Physician′s self-perceived abilities at primary care settings in Indonesia

Abstract

Background:Southeast Asian countries with better-skilled primary care physicians have been shown to have better health outcomes. However, in Indonesia, there has been a large number of inappropriate referrals, leading to suboptimal health outcomes. This study aimed to examine the reasons underlying the unnecessary referrals as related to Indonesian physicians’ standard of abilities.Materials and Methods:This was a multiple-case study that explored physicians’ self-evaluation of their abilities. Self-evaluation questionnaires were constructed from the Indonesian Standards of Physicians Competences of 2006-2012 (ISPC), which is a list of 155 diseases. This study was undertaken in three cities, three towns, and one “border-less developed” area during 2011-2014. The study involved 184 physicians in those seven districts. Data were collected using one-on-one, in-depth interviews, focus group discussions (FGDs), and clinical observations.Results:This study found that primary care physicians in Indonesia felt that they were competent to handle less than one-third of “typical” primary care cases. The reasons were limited understanding of person-centered care principles and limited patient care services to diagnosis and treatment of common biomedical problems. Additionally, physical facilities in primary care settings are lacking.Discussions and Conclusions:Strengthening primary health care in Indonesia requires upscaling doctors’ abilities in managing health problems through more structured graduate education in family medicine, which emphasizes the bio-psycho-socio-cultural background of persons; secondly, standardizing primary care facilities to support physicians’ performance is critical. Finally, a strong national health policy that recognizes the essential role of primary care physicians in health outcomes is an urgent need.

Community-based educational design for undergraduate medical education: a grounded theory study

“…It is evident that any effort to introduce primary health care in any country by implementing CBE programs in many medical schools may be unattractive or misinterpreted by those who participate, primarily if primary health care still viewed as the ‘second class’ of care [9, 20, 34]. In some countries, the career pathway of doctors working at primary health care levels is set by ‘destiny’ and not by choice of destination [9].…”

“…Essentially, person-centered care and continuity of care are the keys for excellent health care services, combined with interprofessional collaborative practice to provide comprehensive care for the patients oriented towards patient-safety [6–10]. With this purpose, general practice or family medicine graduates can help medical students to better comprehend these shifting paradigms in delivering high quality of health care [9, 20, 34].…”

“…This study is a qualitative exploratory study with a grounded theory methodology approach [26–28]. We interview the subjects in this study and inductively coded the data by sensitizing the concepts of ‘student-centered learning’ [1–4], ‘curriculum levels’ [21], ‘experiential learning’ [29], as well as principles of ‘primary health care’ and ‘general practice’ or ‘family medicine’ [9, 20], until saturation.…”

“…They were from a developing country where primary health care concepts were mainly oriented to the curative-care rather than investing in the prevention and continuity of care [30]. Although a universal coverage insurance system was recently established in this country [20, 30], the graduate general practice specialist education does not yet exist [20].…”

“…CBE teachers should have the same role. Nevertheless, in some countries, the doctors who work at primary care settings may be forced into being the general practice without proper preparation in their undergraduate medical education, have no graduate education specialist training in general practice, and limited exposure to systematic continuing medical education training in delivering better primary care services [9, 20]. Thus, in this kind of circumstances, many teachers involved in a ‘CBE program’ may not be able to inspire medical students to fully comprehend the importance of primary health care [9].…”