Many Ethiopians think hospitals offer better services than smaller clinics

Ethiopian patients often prefer to go to hospitals, rather than smaller local clinics or doctors, even for common health problems. The reasons include transport problems and expecting better care at hospitals. This information can help authorities improve local healthcare options.

Self-referral is when patients head straight to hospital without first consulting with a doctor or local healthcare practitioner. As a result of self-referrals, hospital facilities are often overcrowded with people who could be treated at local health facilities, like clinics, instead.

In Ethiopia, this problem is still widespread, despite a country-wide effort to improve local, small-scale healthcare.

In this study, researchers wanted to find out why patients still prefer to go to bigger hospitals for common health problems. They believed that having a better understanding of patients’ reasons could help small healthcare facilities to encourage patients to use their services and improve the healthcare system in Ethiopia overall.

During December 2017, the researchers interviewed 391 patients who had been treated at the Nekemte hospital in east Wollega, Ethiopia. This hospital is a referral hospital, meaning that they often deal with complex medical cases that have been referred to them by doctors or clinics.  However, many outpatients come to the hospital without referrals.

The researchers therefore asked patients why they had chosen to use Nekemte hospital instead of other healthcare facilities. They included questions about how accessible healthcare facilities were, the quality of service they provided, the treatment options available, and how sick the patients felt when seeking treatment. They also asked patients how much they knew about how, and why, smaller health facilities refer patients to specialists at the hospital.

They then analysed the patients’ answers to find out the most important reasons for patients using the hospital rather than local healthcare.

What the researchers found was that 330 (84%) of the patients they interviewed had come to Nekemte hospital without referrals even though there were other healthcare options closer to home. 

Some of the most important reasons the patients gave included thinking their illness was very serious, difficulty in finding transport to closer facilities, believing the hospital had better healthcare staff, and thinking that the hospital provides better overall care and treatments.

The researchers also noticed that patients who understood that smaller facilities like clinics could refer them to hospital if needed, were less likely to go straight to the hospital with health issues.

The results of the study deepen scientific understanding of the healthcare system in Ethiopia. The researchers add that understanding how and why people go to the hospital, rather than local facilities, can improve the effectiveness of the healthcare system overall. 

They also suggest monitoring how, and when, patients are referred from smaller facilities to hospitals, and add that healthcare providers should educate their local community about referral practices.

In the future, the researchers suggest that more information should be collected on the costs of self-referrals to both patients and the healthcare system.

The study was conducted by researchers from Ethiopia and builds on knowledge from across the continent about how to improve healthcare systems.

Abstract

Background

Patient self-referral is a condition when patients refer themselves to higher level health facilities without having to see anyone else first or without being told to refer themselves by health professional. Despite the expansion in the number of health facilities, it has been seen when patients routinely accessed referral hospitals. The study aims to determine the magnitude and identify determinants of outpatient self-referral at referral hospitals.

Methods

Facility based cross sectional study design was used to collect data from December 01- 30; 2017.The sample size was determined by using single population proportion formula. Data entry and analysis were made using SPSS version 20. Descriptive statistics of frequency, bivariate and multivariate logistic regression were performed.

Results

A total of 404 outpatients were included making response rate 96.8%. Among 391 outpatients interviewed 330(84.4%) were self-referred.

The factors significantly associated with outpatient self-referral were referral information (AOR and 95%CI=0.324(0.150-0.696), illness severity (AOR and 95% CI=3.496(1.473-8.297), confidence of patients to get providers (AOR and 95 CI=3.027(1.510-6.070), availability of laboratory (AOR and 95%CI=4.966(2.199-11.216) and drugs (AOR and 95%CI=2.366(1.013-5.526) and quality of services (AOR and 95%CI=2.996(1.418-6.328). 

Conclusion

The proportion of outpatients’ self-referral was high and that associated with referral information, patient confidence to get health care providers, severity of illness, availability of laboratory and drugs, and quality of services. There should be monitoring system of referral linkage of health facilities at all levels and the health facilities should create awareness in the community about referral linkages of health facilities.

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