%0 Journal Article
%T Assessment of providers' referral decisions in Rural Burkina Faso: a retrospective analysis of medical records
%A Tegawende Ilboudo
%A Yiing-Jenq Chou
%A Nicole Huang
%J BMC Health Services Research
%D 2012
%I BioMed Central
%R 10.1186/1472-6963-12-54
%X A record review of twelve months of consultations was conducted covering eight randomly selected HCs to identify severe malaria (SM) cases among children under five and pneumonia cases among adults. The correctness of the diagnosis and appropriateness of providers' referral decisions were determined using the National Clinical Guidebook as a 'gold standard'.Among the 457 SM cases affecting children under five, only 66 cases (14.4%) were correctly diagnosed and of those 66 correctly diagnosed cases, 40 cases (60.6%) received an appropriate referral decision from their providers. Within these 66 correctly diagnosed SM cases, only 60.6% were appropriately referred. Among the adult pneumonia cases, 5.9% (79/1331) of the diagnoses were correctly diagnosed; however, the appropriateness rate of the provider's referral decision was 98.7% (78/79). There was only one case that should not have been referred but was referred.The adherence to the National Guidelines among the health center providers when making a diagnosis was low for both severe malaria cases and pneumonia cases. The appropriateness of the referral decisions was particularly poor for children with severe malaria. Health center providers need to be better trained in the diagnostic process and in disease management in order to improve the performance of the referral system in rural Burkina Faso.A well-functioning referral system is fundamental to primary health care (PHC) delivery. Through referrals, primary care facilities save lives and provide prompt responses to emergency situations; they do this by helping people obtain access to higher levels of care, particularly at the district level [1]. Evidence has shown that intervention aimed at improving the referral system should concentrate on improving referral appropriateness rather than controlling the referral rate [2]. Assessing and understanding the providers' referral decision-making process become critical. Findings from developed countries have shown that
%K Diagnostic errors
%K Compliance
%K Healthcare quality improvement
%K Patient safety
%K Primary care
%U http://www.biomedcentral.com/1472-6963/12/54