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Research article
Joko Mulyanto
Amsterdam Universitair Medische Centra
Corresponding Author
ORCiD: https://orcid.org/0000-0002-4653-2470
License:
This work is licensed under a CC BY 4.0 License. Read Full License
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.
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.
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.
Keywords
Primary care; Gatekeeper; Referral behaviour; General practitioner; Perception
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CURRENT STATUS: Published
View the published article at BMC Primary Care.
No community comments so far
Editorial decision: Accept
On 25 Dec, 2020
Editor assigned
On 15 Dec, 2020
Submission checks complete
On 15 Dec, 2020
Editor invited
On 15 Dec, 2020
No comments provided
Review #2 received
Received 25 Nov, 2020
Editorial decision: Minor revision
On 25 Nov, 2020
Reviewer #2 agreed
On 08 Nov, 2020
Review #1 received
Received 30 Oct, 2020
Reviewer #1 agreed
On 29 Oct, 2020
Reviewers invited
Invitations sent on 28 Oct, 2020
Editor assigned
On 26 Oct, 2020
Submission checks complete
On 25 Oct, 2020
Editor invited
On 25 Oct, 2020
Version 2
Posted 27 Aug, 2020
No comments provided
Editorial decision: Major revision
On 26 Sep, 2020
Review #3 received
Received 24 Sep, 2020
Review #2 received
Received 17 Sep, 2020
Review #1 received
Received 12 Sep, 2020
Reviewer #3 agreed
On 30 Aug, 2020
Reviewers invited
Invitations sent on 27 Aug, 2020
Reviewer #1 agreed
On 27 Aug, 2020
Reviewer #2 agreed
On 27 Aug, 2020
Editor assigned
On 25 Aug, 2020
Submission checks complete
On 24 Aug, 2020
Editor invited
On 24 Aug, 2020
No comments provided
Editorial decision: Revise before sending to peer reviewers
On 16 Aug, 2020
Editor assigned
On 06 Aug, 2020
First submitted
On 05 Aug, 2020
Submission checks complete
On 05 Aug, 2020
Editor invited
On 05 Aug, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
General Practice
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at BMC Primary Care.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Joko Mulyanto
Amsterdam Universitair Medische Centra
Corresponding Author
ORCiD: https://orcid.org/0000-0002-4653-2470
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Primary Care.
No community comments so far
Editorial decision: Accept
On 25 Dec, 2020
Editor assigned
On 15 Dec, 2020
Submission checks complete
On 15 Dec, 2020
Editor invited
On 15 Dec, 2020
No comments provided
Review #2 received
Received 25 Nov, 2020
Editorial decision: Minor revision
On 25 Nov, 2020
Reviewer #2 agreed
On 08 Nov, 2020
Review #1 received
Received 30 Oct, 2020
Reviewer #1 agreed
On 29 Oct, 2020
Reviewers invited
Invitations sent on 28 Oct, 2020
Editor assigned
On 26 Oct, 2020
Submission checks complete
On 25 Oct, 2020
Editor invited
On 25 Oct, 2020
Version 2
Posted 27 Aug, 2020
No comments provided
Editorial decision: Major revision
On 26 Sep, 2020
Review #3 received
Received 24 Sep, 2020
Review #2 received
Received 17 Sep, 2020
Review #1 received
Received 12 Sep, 2020
Reviewer #3 agreed
On 30 Aug, 2020
Reviewers invited
Invitations sent on 27 Aug, 2020
Reviewer #1 agreed
On 27 Aug, 2020
Reviewer #2 agreed
On 27 Aug, 2020
Editor assigned
On 25 Aug, 2020
Submission checks complete
On 24 Aug, 2020
Editor invited
On 24 Aug, 2020
No comments provided
Editorial decision: Revise before sending to peer reviewers
On 16 Aug, 2020
Editor assigned
On 06 Aug, 2020
First submitted
On 05 Aug, 2020
Submission checks complete
On 05 Aug, 2020
Editor invited
On 05 Aug, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
General Practice
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Primary Care.
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.
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.
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.
This is a list of supplementary files associated with this preprint. Click to download.
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