Perception of Healthcare Providers on the Existing Patient Referral System and Recommendations on the Development of the Electronic Referral System in Rwanda: A Mixed Method Study

Abstract

Background Referral systems support the mobility of patients to ensure they receive adequate healthcare services from the appropriate provider. The major triggers for referrals are limited resources and skills at the lower level of care. An electronic referral system has the potential to considerably improve communication between primary care providers and specialists by submitting standardized and complete electronic referral requests which contain all relevant information needed for a smooth coordination, continuity of care, and facilitating urgent cases. The main objective of this study is to investigate the perception of healthcare providers regarding the existing paper-based referrals and their suggestions on the development of the electronic referral system in order to improve the health information exchange, the coordination and the continuity of care. Methods A mixed method approach was used to examine healthcare providers' perception of the referral system. For the quantitative analysis, a questionnaire was used to collect data from July to October 2021. A purposive sampling was used to select healthcare providers and a descriptive analysis was performed using SPSS 27. For the qualitative study design two focused group discussions were conducted, data were transcribed and analyzed using NVivo R 1.6. Results Overall, 345 referral constituents, including 202 mandatory and 143 optional ones were confirmed by the healthcare providers. The qualitative findings concerned two themes. The first one elucidated the challenges with the existing paper-based referral system pointing out delays in the referral process; incompleteness of paper-based referral sheet; referral triage; premature referral; absence or incomplete counter referral; patient privacy; and language problems. The second theme suggested features to be included in the electronic referral system, the procedures to follow during the transition phase, proposed mandatory and optional constituents, predicted challenges and expected benefits. Conclusion This study gathered perceptions of healthcare providers on the existing referral system, further elucidated their expectations on the electronic referral system and proposed features to be considered in its design. Finally, leads to a proposed design of an electronic external referral form.