title: Caregiver reasons for tertiary health-care seeking for children aged ≤12 years.
abstract: BACKGROUND
  In Turkey, a mandatory referral system is not used. Caregivers, for their children, present directly to health-care providers at all levels. This allows patients to present directly to university hospitals. In this study, reasons for university hospital-treatment seeking by caregivers for child health problems is discussed.
  
  
  METHODS
  This was a cross-sectional descriptive study at Dokuz Eylul University Faculty of Medicine, Izmir, Turkey, of 235 caregivers whose children were admitted to the outpatient clinic of the General Pediatrics Department between 4 and 11 April 2013. They completed a questionnaire on demographic data and reasons for presentation to the university hospital. Mann-Whitney U-test was used to compare group means, and Pearson chi-squared test for ratios between groups. P <0.05 was considered to be statistically significant.
  
  
  RESULTS
  A total of 54.5% of participants lived far from the hospital. The most frequent complaints involved the respiratory tract, among which the most frequent complaint was cough. Time from symptom onset to presentation was ≥7 days in 58.3% of patients, and 48.9% had never presented to another institution. The most common reason for choosing the university hospital was the availability of the necessary tests (88.1%).
  
  
  CONCLUSIONS
  Despite common use of primary health-care systems, with regard to tertiary hospital presentation, the most important factors for preferring tertiary hospital presentation were caregiver trust in tertiary hospital resources for diagnosis and treatment.
authors.affiliation: Department of Family Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
authors.forename: Seval
authors.initials: S
authors.lastname: Yaprak
authors.affiliation: Department of Family Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
authors.forename: Ulku
authors.initials: U
authors.lastname: Bulut
authors.affiliation: Department of Cardiology, Yuzuncu Yil University, Van, Turkey.
authors.forename: Yunus Emre
authors.initials: YE
authors.lastname: Okudan
authors.affiliation: Department of Family Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
authors.forename: Ozden
authors.initials: O
authors.lastname: Gokdemir
authors.affiliation: Department of Family Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
authors.forename: Muhteber
authors.initials: M
authors.lastname: Colak
authors.affiliation: Department of Family Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey. ediz.yildirim@deu.edu.tr.
authors.forename: Ediz
authors.initials: E
authors.lastname: Yıldırım
authors.affiliation: Department of Family Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
authors.forename: Dilek
authors.initials: D
authors.lastname: Guldal
mesh_terms: D000293:Adolescent; D000328:Adult; D017028:Caregivers / Q000458:organization & administration*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers; D014421:Turkey; D055815:Young Adult
keywords: caregiver; child; health-care delivery; patient acceptance of health care; tertiary health care