Hospital appointment systems have a positive impact on patients’ satisfaction with the services they receive. They aid in reducing the number of patients who do not visit and decrease staff workload
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11, provide timely consultations with physicians, and offer 24-hour access to the system
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14. Despite all these positive aspects, the disproportionate increase in applications to hospital outpatient clinics has rendered the appointment system inadequate, and patients experience difficulties accessing healthcare services. Patients can only receive appropriate healthcare if they apply to the correct medical specialty outpatient clinic in a timely manner. CPAS, developed by the Turkish Ministry of Health, has been used for this purpose since 2010. However, despite its advantages such as ease of use and the provision of services through multiple channels, the system has proven inadequate in preventing incorrect outpatient clinic applications.
According to the results of the present study, one out of every seven patients who applied via the CPAS made an incorrect application to our clinic. In a previous study conducted by our team, the rate of incorrect referrals to the cardiovascular surgery outpatient clinic was 11.5% of all applications, compared to 18.63% among the applications made through the CPAS5. These high rates observed in the present study parallel the rates reported in our previous work. The consistently high and persistent incorrect referral rates observed in studies conducted during different time periods underscore the gravity of the problem.
A key finding of the present study, which distinguishes it from our previous research, is its focus on the reasons behind incorrect referrals. The primary factor resulting in incorrect appointments is that patients make their appointments by including the word “heart” in the department name without adequate information about the relevant department. The following recommendations may aid in addressing this issue:
1. Revising the names of specialties to make them more understandable to patients,
2. Clearly defining the areas of interest for both the cardiology and cardiovascular surgery departments within the CPAS system, and
3. Ensuring proper patient guidance through public service announcements and awareness campaigns.
Another significant cause of incorrect referrals is that patients who are unable to secure an appointment with the cardiology department subsequently apply to the cardiovascular surgery outpatient clinic. Three out of every ten patients make incorrect referrals because they are unable to obtain an appointment with the cardiology department. A study conducted by Solmaz et al.15, showed that 40% of patients applying to the cardiology outpatient clinic via the CPAS did not have “cardiac” complaints. We believe that, in addition to addressing unnecessary applications to the cardiovascular surgery department, measures aimed at reducing the number of incorrect applications to the cardiology department will indirectly help to prevent incorrect referrals to the cardiovascular surgery outpatient clinic.
In the present study we observed that the incorrect referral group consisted of relatively younger patients, which is consistent with our previous research5. This finding may be explained by the fact that younger patients have less experience in accessing or utilizing healthcare services. Another possible reason might be that younger individuals tend to use the internet and mobile applications more effectively, enabling them to make independent decisions during the appointment process without the necessity for external guidance. Although this propensity to use digital systems such as the CPAS makes it easier for young individuals to make appointments directly, it may also increase the risk of incorrect specialty selection. This finding may be construed as a negative outlook for young individuals, considering their strong interactive skills and adaptability to digital platforms; however, it indicates that with appropriate informational interventions, the issue of patient misdirection can be effectively resolved.
Another significant finding of this study is the relationship between lower age and misreferrals. Lower age was associated with misreferrals independently of CPAS usage. This may be explained by the possibility that older patients tend to have higher health literacy or are more frequently exposed to the healthcare system.
In the present study, the number of patients who made incorrect applications following the guidance of ALO 182 Call Center personnel was relatively low. Nevertheless, given the importance of preventing each erroneous appointment, we believe that assessing and enhancing the knowledge of the ALO 182 Call Center staff would be beneficial.
The findings obtained in the present study reveal that the majority of incorrect applications made via the CPAS stem from factors external to the system. We observed that only one out of every ten incorrect referrals was attributable to the CPAS itself. Although the CPAS functions correctly, it appears to be inadequate to prevent incorrect referrals alone; in line with our previous recommendations, the implementation of a referral chain model may also be considered.
In conclusion, the results obtained in the present study demonstrated that incorrect outpatient clinic applications made via the CPAS constitute a significant difficulty, primarily due to factors such as inadequate patient knowledge and difficulties in securing appointments. Preventing these incorrect referrals would expedite patients’ access to appropriate treatment and enhance the efficiency of the healthcare system. In this regard, measures such as simplifying department names, clearly delineating the focus of each specialty within the CPAS system and its mobile application, providing patient education through public service announcements, and implementing an effective referral chain model may contribute to reducing the incidence of incorrect outpatient clinic referrals.
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