Self-referral and associated factors among patients attending adult outpatient departments in Debre tabor general hospital, North West Ethiopia

摘要

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. An effective referral linkage is an integral component of a successful health care system for quality health service. Many developing countries have policies regarding referral system while transforming referral policies into practice between primary health care (PHC) facilities and higher-level facilities is challenging. This study was trying to answer the magnitude and factor associated with self-referral through structured interview questionnaires. The participants were asked about their socio-demographic characteristics, institutional related characteristics. There were 690 participants in this study. This study showed that the magnitude of self-referral was 63.9%. Educational status, knowledge about referral system, availability of medication in the nearby PHC facilities, enrollment to CBHI and history of visiting general hospital were factors significantly associated with self-referral. In conclusion, the proportion of self-referral was low compared to the Ethiopian health sector transformation plan 2015/16–20. Educational status, knowledge about referral system, availability of medication in the nearby PHC facilities, enrollment to CBHI and history of visiting general hospital were associated with self-referral. Policy action will be required to further improve ANC service utilization.