TY - JOUR
T1 - Obstetric referral processes and the role of inter-facility communication
T2 - the district-level experience in the Greater Accra region of Ghana
AU - Amoakoh-Coleman, Mary
AU - Klipstein-Grobusch, Kerstin
AU - Vidzro, Edem S.
AU - Arhinful, Daniel K.
AU - Ansah, Evelyn K.
N1 - Publisher Copyright:
© 2022 Ghana Medical Association. All Rights Reserved.
PY - 2022/9
Y1 - 2022/9
N2 - Objective: To describe the capacity of primary health care facilities to manage obstetric referrals, the reasons, and processes for managing obstetric referrals, and how an enhanced inter-facility communication system may have in-fluenced these Design: Mixed methods comparing data before and during the intervention period. Setting: Three districts in the Greater Accra region, Ghana from May 2017 to February 2018 Participants: Referred pregnant women and their relatives, health workers at referring and referral facilities, facility and district health managers. Intervention: An enhanced inter-facility communication system for obstetric referrals Results: Twenty-two facilities and 673 referrals were assessed over the period. The major reason for referrals was pregnancy complications (85.5%). Emergency obstetric medicines - oxytocin and magnesium sulfate (MgSO4) were available in 81.8% and 54.5% facilities, respectively, and a health worker accompanied 110(16.3%) women to the referral centre. Inter-facility communication about the referral occurred for 240 (35.7%) patients. During the interven-tion period, referrals joining queues at the referral facility decreased (7.8% to 0.0%; p=0.01), referrals coming in with referral notes improved (78.4% to 91.2%) and referrals with inter-facility communication improved (43.1% to 52.9%). Health workers and managers reported improvement in feedback to lower-level facilities and better filling of referral forms. Conclusion: Facilities had varying levels of availability of infrastructure, protocols, guidelines, services, equipment, and logistics for managing obstetric referrals. Enhanced inter-facility communication for obstetric referrals which engages health workers and provides requisite tools, can facilitate an efficient referral process for desired outcomes.
AB - Objective: To describe the capacity of primary health care facilities to manage obstetric referrals, the reasons, and processes for managing obstetric referrals, and how an enhanced inter-facility communication system may have in-fluenced these Design: Mixed methods comparing data before and during the intervention period. Setting: Three districts in the Greater Accra region, Ghana from May 2017 to February 2018 Participants: Referred pregnant women and their relatives, health workers at referring and referral facilities, facility and district health managers. Intervention: An enhanced inter-facility communication system for obstetric referrals Results: Twenty-two facilities and 673 referrals were assessed over the period. The major reason for referrals was pregnancy complications (85.5%). Emergency obstetric medicines - oxytocin and magnesium sulfate (MgSO4) were available in 81.8% and 54.5% facilities, respectively, and a health worker accompanied 110(16.3%) women to the referral centre. Inter-facility communication about the referral occurred for 240 (35.7%) patients. During the interven-tion period, referrals joining queues at the referral facility decreased (7.8% to 0.0%; p=0.01), referrals coming in with referral notes improved (78.4% to 91.2%) and referrals with inter-facility communication improved (43.1% to 52.9%). Health workers and managers reported improvement in feedback to lower-level facilities and better filling of referral forms. Conclusion: Facilities had varying levels of availability of infrastructure, protocols, guidelines, services, equipment, and logistics for managing obstetric referrals. Enhanced inter-facility communication for obstetric referrals which engages health workers and provides requisite tools, can facilitate an efficient referral process for desired outcomes.
KW - capacity
KW - interfacility communication
KW - obstetric referrals
KW - outcomes
KW - processes
UR - http://www.scopus.com/inward/record.url?scp=85141620432&partnerID=8YFLogxK
U2 - 10.4314/gmj.v56i3s.7
DO - 10.4314/gmj.v56i3s.7
M3 - Article
AN - SCOPUS:85141620432
SN - 0016-9560
VL - 56
SP - 51
EP - 60
JO - Ghana Medical Journal
JF - Ghana Medical Journal
IS - 3
ER -