Abstract

Background: A two-way referral system is an organized two-way relationship between a health care provider or physician in a health care facility at one level of the health care system and another health care provider or physician in a health care facility at the same or higher level of the health care system. In a two-way referral system, there ought to be effective communication between physicians at the same or different levels of the health care system. It is obligatory for the referring physician to refer a patient promptly, in a manner that guarantees efficient, cost-effective, optimal and quality care for the patient. It also requires the physician in the receiving hospital/health care facility to refer the patient back after treatment, to the health care facility or physician that initiated the referral in the first instance, with clear feedback on the observed findings, investigations conducted for the patient and the treatment given to the patient. This aids effective continuity of care and also updates the referring physician’s knowledge. Since an effective, efficient and integrated referral system is vital to the performance of Nigeria’s healthcare system, the importance of the practice and perception of the two-way referral system by Private Medical Practitioners in Nigeria, particularly as it affects their relationship with Medical Consultants/Specialists cannot be over-emphasized.

Objective:This study assessed the practice and perception of the two-way referral system by Private Medical Practitioners in Nigeria, with the hope of providing valuable information that will help improve the practice of the two-way referral system in Nigeria, particularly through an enhanced relationship between Private Medical Practitioners in Nigeria and Medical Consultants/Specialists.

Methods:This was a cross-sectional survey of Private Medical Practitioners in Nigeria to assess their self-reported practice and perception of the two-way referral system. Data were analysed using the Statistical Package of Social Sciences version 16 (IBM SPSS, Chicago, IL) statistical software, with Pearson’s chi square used to determine associations between variables. Statistical significance was set at a P value of <0.05.

Results:There were 118 respondents with 112 males and 6 females (M:F=1:0.05). The age range of the respondents was 33-71yrs, with a mean age of 58.67±7.06yrs. Majority of the respondents (92.4%) had practiced for more than 20yrs, while majority (98.3%) practiced in only a private health facility. Only 4.2% of the respondents claimed not to be aware of the two-way referral system, while 50% were extremely aware. Most (89.7%) of the respondents had good knowledge of the two-way referral system. 44.4% of the respondents claimed they have never received a backward referral letter or feedback from medical consultants/specialists after referral of patients to them, while 12.0% claimed to have received sometimes. Out of those who reported they got feedback, less than one third (29.9%) got a feedback only when they requested for it. Though more than half (54.7%) of the respondents were not at all satisfied with the handling of referrals by Medical Consultants/Specialists in Tertiary/ Teaching Hospitals and almost half (48.7%) rated the handling of referrals by Medical Consultants/Specialists to be poor, majority (83.9%) strongly agreed that the two-way referral system is relevant to the health care delivery system.

Conclusion: The two-way referral system has the potential to significantly strengthen Nigeria’s healthcare system through effective participation and synergy between Private Medical Practitioners and Medical Consultants/Specialists. Although Private Medical Practitioners in Nigeria may have good awareness and knowledge of the Two-way referral system, their experience and perception of the handling of referrals by Medical Consultants/Specialists is poor.

Keywords

Two-way referral system, Private medical practitioners, Medical consultants, Care provider, Health care system, Consultants, Specialists, Statistical analysis, Robust referral system