Magnitude and Determinants of Self-Referral of Patients at a General Hospital, Western Ethiopia

Abstract

Background. Self-referrals may cause the primary level health care to be under-utilized and hospitals over used, congested and overburdened, leading to an escalation of health care costs. Large patient load in referral hospitals causes human and physical resources to be stretched to capacity, which results in compromising the quality of care they provide to patients. The aforementioned problem is well observed in the study area but the phenomenon has not been formally studied. Therefore, this study aimed to assess the magnitude and determinants of self-referral of patient to the secondary referral level. Method and materials: A hospital based cross sectional study was conducted from April 16-30, 2014. Four hundred twenty two patients were selected using systematic sampling technique. Data was collected using structured and pre-tested questionnaire. Six data collectors and one supervisor collected the data. Data was analyzed using SPSS for window version 20 computer software. Simple and multiple logistic regressions were used to measure the association of variables at 95 percent confidence interval and p-value of <0.05. Ethical clearance was obtained from the ethics committee of the college of Health sciences, Jimma University, in Ethiopia. Result: A total of 422 patients responded to the interview making the response rate 99.8%. Three hundred forty six (82%) of the participants were self-referred among which 218(63.0%) were females. Three hundred and twenty two (93%) of the self-referred patients bypassed the first rung in the referral ladder despite knowledge of the closer health facility as their first level of care. Those who obtained information on the referral system from health workers were 3.5 times less likely to self refer themselves to the general referral study Hospital. Conclusions: Obtaining laboratory test, availability of drugs at closer health facility, knowing the closer health facility is first referral level and obtaining health education on referral systems from health worker were found to be significantly associated with self-referral to Nekemte General Hospital. Thus it is recommended that the healthcare leaders should strive to ensure better availability of drug supply and laboratory tests at local health centers and health care providers should work hard to make their community aware of the referral system to get efficient and effective service at a closer heath facility.