Department of Health Systems and Policy, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
Department of Reproductive Health, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
Front Public Health. 2023 Jun 5;11:1128845. doi: 10.3389/fpubh.2023.1128845. eCollection 2023.
Patient self-referral is when patients refer themselves to upper-level health facilities without having to see anyone else first or without being told to refer themselves by another health professional. Self-referral leads to a diminished quality of healthcare services. However, globally, many women who gave birth referred themselves to hospitals without having referral sheets, including in Ethiopia and the study area. Therefore, this study aimed to assess self-referral practice and associated factors among women who gave birth in South Gondar zone primary hospitals in Northwest Ethiopia.
A cross-sectional mixed-method study was conducted among women who gave birth in South Gondar zone primary hospitals between 1 June 2022 and 15 July 2022. Semi-structured questionnaires were used to gather quantitative data from 561 participants who were selected by a systematic random sampling technique. Interview guides were used to collect qualitative data from selected six key informants. Quantitative data were entered into Epi Data version 4.6.0.4 and then exported to the statistical software SPSS version 25 for further analysis. Thematic analysis using open code version 4.02 software was applied for qualitative data analysis. A binary logistic regression analysis was employed. In a bivariable analysis, a < 0.25 was used to select candidate variables for multivariable analysis. < 0.05 and a 95% confidence interval were used to determine significant variables on the outcome of interest.
The overall magnitude of self-referral was 45.6%, with 95% CI (41.5%, 49.9%). They had no antenatal care (ANC) follow-up (AOR = 3.02, 95% CI: 1.64-5.57) and 1-3 ANC follow-ups (AOR = 1.57, 95% CI: 1.03-2.41), poor knowledge about the referral system (AOR = 4.04, 95% CI: 2.30-7.09), and use of public transportation (AOR = 2.34, 95% CI: 1.43-3.82), which were significantly associated with self-referral practice.
This study showed that nearly half of the deliveries were self-referred. ANC follow-up, women's knowledge of the referral system, and mode of transportation were factors significantly associated with the self-referral practice. Therefore, developing awareness-creation strategies and increasing coverage of ANC 4 and above are necessary interventions to reduce the self-referral practice.
患者自行转诊是指患者在没有先看其他人或未经其他卫生专业人员告知的情况下，自行转诊到上一级医疗机构。自行转诊会导致医疗服务质量下降。然而，在全球范围内，许多分娩后的女性在没有转诊单的情况下自行转诊到医院，包括在埃塞俄比亚和研究地区。因此，本研究旨在评估埃塞俄比亚西北部南贡德尔地区初级医院分娩后女性的自行转诊实践及其相关因素。
这是一项横断面混合方法研究，于 2022 年 6 月 1 日至 7 月 15 日在南贡德尔地区初级医院分娩的女性中进行。采用半结构式问卷从 561 名通过系统随机抽样技术选择的参与者中收集定量数据。采用访谈指南从选定的 6 名关键知情人那里收集定性数据。定量数据输入 EpiData 版本 4.6.0.4，然后导出到统计软件 SPSS 版本 25 进行进一步分析。采用开放式代码版本 4.02 软件对定性数据进行主题分析。采用二元逻辑回归分析。在单变量分析中，选择候选变量进行多变量分析的 < 0.25。对感兴趣的结果，采用 < 0.05 和 95%置信区间来确定显著变量。
自行转诊的总体比例为 45.6%，95%置信区间为（41.5%，49.9%）。她们没有接受产前保健（ANC）随访（AOR = 3.02，95%CI：1.64-5.57）和接受 1-3 次 ANC 随访（AOR = 1.57，95%CI：1.03-2.41），对转诊系统的知识较差（AOR = 4.04，95%CI：2.30-7.09），以及使用公共交通工具（AOR = 2.34，95%CI：1.43-3.82），这些因素与自行转诊实践显著相关。
本研究表明，近一半的分娩是自行转诊的。ANC 随访、女性对转诊系统的知识以及交通方式是与自行转诊实践显著相关的因素。因此，制定提高认识的策略和增加 ANC 4 次及以上的覆盖率是减少自行转诊实践的必要干预措施。
