Why do people travel upto 70km to seek treatment from the Colombo North Teaching Hospital Outpatient Department? A qualitative study

Abstract

INTRODUCTION AND OBJECTIVES: Bypassing nearby primary care facilities to seek treatment from teaching/general hospital OPDs is a known challenge to the equitable distribution of healthcare. A 2017 morbidity study at CNTH OPD showed that 25.3% travelled distances more than lOkm to visit the OPD. Our aim was to understand why patients travel straight line distances more than lOkm to seek healthcare from the CNTH OPD.METHODS: Four trained medical student interviewers conducted individual in-depth interviews with patients attending the CNTH OPD from a distance of more than lOkm. Interviews were conducted in Sinhala/Tamil, recorded, transcribed and translated to English prior to inductive thematic analysis until there was saturation of themes.RESULTS: Participants were 13 female and 10 male patients from 24 to 68 years; from distances of 12km to 69km. Significant driving factors that emerged were a) trust in the quality of care arising from prior satisfactory experience and social perceptions, b) efficient administration and better facilities, c) perceived severity of the illness, d) reluctance to seek treatment from nearby healthcare facilities due to perceived inefficiencies in administration, lack of facilities and poor service delivery, e) ease of access using the train system, f) familiarity with the institution and personal connections with staff members and g) incidental visits to CNTH or Ragama town not related to healthcare.CONCLUSION: Patients appear to make calculated decisions on which healthcare facility to attend based on the desire to receive the best care possible. However, some visits were inappropriate and contributed to unnecessary overcrowding of the OPD.