Health facilities

Background: A good referral system serves as a link between the three levels of health care practiced in Nigeria and ensures the continuity of proper health care service delivery. The effectiveness of referral system is an important determinant of the strength of health care service delivery. This study assesses referral system effectiveness among health facilities (primary, secondary and tertiary) in the urban and rural areas using two local government areas in Enugu State. Objective: To assess referral system effectiveness among health facilities in Enugu state Nigeria. Methodology: A cross-sectional epidemiological study of the analytical type was carried out among health workers in the various levels of health facilities within two local governments in the urban and rural areas in Enugu state. Stratified sampling technique was used to select the study participants. A pretested self- administered questionnaire was used to collect data from the respondents and was analysed using SPSS version 23. Results: The mean age of the respondents was 36.26 ± 8.73(SD) years. There was a good overall knowledge and practice of referral given as 392 (95.6%) and 235 (57.3%) respectively. Majority 74(47.3%) of the respondents had a relatively good knowledge of feedback but do not practice the feedback system of referral. Conclusion and Recommendations: The level of awareness of the referral system was impressive. However, the actual referral practice was not very satisfactory due to the lack of proper feedback and poor follow up. Efforts should be made by the agencies involved towards an improvement of the referral system.

Although Canadian policies support aging in place, there still will be a number of older adults who will require institutional care in the future. Most research on elder abuse, however, has focused on domestic abuse and has paid less attention to institutional abuse. The purpose of this article is to comprehensively review current research to identify gaps in knowledge and methodological issues in the study of institutional abuse. Overall, 49 studies in English and 20 studies in French were reviewed, and 11 key-informant interviews were conducted with methodological experts. Methodological challenges are addressed in light of the review and interviews.

McDonald, L., Beaulieu, M., Harbison, J., Hirst, S., Lowenstein, A., Podnieks, E., & Wahl, J. (2012). Institutional abuse of older adults: what we know, what we need to know. Journal of Elder Abuse and Neglect, 24(2), 138-160.