A network analysis of patient referrals in two district health systems in Tanzania.
Referral system
child health
networks
non-communicable disease
primary health care
Journal
Health policy and planning
ISSN: 1460-2237
Titre abrégé: Health Policy Plan
Pays: England
ID NLM: 8610614
Informations de publication
Date de publication:
26 Mar 2021
26 Mar 2021
Historique:
accepted:
08
10
2020
pubmed:
29
12
2020
medline:
29
7
2021
entrez:
28
12
2020
Statut:
ppublish
Résumé
Patient referral systems are fragile and overlooked components of the health system in Tanzania. Our study aims at exploring patient referral networks in two rural districts in Tanzania, Kilolo and Msalala. Firstly, we ask whether secondary-level facilities act as gatekeepers, mediating referrals from primary- to tertiary-level facilities. Secondly, we explore the facility and network-level determinants of patient referrals focusing on treatment of childhood illnesses and non-communicable diseases. We use data collected across all public health facilities in the districts in 2018. To study gatekeeping, we employ descriptive network analysis tools. To explore the determinants of referrals, we use exponential random graph models. In Kilolo, we find a disproportionate share of patients referred directly to the largest hospital due to geographical proximity. In Msalala, small and specialized secondary-level facilities seem to attract more patients. Overall, the results call for policies to increase referrals to secondary facilities avoiding expensive referrals to hospitals, improving timeliness of care and reducing travel-related financial burden for households.
Identifiants
pubmed: 33367559
pii: 6046539
doi: 10.1093/heapol/czaa138
pmc: PMC7996649
doi:
Types de publication
Journal Article
Langues
eng
Pagination
162-175Informations de copyright
© The Author(s) 2020. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.
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