THE REFERRAL SYSTEM AND FEEDBACK PROCESS BY MEDICAL CONSULTANTS AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN.
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Date
2012
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Abstract
Referral is an essential two-way process linking the three tiers of health care together. Lack of
feedback is a common constraint to the proper functioning of the referral process and
information is lacking on the factors which affect this process. This study was therefore designed
to assess the knowledge, level of practice as well as the factors influencing the feedback process
in the two-way referral system by medical consultants at the University College Hospital,
Ibadan.
A cross-sectional study of all medical consultants (82) who routinely receive referrals and
actively provide specialized patient care at the University College Hospital, Ibadan was carried
out. Using a self-administered questionnaire, information on socio-demographic characteristics,
knowledge, practice and the factors affecting the two-way referral process was obtained from
respondents. Validation was done by assessing all new patients’ records (1,207) in their clinics.
Knowledge scores ranged between 0-8, scores of 0-4 were classified as poor knowledge and 5-8
as good knowledge. Chi-square test was used to determine association between categorical
variables at 5% level of statistical significance.
The mean age of the respondents was 46.5 ±7.5 years, 64.6% of the respondents were males and
51.2% had 15-24 years working experience as a doctor. The respondents included were surgeons
(17.1%), dentists (15.9%), paediatricians (14.6%), physicians (12.2%), obstetrician and
gynaecologists (9.8%), psychiatrists (6.1%), community health physicians (6.1%),
haematologists (6.1%), radiotherapists (4.9%), ophthalmologists (3.7%), and otorhinolaryngologists (3.7%). Although 84.1% of the respondents had good knowledge of the
two-way referral system, only 56.1% reported sending feedbacks. Evidence of feedbacks was
available however in only 9.7% of case notes. The decision to send feedbacks was based on the
reason for referral and detail of clinical information supplied by the referring healthcare provider
as reported by 42.7% and 32.9% of the respondents respectively. Ignorance of the existence of
the feedback system (14.6%), lack of commitment to the practice of sending feedbacks (13.4%),
inadequate resources (11.0%) and a heavy patient load (9.8%) were identified by respondents as
challenges to the two-way referral system. Most (97.6%) of the respondents believed that there
was a need to improve the feedback system. Working experience was significantly and positively
associated with sending of feedbacks. Feedback was also significantly associated with the
existence of a coordinating system for referrals within the departments. Feedbacks were given
more on outpatients than inpatients. Feedbacks from Ophthalmologists were significantly higher
than those from other consultants. A feedback was also more likely if the information on the
referral letter to the consultants contained detailed information.
Knowledge about the two-way referral system was high in the study population but the feedback
practice was poor. There is a need for a mechanism to monitor referrals, provide adequate
resources and re-orientate medical consultants about the feedback.