A Decongestion Framework for Addressing Patients' Self-Referral Crisis within a Health Facility: Case of Kisil Teaching and Referral Hospital, Kenya

Abstract

This paper focuses on addressing the crisis advanced by patient’s self-referrals through a proposed decongesting framework. Observably, a referral framework enables control of client health demands that cannot be met locally. It is a common occurrence that patients walking into referral hospitals increases thus resulting in the overuse of available services and a deterioration of the facility’s standard of care. In this work, a descriptive research design was adopted where self-referral patients who visit the outpatient department at Kisii Teaching and Referral Hospital were interviewed. Purposive random sampling was used to pick interviewee from the facility. Respondents were provided with questionnaires to answer, and the data was analyzed quantitatively using the Statistical Package for Social Sciences (SPSS). Quantitative data were presented in the form of tables and pie charts, quantitative methods (descriptive and inferential analysis) such as frequencies and percentages were used. The resulting framework is expected to aid in the decongestion of patient self-referrals. The findings established a significant positive relationship (r=.7438) between Socio-Demographic Factors and hospital decongestion in the referral hospitals. The study highlighted a positive relationship (r=.703) between primary health facility characteristics and hospital decongestion. The study established a positive relationship between Referral Facility Characteristics (r=.431) and hospital decongestion. The study established a positive relationship between Referral Facility Characteristics (r=.431) and Decongestion Framework. The study findings highlighted that a unit increase of 0.01 by Referral Facility Characteristics could increase hospital decongestion of referral hospitals. The study findings also revealed that the administrative factors also influenced the level of referral hospital congestion. The study recommends the need to strengthen the referral mechanism and linkages between the various levels of the facility by having a healthcare provider coordinate referral processes through the provision of healthcare services in remote areas via mobile clinics. Increase collaboration between all levels of care and introduce the use of technology in communication, such as the use of EHR and mobile phones for receiving feedback and sending referrals to enhance proper communication within the health care system. The public and the healthcare providers are to be updated on the referral guidelines.

Country : Kenya

1 Bisieri Lydia2 Omollo Richard

  1. Department of Information Systems and Technology, Jaramogi Oginga Odinga University of Science and Technology, Kenya
  2. Department of Computer Science and Software Engineering, Jaramogi Oginga Odinga University of Science and Technology, Kenya

IRJIET, Volume 8, Issue 4, April 2024 pp. 14-33

doi.org/10.47001/IRJIET/2024.804003

References

  1. Abdelrahman E. M., Ezzat, H.S., and Bader E.F.(2015) Factors affecting patient flow planning in hospitals.
  2. Abdi, W. O., Salgedo, W. B., &Nebeb, G. T. (2015).Magnitude and Determinants of Self-Referral of Patients at a General Hospital, Western Ethiopia. Science Journal of Clinical Medicine, 4(5), 86-92.
  3. Agarwal, S., Banerjee, J., Baker, R., Conroy, S., Hsu, R., Rashid, A., & Habiba, M. (2012). Potentially avoidable emergency department attendance: interview study of patients' reasons for attendance. Emergency Medicine Journal, 29(12), e3-e3.
  4. Agola, J., & Raburu, G. (2018).Analysis of scheduling models applicable in referral health systems.
  5. Akinode, J. L., & Oloruntoba, S. A. (2017).Design and Implementation of a Patient Appointment and Scheduling System. Department of Computer Science, Federal Polytechnic Ilaro Nigeria.
  6. Akpede, G. O., Omoigberale, A. I., Dawodu, S. O., Olomu, S. C., Shatima, D. R., &Apeleokha, M. (2005). Referral and previous care of children with meningitis in Nigeria: implications for the presentation and outcome of meningitis in developing countries. Journal of the neurological sciences, 228(1), 41-48.
  7. Alarakhia, M., Costa, A., & Roudsari, A. V. (2019, January). Axe the Fax: What Users Think of Electronic Referral. In ITCH (pp. 9-16).
  8. Alberti H, Alberti B. The influence of gender on the primary care management of diabetes in Tunisia. Pan Afr Med J. 2015 Aug 22;3:2.
  9. AliyuIsah Aliyu et al., International Journal of Science and Advanced Information Technology, 4 (1), January - February 2015, 01-06.
  10. Amoah, P. A., & Phillips, D. R. (2017, December). Strengthening the referral system through social capital: a qualitative inquiry in Ghana. In Healthcare (Vol. 5, No. 4, p. 80).Multidisciplinary Digital Publishing Institute.
  11. Ansah, E. K., Gyapong, M., Narh-Bana, S., Bart-Plange, C., & Whitty, C. J. (2016). Factors influencing choice of care-seeking for acute fever comparing private chemical shops with health centres and hospitals in Ghana: a study using case–control methodology. Malaria journal, 15(1), 1-9.
  12. Beache, S. K., & Guell, C. (2016). Non-urgent accident and emergency department use as a socially shared custom: a qualitative study. Emergency medicine journal, 33(1), 47-51.
  13. Busagala, L. S., & Kawono, G. C. (2013). Underlying Challenges of E-Health Adoption in Tanzania 1.
  14. Cao, J. X., Zhu, K. Y., & Li, X. X. (2012).Calibration and Application of Passenger Parameters in Commuter Based on Social Force Model. In CICTP 2012: Multimodal Transportation Systems—Convenient, Safe, Cost-Effective, Efficient (pp. 1369-1380).
  15. Carter, E. J., Pouch, S. M., & Larson, E. L. (2014). The relationship between emergency department crowding and patient outcomes: a systematic review. Journal of Nursing Scholarship, 46(2), 106-115.
  16. Catwell, L., & Sheikh, A. (2009).Evaluating eHealth interventions: the need for continuous systemic evaluation. PLoS Med, 6(8), e1000126.
  17. Craker, S. M. (2014).Influences on choices to inform a persuasive communications campaign to reduce non-urgent accident and emergency attendance. Journal of Communication in Healthcare, 7(3), 181-196.
  18. Crock, E. (2016).Access to healthcare services for people living with HIV experiencing homelessness-a literature review. Australian Journal of Advanced Nursing, 34(1), 42.
  19. Dantu, R., & Mahapatra, R. K. (2013).Adoption of Telemedicine-Challenges and Opportunities.
  20. Detollenaere, J., Boucherie, J., & Willems, S. (2018). Reasons why self-referring patients attend the emergency department during daytime differ among socioeconomic groups: a survey from Flanders. European Journal of General Practice, 24(1), 246-251.
  21. Durand, A. C., Palazzolo, S., Tanti-Hardouin, N., Gerbeaux, P., Sambuc, R., & Gentile, S. (2012). Nonurgent patients in emergency departments: rational or irresponsible consumers? Perceptions of professionals and patients. BMC research notes, 5(1), 1-9.
  22. Eskandari, M., Abbaszadeh, A. and Borhani, F (2013). Barriers of referral system to health provision in rural societies in Iran.
  23. Geta, E. T., Belete, Y. S., & Yesuf, E. A. (2019).Determinants of Self-referral among Outpatients at Referral Hospitals in East Wollega, Western Ethiopia. BioRxiv, 540476.
  24. He, J., Shen, W., Divakaruni, P., Wynter, L., & Lawrence, R. (2013, June).Improving traffic prediction with tweet semantics. In Twenty-Third International Joint Conference on Artificial Intelligence.
  25. Kahabuka, C., Moland, K. M., Kvåle, G., & Hinderaker, S. G. (2012). Unfulfilled expectations to services offered at primary health care facilities: experiences of caretakers of underfive children in rural Tanzania. BMC health services research, 12(1), 1-10.
  26. Kangovi, S., Barg, F. K., Carter, T., Long, J. A., Shannon, R., & Grande, D. (2013). Understanding why patients of low socioeconomic status prefer hospitals over ambulatory care. Health affairs, 32(7), 1196-1203.
  27. Kempe, D., Kleinberg, J., &Tardos, É. (2003, August).Maximizing the spread of influence through a social network. In Proceedings of the ninth ACM SIGKDD international conference on Knowledge discovery and data mining (pp. 137-146).
  28. KENYA HEALTH SECTOR REFERRAL STRATEGY - Health Publications.(n.d.). Retrieved March 9, 2021.
  29. Khiavi, F. F., Maleki, M. R., Momtaz, N. S., &Jafarian, K. (2012). The effect of extended work shift on performance of Farabi Eye Hospital in Iran. Payesh (Health Monitor), 11(2), 181-187.
  30. Kitui, J., Lewis, S., & Davey, G. (2013). Factors influencing place of delivery for women in Kenya: An analysis of the Kenya demographic and health survey, 2008/2009. Biomedical Central Pregnancy and Childbirth, 13(1), 40. Retrieved from https://doi.org/10.1186/1471-2393-13-40.
  31. Koce, F., Randhawa, G., & Ochieng, B. (2019). Understanding healthcare self-referral in Nigeria from the service users’ perspective: a qualitative study of Niger state. BMC health services research, 19(1), 209.
  32. Kraaijvanger, N., van Leeuwen, H., Rijpsma, D., & Edwards, M. (2016). Motives for self-referral to the emergency department: a systematic review of the literature. BMC health services research, 16(1), 1-19.
  33. Lam, M. K., Hines, M., Lowe, R., Nagarajan, S., Keep, M., Penman, M., & Power, E. (2016). Preparedness for eHealth: Health sciences students' knowledge, skills, and confidence. Journal of Information Technology Education: Research.
  34. Lan, Y. J., Han, B. M., & Li, D. W. (2013). Research on safety risk assessment of large-scale railway passenger station. In Applied Mechanics and Materials (Vol. 361, pp. 1923-1926). Trans Tech Publications Ltd.
  35. Lancaster, G. A., Campbell, M. J., Eldridge, S., Farrin, A., Marchant, M., Muller, S., ...& Rait, G. (2010). Trials in primary care: statistical issues in the design, conduct and evaluation of complex interventions. Statistical methods in medical research, 19(4), 349-377.
  36. Li, J., Zhang, C., Li, X., & Zhang, C. (2020). Patients’ emotional bonding with MHealth apps: An attachment perspective on patients’ use of MHealth applications. International Journal of Information Management, 51, 102054.
  37. Li, Z., Serban, N., & Swann, J. L. (2015).An optimization framework for measuring spatial access over healthcare networks. BMC health services research, 15(1), 1-13.
  38. Maeder, A. J. (2014). The spectrum of needed e-Health capacity building–towards a conceptual framework for e-Health ‘training’. Global Telehealth 2014, 206, 70.
  39. Magoro, S.M., (2015). Factors Contributing to Self-Referrals of Antenatal Women for Delivery at Dilokong Hospital, Greater Tubatse Local Municipality. PhD Thesis. University of Limpopo.
  40. McGuigan, T., & Watson, P. (2010).Non-urgent attendance at emergency departments. Emergency Nurse, 18(6).
  41. Meng, Q., Yin, D., Mills, A., & Abbasi, K. (2019). China’s Health System Reforms: Ten Years of Progress: China’s encouraging commitment to health. The BMJ, 365.
  42. Ministry of Health (South Africa).(2009). White paper for the transformation of the health system in South Africa.
  43. Ministry of Health Kenya (MOH). (2013). Referral Strategy and Investment Plan for Health Services – July 2012 – June 2017. Nairobi: Technical Planning and Monitoring / Coordinating Departments.
  44. Ministry of Health Kenya(2013). Sessional Paper No. 6 of 2012 of the Kenya Health Policy 2012–2030 (Draft).
  45. Ministry of Health Kenya. (2014) The Kenya Health Policy, 2014–2030: Towards attaining the highest standard of health.
  46. Moerman, A. H. (2014). An explorative Delphi study to uncover knowledge, attitudes and skills for nurses using eHealth (Master's thesis).
  47. MoH. (2012). Referral Policy and Guidelines; Ministry of Health (MoH), Ghana: Accra, Ghana.
  48. Mugo, D. M., &Nzuki, D. (2014).Determinants of electronic health in developing countries.
  49. Nanyonjo, A., Bagorogoza, B., Kasteng, F., Ayebale, G., Makumbi, F., Tomson, G., & Källander, K. (2015).Estimating the cost of referral and willingness to pay for referral to higher-level health facilities: a case series study from an integrated community case management programme in Uganda. BMC health services research, 15(1), 1-10.
  50. Naseriasl, M., Adham, D., &Janati, A. (2015). E-referral solutions: successful experiences, key features and challenges-a systematic review. Materia socio-medica, 27(3), 195.
  51. Nyanamba, S. O. (2018). Influence of Capital Structure on Financial Performance of Craft Micro Enterprises in Kenya (Doctoral dissertation, JKUAT-COHRED).
  52. Ogden, J., Morrison, K., & Hardee, K. (2014).Social capital to strengthen health policy and health systems. Health policy and planning, 29(8), 1075-1085.
  53. Okoli, H., Obembe, T., Osungbade, K., Adeniji, F., & Adewole, D. (2017). Self-referral patterns among federal civil servants in oyo state, South-Western Nigeria. The Pan African Medical Journal, 26.
  54. Oslislo, S., Heintze, C., Schmiedhofer, M., Möckel, M., Schenk, L., & Holzinger, F. (2019). How to decide adequately? Qualitative study of GPs’ view on decision-making in self-referred and physician-referred emergency department consultations in Berlin, Germany.BMJ open, 9(4), e026786.
  55. Pines, J. M., Hilton, J. A., Weber, E. J., Alkemade, A. J., Al Shabanah, H., Anderson, P. D., ... & Schull, M. J. (2011). International perspectives on emergency department crowding. Academic Emergency Medicine, 18(12), 1358-1370.
  56. Pittalis, C., Brugha, R., & Gajewski, J. (2019). Surgical referral systems in low-and middle-income countries: a review of the evidence. PloS one, 14(9), e02233.
  57. Pollack, C. E., Rastegar, A., Keating, N. L., Adams, J. L., Pisu, M., & Kahn, K. L. (2015). Is self-referral associated with higher quality care? Health Services Research, 50(5), 1472–1490. https://doi.org/10.1111/1475-6773.12289 28.
  58. Rehman, A., Shaikh, B. T., &Ronis, K. A. (2014). Health care seeking patterns and out of pocket payments for children under five years of age living in Katchi Abadis (slums), in Islamabad, Pakistan. International journal for equity in health, 13(1), 1-6.
  59. Sangalang, R.A., Siochi, J., & Plaza, M. (2017).Factors Influencing Consumers’ Impulse Buying Behavior in the Fifth District of Cavite. Paper Presented at the DLSU Research Congress 2017.
  60. Schmiedhofer, M., Möckel, M., Slagman, A., Frick, J., Ruhla, S., & Searle, J. (2016). Patient motives behind low-acuity visits to the emergency department in Germany: a qualitative study comparing urban and rural sites. BMJ open, 6(11), e013323.
  61. Shams, A., Mofid, M. and Reijlian, F.( 2015).Survey of referral system influenced factors from the perspective of referring of Isfahan Educational Management.
  62. Somasundaram, R., Geissler, A., Leidel, B. A., &Wrede, C. E. (2018). Beweggründefür die Inanspruchnahme von Notaufnahmen–Ergebnisseeiner Patientenbefragung. Das Gesundheitswesen, 80(07), 621-627.
  63. Tiago, S. M., (2017).Reinforcement Learning for primary care appointment scheduling, Faculdade de Engenharia da Universidade do Porto Mestrado de Engenharia da Informação.
  64. Visser, C.A., Govender, I., Ogunbanjo, G.A., Marincowitz, G.J.,(2015). Reasons for and perceptions of patients with minor ailments by passing local primary health care facilities. South African Family Practice.
  65. Wambui, M. F. (2013). Determinants of self-directed referral amongst patients seeking health services at Kenyatta National Hospital, Nairobi, Kenya (Doctoral dissertation).Kenya: Kenyatta University.
  66. World Health Organization (2018).Quality in primary health care (No. WHO/HIS/SDS/2018.54). World Health Organization.
  67. World Health Organization.(2013). Management of Patient Information, 6. Retrieved from http://apps.who.int/iris/bitstream/10665/76794/1/9789241504645_eng.pdf?ua=1