INTRODUCTION AND BACKGROUND:
Traditionally, patient referral occurs from a primary healthcare facility to a secondary or tertiary
healthcare facility. Despite these formalised procedures in place, it has been reported within the
global context that patients often circumvent these procedures and apply various forms of selfreferral
to tertiary hospitals. Through self –referral to the high level of care, patients’ diagnoses and
care are interrupted and get lost along the way.
The overall aim of this study was to develop strategies for patients’ self-referral in tertiary hospitals
in Gauteng. In order to achieve this aim, the specific objectives of the study were:
Objective 1: To explore and describe current patients’ self-referral patterns from patients and
healthcare professionals’ perspectives in tertiary hospitals in Gauteng Province.
Objective 2: To develop strategies for managing patients’ self-referral in tertiary hospitals in Gauteng
A qualitative research approach using critical ethnography was used. Purposive or judgment
sampling was used as the researcher considers the participants to have a profound knowledge and
in-depth information on the phenomenon. Data was generated through three phases: in-depth
interviews with patients and healthcare professionals (registered nurses and doctors) rendering services to self-referred patients in Gauteng Chronic clinics based in tertiary hospitals; reviewing of
relevant site documents; and imbizo as policy discussion forum between the service providers and
users of the services were held for the development of patient self-referral strategies. Data was
analysed through the analytic five steps framework as advocated by the nurse ethnographers Roper
and Shapira (2000: 98).
From the analysis of data five themes emerged as the pathways.. These pathways are emergency
admissions, word of mouth, admissions in disguise, enabling patients to pay for admission, human
rights, and sense of belonging.
This study provided a baseline data on self –referral of chronic disease patients in tertiary hospitals
in Gauteng Province. Given the epidemiology of chronic disease in South Africa, there is a need for
innovative ways of bending the costs for treatment of such. The implementation of National Health
Insurance (NHI) will address this problem as NHI has to have a self –referral scheme. The use of
the hybrid (new technology and traditional) strategies will facilitate access to care and empowerment
of patients to initiate self –referral.