Bypassing primary healthcare institutions: Reasons identified by patients’ attending the out-patient department

Sri Lanka has a hierarchy of health services, from health care units with fewer facilities to hospitals with specialized care. Due to the absence of well demarcated draining areas and lack of clear referral policies, patients tend to bypass the primary health care units and attend much superior health care institutions without referrals. This practice has caused congestion in hospitals and deterioration of efficacy and quality of care provided to needy patients. This study was designed to identify the reasons for bypassing primary health care institutions by patients. Method A cross sectional study was done among conveniently selected sample of patients attending outpatient department of Teaching Hospital Karapitiya (THK). Data were collected by an interviewer administered questionnaire that assessed their socio demographic status and reasons for bypassing their nearest hospital. Patients whose nearest hospital are THK and referred patients were excluded from the study. Results Among 344 patients, 60.2% were females, mean age was 41 years. Most were educated up to GCE O/L, unemployed, and had an average income Conclusions Findings confirmed that averagely educated people with low middle-income avoid primary health care services due to unavailability of specialized care, inadequate facilities and poor quality of service. Improving facilities and building trust on primary care service will therefore improve utilization of primary health care institutions in the country.