).
In 2005 another research studied the evaluation of referrals in
primary care in Madrid on Spain by :
 de Prado Prieto L,
 Garcia Olmos L,
 Rodriguez Salvanes F,
 Otero Puime A.
CONCLUSIONS: The process of referral is similar to previous
studies. Although people are more participative, have more
information and the defensive medicine is increasing, the process of
referral have not changed.
Methodology
This study is cross sectional study . It was done in
20/3/1428 AH. It was conducted to evaluate the referral
system in Makkah , is it appropriate or not .To reach that
the questionnaire was designed and 49 questionaire was
distributed among doctors working at Al Noor and Al
Sheshah hospitals .The data was collected and analyzed
using SPSS.
The questionnaire contains:
1) Personal data.
2) Quality of the referral system.
3) What improve the quality of referral system and
make it more useful to the patients.
Results
The sample was composed of 49 doctors (39 male and 10 female)
from different departments (surgery, medicine, Obstetric &
gynecology, Pediatric and others) in the hospitals aged between 20
and 70 years old. The majority 36.7% of the participant aged from 4049 years old while 34.7% aged from 30-39 years old, 14.3% aged
from 20-29 years old, 12.2% aged from 50-59 years old and 2% aged
from 60-70 years old.
Different doctors have different work duration but 12.2% did not
answer the question related. 10.2% worked for 2 years, while 3, 8 and
15 years work duration scored 8.2 % each. 4, 10 and 18 years of work
scored 6.1% each and 6, 7, 11 and 20 years of work scored 4.1% each.
1, 12, 14, 16, 21, 29, 30, 31 and 34 years of work scored 2% each.
1- Graph (1) showed that out of 49 doctors, 26(53.1%) said that
referral system is good, while 19 (38.8%) said it is poor, 3 (6.1%)
said that it is very good and only 1 (2%) said it is excellent.
2- Graph (2) showed that most of the doctors 39 (79.6%) said
family physician gives a more informative referral notes than a
GP 10 (20.4%)
3- Graph (3) showed that 45 doctors (91.8%) said that a clear, well
written or typed referral notes will improve the quality of referral
system while 4 doctors (8.2%) said it will not.
4- Graph (4) showed that 43 doctors (87.8%) said that network
communication between PHC centers & Hospitals will improve
the quality of referral system while 6 (12.2%) said not.
5- graph (5) showed that 46 doctors (93.9%) said that family
physician availability in all PHC centers will improve the quality
of referral system, while 3 doctors (6.1%) said it will not.
6- graph (6) showed that 47 doctors (95.9%) said that in-service
training for all doctors working at PHC centers will improve the
quality of referral system, while only 2 doctors (4.1%) said it will
not.
7- graph (7) showed that 43 doctors (87.7%) said that feedback
referral notes by the hospital doctors to PHC doctors will
improve the quality of referral system, while 6 doctors (12.2%)
said that it will not.
8- graph (8) showed that 36.7% always give a feedback referral
notes to the PHC centers and 36.7% sometimes do so, while
22.4% not do it at all and 4.1% did not answer the question
related.
9- graph (9) showed that 77.6% give a feedback referral notes to the
PHC centers. 6.1% does not give a feedback referral notes
because they are overloaded and have no time to do that, while
6.1% think that it is of no use and 10.2% did not refer patients
back to the PHC centers.
10- Graph (10) showed that out of 16 surgeon, 9 of them said they
received a poor referral, while 5 surgeon said that they received a
good referral and only 2 said that they received a very good referral.
Out of 21 medical physician, 7 of them said that they received a
poor referral, while 12 said that they received a good referral, one
of them said that it is very good and another one said it is
excellent.
Out of 4 obstetrician, one of them said it is poor, while 3 said it is
good.
Out of 4 pediatrician, 2 of them said it is poor and another 2 said
it is good.
4 specialist in other departments said it is good.
quality1
60
50
40
Percent
30
20
10
0
poor
good
very good
excellent
quality1
Graph (1):Quality of referral from PHC centre to Hospitals.
quality2
80
Graph(2):
comparison between GP & Family Physician in giving more
60
Percent
40
20
0
GP
family physician
quality2
Graph(2): comparison between GP & Family Physician in giving more informative referral
improv1
100
80
60
Percent
40
20
0
yes
no
improv1
Graph(3): the effect of clear, well written referral notes on the quality of referral system.
improv2
100
80
Percent
60
40
20
0
yes
no
improv2
Graph (4): effect of availability of network communication on referral system from PHC centers to
hospitals.
improv4
100
80
Percent
60
40
20
0
yes
no
improv4
Graph (5): effect of family physician availability in all PHC centers on the quality of referral system.
improv5
100
Percent
80
60
40
20
0
yes
no
improv5
Graph (6):effect of in-service training for all doctors working at PHC centers on the quality of referral
system.
improv7
100
80
Percen
60
40
20
0
yes
no
improv7
Graph (7): effect of feedback referral notes by the hospital doctors to PHC doctors on the quality of
referral system.
improv8
40
Percent
30
20
10
0
.00
always
sometimes
not at all
improv8
Graph (8): how often hospital doctors give a feedback referral notes to PHC centers.
improv9
80
60
Percent
40
20
0
.00
I'm overloaded & have
no time to do that
I think it's of no use
I don't refer patients back
to health centers
improv9
Graph(9): the reason of not giving a feedback referral notes.
Bar Chart
department
12
surgery
medicine
OB & Gyne
pediatrics
others
10
8
Count
6
4
2
0
poor
good
very good
excellent
quality1
Graph(10): the relation between quality of referral system to different department.
Discussion
After reviewing the literature and writing our results we found the
following:



We found about 53.1% of doctors were satisfied about quality of
the referral system, while 38.8% of them were unsatisfied about
it. In another study conducted in Asir region they found the
feedback referral letters from the hospitals were of higher
quality than the PHC centers referral letters and the reason the
structured format of the PHC referral letters recommended by
the ministry of health , which lack several items which are
recommended by National Quality Assurance Protocol ( NQAP)
and other international investigators [11]. We assume it is one of
the reasons of poor quality of referral system in our study.
Some researchers who were studying the components of quality
in PHC centers in Riyadh found that one of the poor component
of PHC centers was the referral system [14] .
The study showed that 36.7% of doctors give a feedback referral
letters to the PHC centers which is approximately equal to
another study conducted in Asir region which also showed low
rate of hospital feedback repots 39.2% referral letters [11].
Another study conducted in Jeddah showed much lower
feedback referral letters 22.7% [8]. That mean we need to
improve the hospitals doctors awareness about the importance of
feedback referral letters to the PHC centers.
our study showed that network communication between PHC
centers and the hospitals will improve the quality of referral
system, In Vantaa in finland there was a study conclude that the
wide interactive use of the intranet referral system between
secondary and primary care improved clinical effectiveness,
lowered direct costs, increased productivity and was costeffective [18],so we can see from both studies how the



interactive communication between the PHC centers and the
hospitals is mandatory.
the quality of referral system will improve by the availability of
family physician in the PHC centers that what we concluded
from our study. In Pakistan, there was a study evaluating the
effectiveness of patient referral. One of the reasons of poor
referral system there was non-availability of physician at all[19].
So, the availability of a family physician who is qualified to deal
with PHC centers issues absolutely will improve the referral
system in the PHC centers .
95.9% of the doctors see that the in–service training for the
doctors working in PHC centers will improve the quality of
referral system that what our study conclude . A comparative
study of knowledge, attitude and practice regarding referral
system was undertaken among all governmental primary health
care and private physicians in Asir region and they found good
knowledge but bad practice were undertaken [10] .so defiantly
we need in service training for the physicians working in the
PHC centers .
Improving the quality of referral system need a clear well
written referral notes that what our study showed where 91.8%
of doctors saw that.
Conclusion
from our study we conclude that:
1- the primary health care centers in Holy Makkah and those
especially which refer to Al-Noor and Al-shesha Hospitals need to
improve the quality of their referral system.
2- The PHC centers lack the availability of a family physician,
network communication.
3- Most of the referral papers are written in unclear form.
4-in –service training is not available for all doctors who’s working in
PHC centers.
5-not all the hospitals doctors concerning a feed back notes to the
PHC centers.
6-even the doctors who give a feed back notes to the PHC centers are
not doing that all the time.
7-the reasons behind skipping the referral feed back notes are either
an overloaded doctors or they think it is of no use and some do not
send the patient to the PHC centers at all.
Recommendation
We recommend that
1- Family physician availability in each PHC center is a must
2- There should be a network communication between the PHC
centers and the hospital doctors.
3- The PHC doctors have to try their best to write a clear well written
referral notes.
4- The ministry of health have to concern the involvement of there
employees in training programs to improve the quality of the health
services.
5- We should draw the doctors attention to the importance of feed
back notes to PHC centers in improving the health service and the
patient satisfaction.
6- We should encourage those doctors who give feedback referral
notes to keep doing their job for all patients.
7- The PHC center should decrease the load on the hospitals by refer
the patients who are really in need.
Reference
1. Al-Mazrou YY, Al-Shehri S, Rao M. Principles and practice of
primary health care. Riyadh, Directorate of Health Centres, Ministry
of Health, Al-Helal Press, 1990.
2. Al-Shehri AM, Thomas M, Al-Ghuli A. Use and misuse of
emergency services at King Fahd Hospital, Riyadh, Saudi Arabia.
Saudi medical journal, 1991, 13(1):21-4.
3. Al-Mazrou YY et al. A preliminary report on the effect of a referral
system in four areas of Saudi Arabia. Annals of Saudi medicine, 1991,
11(6):663-8.
4. Al-Mazrou YY, Al-Shammari SA, Siddique M, Jarallah JS. A
preliminary report on the effect of the referral system in four areas of
the kingdom of Saudi Arabia. Saudi Med J 1991;11:663-8.
5. Khoja TA, Al Shari AM, Abdul-Aziz AF, Khwaja MS. Patterns of
referral from health centers to hospitals in Riyadh region. East Medit
Health J 1997;3:237-43.
6. Badawi I, Khattab MS, Campbell J. Referral rates and patterns in
primary care department, Khamis Mushayt, Saudi Arabia. Saudi Med
J 1998;19:157-61.
7. Jarallah JS. The quality of referral letters in two health centers in
Riyadh. Ann Saudi Med 1991;11:658-62.
8. Kordy MN ET AL. The morbidity pattern of referred patients and
the effectiveness of the referral system in primary health care centers
in Jeddah in 1992 .
9. Mahfouz AA, Abolfotouth MA, Al-Khozayem AA, Al-Erian RA.
Referral system in the Asir Region, Saudi Arabia: a study on
Hospitals' Referral Coordination Offices. Saudi Med J 1993;14:237-9.
10. Al-Erian RA, Mahfouz AA, Alakija W, al-Khozayem AA. The
referral system in the Asir Region, Saudi Arabia: knowledge, attitude,
and practice of physicians working in urban areas--a comparative
study of governmental and private health sectors in 1994.
11. Khattab MS, Aboalftooh AM, Alkhaldi YM, Khan MY. The
referral system in one family practice center in Saudi Arabia at wasat
Abha PHC center in the Asir region in 1997.
12. Maged S. Khattab, MD, MRCGP; Mostafa A. Abolfotouh, DrPH;
Yahia M. Al-Khaldi, CABFM; Mohamed Y. Khan, MD Studying the
Referral System in One Family Practice Centre In Saudi Arabia, 1998
13. Tawfik A.M. Khoja, Ali M. Al Shehri, Abdul-Aziz F. Abdul-Aziz
and Khwaja M.S. Aziz. Patterns of referral from health centres to
hospitals in Riyadh region, 1997.
14. Al-Ahmadi H, Roland M. Quality of primary health care in Saudi
Arabia: a comprehensive review in Riyadh in 2005.
15. Mimbela Sanchez MM, Foradada Baldellou S. Analysis of the
interrelations of primary care-specialized care in patient referral in
Zaragoza in 1993.
16. Ohara K, Melendez V, Uehara N, Ohi G. Study of a patient
referral system in the Republic of Honduras in 1998.
17. Hongoro C, MusonzaMacq J, Anozie A . A qualitative assessment
of the referral system at district level in Zimbabwe: implications on
efficiency and effective delivery of health services in Zimbabwe in
1998.
18. Harno K, Paavola T, Carlson C, Viikinkoski P. Patient referral by
telemedicine: effectiveness and cost analysis of an Intranet system in
Vantaa in finland in 2000.
19. Siddiqi S, Kielmann A, Khan M, Ali N, Ghaffar A, Sheikh U,
Mumtaz Z. The effectiveness of patient referral in Pakistan in 2001.
20. Grimshaw JM, Winkens RA, Shirran L, Cunningham C, Mayhew
A, Thomas R, Fraser C. Interventions to improve outpatient referrals
from primary care to secondary care. In Canada 2005 .
21. De Prado Prieto L, Garcia Olmos L, Rodriguez Salvanes F, Otero
Puime A. The evaluation of referrals in primary care in Madrid on
Spain in 2005.
Annex
6th
year female medical students` questionnaire
1 ) Personal Data :
1- Age :
( 20-29 , 30-39 , 40-49 , 50-59 , 60-70 ).
2- Gender :
( male , female ) .
3- Marital status : ( single , married , divorced , widow ) .
4- Department : (surgery, medicine , obstetric and gynecology , pediatric, others ) .
5- Specialty : ………………..
6- duration of work as a specialist : ……………………
11)Quality of referral :
1- Quality of referral from PHC to hospitals is:
- Poor.
- Good.
- Very good.
- Excellent.
2- Referral notes more informative if the referring doctor is a:
- GP.
- Family physician.
3- Investigations done at the PHC centers are:
- Helpful for you in diagnosis.
- Useless for you in diagnosis.
- Unnecessary.
4- Treatments received at PHC centers are:
- Appropriate.
- Inappropriate.
- Wrong.
5- Is there a misuse of antibiotics at PHC centers ?
- Yes.
- No.
6- What is the most common disease referred to you ?
………………………………………………………………………………
111) What improves the quality of referral and make it more useful for patients:
1-Clear, well written or typed referral notes:
Yes.
No.
2-Network communications between the PHC centers and the hospitals:
Yes.
No.
3- Ambulance service availability for all PHC centers:
Yes.
No.
4-At least one family physician should be appointed at each PHC center:
Yes.
No.
5-In-service training for all doctors working at the health center:
Yes.
No.
6-In-service training for all medical personnel working at the health center:
Yes.
No.
7-Feedback referral notes by the hospital specialist and consultants to health center
doctors:
Yes.
No.
8-If question 7 is 'yes' , how often you do that ?
- Always.
- Sometimes.
- Not at all.
9-If question 8 is 'not at all' , then why?
- Am overloaded and have no time to do that.
- I think its of no use.
-Those doctors working in PHC will not benefit from it.
- I don’t refer patients back to health center.
Bar Chart
quality2
25
GP
family physician
Count
20
15
10
5
0
poor
good
very good
excellent
quality1
Bar Chart
quality3
20
helpful for you in
diagnosis
useless for you in
diagnosis
unnecessary
Count
15
10
5
0
poor
good
very good
excellent
quality1
Bar Chart
quality4
14
.00
appropriate
inappropriate
12
wrong
Count
10
8
6
4
2
0
poor
good
very good
quality1
excellent
Bar Chart
quality5
20
.00
yes
no
Count
15
10
5
0
poor
good
very good
excellent
quality1
Bar Chart
quality6
8
DM, HTN & their
complications
respiratory illnesses
surgical problems
dermatological problems
6
OB & Gyne problems
Count
others
4
2
0
poor
good
very good
excellent
quality1
Bar Chart
improv1
25
yes
no
Count
20
15
10
5
0
poor
good
very good
quality1
excellent
Bar Chart
improv2
25
yes
no
Count
20
15
10
5
0
poor
good
very good
excellent
quality1
Bar Chart
improv3
20
yes
no
Count
15
10
5
0
poor
good
very good
excellent
quality1
Bar Chart
improv4
25
yes
no
Count
20
15
10
5
0
poor
good
very good
quality1
excellent
Bar Chart
improv5
25
yes
no
Count
20
15
10
5
0
poor
good
very good
excellent
quality1
Bar Chart
improv6
30
.00
yes
no
25
Count
20
15
10
5
0
poor
good
very good
excellent
quality1
Bar Chart
improv7
25
yes
no
Count
20
15
10
5
0
poor
good
very good
quality1
excellent
Bar Chart
improv8
12
.00
always
sometimes
10
not at all
Count
8
6
4
2
0
poor
good
very good
excellent
quality1
Bar Chart
improv9
25
.00
I'm overloaded & have
no time to do that
I think it's of no use
Count
20
I don't refer patients back
to health centers
15
10
5
0
poor
good
very good
excellent
quality1
Bar Chart
quality3
25
helpful for you in
diagnosis
useless for you in
diagnosis
Count
20
unnecessary
15
10
5
0
GP
family physician
quality2
Bar Chart
quality4
25
.00
appropriate
inappropriate
wrong
Count
20
15
10
5
0
GP
family physician
quality2
Bar Chart
quality5
30
.00
yes
no
25
Count
20
15
10
5
0
GP
family physician
quality2
Bar Chart
quality6
12
DM, HTN & their
complications
respiratory illnesses
10
surgical problems
dermatological problems
OB & Gyne problems
others
Count
8
6
4
2
0
GP
family physician
quality2
Bar Chart
improv1
40
yes
no
Count
30
20
10
0
GP
family physician
quality2
Bar Chart
improv2
40
yes
no
Count
30
20
10
0
GP
family physician
quality2
Bar Chart
improv3
25
yes
no
Count
20
15
10
5
0
GP
family physician
quality2
Bar Chart
improv4
40
yes
no
Count
30
20
10
0
GP
family physician
quality2
Bar Chart
improv5
40
yes
no
Count
30
20
10
0
GP
family physician
quality2
Bar Chart
improv6
40
.00
yes
no
Count
30
20
10
0
GP
family physician
quality2
Bar Chart
improv7
40
yes
no
Count
30
20
10
0
GP
family physician
quality2
Bar Chart
improv8
15
.00
always
sometimes
not at all
Count
12
9
6
3
0
GP
family physician
quality2
Bar Chart
improv9
40
.00
I'm overloaded & have
no time to do that
I think it's of no use
I don't refer patients back
to health centers
Count
30
20
10
0
GP
family physician
quality2
Bar Chart
department
20
surgery
medicine
OB & Gyne
pediatrics
others
Count
15
10
5
0
GP
family physician
quality2
Bar Chart
quality1
25
poor
good
very good
excellent
Count
20
15
10
5
0
GP
family physician
quality2
Bar Chart
quality4
15
.00
appropriate
inappropriate
wrong
Count
12
9
6
3
0
helpful for you in
diagnosis
useless for you in
diagnosis
quality3
unnecessary
Bar Chart
quality5
25
.00
yes
no
Count
20
15
10
5
0
helpful for you in
diagnosis
useless for you in
diagnosis
unnecessary
quality3
Bar Chart
quality6
10
DM, HTN & their
complications
respiratory illnesses
surgical problems
8
dermatological problems
OB & Gyne problems
Count
others
6
4
2
0
helpful for you in
diagnosis
useless for you in
diagnosis
unnecessary
quality3
Bar Chart
improv1
30
yes
no
25
Count
20
15
10
5
0
helpful for you in
diagnosis
useless for you in
diagnosis
quality3
unnecessary
Bar Chart
improv2
25
yes
no
Count
20
15
10
5
0
helpful for you in
diagnosis
useless for you in
diagnosis
unnecessary
quality3
Bar Chart
improv3
14
yes
no
12
Count
10
8
6
4
2
0
helpful for you in
diagnosis
useless for you in
diagnosis
unnecessary
quality3
Bar Chart
improv4
30
yes
no
25
Count
20
15
10
5
0
helpful for you in
diagnosis
useless for you in
diagnosis
quality3
unnecessary
Bar Chart
improv5
30
yes
no
25
Count
20
15
10
5
0
helpful for you in
diagnosis
useless for you in
diagnosis
unnecessary
quality3
Bar Chart
improv6
30
.00
yes
no
25
Count
20
15
10
5
0
helpful for you in
diagnosis
useless for you in
diagnosis
unnecessary
quality3
Bar Chart
improv7
25
yes
no
Count
20
15
10
5
0
helpful for you in
diagnosis
useless for you in
diagnosis
quality3
unnecessary
Bar Chart
improv8
12
.00
always
sometimes
10
not at all
Count
8
6
4
2
0
helpful for you in
diagnosis
useless for you in
diagnosis
unnecessary
quality3
Bar Chart
improv9
20
.00
I'm overloaded & have
no time to do that
I think it's of no use
I don't refer patients back
to health centers
Count
15
10
5
0
helpful for you in
diagnosis
useless for you in
diagnosis
unnecessary
quality3
Bar Chart
department
14
surgery
medicine
12
OB & Gyne
pediatrics
others
Count
10
8
6
4
2
0
helpful for you in
diagnosis
useless for you in
diagnosis
quality3
unnecessary
Bar Chart
quality1
20
poor
good
very good
excellent
Count
15
10
5
0
helpful for you in
diagnosis
useless for you in
diagnosis
unnecessary
quality3
Bar Chart
quality2
25
GP
family physician
Count
20
15
10
5
0
helpful for you in
diagnosis
useless for you in
diagnosis
unnecessary
quality3
Bar Chart
quality5
25
.00
yes
no
Count
20
15
10
5
0
.00
appropriate
inappropriate
quality4
wrong
Bar Chart
quality6
10
DM, HTN & their
complications
respiratory illnesses
surgical problems
8
dermatological problems
OB & Gyne problems
Count
others
6
4
2
0
.00
appropriate
inappropriate
wrong
quality4
Bar Chart
improv1
25
yes
no
Count
20
15
10
5
0
.00
appropriate
inappropriate
wrong
quality4
Bar Chart
improv2
25
yes
no
Count
20
15
10
5
0
.00
appropriate
inappropriate
quality4
wrong
Bar Chart
improv3
20
yes
no
Count
15
10
5
0
.00
appropriate
inappropriate
wrong
quality4
Bar Chart
improv4
25
yes
no
Count
20
15
10
5
0
.00
appropriate
inappropriate
wrong
quality4
Bar Chart
improv5
25
yes
no
Count
20
15
10
5
0
.00
appropriate
inappropriate
quality4
wrong
Bar Chart
improv6
25
.00
yes
no
Count
20
15
10
5
0
.00
appropriate
inappropriate
wrong
quality4
Bar Chart
improv7
25
yes
no
Count
20
15
10
5
0
.00
appropriate
inappropriate
wrong
quality4
Bar Chart
improv8
10
.00
always
sometimes
not at all
Count
8
6
4
2
0
.00
appropriate
inappropriate
quality4
wrong
Bar Chart
improv9
20
.00
I'm overloaded & have
no time to do that
I think it's of no use
I don't refer patients back
to health centers
Count
15
10
5
0
.00
appropriate
inappropriate
wrong
quality4
Bar Chart
department
10
surgery
medicine
OB & Gyne
pediatrics
8
Count
others
6
4
2
0
.00
appropriate
inappropriate
wrong
quality4
Bar Chart
quality1
14
poor
good
very good
12
excellent
Count
10
8
6
4
2
0
.00
appropriate
inappropriate
quality4
wrong
Bar Chart
quality2
25
GP
family physician
Count
20
15
10
5
0
.00
appropriate
inappropriate
wrong
quality4
Bar Chart
quality3
15
helpful for you in
diagnosis
useless for you in
diagnosis
Count
12
unnecessary
9
6
3
0
.00
appropriate
inappropriate
wrong
quality4
Bar Chart
quality6
12
DM, HTN & their
complications
respiratory illnesses
10
surgical problems
dermatological problems
OB & Gyne problems
others
Count
8
6
4
2
0
.00
yes
quality5
no
Bar Chart
improv1
40
yes
no
Count
30
20
10
0
.00
yes
no
quality5
Bar Chart
improv2
40
yes
no
Count
30
20
10
0
.00
yes
no
quality5
Bar Chart
improv3
25
yes
no
Count
20
15
10
5
0
.00
yes
quality5
no
Bar Chart
improv4
40
yes
no
Count
30
20
10
0
.00
yes
no
quality5
Bar Chart
improv5
40
yes
no
Count
30
20
10
0
.00
yes
no
quality5
Bar Chart
improv6
40
.00
yes
no
Count
30
20
10
0
.00
yes
quality5
no
Bar Chart
improv7
yes
no
Count
30
20
10
0
.00
yes
no
quality5
Bar Chart
improv8
14
.00
always
sometimes
12
not at all
Count
10
8
6
4
2
0
.00
yes
no
quality5
Bar Chart
improv9
30
.00
I'm overloaded & have
no time to do that
25
I think it's of no use
I don't refer patients back
to health centers
Count
20
15
10
5
0
.00
yes
quality5
no
Bar Chart
department
14
surgery
medicine
OB & Gyne
12
pediatrics
others
Count
10
8
6
4
2
0
.00
yes
no
quality5
Bar Chart
quality1
20
poor
good
very good
excellent
Count
15
10
5
0
.00
yes
no
quality5
Bar Chart
quality2
30
GP
family physician
25
Count
20
15
10
5
0
.00
yes
quality5
no
Bar Chart
quality3
25
helpful for you in
diagnosis
useless for you in
diagnosis
Count
20
unnecessary
15
10
5
0
.00
yes
no
quality5
Bar Chart
quality4
25
.00
appropriate
inappropriate
wrong
Count
20
15
10
5
0
.00
yes
no
quality5
Bar Chart
improv1
14
yes
no
12
Count
10
8
6
4
2
0
DM, HTN &
their
complications
respiratory
illnesses
surgical
problems
dermatological
problems
quality6
OB & Gyne
problems
others
Bar Chart
improv2
14
yes
no
12
Count
10
8
6
4
2
0
DM, HTN &
their
complications
respiratory
illnesses
surgical
problems
dermatological
problems
OB & Gyne
problems
others
quality6
Bar Chart
improv3
8
yes
no
Count
6
4
2
0
DM, HTN &
their
complications
respiratory
illnesses
surgical
problems
dermatological
problems
OB & Gyne
problems
others
quality6
Bar Chart
improv4
14
yes
no
12
Count
10
8
6
4
2
0
DM, HTN &
their
complications
respiratory
illnesses
surgical
problems
dermatological
problems
quality6
OB & Gyne
problems
others
Bar Chart
improv5
14
yes
no
12
Count
10
8
6
4
2
0
DM, HTN &
their
complications
respiratory
illnesses
surgical
problems
dermatological
problems
OB & Gyne
problems
others
quality6
Bar Chart
improv6
14
.00
yes
12
no
Count
10
8
6
4
2
0
DM, HTN &
their
complications
respiratory
illnesses
surgical
problems
dermatological
problems
OB & Gyne
problems
others
quality6
Bar Chart
improv7
14
yes
no
12
Count
10
8
6
4
2
0
DM, HTN &
their
complications
respiratory
illnesses
surgical
problems
dermatological
problems
quality6
OB & Gyne
problems
others
Bar Chart
improv8
7
.00
always
6
sometimes
not at all
Count
5
4
3
2
1
0
DM, HTN &
their
complications
respiratory
illnesses
surgical
problems
dermatological
problems
OB & Gyne
problems
others
quality6
Bar Chart
improv9
10
.00
I'm overloaded & have
no time to do that
I think it's of no use
8
Count
I don't refer patients back
to health centers
6
4
2
0
DM, HTN &
their
complications
respiratory
illnesses
surgical
problems
dermatological
problems
OB & Gyne
problems
others
quality6
Bar Chart
department
12
surgery
medicine
OB & Gyne
10
pediatrics
others
Count
8
6
4
2
0
DM, HTN &
their
complications
respiratory
illnesses
surgical
problems
dermatological
problems
quality6
OB & Gyne
problems
others
Bar Chart
quality1
8
poor
good
very good
excellent
Count
6
4
2
0
DM, HTN &
their
complications
respiratory
illnesses
surgical
problems
dermatological
problems
OB & Gyne
problems
others
quality6
Bar Chart
quality2
12
GP
family physician
10
Count
8
6
4
2
0
DM, HTN &
their
complications
respiratory
illnesses
surgical
problems
dermatological
problems
OB & Gyne
problems
others
quality6
Bar Chart
quality3
10
helpful for you in
diagnosis
useless for you in
diagnosis
Count
8
unnecessary
6
4
2
0
DM, HTN &
their
complications
respiratory
illnesses
surgical
problems
dermatological
problems
quality6
OB & Gyne
problems
others
Bar Chart
quality4
10
.00
appropriate
inappropriate
Count
8
wrong
6
4
2
0
DM, HTN &
their
complications
respiratory
illnesses
surgical
problems
dermatological
problems
OB & Gyne
problems
others
quality6
Bar Chart
quality5
12
.00
yes
no
10
Count
8
6
4
2
0
DM, HTN &
their
complications
respiratory
illnesses
surgical
problems
dermatological
problems
OB & Gyne
problems
others
quality6
Bar Chart
improv2
40
yes
no
Count
30
20
10
0
yes
no
improv1
Bar Chart
improv3
25
yes
no
Count
20
15
10
5
0
yes
no
improv1
Bar Chart
improv4
50
yes
no
Count
40
30
20
10
0
yes
no
improv1
Bar Chart
improv5
50
yes
no
Count
40
30
20
10
0
yes
no
improv1
Bar Chart
improv6
50
.00
yes
no
Count
40
30
20
10
0
yes
no
improv1
Bar Chart
improv7
40
yes
no
Count
30
20
10
0
yes
no
improv1
Bar Chart
improv8
20
.00
always
sometimes
not at all
Count
15
10
5
0
yes
no
improv1
Bar Chart
improv9
40
.00
I'm overloaded & have
no time to do that
I think it's of no use
I don't refer patients back
to health centers
Count
30
20
10
0
yes
no
improv1
Bar Chart
department
20
surgery
medicine
OB & Gyne
pediatrics
others
Count
15
10
5
0
yes
no
improv1
Bar Chart
quality1
25
poor
good
very good
excellent
Count
20
15
10
5
0
yes
no
improv1
Bar Chart
quality2
40
GP
family physician
Count
30
20
10
0
yes
no
improv1
Bar Chart
quality3
30
helpful for you in
diagnosis
useless for you in
diagnosis
25
unnecessary
Count
20
15
10
5
0
yes
no
improv1
Bar Chart
quality4
25
.00
appropriate
inappropriate
wrong
Count
20
15
10
5
0
yes
no
improv1
Bar Chart
quality5
40
.00
yes
no
Count
30
20
10
0
yes
no
improv1
Bar Chart
quality6
14
DM, HTN & their
complications
respiratory illnesses
12
surgical problems
dermatological problems
OB & Gyne problems
10
Count
others
8
6
4
2
0
yes
no
improv1
Bar Chart
improv3
25
yes
no
Count
20
15
10
5
0
yes
no
improv2
Bar Chart
improv4
40
yes
no
Count
30
20
10
0
yes
no
improv2
Bar Chart
improv5
50
yes
no
Count
40
30
20
10
0
yes
no
improv2
Bar Chart
improv6
40
.00
yes
no
Count
30
20
10
0
yes
no
improv2
Bar Chart
improv7
40
yes
no
Count
30
20
10
0
yes
no
improv2
Bar Chart
improv8
20
.00
always
sometimes
not at all
Count
15
10
5
0
yes
no
improv2
Bar Chart
improv9
40
.00
I'm overloaded & have
no time to do that
I think it's of no use
I don't refer patients back
to health centers
Count
30
20
10
0
yes
no
improv2
Bar Chart
department
20
surgery
medicine
OB & Gyne
pediatrics
others
Count
15
10
5
0
yes
no
improv2
Bar Chart
quality1
25
poor
good
very good
excellent
Count
20
15
10
5
0
yes
no
improv2
Bar Chart
quality2
40
GP
family physician
Count
30
20
10
0
yes
no
improv2
Bar Chart
quality3
25
helpful for you in
diagnosis
useless for you in
diagnosis
Count
20
unnecessary
15
10
5
0
yes
no
improv2
Bar Chart
quality4
25
.00
appropriate
inappropriate
wrong
Count
20
15
10
5
0
yes
no
improv2
Bar Chart
quality5
40
.00
yes
no
Count
30
20
10
0
yes
no
improv2
Bar Chart
quality6
14
DM, HTN & their
complications
respiratory illnesses
12
surgical problems
dermatological problems
OB & Gyne problems
10
Count
others
8
6
4
2
0
yes
no
improv2
Bar Chart
improv1
40
yes
no
Count
30
20
10
0
yes
no
improv2
Bar Chart
improv4
30
yes
no
25
Count
20
15
10
5
0
yes
no
improv3
Bar Chart
improv5
30
yes
no
25
Count
20
15
10
5
0
yes
no
improv3
Bar Chart
improv6
25
.00
yes
no
Count
20
15
10
5
0
yes
no
improv3
Bar Chart
improv7
25
yes
no
Count
20
15
10
5
0
yes
no
improv3
Bar Chart
improv8
12
.00
always
sometimes
10
not at all
Count
8
6
4
2
0
yes
no
improv3
Bar Chart
improv9
25
.00
I'm overloaded & have
no time to do that
I think it's of no use
Count
20
I don't refer patients back
to health centers
15
10
5
0
yes
no
improv3
Bar Chart
department
12
surgery
medicine
OB & Gyne
10
pediatrics
others
Count
8
6
4
2
0
yes
no
improv3
Bar Chart
quality1
20
poor
good
very good
excellent
Count
15
10
5
0
yes
no
improv3
Bar Chart
quality2
25
GP
family physician
Count
20
15
10
5
0
yes
no
improv3
Bar Chart
quality3
14
helpful for you in
diagnosis
useless for you in
diagnosis
12
unnecessary
Count
10
8
6
4
2
0
yes
no
improv3
Bar Chart
quality4
20
.00
appropriate
inappropriate
wrong
Count
15
10
5
0
yes
no
improv3
Bar Chart
quality5
25
.00
yes
no
Count
20
15
10
5
0
yes
no
improv3
Bar Chart
quality6
8
DM, HTN & their
complications
respiratory illnesses
surgical problems
dermatological problems
6
OB & Gyne problems
Count
others
4
2
0
yes
no
improv3
Bar Chart
improv1
25
yes
no
Count
20
15
10
5
0
yes
no
improv3
Bar Chart
improv2
25
yes
no
Count
20
15
10
5
0
yes
no
improv3
Bar Chart
improv5
50
yes
no
Count
40
30
20
10
0
yes
no
improv4
Bar Chart
improv6
50
.00
yes
no
Count
40
30
20
10
0
yes
no
improv4
Bar Chart
improv7
50
yes
no
Count
40
30
20
10
0
yes
no
improv4
Bar Chart
improv8
20
.00
always
sometimes
not at all
Count
15
10
5
0
yes
no
improv4
Bar Chart
improv9
40
.00
I'm overloaded & have
no time to do that
I think it's of no use
I don't refer patients back
to health centers
Count
30
20
10
0
yes
no
improv4
Bar Chart
department
25
surgery
medicine
OB & Gyne
pediatrics
20
Count
others
15
10
5
0
yes
no
improv4
Bar Chart
quality1
25
poor
good
very good
excellent
Count
20
15
10
5
0
yes
no
improv4
Bar Chart
quality2
40
GP
family physician
Count
30
20
10
0
yes
no
improv4
Bar Chart
quality3
30
helpful for you in
diagnosis
useless for you in
diagnosis
25
unnecessary
Count
20
15
10
5
0
yes
no
improv4
Bar Chart
quality4
25
.00
appropriate
inappropriate
wrong
Count
20
15
10
5
0
yes
no
improv4
Bar Chart
quality5
40
.00
yes
no
Count
30
20
10
0
yes
no
improv4
Bar Chart
quality6
14
DM, HTN & their
complications
respiratory illnesses
12
surgical problems
dermatological problems
OB & Gyne problems
10
Count
others
8
6
4
2
0
yes
no
improv4
Bar Chart
improv1
50
yes
no
Count
40
30
20
10
0
yes
no
improv4
Bar Chart
improv2
40
yes
no
Count
30
20
10
0
yes
no
improv4
Bar Chart
improv3
30
yes
no
25
Count
20
15
10
5
0
yes
no
improv4
Bar Chart
improv6
50
.00
yes
no
Count
40
30
20
10
0
yes
no
improv5
Bar Chart
improv7
50
yes
no
Count
40
30
20
10
0
yes
no
improv5
Bar Chart
improv8
20
.00
always
sometimes
not at all
Count
15
10
5
0
yes
no
improv5
Bar Chart
improv9
40
.00
I'm overloaded & have
no time to do that
I think it's of no use
I don't refer patients back
to health centers
Count
30
20
10
0
yes
no
improv5
Bar Chart
department
20
surgery
medicine
OB & Gyne
pediatrics
others
Count
15
10
5
0
yes
no
improv5
Bar Chart
quality1
25
poor
good
very good
excellent
Count
20
15
10
5
0
yes
no
improv5
Bar Chart
quality2
40
GP
family physician
Count
30
20
10
0
yes
no
improv5
Bar Chart
quality3
30
helpful for you in
diagnosis
useless for you in
diagnosis
25
unnecessary
Count
20
15
10
5
0
yes
no
improv5
Bar Chart
quality4
25
.00
appropriate
inappropriate
wrong
Count
20
15
10
5
0
yes
no
improv5
Bar Chart
quality5
40
.00
yes
no
Count
30
20
10
0
yes
no
improv5
Bar Chart
quality6
14
DM, HTN & their
complications
respiratory illnesses
12
surgical problems
dermatological problems
OB & Gyne problems
10
Count
others
8
6
4
2
0
yes
no
improv5
Bar Chart
improv1
50
yes
no
Count
40
30
20
10
0
yes
no
improv5
Bar Chart
improv2
50
yes
no
Count
40
30
20
10
0
yes
no
improv5
Bar Chart
improv3
30
yes
no
25
Count
20
15
10
5
0
yes
no
improv5
Bar Chart
improv4
50
yes
no
Count
40
30
20
10
0
yes
no
improv5
Bar Chart
improv7
50
yes
no
Count
40
30
20
10
0
.00
yes
improv6
no
Bar Chart
improv8
20
.00
always
sometimes
not at all
Count
15
10
5
0
.00
yes
no
improv6
Bar Chart
improv9
40
.00
I'm overloaded & have
no time to do that
I think it's of no use
I don't refer patients back
to health centers
Count
30
20
10
0
.00
yes
no
improv6
Bar Chart
department
25
surgery
medicine
OB & Gyne
pediatrics
20
Count
others
15
10
5
0
.00
yes
improv6
no
Bar Chart
quality1
30
poor
good
very good
25
excellent
Count
20
15
10
5
0
.00
yes
no
improv6
Bar Chart
quality2
40
GP
family physician
Count
30
20
10
0
.00
yes
no
improv6
Bar Chart
quality3
30
helpful for you in
diagnosis
useless for you in
diagnosis
25
unnecessary
Count
20
15
10
5
0
.00
yes
improv6
no
Bar Chart
quality4
25
.00
appropriate
inappropriate
wrong
Count
20
15
10
5
0
.00
yes
no
improv6
Bar Chart
quality5
40
.00
yes
no
Count
30
20
10
0
.00
yes
no
improv6
Bar Chart
quality6
14
DM, HTN & their
complications
respiratory illnesses
12
surgical problems
dermatological problems
OB & Gyne problems
10
Count
others
8
6
4
2
0
.00
yes
improv6
no
Bar Chart
improv1
50
yes
no
Count
40
30
20
10
0
.00
yes
no
improv6
Bar Chart
improv2
40
yes
no
Count
30
20
10
0
.00
yes
no
improv6
Bar Chart
improv3
25
yes
no
Count
20
15
10
5
0
.00
yes
improv6
no
Bar Chart
improv4
50
yes
no
Count
40
30
20
10
0
.00
yes
no
improv6
Bar Chart
improv5
50
yes
no
Count
40
30
20
10
0
.00
yes
no
improv6
Bar Chart
improv8
20
.00
always
sometimes
not at all
Count
15
10
5
0
yes
no
improv7
Bar Chart
improv9
40
.00
I'm overloaded & have
no time to do that
I think it's of no use
I don't refer patients back
to health centers
Count
30
20
10
0
yes
no
improv7
Bar Chart
department
20
surgery
medicine
OB & Gyne
pediatrics
others
Count
15
10
5
0
yes
no
improv7
Bar Chart
quality1
25
poor
good
very good
excellent
Count
20
15
10
5
0
yes
no
improv7
Bar Chart
quality2
40
GP
family physician
Count
30
20
10
0
yes
no
improv7
Bar Chart
quality3
25
helpful for you in
diagnosis
useless for you in
diagnosis
Count
20
unnecessary
15
10
5
0
yes
no
improv7
Bar Chart
quality4
25
.00
appropriate
inappropriate
wrong
Count
20
15
10
5
0
yes
no
improv7
Bar Chart
quality5
.00
yes
no
Count
30
20
10
0
yes
no
improv7
Bar Chart
quality6
14
DM, HTN & their
complications
respiratory illnesses
12
surgical problems
dermatological problems
OB & Gyne problems
10
Count
others
8
6
4
2
0
yes
no
improv7
Bar Chart
improv1
40
yes
no
Count
30
20
10
0
yes
no
improv7
Bar Chart
improv2
40
yes
no
Count
30
20
10
0
yes
no
improv7
Bar Chart
improv3
25
yes
no
Count
20
15
10
5
0
yes
no
improv7
Bar Chart
improv4
50
yes
no
Count
40
30
20
10
0
yes
no
improv7
Bar Chart
improv5
50
yes
no
Count
40
30
20
10
0
yes
no
improv7
Bar Chart
improv6
50
.00
yes
no
Count
40
30
20
10
0
yes
no
improv7
Bar Chart
improv9
20
.00
I'm overloaded & have
no time to do that
I think it's of no use
I don't refer patients back
to health centers
Count
15
10
5
0
.00
always
sometimes
improv8
not at all
Bar Chart
department
10
surgery
medicine
OB & Gyne
pediatrics
8
Count
others
6
4
2
0
.00
always
sometimes
not at all
improv8
Bar Chart
quality1
12
poor
good
very good
10
excellent
Count
8
6
4
2
0
.00
always
sometimes
not at all
improv8
Bar Chart
quality2
15
GP
family physician
Count
12
9
6
3
0
.00
always
sometimes
improv8
not at all
Bar Chart
quality3
12
helpful for you in
diagnosis
useless for you in
diagnosis
10
unnecessary
Count
8
6
4
2
0
.00
always
sometimes
not at all
improv8
Bar Chart
quality4
10
.00
appropriate
inappropriate
wrong
Count
8
6
4
2
0
.00
always
sometimes
not at all
improv8
Bar Chart
quality5
14
.00
yes
no
12
Count
10
8
6
4
2
0
.00
always
sometimes
improv8
not at all
Bar Chart
quality6
7
DM, HTN & their
complications
respiratory illnesses
6
surgical problems
dermatological problems
OB & Gyne problems
5
Count
others
4
3
2
1
0
.00
always
sometimes
not at all
improv8
Bar Chart
improv1
20
yes
no
Count
15
10
5
0
.00
always
sometimes
not at all
improv8
Bar Chart
improv2
20
yes
no
Count
15
10
5
0
.00
always
sometimes
improv8
not at all
Bar Chart
improv3
12
yes
no
10
Count
8
6
4
2
0
.00
always
sometimes
not at all
improv8
Bar Chart
improv4
20
yes
no
Count
15
10
5
0
.00
always
sometimes
not at all
improv8
Bar Chart
improv5
20
yes
no
Count
15
10
5
0
.00
always
sometimes
improv8
not at all
Bar Chart
improv6
20
.00
yes
no
Count
15
10
5
0
.00
always
sometimes
not at all
improv8
Bar Chart
improv7
20
yes
no
Count
15
10
5
0
.00
always
sometimes
not at all
improv8
Bar Chart
department
20
surgery
medicine
OB & Gyne
pediatrics
Count
15
others
10
5
0
.00
I'm overloaded &
have no time to do
that
I think it's of no use
improv9
I don't refer
patients back to
health centers
Bar Chart
quality1
25
poor
good
very good
Count
20
excellent
15
10
5
0
.00
I'm overloaded &
have no time to do
that
I think it's of no use
I don't refer
patients back to
health centers
improv9
Bar Chart
quality2
40
GP
family physician
Count
30
20
10
0
.00
I'm overloaded &
have no time to do
that
I think it's of no use
I don't refer
patients back to
health centers
improv9
Bar Chart
quality3
20
helpful for you in
diagnosis
useless for you in
diagnosis
unnecessary
Count
15
10
5
0
.00
I'm overloaded &
have no time to do
that
I think it's of no use
improv9
I don't refer
patients back to
health centers
Bar Chart
quality4
20
.00
appropriate
inappropriate
wrong
Count
15
10
5
0
.00
I'm overloaded &
have no time to do
that
I think it's of no use
I don't refer
patients back to
health centers
improv9
Bar Chart
quality5
30
.00
yes
no
25
Count
20
15
10
5
0
.00
I'm overloaded &
have no time to do
that
I think it's of no use
I don't refer
patients back to
health centers
improv9
Bar Chart
quality6
10
DM, HTN & their
complications
respiratory illnesses
surgical problems
8
dermatological problems
OB & Gyne problems
Count
others
6
4
2
0
.00
I'm overloaded &
have no time to do
that
I think it's of no use
improv9
I don't refer
patients back to
health centers
Bar Chart
improv1
40
yes
no
Count
30
20
10
0
.00
I'm overloaded &
have no time to do
that
I think it's of no use
I don't refer
patients back to
health centers
improv9
Bar Chart
improv2
40
yes
no
Count
30
20
10
0
.00
I'm overloaded &
have no time to do
that
I think it's of no use
I don't refer
patients back to
health centers
improv9
Bar Chart
improv3
25
yes
no
Count
20
15
10
5
0
.00
I'm overloaded &
have no time to do
that
I think it's of no use
improv9
I don't refer
patients back to
health centers
Bar Chart
improv4
40
yes
no
Count
30
20
10
0
.00
I'm overloaded &
have no time to do
that
I think it's of no use
I don't refer
patients back to
health centers
improv9
Bar Chart
improv5
40
yes
no
Count
30
20
10
0
.00
I'm overloaded &
have no time to do
that
I think it's of no use
I don't refer
patients back to
health centers
improv9
Bar Chart
improv6
40
.00
yes
no
Count
30
20
10
0
.00
I'm overloaded &
have no time to do
that
I think it's of no use
improv9
I don't refer
patients back to
health centers
Bar Chart
improv7
40
yes
no
Count
30
20
10
0
.00
I'm overloaded &
have no time to do
that
I think it's of no use
I don't refer
patients back to
health centers
improv9
Bar Chart
improv8
20
.00
always
sometimes
not at all
Count
15
10
5
0
.00
I'm overloaded &
have no time to do
that
I think it's of no use
I don't refer
patients back to
health centers
improv9
Bar Chart
quality1
12
poor
good
very good
10
excellent
Count
8
6
4
2
0
surgery
medicine
OB & Gyne
department
pediatrics
others
Bar Chart
quality2
20
GP
family physician
Count
15
10
5
0
surgery
medicine
OB & Gyne
pediatrics
others
department
Bar Chart
quality3
14
helpful for you in
diagnosis
useless for you in
diagnosis
12
unnecessary
Count
10
8
6
4
2
0
surgery
medicine
OB & Gyne
pediatrics
others
department
Bar Chart
quality4
10
.00
appropriate
inappropriate
wrong
Count
8
6
4
2
0
surgery
medicine
OB & Gyne
department
pediatrics
others
Bar Chart
quality5
14
.00
yes
no
12
Count
10
8
6
4
2
0
surgery
medicine
OB & Gyne
pediatrics
others
department
Bar Chart
quality6
12
DM, HTN & their
complications
respiratory illnesses
10
surgical problems
dermatological problems
OB & Gyne problems
others
Count
8
6
4
2
0
surgery
medicine
OB & Gyne
pediatrics
others
department
Bar Chart
improv1
20
yes
no
Count
15
10
5
0
surgery
medicine
OB & Gyne
department
pediatrics
others
Bar Chart
improv2
20
yes
no
Count
15
10
5
0
surgery
medicine
OB & Gyne
pediatrics
others
department
Bar Chart
improv3
12
yes
no
10
Count
8
6
4
2
0
surgery
medicine
OB & Gyne
pediatrics
others
department
Bar Chart
improv4
25
yes
no
Count
20
15
10
5
0
surgery
medicine
OB & Gyne
department
pediatrics
others
Bar Chart
improv5
20
yes
no
Count
15
10
5
0
surgery
medicine
OB & Gyne
pediatrics
others
department
Bar Chart
improv6
25
.00
yes
no
Count
20
15
10
5
0
surgery
medicine
OB & Gyne
pediatrics
others
department
Bar Chart
improv7
20
yes
no
Count
15
10
5
0
surgery
medicine
OB & Gyne
department
pediatrics
others
Bar Chart
improv8
10
.00
always
sometimes
not at all
Count
8
6
4
2
0
surgery
medicine
OB & Gyne
pediatrics
others
department
Bar Chart
improv9
20
.00
I'm overloaded & have
no time to do that
I think it's of no use
I don't refer patients back
to health centers
Count
15
10
5
0
surgery
medicine
OB & Gyne
pediatrics
others
department
age
40
Percent
30
20
10
0
20- 29
30- 39
40- 49
age
50- 59
60- 70
gender
80
Percent
60
40
20
0
male
female
gender
marital
100
Percent
80
60
40
20
0
single
married
widow
marital
department
50
Percent
40
30
20
10
0
surgery
medicine
OB & Gyne
department
pediatrics
others
specialty
30
25
Percent
20
15
10
5
0
.00
consultant
specialist
resident
specialty
workDuration
12.5
Percent
10.0
7.5
5.0
2.5
0.0
.00
1.00
2.00
3.00
4.00
6.00
7.00
8.00
10.00 11.00 12.00 14.00 15.00 16.00 18.00 20.00 21.00 29.00 30.00 31.00 34.00
workDuration
quality3
60
50
Percent
40
30
20
10
0
helpful for you in diagnosis
useless for you in diagnosis
quality3
unnecessary
quality4
60
50
Percent
40
30
20
10
0
.00
appropriate
inappropriate
wrong
quality4
quality5
80
Percent
60
40
20
0
.00
yes
no
quality5
quality6
30
25
Percent
20
15
10
5
0
DM, HTN & their
complications
respiratory
illnesses
surgical
problems
dermatological
problems
quality6
OB & Gyne
problems
others
improv3
60
50
Percent
40
30
20
10
0
yes
no
improv3
improv6
100
Percent
80
60
40
20
0
.00
yes
improv6
no