An information technology based framework for integrating referral levels among public healthcare facilities in Uganda

Abstract

An effective referral system ensures a close relationship across all levels of the healthcare system to ensure that people receive the best possible healthcare. Coordination among referral levels can be achieved by strengthening communication and feedback between the different levels of healthcare facilities, supervisors, and healthcare professionals based in their respective healthcare facilities. This can improve the access of patient management details and better services provided to patients at all times hence promoting efficiency and effectiveness in the referral system (Heeringa, Mutti, Furukawa, Lechner, Maurer & Rich, 2020). This study investigated the challenges faced by referral levels such as lack of coordination, limited patient management details transferred with the patients across various levels, among others to design an Information Technology (IT) based framework for integrating referral levels among public healthcare facilities in Uganda. This study used the design science research methodology with the output of an artefact which is the designed framework of integration. An exploratory study was conducted to collect primary data among 84 respondents (76 questionnaires and 8 interviews) from four selected public healthcare facilities at various levels of healthcare which included Health Centre, General Hospital, and National Referral Hospital. The data collected was analysed and challenges faced by referral levels were revealed where requirements for designing the framework were derived from and the existing frameworks that were reviewed. The framework was tested and validated following design science parameters (efficiency and usability). Results from testing and validation indicated that the framework addressed the challenges facing referral levels and achieved the objective of the study. Results from this study indicated that 100% of referral levels in the healthcare facilities either make or receive referrals and the majority of these respondents agreed that it is important for referral levels to be integrated and these respondents constituted 92.4% while 7.6% disagreed that it is not important to integrate referral levels. The referral system in Uganda faces challenges with a 97.3% level of agreement and the greatest challenge was the failure to capture patient referral data and keep track of these patient records at some levels of healthcare facilities with an average mean of 4.857. Findings revealed that the majority of the respondents agreed that it is important for referral levels to be integrated and these respondents constituted 92.4% and 7.6% disagreed that it is not important to integrate referral levels. And the greatest importance of integration towards solving the challenges affecting the referral system was integration improves and streamlines communication among healthcare providers involved in a patient’s care across different levels of healthcare facilities with a mean of 4.799.