Bypassing Primary Healthcare Institutions: Reasons Identified by Patients’ Attending the Out-patient Department

Abstract

Introduction

Sri Lanka has a hierarchy of health services, from health care units with fewer facilities to hospitals with specialized care. Due to the absence of well demarcated draining areas and lack of clear referral policies, patients tend to bypass the primary health care units and attend much superior health care institutions without referrals. This practice has caused congestion in hospitals and deterioration of efficacy and quality of care provided to needy patients.

This study was designed to identify the reasons for bypassing primary health care institutions by patients.

Method

A cross sectional study was done among conveniently selected sample of patients attending outpatient department of Teaching Hospital Karapitiya (THK). Data were collected by an interviewer administered questionnaire that assessed their socio demographic status and reasons for bypassing their nearest hospital. Patients whose nearest hospital are THK and referred patients were excluded from the study.

Results

Among 344 patients, 60.2% were females, mean age was 41 years. Most were educated up to GCE O/L, unemployed, and had an average income<Rs 30,000. More than half (52%) of the patients had a primary health care unit less than 5km from their residence. In average, patients spent nearly 1 & 1/2 hours for traveling and paid Rs. 186 to reach tertiary care hospital. According to the participants’ understanding, most of their nearest hospitals had adequate supply of medicine (72%) and staff (79%), but not the laboratory facilities (48%).Poor quality of service represented by of doctors, delayed service, lack of essential facilities and lack of laboratory facilities and specialized services were reported as main reasons for by passing their nearest health care institutions.

Conclusions Findings confirmed that averagely educated people with low middle-income avoid primary health care services due to unavailability of specialized care, inadequate facilities and poor quality of service. Improving facilities and building trust on primary care service will therefore improve utilization of primary health care institutions in the country.