Determinants of Self-referral among Outpatients at Referral Hospitals in East Wollega, Western Ethiopia

Background Patient self-referral is a condition when patients refer themselves to higher level health facilities without having to see anyone else first or without being told to refer themselves by health professional. Despite the expansion in the number of health facilities, it has been seen when patients routinely accessed referral hospitals. The study aims to determine the magnitude and identify determinants of outpatient self-referral at referral hospitals. Methods Facility based cross sectional study design was used to collect data from December 01- 30; 2017.The sample size was determined by using single population proportion formula. Data entry and analysis were made using SPSS version 20. Descriptive statistics of frequency, bivariate and multivariate logistic regression were performed. Results A total of 404 outpatients were included making response rate 96.8%. Among 391 outpatients interviewed 330(84.4%) were self-referred. The factors significantly associated with outpatient self-referral were referral information (AOR and 95%CI=0.324(0.150-0.696), illness severity (AOR and 95% CI=3.496(1.473-8.297), confidence of patients to get providers (AOR and 95 CI=3.027(1.510-6.070), availability of laboratory (AOR and 95%CI=4.966(2.199-11.216) and drugs (AOR and 95%CI=2.366(1.013-5.526) and quality of services (AOR and 95%CI=2.996(1.418-6.328). Conclusion The proportion of outpatients’ self-referral was high and that associated with referral information, patient confidence to get health care providers, severity of illness, availability of laboratory and drugs, and quality of services. There should be monitoring system of referral linkage of health facilities at all levels and the health facilities should create awareness in the community about referral linkages of health facilities.