Hülya ABALI, Fatma TOKGÖZ AKYIL
Thoracic Research and Practice - 2026;27(1):30-37
OBJECTIVE: Providing care at the appropriate level is key to cost-effective healthcare. In Türkiye, a mandatory referral system has not yet been implemented. This study aimed to determine the proportion of cases presented to a tertiary outpatient clinic that genuinely required tertiary-level care and to analyze their characteristics compared with those better suited for management at lower levels of care. MATERIAL AND METHODS: This observational study included 692 patients (mean age: 54+/-15 years; 51% male) who attended two pulmonologists' outpatient clinics. Data on demographics, reasons for application, and all institutions to which individuals applied (primary , secondary , tertiary) for chest conditions within the previous 12 months were collected. After clinical evaluations, the appropriate level of care for each case was assessed. RESULTS: Overall, 70.2% (n = 486) of cases bypassed primary care. While 10.7% (n = 74) required tertiary-level care, 66.3% (n = 459) required secondary-level care. Emergency departments (30%, n = 208) were visited more frequently than family physicians (29.6%, n = 205). Among cases seen in primary care, 11% were referred to higher-level care. The most common diagnoses were asthma and chronic obstructive pulmonary disease (56.8%; n = 394). While 46% (n = 318) of all cases received prescriptions or follow-up, 18.6% (n = 129) required interventions. Among the cases, 70.1% avoided non-teaching public hospitals, while 15% (n = 104) made more than 10 return visits to the study hospital. CONCLUSION: Approximately 70% of cases presenting to a tertiary pulmonology center could have been managed at lower levels of care. Healthcare policymakers should urgently implement sustainable solutions to address the factors that impede the referral chain.
