Barriers to self-referral
Participants described self-referral was restricted by various
conditions, especially external factors. The most mentioned were
distance to referral hospital, economic condition and medical
reimbursement. Those unsurmountable factors usually directly leaded to
not referral.
“Self-referral can’t be achieved easily for me, because My
families had to suspend normal life and ask for leave work. Besides, it
was predicted that the medical bills incurred was higher along with
lower reimbursement radio. In general, it would take extra medical
expenditure and time”. (P19)
Another barrier was a lack of general knowledge of CKD, including
symptoms, the severity of illness and such on. Eight patients regretted
no earlier self-referral.
“If give me another chance, I would go to the top hospitals
earlier (cry…). I really didn’t know it was going to happen, so
did people around me.” (P12)
Two nephrologists expressed another piece of insight about barriers they
felt to self-referral during clinic consultation. Four nephrologists
expressed their expectation of referral timing and renal disease
referral system, reflecting systematic barriers.
“Most self-referral patients are at advanced stage, at which
phase physicians can’t take more measures to delay disease progression
reversibly. However, self-referral patients seem too resist to accept
the bad news. If patients can turn to higher authority hospitals earlier
for detecting causes, we may be able to slow disease progression”.(N2)