Abstract
Patient self-referral is a process through which patients refer themselves to higher level health facilities without seeing anyone else first or being advised to refer themselves by a health professional. Despite the expansion in the number of health facilities, this phenomenon is perceived when patients routinely access referral hospitals. This study aimed to determine the magnitude and identify the determinants of outpatient self-referral at referral hospitals. It was conducted in East Wollega zone of Oromia National Regional State, Ethiopia. A cross-sectional study design was used to collect data between December 1 and 30, 2017. For the study, a 404 samples size was determined using a single population proportion formula. Data entry and analysis were done using SPSS version 20. Descriptive statistics, binary and multiple logistic regressions were performed. A total of 404 outpatients were included, thereby making the response rate of 96.8%. Amongst the 391 outpatients who were interviewed, 330 (84.4%) engaged in self-referral. The factors significantly associated with outpatient self-referral were referral information (Adjusted odds ratio and 95% confidence interval (CI) = 0.32 [0.15–0.70]), illness severity (Adjusted odds ratio and 95% CI = 3.50 [1.47–8.30]), confidence of patients in getting care providers (Adjusted odds ratio and 95 CI = 3.03 [1.51–6.07]), availability of laboratory services (Adjusted odds ratio and 95% CI = 5.00 [2.20–11.23]) and drugs (Adjusted odds ratio and 95% CI = 2.37 [1.01–5.53]) and quality of health services (Adjusted odds ratio and 95% CI = 3.00 [1.42–6.33]). The proportion of outpatient self-referral was high and it was associated with referral information, patient confidence in getting healthcare providers, the severity of illness, availability of laboratory services, drugs and the quality of services. A monitoring system of the referral linkage of health facilities should be established at all levels and health facilities should create awareness in the community regarding the referral linkages of health facilities.
Highlights
Patient self-referral is a condition when patients refer themselves to higher level health facilities without having to see anyone else first or without being told to refer themselves by another health professional [1]
According to the study findings, the proportion of outpatient self-referral to referral hospitals bypassing the proximal health facilities was 84.4%. This finding shows the magnitude of patients’ self-referral was higher than the magnitude of patients’ self-referral in India which was 76.2% [12], in Tanzania 72.5% [13], but lower than that of Ghana which was 90% [14] and in Australia, where self-referral has been possible for over 30 years, approximately 65% of patients use self-referral [15]. This difference might be due to those studies findings show the proportion of general patients’ self-referral whereas this study shows the magnitude of outpatients’ self-referral to visit outpatient departments of referral hospitals
Referral information on referral linkage of health facilities, perception of patients about their severity of illnesses and confidence of patients in getting the type of health care providers they want to see at the facilities were the individual factors that influence outpatient self-referral to referral hospitals whereas unavailability of laboratory services, adequate drugs that patients expect to get from the health facilities, quality of health services, convenient location and accessibility of the health facilities to transportation were major institutional factors that influence the outpatients selfreferral to referral health facilities
Summary
Patient self-referral is a condition when patients refer themselves to higher level health facilities without having to see anyone else first or without being told to refer themselves by another health professional [1]. A high proportion of clients or patients seen at the outpatient departments at secondary health care facilities could be appropriately looked after at primary health care centers [3]. Ethiopia has successfully implemented its strategy of expanding and rehabilitating primary health care facilities to make health services closer to the community and accessible and to ensure further decentralization efforts have been done. Health care utilization at the nearest primary health care facilities in the country is still low [4]. To counter-argue with hard evidence of reduced referral caseloads may strengthen the bargaining position of lowerlevel facilities and the expansion of overcrowded referral
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