Objective To examine barriers to the uptake of referral services from secondary care centres to higher level tertiary care centres.
Design Cross-sectional study.
Setting Secondary care hospital in Khammam District in the Telangana state of India.
Participants Nine hundred and three patients who were referred from a secondary care centre to tertiary care centres between June 2011 and December 2012, were over the age of 18 and lived within 50 km of the secondary care centre were identified. Six hundred and sixteen (68.2%) of these patients were successfully contacted, and 611 (99%) of those contacted consented to participation in the study.
Interventions Those who attended at higher centres after referral (compliant) and those who failed to attend (non-compliant) were interviewed with a standard questionnaire designed for the study.
Primary and secondary outcome measures Outcome measures were barriers to the uptake of eye care services for the non-compliant participants and the associated risk factors for non-compliance.
Results Of the contacted patients, 418 (68.4%) were compliant and 193 (31.6%) were non-compliant. The mean age of interviewed patients was 48.4 years (SD: 17.9 years) and 365 (59.7%) were male. Of those who did not comply with their referral, the major identified barriers were ‘cannot afford treatment cost’ (30%) and ‘able to see adequately’ (20.7%). Multivariable analysis showed that participants in the non-compliant group were more likely to have had only one prior visit to the centre (OR: 2.5, 95% CI 1.6 to 3.9), be referred for oculoplastic services (OR: 3.0, 95% CI 1.0 to 8.8) and to be the main earning member of the family (OR: 1.9, 95% CI 1.2 to 2.8).
Conclusions Non-compliance with referrals in this population is largely attributable to economic and attitudinal reasons. Focusing on these specific barriers and targeting groups at higher risk of non-compliance could potentially improve uptake of referral services.
- uptake of service
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Contributors RCK contributed to the concept and design of the study, data acquisition, analysis and interpretation, and drafting and revision of the article. KS contributed to data acquisition, analysis, interpretation of data, and drafting and revision of the article, as well as approval of the final version. PG contributed to data acquisition and revision of the article, as well as approval of the final version. ALM contributed to data acquisition, analysis, interpretation of data and revision of the article, as well as approval of the final version. SM contributed to data acquisition and revision of the article, as well as approval of the final version. GNR contributed to the concept, interpretation of the data and revision of the article, as well as approval of the final version.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Obtained.
Ethics approval The Institutional Review Board of Hyderabad Eye Research Foundation, LV Prasad Eye Institute approved the study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data are available with the institute and can be accessed on request.
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