Experiences of injured patients referred to higher levels of care after initial assessment and management at non-tertiary hospitals in Ghana

Lauren L Agoubi; Adamu Issaka; Sakinah Sulaiman; Adam Gyedu

doi:10.1016/j.afjem.2024.04.001

Experiences of injured patients referred to higher levels of care after initial assessment and management at non-tertiary hospitals in Ghana

Afr J Emerg Med. 2024 Jun;14(2):109-114. doi: 10.1016/j.afjem.2024.04.001. Epub 2024 May 6.

Authors

Lauren L Agoubi¹, Adamu Issaka², Sakinah Sulaiman³, Adam Gyedu^{4

5}

Affiliations

¹ Harborview Injury Prevention and Research Center, Seattle, WA, USA.
² Department of Surgery, School of Medicine, University for Development Studies, Tamale, Ghana.
³ University of Buckingham Medical School, Buckingham, United Kingdom.
⁴ Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
⁵ University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

Abstract

Background: The experiences of trauma patients referred from Ghanaian non-tertiary hospitals for definitive care at higher levels is not well-known. Understanding the motivations of injured patients who do not attend their referral for definitive management may inform interventions to improve injury outcomes.

Methods: This study is a follow-up survey of participants of a larger study involving initial management of injured patients presenting to 8 non-tertiary hospitals in Ghana from October 2020 to March 2022. Injured patients referred to higher levels of care were surveyed by phone using a structured questionnaire and patients who could not be reached were excluded. The main outcome was referral non-attendance and differences between patients who attended the referral and those who did not were determined with chi squared tests. Variables with intergroup differences were included in a multivariable logistic regression. Open-ended survey responses were analyzed using thematic content analysis.

Results: Of 335 referred patients surveyed, 17 % did not attend the referral. Factors associated with referral non-attendance included being male (Adjusted odds ratio (AOR)=2.70, p = 0.013), sustaining a fracture (AOR=2.83, p = 0.003), and having less severe injury (AOR 2.84, p = 0.017). Primary drivers of referral non-attendance included financial problems (59 %), family influence (45 %), and lack of transportation (20 %). The majority of patients (77 %) not attending the referral sought treatment from traditional healers, citing lower cost, faster service, and a perception of equivalent outcomes. Reported facilitators of referral attendance included positive hospital staff experiences and treatment while barriers included higher hospital costs, lack of bed space, and poor interhospital communication.

Conclusions: An important proportion of injured patients in Ghana do not attend referrals for definitive management, with many seeking care from traditional healers. Our study identified possible targets for interventions aimed at maintaining the continuum of hospital-based care for injured patients in order to improve outcomes.

Keywords: Ghana; LMIC; Non-tertiary hospitals; Referral; Traditional healers; Trauma.