title: Psychological factors explaining the referral behavior of Iranian family physicians.
abstract: BACKGROUND
  The recently developed policy of the family practice program in rural regions of Iran faced some challenges such as inefficient referral system. The health insurance organizations (purchaser) and health policy makers are concerned about the high rate of patient referrals from family physicians to specialists due to imposing unnecessary services and costs.
  
  
  OBJECTIVE
  This study examined utility of the theory of planned behavior to explain intention of Iranian family physicians to reduce referral rate of patients with respiratory diseases to medical specialist.
  
  
  METHODS
  An exploratory cross-sectional study, employing a correlational design directed by the theory of planned behavior was conducted. A questionnaire was developed based on an eliciting study and review of literature. One hundred and seventy-four family physicians working at primary care centers in two provinces of Iran completed the questionnaire (response rate of 86%).
  
  
  RESULTS
  The finding revealed that intention of family physicians to reduce referral rate of patients to specialists was significantly related to two theory-based variables of subjective norms (r = 0.38, P < 0.001) and perceived behavioral control (r = 0.43, P < 0.001), and not to attitudes. A stepwise regression entering direct measures of the theory variables explained 35% of the variance on the intention, with perceived behavioral control being the strongest predictor. Adding background variables to the model achieved further 5% by variables of practice size and past referral rate behavior.
  
  
  CONCLUSIONS
  The results indicated that psychological variables of the theory of planned behavior could explain a noticeable proportion of variance in family physician's intention to decrease the rate of referring patients with respiratory diseases to medical specialists. The intention is primarily influenced by normative and control considerations. These findings contribute to a better understanding of referral decisions by family physicians and are of great value in developing interventions to reduce the variation in referral rate of patients to medical specialists at primary care health centers.
authors.affiliation: School of Health Management and Information Sciences, Iran University of Medical Sciences, Iranian Ministry of Health and Medical Education, Tehran, IR Iran.
authors.forename: Bahram
authors.initials: B
authors.lastname: Mohaghegh
authors.affiliation: Health Management and Economic Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Iranian Ministry of Health and Medical Education, Tehran, IR Iran.
authors.forename: Hesam
authors.initials: H
authors.lastname: Seyedin
authors.affiliation: Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Arash
authors.initials: A
authors.lastname: Rashidian
authors.affiliation: Health Management and Economic Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Iranian Ministry of Health and Medical Education, Tehran, IR Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Ravaghi
authors.affiliation: School of Health Management and Information Sciences, Iran University of Medical Sciences, Iranian Ministry of Health and Medical Education, Tehran, IR Iran.
authors.forename: Nader
authors.initials: N
authors.lastname: Khalesi
authors.affiliation: Ministry of Health and Education of Iran, Tehran, IR Iran.
authors.forename: Hossein
authors.initials: H
authors.lastname: Kazemeini
keywords: Iran; Physicians, Primary Care; Referral and Consultation