Determinants of Self-referral among Outpatients at Referral Hospitals in East Wollega, Western Ethiopia

Patient self-referral is a process through which patients refer themselves to higher level health facilities without seeing anyone else first or being advised to refer themselves by a health professional. Despite the expansion in the number of health facilities, this phenomenon is perceived when patients routinely access referral hospitals. This study aimed to determine the magnitude and identify the determinants of outpatient self-referral at referral hospitals. It was conducted in East Wollega zone of Oromia National Regional State, Ethiopia. A cross-sectional study design was used to collect data between December 1 and 30, 2017. For the study, a 404 samples size was determined using a single population proportion formula. Data entry and analysis were done using SPSS version 20. Descriptive statistics, binary and multiple logistic regressions were performed. A total of 404 outpatients were included, thereby making the response rate of 96.8%. Amongst the 391 outpatients who were interviewed, 330 (84.4%) engaged in self-referral. The factors significantly associated with outpatient self-referral were referral information (Adjusted odds ratio and 95% confidence interval (CI) = 0.32 [0.15–0.70]), illness severity (Adjusted odds ratio and 95% CI = 3.50 [1.47–8.30]), confidence of patients in getting care providers (Adjusted odds ratio and 95 CI = 3.03 [1.51–6.07]), availability of laboratory services (Adjusted odds ratio and 95% CI = 5.00 [2.20–11.23]) and drugs (Adjusted odds ratio and 95% CI = 2.37 [1.01–5.53]) and quality of health services (Adjusted odds ratio and 95% CI = 3.00 [1.42–6.33]). The proportion of outpatient self-referral was high and it was associated with referral information, patient confidence in getting healthcare providers, the severity of illness, availability of laboratory services, drugs and the quality of services. A monitoring system of the referral linkage of health facilities should be established at all levels and health facilities should create awareness in the community regarding the referral linkages of health facilities.