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Determinants of Self-referral among Outpatients at Referral Hospitals in East Wollega, Western Ethiopia

Received: 28 July 2021    Accepted: 9 August 2021    Published: 23 August 2021
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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.

Published in Journal of Family Medicine and Health Care (Volume 7, Issue 3)
DOI 10.11648/j.jfmhc.20210703.11
Page(s) 57-64
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Self-referral, Outpatient Visit, Referral Hospital, Health Care Utilization

References
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[3] Macintyre K, Megan L, David R, etal. Barriers to Referral in Swaziland: Perceptions from providers and Clients of System under Stress. World and medical and health policy. PSO 2011. Manuscript 1183; 24-26.
[4] Health Sector Transformation plan /HSTP2015/2016-2020/. Ethiopian federal ministry of health. Addis Ababa, Ethiopia. 2015; 41-43.
[5] Studying the healthcare network and Analyzing Disrupting Health sector. World health organization. WHO/HAC/MAN/.2008; 8 rev 1: 281-289.
[6] Mojaki ME, Basu D, Letskokgohka ME, Govender M. Referral steps in district health system are side-stepped. Scientific letters. SAMJ. 2011; 101 (2): 109.
[7] Abrahim O, Linnander E, Mohammed H, Fetene N, Bradley E. A Patient-Centered Understanding of the Referral System in Ethiopian Primary Health Care Unit. PloSONE. 2015; 10 (10): 1-10. DOI: 10.1371/journal.pone.0139024.
[8] Wolkite O, Waju B, GebeyehuT. Magnitude and Determinants of Self-Referral of Patients at a General Hospital, Western Ethiopia. Science Journal of Clinical Medicine. 2015; 4 (5): 86-92. Doi: 10.11648/j.sjcm.20150405.12.
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[14] Yaffee A, Whiteside L, Oteng R, etal. By passing proximal health care facilities for acute care: a survey of patients in a Ghanaian Accident and Emergency Centre. Tropical medicine and International Health. 2012; 17 (6): 777-781. Doi: 10.1111/j.1365-3156.2012.02984.
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[17] Christopher B, Jonathan P, Jinnet F, etal. Self-referral in Point-of-Service Health Plans. JAMA. 2010; 285 (17): 2223-2234.
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  • APA Style

    Edosa Tesfaye Geta, Yibeltal Siraneh, Elias Ali Yesuf. (2021). Determinants of Self-referral among Outpatients at Referral Hospitals in East Wollega, Western Ethiopia. Journal of Family Medicine and Health Care, 7(3), 57-64. https://doi.org/10.11648/j.jfmhc.20210703.11

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    ACS Style

    Edosa Tesfaye Geta; Yibeltal Siraneh; Elias Ali Yesuf. Determinants of Self-referral among Outpatients at Referral Hospitals in East Wollega, Western Ethiopia. J. Fam. Med. Health Care 2021, 7(3), 57-64. doi: 10.11648/j.jfmhc.20210703.11

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    AMA Style

    Edosa Tesfaye Geta, Yibeltal Siraneh, Elias Ali Yesuf. Determinants of Self-referral among Outpatients at Referral Hospitals in East Wollega, Western Ethiopia. J Fam Med Health Care. 2021;7(3):57-64. doi: 10.11648/j.jfmhc.20210703.11

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  • @article{10.11648/j.jfmhc.20210703.11,
      author = {Edosa Tesfaye Geta and Yibeltal Siraneh and Elias Ali Yesuf},
      title = {Determinants of Self-referral among Outpatients at Referral Hospitals in East Wollega, Western Ethiopia},
      journal = {Journal of Family Medicine and Health Care},
      volume = {7},
      number = {3},
      pages = {57-64},
      doi = {10.11648/j.jfmhc.20210703.11},
      url = {https://doi.org/10.11648/j.jfmhc.20210703.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jfmhc.20210703.11},
      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.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - Determinants of Self-referral among Outpatients at Referral Hospitals in East Wollega, Western Ethiopia
    AU  - Edosa Tesfaye Geta
    AU  - Yibeltal Siraneh
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    DO  - 10.11648/j.jfmhc.20210703.11
    T2  - Journal of Family Medicine and Health Care
    JF  - Journal of Family Medicine and Health Care
    JO  - Journal of Family Medicine and Health Care
    SP  - 57
    EP  - 64
    PB  - Science Publishing Group
    SN  - 2469-8342
    UR  - https://doi.org/10.11648/j.jfmhc.20210703.11
    AB  - 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.
    VL  - 7
    IS  - 3
    ER  - 

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Author Information
  • School of Public Health, Institute of Health Science, Wollega University, Nekemte, Ethiopia

  • Department of Health Policy and Management, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia

  • Department of Health Policy and Management, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia

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