scholarly journals Assessing the functionality of an emergency obstetric referral system and continuum of care among public healthcare facilities in a low resource setting: an application of process mapping approach

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bernice Ofosu ◽  
Dan Ofori ◽  
Michael Ntumy ◽  
Kwaku Asah-Opoku ◽  
Theodore Boafor
Keyword(s):  
Referral System ◽  
Public Healthcare ◽  
Referral Process ◽  
Urban District ◽  
Cross Sectional ◽  
Healthcare Facilities ◽  
Resource Setting ◽  
Referral Systems ◽  
Obstetric Referral ◽  
Different Levels

Abstract Background Weak referral systems remain a major concern influencing timely access to the appropriate level of care during obstetric emergencies, particularly for Low-and Middle-Income Countries, including Ghana. It is a serious factor threatening the achievement of the maternal health Sustainable Development Goal. The objective of this study is to establish process details of emergency obstetric referral systems across different levels of public healthcare facilities to deepen understanding of systemic barriers and preliminary solutions in an urban district, using Ablekuma in Accra, Ghana as a case study. Methods The study is an analytical cross-sectional study. Nine [1] targeted interviews were carried out for a three-week period in June and July 2019 after informed written consent with two [2] Obstetrics & Gynaecology consultants, two [2] Residents, one family physician, and four [3] Midwives managing emergency obstetric referral across different levels of facilities. Purposeful sampling technique was used to collect data that included a narration of the referral process, and challenges experienced with each step. Qualitative data was transcribed, coded by topics and thematically analysed. Transcribed narratives were used to draft a process map and analyze the defects within the emergency obstetric referral system. Results Out of the 34 main activities in the referral process within the facilities, the study identified that 24 (70%) had a range of barriers in relation to communication, transport system, resources (space, equipment and physical structures), staffing (numbers and attitude), Healthcare providers (HCP) knowledge and compliance to referral policy and guideline, and financing for referral. These findings have implication on delay in accessing care. HCP suggested that strengthening communication and coordination, reviewing referral policy, training of all stakeholders and provision of essential resources would be beneficial. Conclusion Our findings clearly establish that the emergency obstetric referral system between a typical teaching hospital in an urban district of Accra-Ghana and peripheral referral facilities, is functioning far below optimum levels. This suggests that the formulation and implementation of policies should be focused around structural and process improvement interventions, strengthening collaborations, communication and transport along the referral pathway. These suggestions are likely to ensure that women receive timely and quality care.

scholarly journals Assessing the Functionality of an Emergency Obstetric Referral System Among Public Healthcare Facilities in A Low Resource Setting: An Application of Process Mapping Approach

2021 ◽  
Author(s):  
Bernice Ofosu ◽  
Dan Ofori ◽  
Michael Ntumy ◽  
Kwaku Asah-Opoku ◽  
Theodore Boafor
Keyword(s):  
Referral System ◽  
Public Healthcare ◽  
Referral Process ◽  
Urban District ◽  
Cross Sectional ◽  
Healthcare Facilities ◽  
Resource Setting ◽  
Referral Systems ◽  
Obstetric Referral ◽  
Different Levels

Abstract Background: Weak referral systems remain a major concern influencing timely access to the appropriate level of care during obstetric emergencies, particularly for Low-and Middle-Income Countries, including Ghana. It is a serious factor threatening the achievement of the maternal health Sustainable Development Goal. The objective of this study is to establish process details of emergency obstetric referral systems across different levels of public healthcare facilities to deepen understanding of systemic barriers and preliminary solutions in an urban district, using Ablekuma in Accra, Ghana as a case study.Methods: The study is an analytical cross-sectional study. Nine (9) in-depth interviews (IDI) were carried out for a three-weeks period in June and July 2019 after informed consent with two (2) Obstetrics & Gynaecology consultants, two (2) Residents, one family physician, and four (4) Midwives managing emergency obstetric referral across different levels of facilities. Purposeful sampling technique was used to collect data that included a narration of the referral process, and challenges experienced with each step. Qualitative data was transcribed, coded by topics and thematically analysed. Transcribed narratives were used to draft a process map and analyze the defects within the emergency obstetric referral system.Results: Out of the 33 main activities in the referral process within the facilities, the study identified that 24 (73%) had a range of barriers in relation to communication, transport system, resources (space, equipment and physical structures), staffing (numbers and attitude), Healthcare providers (HCP) knowledge and compliance to referral policy and guideline, and financing for referral. These findings have implication on delay in accessing care. HCP suggested that strengthening communication and coordination, reviewing referral policy, training of all stakeholders and provision of essential resources would be beneficial. Conclusion: Our findings clearly establish that the emergency obstetric referral system between a typical teaching hospital in an urban district of Accra-Ghana and periphery referral facilities, is functioning far below optimum levels. This suggests that the formulation and implementation of policies should be focused around structural and process improvement interventions, strengthening collaborations, communication and transport along the referral pathway is likely to ensure that women receive timely and quality care.

scholarly journals Assessing the functionality of an emergency obstetric referral system among public healthcare facilities in a low resource setting: an application of process mapping approach

2020 ◽  
Author(s):  
BERNICE OFOSU ◽  
DAN OFORI ◽  
MICHAEL YAO NTUMY ◽  
KWAKU ASAH-OPOKU ◽  
THEODORE KOBLA BOAFOR
Keyword(s):  
Quality Care ◽  
Referral System ◽  
Public Healthcare ◽  
Referral Process ◽  
Cross Sectional ◽  
Healthcare Facilities ◽  
Resource Setting ◽  
Referral Systems ◽  
Obstetric Referral ◽  
Different Levels

Abstract Background: Weak referral systems remain a major concern influencing timely access to the appropriate level of care during obstetric emergencies, particularly for Low-and Middle-Income Countries, including Ghana. It is a serious factor threatening the achievement of the maternal health Sustainable Development Goal. The objective of this study is to establish process details of emergency obstetric referral systems across different levels of public healthcare facilities to deepen understanding of systemic barriers and preliminary solutions, using Ablekuma district in Accra, Ghana as a case study.Methods: The study is an analytical cross-sectional study. Nine (9) in-depth interviews (IDI) were carried out for a three-weeks period in June and July 2019 after informed consent with two (2) Obstetrics & Gynaecology consultants, two (2) Residents, one family physician, and four (4) Midwives managing emergency obstetric referral across different levels of facilities. Data collected included a narration of the referral process, and challenges experienced with each step. Qualitative data was transcribed, coded by topics and thematically analysed. Transcribed narratives were used to draft a process map and analyze the defects within the emergency obstetric referral system.Results: Out of the 33 main activities in the referral process within the facilities, 24 (73%) had a range of barriers in relation to communication, transport system, resources (space, equipment and physical structures), staffing (numbers and attitude), HCP knowledge and compliance of referral policy and guideline, and financing for referral. Healthcare providers suggested that strengthening communication and coordination, review of referral policy, training of all stakeholders and provision of essential resources would be beneficial.Conclusion: Our findings clearly establish that the emergency obstetric referral system in Ablekuma district, Accra-Ghana is functioning far below optimum levels. This suggests that the formulation and implementation of policies should be focused around structural and process improvement interventions likely to ensure that women receive timely and quality care.

The effect of social relationships on the rates of referral to specialists

2016 ◽  
Vol 36 (4) ◽  
pp. 384-407 ◽  
Author(s):  
Rosa Hendijani ◽  
Diane P. Bischak
Keyword(s):  
Social Relationships ◽  
Service System ◽  
Healthcare Systems ◽  
Referral System ◽  
Referral Process ◽  
High Confidence ◽  
Content Type ◽  
Close Relationship ◽  
Referral Systems ◽  
Referral Behavior

Purpose – In order to decrease patient waiting time and improve efficiency, healthcare systems in some countries have recently begun to shift away from decentralized systems of patient referral from general practitioners (GPs) to specialists toward centralized ones. From a queueing theory perspective, centralized referral systems can decrease waiting time by reducing the variation in the referral process. However, from a social psychological perspective, a close relationship between referring physician and specialist, which is characteristic of decentralized referral systems, may safeguard against high referral rates; since GPs refer patients directly to the specialists whom they know, they may be reluctant to damage that relationship with an inappropriate referral. The purpose of this paper is to examine the effect upon referral behavior of a relationship between physicians, as is found in a decentralized referral system, vs a centralized referral system, which is characterized by an anonymous GP-specialist relationship. In a controlled experiment where family practice residents made decisions concerning referral to specialists, physicians displaying high confidence referred significantly fewer patients in a close relationship condition than in a centralized referral system, suggesting that for some physicians, referral behavior can be affected by the design of the service system and will, in turn, affect system performance. Design/methodology/approach – The authors used a controlled experiment to test the research hypotheses. Findings – Physicians displaying high confidence referred significantly fewer patients in a close relationship condition than in a centralized referral system, suggesting that for some physicians, referral behavior can be affected by system attributes and will, in turn, affect system performance. Research limitations/implications – The current study has some limitations, however. First, the sample consisted only of family practice residents and did not have the knowledge and experience of GPs regarding the referral process. Second, the authors used hypothetical patient case descriptions instead of real-world patients. Repeating this experiment with primary care physicians in real setting would be beneficial. Practical implications – The study indicates that decentralized referral systems may act (rightly or wrongly) as a restraint on the rate of referrals to specialists. Thus, an implementation of a centralized referral system should be expected to produce an increase in referrals simply due to the change in the operational system setup. Even if centralized referral systems are more efficient and can facilitate the referral process by creating a central queue rather than multiple single queues for patients, the removal of social ties such as long-term social relationships that are developed between GPs and specialists in decentralized referral systems may act to counterbalance these theoretical gains. Social implications – This study provide support for the idea that non-clinical factors play an important role in referrals to specialists and hence in the quality of provided care, as was suggested by previous studies in this area (Hajjaj et al., 2010; Reid et al., 1999). The design of the service system may inadvertently influence some doctors to refer too many patients to specialists when there is no need for a specialist visit. In high-utilization health systems, this may cause some patients to be delayed (or even denied) in obtaining specialist access. Healthcare systems may be able to implement behavioral-based techniques in order to mitigate the negative consequences of a shift to centralized referral systems. One approach would be to try to create a feeling of close relationship among doctors in centralized referral systems. High communication and frequent interaction among GPs and specialists can boost the feelings of teamwork and personal efficacy through social comparison (Schunk, 1989, 1991) and vicarious learning (Zimmerman, 2000), which can in turn motivate GPs to take control of the patient care process when appropriate, instead of referring patients to specialists. Originality/value – The authors’ study is the first examining the effect of social relationships between GPs and specialists on the referral patterns. Considering the significant implications of referral decisions on patients, doctors, and the healthcare systems, the study can shed light into a better understanding of the social and behavioral aspects of the referral process.

scholarly journals Publicly funded interfacility ambulance transfers for surgical and obstetrical conditions: A cross sectional analysis in an urban middle-income country setting

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241553
Author(s):  
Paul Truche ◽  
Rachel E. NeMoyer ◽  
Sara Patiño-Franco ◽  
Juan P. Herrera-Escobar ◽  
Myerlandi Torres ◽  
...  
Keyword(s):  
Surgical Care ◽  
Healthcare Facility ◽  
Public Hospitals ◽  
Public Healthcare ◽  
Publicly Funded ◽  
Cross Sectional ◽  
Middle Income ◽  
Healthcare Facilities ◽  
Timely Access ◽  
Surgical Conditions

Introduction Interfacility transfers may reflect a time delay of definitive surgical care, but few studies have examined the prevalence of interfacility transfers in the urban low- and middle-income (LMIC) setting. The aim of this study was to determine the number of interfacility transfers required for surgical and obstetric conditions in an urban MIC setting to better understand access to definitive surgical care among LMIC patients. Methods A retrospective analysis of public interfacility transfer records was conducted from April 2015 to April 2016 in Cali, Colombia. Data were obtained from the single municipal ambulance agency providing publicly funded ambulance transfers in the city. Interfacility transfers were defined as any patient transfer between two healthcare facilities. We identified the number of transfers for patients with surgical conditions and categorized transfers based on patient ICD-9-CM codes. We compared surgical transfers from public vs. private healthcare facilities by condition type (surgical, obstetric, nonsurgical), transferring physician specialty, and transfer acuity (code blue, emergent, urgent and nonurgent) using logistic regression. Results 31,659 patient transports occurred over the 13-month study period. 22250 (70.2%) of all transfers were interfacility transfers and 7777 (35%) of transfers were for patients with surgical conditions with an additional 2,244 (10.3%) for obstetric conditions. 49% (8660/17675) of interfacility transfers from public hospitals were for surgical and obstetric conditions vs 32% (1466/4580) for private facilities (P<0.001). The most common surgical conditions requiring interfacility transfer were fractures (1,227, 5.4%), appendicitis (913, 4.1%), wounds (871, 3.9%), abdominal pain (818, 3.6%), trauma (652, 2.9%), and acute abdomen (271, 1.2%). Conclusion Surgical and obstetric conditions account for nearly half of all urban interfacility ambulance transfers. The most common reasons for transfer are basic surgical conditions with public healthcare facilities transferring a greater proportion of patient with surgical conditions than private facilities. Timely access to an initial healthcare facility may not be a reliable surrogate of definitive surgical care given the substantial need for interfacility transfers.

scholarly journals Evaluation of the Accuracy of Implementation of Obstetric Referral Cases to the Emergency in the JKN Era

2019 ◽  
pp. 159-165
Author(s):  
Omo Abdul Madjid ◽  
Arietta R.D. Pusponegoro ◽  
Immanuel S Margatan
Keyword(s):  
Emergency Department ◽  
Monitoring And Evaluation ◽  
Cross Sectional Study ◽  
Referral System ◽  
Local Health ◽  
Cross Sectional ◽  
Primary Health ◽  
Obstetric Emergencies ◽  
Obstetric Referral

Abstract Objective: To investigate the circumstances of the obstetric referral case at the emergency department of the Dr.Cipto Mangunkusumo Hospital as well as the accuracy of the referral implementation. Method: We used cross-sectional study. Medical records of obstetric patients at Emergency department in RSCM in January 2013-July 2014 were obtained, then information about patients and their characteristic were collected. The accuracy of referral cases is based on emergency obstetric criteria by BPJS rules. Results: Primary Health Care became the leading referrer. Inappropriate diagnostic referral cases amounted to 21.2%when JKN first began to be implemented in 2014. Cases with improper diagnoses were more referred when JKN was implemented which amounted to 16.8% and non-emergency referral cases of 6.9% in 2014. Conclusion: Referral implementation has not been efficient and effective, the number of obstetric referral cases to emergency department of RSCM that can actually be handled in the secondary advanced health services after the application of JKN is still high. Monitoring and evaluation is needed by the Local Health Office to improve the quality of the referral system that applied in the newly JKN era.   Keywords:accuracy of referrals,BPJS, JKN, obstetric emergencies, referral system.   Abstrak Tujuan: Mengetahui gambaran kasus rujukan obstetri di IGD RSCM dan ketepatan pelaksanaan rujukan.  Metode: Deskriptif desain studi potong lintang. Data diambil dari rekam medis pasien obstetri di IGD RSCMpada bulan Januari 2013 hingga Desember 2014, kemudian informasi mengenai data dan karakteristik pasien dikumpulkan. Ketepatan pelaksanaan rujukan kasus gaat daraurat obstetri berdasarkan Krietria gawatdarurat bagian kebidanan menurut ketentuan BPJS Kesehatan. Hasil: Perujuk terbanyak adalah Puskesmas (FKTP). Kasus rujukan dengan ketidaksesuaian diagnosa lebih banyakjumlahnya pada saat JKN mulai diterapkan pada tahun 2014 sebesar 21.2%. Kasus dengan diagnosa yang tidak tepat rujuk lebih banyak pada saat JKN di laksanakan yaitu sebesar 16.8% dan kasus rujukan yang bukan gawatdarurat sebesar 6.9% pada tahun 2014. Kesimpulan: Pelaksanaan rujukan belum efisien dan efektif, jumlah rujukan obstetri ke IGD RSCM yangsebenarnya dapat ditangani di fasilitas kesehatan tingkat lanjutan sekunder setelah penerapan JKN masih tinggi. Dibutuhkan monitoring dan evaluasi oleh Dinas Kesehatan setempat untuk meningkatkan kualitas sistem rujukan yang berlaku di era JKN yang baru diterapkan. Kata kunci :  BPJS, gawat darurat obstetri, JKN, ketepatan rujukan, sistem rujukan.

scholarly journals Supply-Side Barriers to the Use of Public Healthcare Facilities for Childhood Illness Care in Rural Zambia: A Cross-Sectional Study Linking Data from a Healthcare Facility Census to a Household Survey

2021 ◽  
Vol 18 (10) ◽  
pp. 5409
Author(s):  
Keiji Mochida ◽  
Daisuke Nonaka ◽  
Jason Wamulume ◽  
Jun Kobayashi
Keyword(s):  
Human Resources ◽  
Household Survey ◽  
Healthcare Facility ◽  
Cross Sectional Study ◽  
Public Healthcare ◽  
Supply Side ◽  
Cross Sectional ◽  
Healthcare Facilities ◽  
Rural Zambia ◽  
The Village

Child mortality due to malaria and diarrhea can be reduced if proper treatment is received timely at healthcare facilities, but various factors hinder this. The present study assessed the associations between the use of public healthcare facilities among febrile/diarrheal children in rural Zambia and supply-side factors (i.e., the distance from the village to the nearest facility and the availability of essential human resources and medical equipment at the facility). Data from the Demographic and Health Survey 2018 and the Health Facility Census 2017 were linked. Generalized linear mixed models were used to assess the associations, controlling for clustering and other variables. The median distances to the nearest facility were 4.5 km among 854 febrile children and 4.6 km among 813 diarrheal children. Children who were over 10 km away from the facility were significantly less likely to use it, compared to those within 5 km (fever group: odds ratio (OR) = 0.37, 95% confidence interval (CI) = 0.21–0.68; diarrhea group: OR = 0.32, 95% CI = 0.20–0.50). The availability of human resources and equipment was, however, not significantly associated with facility use. Poor geographic access could be a critical barrier to facility use among children in rural Zambia.

scholarly journals Prevalence and determinants of violence against health care in the metropolitan city of Peshawar: a cross sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Muhammad Naseem Khan ◽  
Zia Ul Haq ◽  
Mirwais Khan ◽  
Sadia Wali ◽  
Faryal Baddia ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Cross Sectional Study ◽  
Healthcare Personnel ◽  
Public Healthcare ◽  
Major Public Health Problem ◽  
Sectional Study ◽  
Cross Sectional ◽  
Healthcare Facilities ◽  
Violent Events

Abstract Background Violence against healthcare personnel is a major public health problem. Healthcare personnel are at the frontline dealing with people in stressful and unpredictable situations. Therefore, this study was conducted to determine the prevalence and associated factors of violence against health care personnel. Methods A cross sectional study was conducted in the district Peshawar. Healthcare personnel from public and private sectors working in both the primary and tertiary levels of healthcare were invited to participate. Violence was assessed through a structured questionnaire previously used in Pakistan and was defined as experiencing and/or witnessing any form of violence in the last 12 months. Mental health was assessed through the General Health Questionnaire. Logistic regression was used to estimate the association of violence against healthcare personnel with psychological distress and demographic characteristics. Data entry and analysis were conducted in STATA 14. Results A total of 842 healthcare personnel participated in the study. The prevalence of violence experienced and/or witnessed by healthcare personnel in Peshawar was 51%. Verbal violence remained the predominant form of violence and almost half of the healthcare personnel (45%) were exposed to it. A quarter of the respondents (24%) reported physical violence alone or in combination with other forms of violence. In almost two third of the incidents the perpetrators were either attendants, relatives or the patients. The emergency unit and wards within healthcare facilities were the most common places where violent events took place. The major factors responsible for the violent incidents were communication failure, unreasonable expectations and perceived substandard care. No uniform policy/procedure existed to manage the incidents and the healthcare personnel adopted different responses in the wake of violent events targeting health care. Working in public healthcare facilities and having a larger number of co-workers/colleagues significantly increased the risk of violence in the healthcare settings while being a paramedic significantly reduced the risk as compared to physicians. Conclusions Violence against healthcare personnel is a serious public health issue and the prevalence is quite high. A holistic effort is needed by all stakeholders including healthcare community, the administration, lawmakers, law enforcement, civil society, and international organizations.

scholarly journals Perinatal outcomes of free maternity services in Mama Lucy Kibaki Hospital, Nairobi County, Kenya

2020 ◽  
Vol 7 (10) ◽  
pp. 3860
Author(s):  
Musyoka Kainde ◽  
Maria Mpali Adela
Keyword(s):  
Survey Design ◽  
Perinatal Outcomes ◽  
World Health ◽  
Public Healthcare ◽  
Hospital Data ◽  
Cross Sectional ◽  
Healthcare Facilities ◽  
Maternity Services ◽  
The Republic ◽  
Health Organization

Background: The introduction of free maternity services in all public healthcare facilities in Kenya was the government’s initiative to decrease maternal morbidity and mortality and promote sustainable health for both the mother and infant. Maternal health is significant in the achievement of Government of the Republic of Kenya (GOK) vision 2030. In order to determine the level of implementation of free maternity services in Kenya, it is important to understand perinatal outcomes.Methods: The study adopted a cross-sectional descriptive survey design involving all women seeking free delivery services at Mama Lucy Kibaki Hospital. Data was collected using both open-ended and closed-ended questions.Results: The study findings showed an increase in maternal seeking behaviour, increase quality of care and increase in good perinatal outcomes. Further, the study showed that although free maternity services (FMS) was literally accessible to mothers, 60.2% sought antenatal care (ANC) services in the second semester while majority failed to meet the World Health Organization (WHO) recommended number of ANC visits per cycle. The study also showed that 88.5% of the women did not suffer serious comorbidities during pregnancy. However a total of 65.4% suffered anaemia with 80% of those who suffered being primigravidae.Conclusions: The study concluded that FMS has contributed to improved perinatal outcome and it recommended that pregnant women be sensitized on the importance of seeking ANC services immediately they are diagnosed pregnant, and further that the county government of Nairobi should boost the hospitals with supplies, equipment and human resource specifically nurses, so as to cope with the increased workload. 

scholarly journals Religiosity and patterns of alcohol consumption among users of primary healthcare facilities in Brazil

2019 ◽  
Vol 27 (2) ◽  
pp. 146-157
Author(s):  
Edson Zangiacomi Martinez ◽  
Anderson Soares da Silva ◽  
Flávia Masili Giglio ◽  
Natalia Akemi Yamada Terada ◽  
Miriane Lucindo Zucoloto
Keyword(s):  
Alcohol Consumption ◽  
Alcohol Use ◽  
Health Beliefs ◽  
Primary Healthcare ◽  
Multinomial Logistic Regression ◽  
Religious Affiliation ◽  
Religious Involvement ◽  
Public Healthcare ◽  
Cross Sectional ◽  
Healthcare Facilities

Abstract Background A number of studies have been reported on the role of religiosity in health beliefs and behaviors. Objective The objective of this cross-sectional study is to examine the association between religious involvement and patterns of alcohol consumption in a large representative sample of users of primary healthcare facilities in Ribeirão Preto, Southeast Brazil. Method Data were collected through personal interviews. Religiosity was measured using the Duke University Religion Index (DUREL) and the alcohol consumption was measured using the Alcohol Use Disorders Identification Test (AUDIT) questionnaire. Multinomial logistic regression models were used to evaluate the associations between the participant characteristics, the AUDIT risk levels, and the drinking groups. Results The sample was composed of 841 women with a mean age of 39.5 years old and 214 men with a mean age of 45.1 years old. A significant relationship between patterns of alcohol consumption and the multiple dimensions of religiosity was detected, such as religious affiliation, religious practices, self-perception of the level of religiosity and the ORA, NORA and IR components of DUREL. Lower levels of drinking risk were detected among religious individuals and among those who practice their religions compared to individuals who have no religion and/or non-practicing individuals, respectively. Conclusion A lifestyle motivated by religious concerns is associated with alcohol use habits among the Brazilian users of the public healthcare facilities.

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