Self-referral practice among patients attending outpatient department of Northwest Comprehensive Specialized Hospital, Ethiopia: A multi-center cross-sectional study

Lakew Asmare^1*Tihtna Alemu²Zeamanuel Anteneh Yigzaw³Mekides Engeda Alemu⁴

• ¹Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
• ²Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara Region, Ethiopia
• ³Department of Health Promotion and Behavioral studies, School of Public Health, College of Medicine and Health sciences, Bahir Dar University, Bahir Dar, Amhara Region, Ethiopia
• ⁴Department of Surgical Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia, Ethiopia, Ethiopia

Background: In resource-scarce countries such as Ethiopia, patients coming from primary care facilities directly to specialist hospitals pose an enormous challenge to the health system. It hinders continuity of care and can reduce the quality of healthcare. However, little is known about the magnitude of self-referral in Ethiopia. Therefore, this study aimed to determine self-referral practice and its associated factors in Northwest Comprehensive Specialized Hospital, Ethiopia.Methods: A multicenter institutional-based cross-sectional study design study was conducted. A systematic random sampling technique was employed to recruit a total of 446 participants.Structured interviewer-administered questionnaires were used. Data were entered in Epi-data software and exported. A variable with a p-value < 0.25 in the bi-variable was a candidate for multivariable analysis. P-value < 0.05 with a 95% confidence interval was used to declare association.The magnitude of self-referral practice was 339 (70.40%). Thus, respondents who had an education level of college & above [AOR = 0.35, 95% CI = 0.10,0.92], respondents who perceived their illness [AOR = 1.11, 95% CI=1.06, 2.53] and those who had adequate knowledge about the referral system (AOR = 0.31, 95%CI = 0.16, 0.68) were significantly associated variables with self-referral practice.In this study's findings, more patients than expected visited specialized hospitals than previously reported. Various factors, such as educational level, perceived severity of illness, confidence in laboratory services, lack of information about referral methods, and use of primary care contribute to this issue. Addressing these factors and strengthening the referral process are important steps to improve healthcare delivery, continuity of care, and patient satisfaction in Ethiopia.