en Health Policy Original Article <div style="text-align: justify;"><span style="font-size:12px;"><span style="font-family:Times New Roman;"><b>Background:</b> Although Iran&rsquo;s healthcare network has had many successes in providing healthcare services to the community, it has not had much success in the field of referrals. This study was conducted to determine the reasons why outpatients do not visit specialists and the relationship between these reasons and their demographic characteristics.<br> <b>Methods:</b> A cross-sectional study of 429 rural patients who were referred by a Family Physician (FP) to a specialist physician but who did not visit the designated specialist was carried out in the cities of Bandar-e-Turkman, Aq-Qala and Aliabad-e-Katoul. The sampling method was stratified random sampling.&nbsp; The data were collected using a two-part self-made questionnaire. For data analysis, descriptive statistics and a linear regression model in SPSS 16 software were used.<br> <b>Results:</b> Overall, 229 patients (54.7%) were female and 186 patients (43.4%) were in the 30&ndash;60 years age group. Of the patients referred to a specialist, 65% visited another physician rather than the one designated, and 35% did not visit a specialist at all. Among the reasons for not visiting specialists, clinic conditions (3.26&plusmn;0.74), side expenditures (2.51&plusmn;0.74) and the admission and queuing system (2.45&plusmn;0.70) had the highest average scores.<br> <b>Conclusion</b>: Providing patients with suitable guidance at the time of making an appointment, providing patients with more options in choosing an appropriate appointment in non-emergency cases, training specialist physicians to establish appropriate communication, and reducing costs for low-income patients could effectively persuade patients to receive specialized outpatient services within the framework of the electronic Referral system.</span></span></div> Patient Care, Health Services, Health Care (Delivery of Health Care), Referral System 0 0 http://jhd.goums.ac.ir/browse.php?a_code=A-10-33-9&slc_lang=en&sid=1 Mohammad Javad Kabir kabirmj63@gmail.com 1003194753284600569 1003194753284600569 No Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran Alireza Heidari alirezaheidari7@gmail.com 1003194753284600570 1003194753284600570 Yes Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran Hamid Pourasghari hamidpourasghari@gmail.com 1003194753284600571 1003194753284600571 No School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran Zahra Khatirnamani khatirzahra@gmail.com 1003194753284600572 1003194753284600572 No Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran Sakine Beygom Kazemi sadat_kazemi@yahoo.com 1003194753284600573 1003194753284600573 No Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran Mohammad Reza Honarvar drmrhonarvar@gmail.com 1003194753284600574 1003194753284600574 No Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran Reza Golpira golpira@gmail.com 1003194753284600575 1003194753284600575 No Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran