Abodunrin O L, Akande T M, Osagbemi G K
Department of Community Medicine, Ladoke Akintola University of Technology, Osogbo, Nigeria.
Ann Afr Med. 2010 Jul-Sep;9(3):176-80. doi: 10.4103/1596-3519.68359.
The Nigeria Health System operates three levels of health care, which correspond to the tiers of government and interacts through a referral system. The national health policy recommends the Primary Health Care (PHC) as the entry point to health care system. However, these facilities are poorly managed leading to underutilization. Therefore, people usually attend any facility that will meet their needs, not considering the appropriateness of the level of care. This study is to determine the awareness and perception of adult residents in Ilorin toward referral in health care.
A cross-sectional descriptive survey was conducted among 366 adult residents in Ilorin, selected by multi-stage sampling technique. Data were obtained using a semi-structured questionnaire, appropriately scored and analyzed with Epi-Info 2005 computer software.
Only 22 (6.0%) respondents knew that PHC is supposed to be the fi rst point of call when ill and 25 (6.8%) were aware that referral hospitals have the right to reject patients without referral. More than two third, 256 (69.9%) of the respondents felt it will be unreasonable for any hospital to reject patients on the basis of not being referred. The level of education was significantly associated with the knowledge and perception of referral in the health care.
There is low awareness and poor perception of referral protocol in the health care system among the people of Ilorin. The higher the level of education, the more knowledge the respondents have about referral in the health system and the more likely they have correct perception of referral in health care. The Nigeria health care system policy on referral and appropriate hospital utilization could be more effective if public awareness is created about it via the media while making effort to improve the credibility of the PHC.
尼日利亚卫生系统设有三级医疗保健机构，与政府层级相对应，并通过转诊系统相互协作。国家卫生政策建议将初级卫生保健（PHC）作为卫生保健系统的切入点。然而，这些机构管理不善，导致利用率低下。因此，人们通常会前往任何能满足其需求的机构就医，而不考虑护理级别的适宜性。本研究旨在确定伊洛林成年居民对医疗保健转诊的认知和看法。
采用多阶段抽样技术，对伊洛林的366名成年居民进行了横断面描述性调查。使用半结构化问卷获取数据，进行适当评分，并使用Epi-Info 2005计算机软件进行分析。
只有22名（6.0%）受访者知道生病时初级卫生保健应该是首选，25名（6.8%）知道转诊医院有权拒绝未经转诊的患者。超过三分之二，即256名（69.9%）受访者认为任何医院以未转诊为由拒绝患者是不合理的。教育水平与医疗保健转诊的知识和认知显著相关。
伊洛林居民对卫生保健系统中的转诊协议认知度低，看法不佳。教育水平越高，受访者对卫生系统转诊的了解就越多，他们对医疗保健转诊有正确认知的可能性就越大。如果通过媒体提高公众对尼日利亚卫生保健系统转诊和适当医院利用政策的认识，同时努力提高初级卫生保健的可信度，该政策可能会更有效。
