Bypassing primary healthcare facilities among admissions to medical wards, Teaching Hospital, Kandy

Abstract

INTRODUCTION AND OBJECTIVES: Bypassing of health institutions is a major concern in healthcare. This study aimed to estimate the proportion and to determine the factors associated with bypassing primary health care facilities among admissions to medical wards, Teaching Hospital, Kandy (THK). METHODS: This descriptive cross sectional study was carried out during March & April 2015 among 380 patients selected using systematic sampling from medical wards, THK. Patients transferred from other hospitals were excluded data was collected using an interviewer administered questionnaire and analysed using SPSS. 'By-passer” is defined as a person admitted to medical ward, THK without seeking treatment from a state facility closest to home.RESULTS: Of the 596 patients accessed, 216 patients transferred from other hospitals were excluded. Of 380 non• transferred patients, 162 patients were by-passers (42.6%, 95% CI: 37.7 to 47.6%). Mean age of the respondents was 57.72 years. Majority of the respondents (78.4%, n=l27) were married and 51.2% (n=83) did not have job,46.9% (n=76) of them had primary education. By-passing was associated with age group (p=0.03), educational level (P=0.02), category of employment (p=0.002) and monthly income (p<0.001). Availability of facilities for diagnosis and treatment, adequacy of medical supplies, competent health staff, severity of the illness, patient friendly approach of staff, use of latest technologies and self-satisfaction due to unknown reasons were cited as reasons for by-passing.CONCLUSION: By-passing was around 2 in 5 admissions in medical wards of THK and was associated with age, education, employment and monthly income. Participants indicated their reasons for by-passing.