Experiences of injured patients referred to higher levels of care after initial
assessment and management at non-tertiary hospitals in Ghana
Dublin Core
Title
Experiences of injured patients referred to higher levels of care after initial
assessment and management at non-tertiary hospitals in Ghana
assessment and management at non-tertiary hospitals in Ghana
Subject
Trauma
Referral
Non-tertiary hospitals
Ghana
LMIC
Traditional healers
Referral
Non-tertiary hospitals
Ghana
LMIC
Traditional healers
Description
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 nonattendance 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.
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 nonattendance 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.
Creator
Lauren L. Agoubi a
, Adamu Issaka b
, Sakinah Sulaiman c
, Adam Gyedu d,e,
, Adamu Issaka b
, Sakinah Sulaiman c
, Adam Gyedu d,e,
Source
https://pdf.sciencedirectassets.com/280685/1-s2.0-S2211419X24X00026/1-s2.0-S2211419X24000119/main.pdf?X-Amz-Security-Token=IQoJb3JpZ2luX2VjELj%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FwEaCXVzLWVhc3QtMSJHMEUCIQDrz16jFMX0ge8QthCNNAfKqls%2BhQ7M0qW8Nm7Xark9QQIgf4dEmMEOlx5FnaBPDlkiWyK16h6qr4%2FdH68O%2Fx3aKHIqvAUIoP%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FARAFGgwwNTkwMDM1NDY4NjUiDGL0elM7wzpCGaUPwSqQBcEm0EEhP0eboeiLrA8NE1w1qg9vjkgNKi8zJ3Fe3pvXEcRGLqcMkAYyjYavro7E9oz69Gw3cnaxsup3NS4%2FWgZQ6NK7aVM5foskrQi3rgMACUWsnHeuu3MLNec6xJUlz1hf8Hx3UI8eHi3kwiiSkgXVJ%2Bi%2B0gyi8qdW3etlne%2FdY%2FH6cHupffhuXkrAKVLZmKsyfMjw%2F%2FSjfSrNC4Io11s95EqDgQCNIEVPEkRpBnAPMaTxfqOTTDKbD6%2BD2h%2FWPwO84X4LFfIYX4LoFtPkr3le%2FemuMntOqjmnbAjfKF1Xz82xRy%2FUyQH8%2FHOpQS%2B1%2F%2B3zNEZBIzEItV80KQEPH9qH9qBVe0OyQWjMtzlDBWEGoaHzfVRKC87h4A4WNghW0ge2qx2RCTKJhdEH1R3mlcUr7XzK2lyosCQGCVHsPxOkW6Xpi5rmdqPObEOTMxdgf3QHt6HyAwdtI74jwdGnjTU%2Bi05a9MPeeAT8am1XoWnmp7UWpuxEuLqQjhHR7HeHSJ3UugoFOEnDmhOKqgbTSgTUsCL0jZPhibXEf%2FN1lxn2hE2N%2FdqjPqOJPTGvFdyH3JAOYNd%2FXd7v95C7DmMobE2n4Pg2TqVnNTmNzM7%2B%2B8qEl8pii99lbJ1pIcnPHKEb5J4aFehdgfAGTXJLjvYKFbO6zdFwK468ZfALU8JT6BkgINw56RCDrO0OuRk1m6e5eostSqFrbk9JItd1QKrGlywEskZCSj4W%2FYCt5xZYJKGv6iFA6XcDWU4GuafqA1kwn5U2%2FzIqARvNQ7nt0BltJ%2BbJPWU1YLbz6up9GNA85oEuMhdDM3HPacRoiejaG8R4FGwUtDvdhWi6Ng%2BTc9V%2Fgf3F7gLK84X2whZiScv0IctFMLrxzsIGOrEBNidliMmswE%2FMBV4DxkcVmsYvEoGvdTFlhQIpZKPVX4Y738pKt%2FfQMICJGurOEFM3IheryzoeNJbdYWbuxjFh8cetONtcuOYu0H58d5J0f2PVGe3499NKy4AGAkwFG1ZXkeXyGrp7ZFF49cyXkwV4A9HE7VsJOhaUPgyLf3D%2Bw3VSeF7smdjLgCi7NMa1SdxjRAoNjpgEl4AFUftlYAJCSaLn%2FvYIQmh%2Bweb24gR5KyJy&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Date=20250619T075751Z&X-Amz-SignedHeaders=host&X-Amz-Expires=300&X-Amz-Credential=ASIAQ3PHCVTYU4OWNNCK%2F20250619%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Signature=6763518077f27501f15cdd2d99c6bc76b614c6fc7286c7fc4a9f00d12bced972&hash=9901863d74cc0e03deb287e25dac86351e81e1f55fd6bdeeb839096cc15444a2&host=68042c943591013ac2b2430a89b270f6af2c76d8dfd086a07176afe7c76c2c61&pii=S2211419X24000119&tid=spdf-ab31291a-296f-4505-910d-d9db5adecbbc&sid=00688b7b811b2744bd985b7238466a2c58a0gxrqb&type=client&tsoh=d3d3LnNjaWVuY2VkaXJlY3QuY29t&rh=d3d3LnNjaWVuY2VkaXJlY3QuY29t&ua=13025d5356515005570253&rr=95217a5b0eb8e789&cc=id
Publisher
Harborview Injury Prevention and Research Center, Seattle, WA, USA b Department of Surgery, School of Medicine, University for Development Studies, Tamale, Ghana c University of Buckingham Medical School, Buckingham, United Kingdom d Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana e University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
Date
14 april 2024
Contributor
Fajar bagus w
Format
PDF
Language
English
Type
Text
Files
Citation
Lauren L. Agoubi a
, Adamu Issaka b
, Sakinah Sulaiman c
, Adam Gyedu d,e,, “Experiences of injured patients referred to higher levels of care after initial
assessment and management at non-tertiary hospitals in Ghana,” Repository Horizon University Indonesia, accessed June 20, 2025, https://repository.horizon.ac.id/items/show/9562.
assessment and management at non-tertiary hospitals in Ghana,” Repository Horizon University Indonesia, accessed June 20, 2025, https://repository.horizon.ac.id/items/show/9562.