Abstract
<title>Abstract</title> <p>Objective To map the healthcare referral pathways of patients with Type 2 Diabetes (T2D) across primary and secondary levels and to identify obstacles to an effective healthcare referral system in Isfahan Province, Iran. Methods A qualitative case study was conducted through semi-structured interviews with twenty-nine participants, including health workers and patients with T2D. We conducted a thematic analysis, and the T2D referral pathways were visualized with a process map. Results The referral system was implemented through an Integrated Electronic Primary Health Care Information System, known as SIB, following relevant guidelines, such as IraPEN. Three overarching themes emerged. Access-related constraints and limited capacity of primary health care (PHC), particularly due to deficiencies in E-referral functionality and insufficient specialists for diabetes, undermined the successful T2D referral system. Inadequate coordination and communication, and a lack of an integrated electronic information record between PHC and other healthcare providers, contributed to the fragmentation of T2D care. Conclusion The findings reveal system-level barriers to effective T2D healthcare referral pathways, underscoring the necessity of addressing them to improve effective management of T2D.</p>