College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia.
Department of Health System & Health Economics, Bahir Dar University College of Medicine and Health Science, School of Public Health, Bahir Dar, Ethiopia.
BMC Health Serv Res. 2021 Jun 28;21(1):607. doi: 10.1186/s12913-021-06642-7.
Self-referral leads to diminished quality of health care service; increase resource depletion and poorer patient outcomes. However, a significant number of patients referred themselves to the higher health care facilities without having referral sheets globally including Ethiopia. Even though the problem is much exacerbated in Ethiopia, there is limited evidence regarding self-referral patients in Ethiopia in particular in the study area.
To assess the magnitude and associated factors of self-referral among patients at the adult outpatient department in Debre Tabor general hospital, North West Ethiopia.
Institution-based cross-sectional study was conducted from March 11-April 9, 2020 among 693 patients who attended adult outpatient departments. A systematic sampling technique was employed. Structured and pretested interviewer-administered questionnaire was used for data collection. Data were coded, cleaned and entered into Epi Info version 7.1 and exported to SPSS version 23 for further analysis. Binary logistic regression analysis was employed. In bivariable analysis p-value, less than 0.25 was used to select candidate variables for multivariable analysis. P-values less than 0.05 and 95% confidence intervals were used to select significant variables on the outcome of interest.
The proportion of self-referral was 443(63.9%) with 95% CI (60.5; 67.5). Formally educated, (AOR = 1.83; (95% CI: 1.12, 3.01)), enrolled to Community Based Health Insurance (AOR = 1.57; (95% CI: 1.03, 2.39)), poor knowledge about referral system (AOR = 2.07; 95% CI: (1.28, 3.39)), not and partially available medication in the nearby Primary Health Care facilities (AOR = 2.12; (95% CI: 1.82, 6.15)) & (AOR = 3.24; (95% CI: 1.75, 5.97)) respectively and history of visiting general hospital (AOR = 1.52; (95%CI: 1.03, 2.25)) were factors statistically associated with self-referral.
The proportion of self-referral was low compared to the Ethiopian health sector transformation plan 2015/16-20. Socio-demographic and institutional factors were associated with self-referral. Therefore, regional health bureau better to work to fulfill the availability of medications in the primary health care facilities. In addition, Community Based Health Insurance (CBHI) agency should work to implement the law of out-of-pocket expenditure which states to pay 50% for self-referred patients who claim utilization of healthcare.
自我转诊导致医疗服务质量下降；增加资源消耗和较差的患者预后。然而，在全球范围内，包括埃塞俄比亚在内，仍有相当数量的患者自行转诊至更高水平的医疗机构。尽管在埃塞俄比亚，这一问题更为严重，但关于埃塞俄比亚特别是在研究区域内自我转诊患者的证据有限。
评估德布雷塔博尔综合医院成人门诊部门患者自我转诊的程度和相关因素，位于埃塞俄比亚西北部。
这是一项 2020 年 3 月 11 日至 4 月 9 日在德布雷塔博尔综合医院成人门诊部门进行的基于机构的横断面研究，共纳入了 693 名患者。采用系统抽样技术。使用经过结构化和预测试的访谈式问卷收集数据。数据经过编码、清理后输入 Epi Info 版本 7.1，并导出到 SPSS 版本 23 进行进一步分析。采用二元逻辑回归分析。在单变量分析中，p 值小于 0.25 被用于选择多变量分析的候选变量。p 值小于 0.05 和 95%置信区间被用于选择对感兴趣的结果有显著影响的变量。
自我转诊的比例为 443（63.9%），95%置信区间为（60.5%；67.5%）。受正规教育者（AOR=1.83；95%置信区间：1.12，3.01）），参加社区基础医疗保险者（AOR=1.57；95%置信区间：1.03，2.39）），对转诊系统知识了解不足者（AOR=2.07；95%置信区间：1.28，3.39）），附近初级保健设施中药物供应不足或部分供应者（AOR=2.12；95%置信区间：1.82，6.15）和（AOR=3.24；95%置信区间：1.75，5.97）），以及有一般医院就诊史者（AOR=1.52；95%CI：1.03，2.25）是与自我转诊相关的统计学因素。
与 2015/16-20 年埃塞俄比亚卫生部门转型计划相比，自我转诊的比例较低。社会人口学和机构因素与自我转诊有关。因此，地区卫生局应努力确保初级保健设施中有足够的药物供应。此外，社区基础医疗保险机构应努力实施自费支出法，规定对自我转诊并声称使用医疗保健的患者支付 50%的费用。
