Abstract
IntroductionSelf-referrals to inappropriate levels of care result in an increased patient waiting time, overburdening of higher levels of care, reduced primary healthcare utilisation rate and increasing healthcare costs. Furthermore, self-referral places an additional encumbrance on various levels of care as allocation of resources and infrastructure cannot be accurately planned, based on the facility catchment population. The aim of this study was to determine the prevalence and determinants of patient self-referral at the out-patient department of Stanger Hospital, KwaZulu-Natal between January and June 2017.MethodsA cross-sectional study was conducted at the out-patient department in Stanger Hospital, using interviewer administered questionnaires to collect information from 385 patients, through convenience sampling, between January and June 2017. Multivariable regression analysis was used to test for factors associated with self-referral.Resultsof the 385 patients interviewed 36% (n = 138) were self-referrals. Most of the self-referrals were male (51.5%) and of the African race (57.2%). Five institutional factors namely: care received from healthcare workers (91.3%); waiting times (88.4%); help offered (87%); treatment and attitude of healthcare workers (63%) and availability of medication (55.8%) were considered as the main drivers of self-referral. Multivariable regression analysis established a significant positive association between patient self-referral and age (40 years and below), attitude of healthcare workers, quality of care received form healthcare workers, waiting times and the availability of diagnostic tests.ConclusionThis study indicates that most patients attending Stanger Hospital do comply with the prescribed referral pathway, however a significant proportion still bypass the referral system.
Highlights
IntroductionUniversal health coverage (UHC) means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while ensuring that the use of these services does not expose the user to financial hardship [4]
Guided by the Sustainable Development Goals (SDG) [1], Goal 3 and the National Development Plan (NDP) 2030 [2], the National Department of Health (NDoH) has commenced with the implementation of the National Health Insurance (NHI) as a mechanism to achieve Universal Health Coverage (UHC) [3]
The Public healthcare system in South Africa is organised in a hierarchical manner with the district health system (DHS) based on the principles of primary health care (PHC) [5] forming the base of the pyramid
Summary
Universal health coverage (UHC) means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while ensuring that the use of these services does not expose the user to financial hardship [4]. Ward Based Outreach PHC teams and Integrated School Health Teams offer health education, health promotion and screening at a community level, whilst the District Clinical Specialist team provide mentoring, supervision, clinical supportive and outreach services for PHC clinics [6]. Patients will be able to present at the PHC clinics with any health care requirement (whether for promotive, preventive, curative; rehabilitative, palliative or community-based mental health) and will either receive the care they need based on the defined package of services at this level or will be referred to a hospital if more specialised services are necessary (Figure 1)
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