Journal Article

Patient self-referral patterns in a developing country: characteristics, prevalence, and predictors

Shahnoor, Saadi Abdullah Bin, Hasan, Mohammad Jahid, Aslam, Mehjabeen Tasnuva, Poushi, Maisha Zaman, Fardous, Jannatul, Tabassum, Tamanna, Nishat, Nahida Hannan, Kalam, Sumiya Bent, Islam, Sadia, Rafi, Md. Abdur, Afrin, Nusrat, Joarder, Taufique, Kabir, Etminan, Akhter, Samiha Zaman, Islam, Ima, Ghosh, Bikona

2024

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Admission and discharge / Adolescent / Adult / Aged / Analysis / Bangladesh / Cross-Sectional Studies / Data collection / Departments / Developing Countries / Emergency medical care / Female / Health Administration / Health care / Health Informatics / Health Services Accessibility - statistics & numerical data / Health System / Hospitals / Humans / Male / Medical referral / Medical schools / Medicine / Medicine & Public Health / Middle Aged / Nursing Research / Patients / Prevalence / Primary care / Public Health / Questionnaires / Referral and Consultation - statistics & numerical data / Referral System / Self-referral / Surveys and Questionnaires / Tertiary Care Centers - statistics & numerical data / Tertiary Care hospitals / Young Adult