探讨印度尼西亚全科医生对初级保健守门人角色的看法。
Exploring general practitioners' perceptions about the primary care gatekeeper role in Indonesia.
机构信息
Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia.
Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam; and Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
出版信息
BMC Fam Pract. 2021 Jan 4;22(1):5. doi: 10.1186/s12875-020-01365-w.
BACKGROUND
In the current healthcare delivery system funded by National Health Insurance (NHI) in Indonesia, the gatekeeper role of primary care services is critical to ensuring equal healthcare access for the population. To be effective, gatekeeping relies on the performance of general practitioners (GPs). However, the perceptions held by Indonesian GPs about their gatekeeper role are not yet well documented. This study describes the self-perceived knowledge, attitudes and performance of Indonesian GPs with respect to the gatekeeper role and explores associated factors.
METHODS
We conducted a cross-sectional study of all primary care facilities (N = 75) contracted by the regional NHI office in the Banyumas district. The 73 participating GPs completed a written questionnaire that assessed their knowledge, attitudes and performance in relation to the gatekeeper role. Personal and facility characteristics were analysed in a generalised linear model as possible associating factors, as well as for the association between GPs' knowledge and attitude with performance as gatekeepers.
RESULTS
GPs scored relatively high in the domains of knowledge and performance but scored lower in their attitudes towards the gatekeeper role of primary care. In the full-adjusted model, no factors were significantly associated with the knowledge score. Work experience as GPs, private or civil service employment status and rural or urban location of the primary care facility were linked to attitude scores. Full- or part-time employment and type of facility were factors associated with the performance score. Attitude scores were positively associated with performance score.
CONCLUSION
GPs in Indonesia are knowledgeable and report that they adequately perform their function as gatekeepers in primary care. However, their attitudes towards the gatekeeper function are less positive. Attitudes and performance with respect to the primary care gatekeeper role are likely influenced more by contextual factors such as location and type of facility than by personal factors. Efforts to address contextual issues could include improvements in practice standards for privately practising physicians and public information campaigns about gatekeeping regulations. Such efforts will be crucial to improving the gatekeeper role of primary care in Indonesia and assuring efficient access to high-quality care for all.
背景
在印度尼西亚由国家健康保险（NHI）资助的当前医疗保健提供系统中，初级保健服务的守门人角色对于确保全民平等获得医疗保健至关重要。为了发挥作用，守门人依赖于全科医生（GP）的表现。然而，印度尼西亚 GP 对其守门人角色的看法尚未得到很好的记录。本研究描述了印度尼西亚 GP 对守门人角色的自我感知知识、态度和表现，并探讨了相关因素。
方法
我们对班尤马斯地区区域 NHI 办公室签约的所有初级保健机构（N = 75）进行了横断面研究。73 名参与的 GP 完成了一份书面问卷，评估了他们在守门人角色方面的知识、态度和表现。个人和设施特征在广义线性模型中进行了分析，以确定可能的关联因素，以及 GP 知识和态度与作为守门人表现之间的关联。
结果
GP 在知识和表现领域的得分相对较高，但在对初级保健守门人角色的态度方面得分较低。在完全调整的模型中，没有因素与知识得分显著相关。作为 GP 的工作经验、私人或公务员雇佣状况以及初级保健机构的农村或城市位置与态度得分相关。全职或兼职就业以及设施类型是与绩效得分相关的因素。态度得分与绩效得分呈正相关。
结论
印度尼西亚的 GP 知识渊博，并且报告称他们在初级保健中充分履行了守门人的职能。然而，他们对守门人职能的态度不那么积极。对初级保健守门人角色的态度和表现可能更多地受到环境因素的影响，如位置和设施类型，而不是个人因素。解决环境问题的努力可能包括改进私人执业医生的实践标准和开展关于守门人规定的公共宣传活动。这些努力对于改善印度尼西亚初级保健的守门人角色并确保所有人都能获得高质量的医疗保健至关重要。
Zotero 插件