Project Description

Author: Hasan et al.


Efficient healthcare delivery and proper access to specialized care rely heavily on a well-established healthcare sector referral system. However, the referral system faces significant challenges in developing nations such as Bangladesh. Thus, this study aimed to assess self-referral prevalence among patients attending tertiary care hospitals in Bangladesh and identify the associated factors.

This cross-sectional study was conducted from January to June 2022 at Dhaka Medical College Hospital and Delta Medical College Hospital, involving 822 patients visiting their outpatient or inpatient departments. Face-to-face interviews using a semi-structured questionnaire were conducted with the patients or their attendants for data collection. The patients’ mode of referral (self-referral or institutional referral) was considered the outcome variable. A multiple logistic regression model was employed to determine the factors linked with patients’ self-referral to tertiary care hospitals.

Approximately 59% (485 out of 822) of patients visiting tertiary care hospitals engaged in self-referral. Challenges in managing their condition, the need for additional care, the shortage of expert physicians, and inadequate facilities were reported as major reasons for patients’ referrals. Patients visiting the outpatient department (aOR 3.3, 95% CI 2.28-4.82, p-value <0.001), residing in urban areas (aOR 1.29, 95% CI 1.04-1.64, p-value 0.007), belonging to middle- and high-income families (aOR 1.34, 95% CI 1.03-1.62, p-value 0.014, and aOR 1.98, 95% CI 1.54-2.46, p-value 0.005, respectively), living within 20 kilometers of healthcare facilities (aOR 3.15, 95% CI 2.24-4.44, p-value <0.001), and perceiving insufficient treatment facilities in primary care (aOR 2.08, 95% CI 1.24-3.57, p-value 0.007) exhibited a higher tendency for self-referral to tertiary care facilities.

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. Addressing this issue requires establishing an effective referral linkage and strengthening the primary facilities.

Referral system, self-referral, health system, tertiary care hospitals, Bangladesh

Status: Ongoing

Full text link: Not available