Determinants of Self Directed Referral amongst Patients Seeking Health Services at Kenyatta National Hospital, Nairobi, Kenya
Mahinda, Faith Wambui
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Kenyatta National Hospital (KNH) is found at the apex of the referral system of health care. Ideally, patients seen at KNH are supposed to have sought care from lower levels of health care in the referral system first before seeking health services at KNH. Referral can assume two forms: Self and Non-self. Self referral refers to the scenario where a patient bypasses lower health care levels and visits KNH as his first point of entry while non self-referral refers to the referral done by a health care practitioner from a lower level of health care where the patient is sent to KNH with a referral note. The main objective of this study was to identify determinants (individual and institutional) of self directed referral of patients seeking health services at KNH. 404 respondents participated in the study; sample size was determined using the 10% Gay principle (Mugenda and Mugenda). The researcher conducted a cross sectional, descriptive study using both qualitative and quantitative data collection methods to examine patterns of patient self-referral at KNH according to social-economic status, education level and their perception of quality of care offered in lower levels of healthcare as well as the level of awareness of referral procedures. Descriptive and inferential statistics were analyzed using Statistical Package for Social Sciences (SPSS) while Chi square test and Logistic Regression was used to derive relationships that may exist between the dependent and independent variables; results were significant at a p value <0.05 . The findings of the study indicate that only 27.7% of patients seeking health services at the hospital self refer to KNH. Amongst the patients who self refer to KNH, ailments related to surgical complications (28.6%) were found to be the most common health problems. No statistically significant association was found between individual factors and self directed referral. Institutional factors that were found to influence patients‘ decision to have KNH as their hospital of choice were: location of the hospital, availability of medicines, quality of care, clear kept surroundings and affordable deposits. The health problems that cause patients to seek health services from KNH call for high level diagnostic health care which is often unavailable in lower levels of healthcare. It may be useful to introduce reversed referral within the Kenyan health care system where consultant doctors from KNH visit lower level health facilities and see patients on site. This would go a long way in reducing the number of patients who travel from far in search of quality health service at KNH and at the same time help to decongest the hospital.