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- Title
Patient self-referral patterns in a developing country: characteristics, prevalence, and predictors.
- Authors
Hasan, Mohammad Jahid; Rafi, Md. Abdur; Nishat, Nahida Hannan; Islam, Ima; Afrin, Nusrat; Ghosh, Bikona; Kabir, Etminan; Akhter, Samiha Zaman; Poushi, Maisha Zaman; Shahnoor, Saadi Abdullah Bin; Fardous, Jannatul; Tabassum, Tamanna; Islam, Sadia; Kalam, Sumiya Bent; Aslam, Mehjabeen Tasnuva; Joarder, Taufique
- Abstract
Background: Efficient healthcare delivery and access to specialized care rely heavily on a well-established healthcare sector referral system. However, the referral system faces significant challenges in developing nations like Bangladesh. This study aimed to assess self-referral prevalence among patients attending tertiary care hospitals in Bangladesh and identify the associated factors. Methods: This cross-sectional study was conducted at two tertiary care hospital, involving 822 patients visiting their outpatient or inpatient departments. A semi-structured questionnaire was used for data collection. The patients' mode of referral (self-referral or institutional referral) was considered the outcome variable. Results: Approximately 58% of the participants were unaware of the referral system. Of all, 59% (485 out of 822) of patients visiting tertiary care hospitals were self-referred, while 41% were referred by other healthcare facilities. The primary reasons for self-referral were inadequate treatment (28%), inadequate facilities (23%), critical cases (14%), and lack of expert physicians (8%). In contrast, institutional referrals were mainly attributed to inadequate facilities to treat the patient (53%), inadequate treatment (47%), difficult-to-treat cases (44%), and lack of expert physicians (31%) at the time of referral. The private facilities received a higher proportion of self-referred patients compared to government hospitals (68% vs. 56%, p < 0.001). Among patients attending the study sites through institutional referral, approximately 10% were referred from community clinics, 6% from union sub-centers, 25% from upazila health complexes, 22% from district hospitals, 22% from other tertiary care hospitals, and 42% from private clinics. Patients visiting the outpatient department (adjusted odds ratio [aOR] 3.3, 95% confidence interval [CI] 2.28–4.82, p < 0.001), residing in urban areas (aOR 1.29, 95% CI 1.04–1.64, p = 0.007), belonging to middle- and high-income families (aOR 1.34, 95% CI 1.03–1.62, p = 0.014, and aOR 1.98, 95% CI 1.54–2.46, p = 0.005, respectively), and living within 20 km of healthcare facilities (aOR 3.15, 95% CI 2.24–4.44, p-value < 0.001) exhibited a higher tendency for self-referral to tertiary care facilities. Conclusions: A considerable number of patients in Bangladesh, particularly those from affluent urban areas and proximity to healthcare facilities, tend to self-refer to tertiary care centers. Inadequacy of facilities in primary care centers significantly influences patients to opt for self-referral.
- Subjects
BANGLADESH; MEDICAL care; DEVELOPING countries; HEALTH facilities; PUBLIC hospitals; HOSPITAL care
- Publication
BMC Health Services Research, 2024, Vol 24, Issue 1, p1
- ISSN
1472-6963
- Publication type
Article
- DOI
10.1186/s12913-024-11115-8