Abstract
Saudi Arabia has expanded electronic referrals and virtual specialist services, yet their reported endpoints often differ from the outcome that matters to a patient: receiving indicated specialist assessment and an actionable plan. We critically examined purposefully selected Saudi service studies, broader reviews, and international trials, using a reproducible exploratory PubMed search to distinguish requests, acceptance, booking, consultation, and clinical resolution. This is a narrative analysis, not a systematic review or a new patient-data study. The Ehalati case study could not determine attendance after booking; national referral series likewise do not establish completion after a documented specialist-referral decision. A national virtual-appointment analysis observed high no-show frequency and geographic variation but did not supply a linked rural–urban completion cohort. We propose a conceptual, as-yet unvalidated auditable outcome: among residents of participating sites with a documented clinician decision that specialist input is indicated, the proportion completing a qualifying encounter or specialist-supported local resolution within a prespecified, clinically appropriate window. Residence is classified at that decision, permitting rural and urban stratum-specific risks. People whose need is unrecognized or never recorded remain outside this conditional cohort; population-level unmet need requires separate ascertainment. The numerator, denominator, time zero, alternative pathways, competing events, missing linkage, and geography must be defined before comparing regions or modalities. International trials demonstrate that downstream follow-up can be measured, but their effects cannot be transported to Saudi Arabia without local evaluation. A linked Saudi cohort and a pragmatic comparative design could test whether virtual-pathway availability narrows completion gaps without masking failed connections or delayed care. The framework does not assert a Saudi national completion rate or virtual-care benefit.
Keywords
- Saudi Arabia
- rural health
- specialist referral
- telemedicine
- care completion
- health equity
Declarations
- Ethics approval
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- Consent to participate
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- Consent for publication
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- Funding
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- Competing interests
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- Author contributions
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- Data availability
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- Registration
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- Acknowledgements
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