Referral system in rural Iran: improvement proposals

Patient satisfaction with referral service and associated factors among public hospitals in and around Addis Ababa, Central Ethiopia

Objective:

Studies in sub-Saharan Africa have shown that patient satisfaction with referral procedures and systems is low due to multiple factors. Despite the challenges on patient satisfaction with referral service in Ethiopia, there are only limited studies on overall satisfaction and associated factors with referral services of the hospitals. The purpose of this study was to determine patient satisfaction with referral services and related characteristics among patients referred to referral hospitals in Central Ethiopia, in the year 2021.

Methods:

A facility-based multi-center cross-sectional study was conducted at public hospitals in and around Addis Ababa using both quantitative and qualitative data collection methods. The hospitals were selected using a simple random sampling method from the list. Data were collected from 317 referral forms and chart reviews, 310 patient interviews, 27 focused group discussions, and 16 insider observations. The collected data were coded and entered into EPI INFO version 7 and transferred to SPSS version 25 for further analysis. Both binary and multivariable logistic regression models were computed to see the association between independent versus outcome variables. The findings were taken as significant with a p value of <0.05 at 95% confidence interval and results were presented with text, graphs, figures, and tables.

Result:

Overall level of patients’ satisfaction of referral services in Central Ethiopia was 73.5%, confidence interval (67.9%–81.1 %,) and near 85% of the participants had got an examination by the respective health care worker on arrival. This study identified that factors that increase odds of patient satisfaction toward referral services were status of communication (adjusted odd ratio 44.09 (95% confidence interval, 5.47, 355.68), perceived level of experience of health providers who handle the referral process (adjusted odd ratio 6.42 (95% confidence interval, 1.20, 34.42) and coordination status of the hospitals during referral acceptance (adjusted odd ratio 35.50 (95% confidence interval, 4.87, 258.60) and these were significantly associated with patient’s satisfaction toward referral services. Referral without communication among hospitals was stated as the leading challenge by focused group discussants and very limited practice on referral feedback was reported by insider observers.

Conclusion:

This study determined that the overall level of patient satisfaction toward referral services in Central Ethiopia was moderate with identified factors that increase odds of patient satisfaction toward referral system being the way of communication, health provider’s experience, and coordination status of the hospitals on referral acceptance. Hence, policymakers and the ministry of health would better consider the aforementioned factors during referral program development and training for improvement of patients’ satisfaction with referral services.

Effectiveness of telephone-based screening and triage during COVID-19 outbreak in the promoted primary healthcare system: a case study in Ardabil province, Iran

Aims

Screening services for early detection of patients is one of the important capabilities of the health system with a proper referral system. In the crisis of respiratory infection of Covid-19, screening based on symptoms is one of the key measures. The aim of the current study was to evaluate the telephone-based screening and triage services in the promoted primary healthcare system with regard to the Covid-19 outbreak, in terms of reducing unnecessary referrals to the hospital.

Methods

This is a descriptive cross-sectional study conducted in two stages on 1,406,635 households during March/April 2020 in Ardabil province for screening and early detection of Covid-19 disease. In the first stage, conducted by trained healthcare providers through telephone, individuals suspected of Covid-19 were identified. In the second stage, the individuals were referred to the second level of service in comprehensive healthcare centers (16- or 24-h centers) for clinical evaluation by a physician.

Results

The results showed that before establishing a screening and triage system for patients in comprehensive healthcare centers, all patients were referred directly to the hospital, while after the implementation of the program, a significant reduction in hospital visits was observed and a large number of patients undertook the care and triage services in comprehensive healthcare centers.

Conclusion

The use of a grading system in referring patients with suspected cases, triage of patients according to symptoms at the comprehensive health centers, and activation of home isolation were the most important factors in reducing the burden of unnecessary referrals of patients to the hospital.