Exploring Primary Care Physicians' Current Referral Practices to Physiotherapy and Specialized Care for...

Musculoskeletal (MSK) disorders are a leading global cause of disability and healthcare utilization. In Saudi Arabia, the referral behaviors of primary care physicians (PCPs) for MSK management remain underexplored. This study aims to investigate referral patterns and awareness of prognostic stratification tools among primary-care physicians managing musculoskeletal conditions in Riyadh, Saudi Arabia.

A web-based cross-sectional survey of 283 PCPs in Riyadh, Saudi Arabia, assessed demographic variables, MSK caseloads, referral frequencies to physiotherapy, specialist, and radiology services, satisfaction with existing pathways, and familiarity with stratified-care tools (eg, Keele STarT MSK). Associations between the healthcare sector and referral behaviors were examined using chi-square (χ²) tests with Cramér's V, and binary logistic regression was conducted to identify independent predictors of physiotherapy referral frequency. Open-ended responses were analyzed thematically.

Most respondents (61.8%) were male and worked in government sectors. Physiotherapy referrals were infrequent (37.8% rarely referred), with significant sectoral differences (p < 0.001). Over half (53.4%) were unfamiliar with prognostic tools, while 18.4% reported occasional use. Barriers included lack of electronic integration (28%), unclear guidelines (27%), and time constraints (24%). Physicians recommended clearer referral criteria, electronic medical record (EMR) linked digital pathways, and interprofessional education. Multivariable binary logistic regression identified MSK caseload and senior registrar rank as significant independent predictors of more frequent physiotherapy referral. Physicians seeing 3-5 patients daily (OR = 11.597, 95% CI: 2.202-61.085, p =0.004) and senior registrars compared with consultants (OR = 2.857, 95% CI: 1.420-5.746, p =0.003) showed the highest odds of more frequent referral.

Referral practices for MSK conditions among Saudi PCPs remain inconsistent and largely uninformed by evidence-based stratification tools. These findings suggest that enhancing multidisciplinary collaboration, training, and digital integration within EMRs may help align referral behavior with best practices and support Saudi Vision 2030 health system reforms. Future research should evaluate implementation strategies for these improvements within the Saudi primary care context.