Experience, Perceptions, and Barriers to the Management and Referral of Anorectal Disorders in Primary Healthcare: A Cross-Sectional Study in an Extreme Region of Chile

Abstract

Background Anorectal conditions are commonly managed in primary healthcare (PHC), but little is known about physicians’ experiences, confidence, and perceived barriers in geographically remote settings. Identifying these factors may help guide educational and healthcare-network improvement strategies. Objective To describe the perceptions, barriers, and experiences of physicians in the Destination and Training Stage (Etapa de Destinación y Formación (EDF)) working in PHC in an extreme region of Chile regarding the evaluation, management, and referral of anorectal disorders. Methods A descriptive cross-sectional study was conducted between August and September 2025 using an anonymous, self-administered 16-item questionnaire. All 54 EDF physicians working in PHC in the region were invited to participate. Categorical variables, including responses to Likert-type items, were summarized using absolute frequencies and percentages. Associations between selected ordinal variables were assessed using Spearman’s rank correlation coefficient. Results A total of 28 out of 54 physicians responded (51.9%). The most frequently reported conditions were hemorrhoids (56%) and anal fissure (29%). A moderate correlation was observed between perceived undergraduate training and confidence in performing the physical examination (ρ = 0.563; p = 0.002). Perceived functioning of the referral system was significantly associated with feedback from secondary care (ρ = 0.462; p = 0.013). The main barriers identified were lack of supplies, insufficient training, and absence of clear referral protocols. Conclusion Most EDF physicians reported encountering anorectal conditions, with predominantly educational and organizational barriers. Perceived training and coordination with secondary care emerge as key factors to improve the effectiveness and efficiency of management in PHC.