The Gatekeeper Model: patient’s view on the role of the family physician

Abstract

Background. An adequate primary healthcare system substantially determines the quality of health of the population and effective spending of healthcare resources. The family physician, serving as a 'gatekeeper', can make judicious decisions about the appropriate use of medical services. Objectives. The goal of this study was to find out patients' characteristics, preferences and behaviour in regard to the role of the family physician as a gatekeeper in the Republic of Georgia. Material and methods. As part of a cross-sectional quantitative study, respondents were interviewed using a structured questionnaire. Results. A majority of the respondents (53.7%, n = 245) had a permanent family physician, but were not satisfied with the level of the family physician's professionalism (56.6%, n = 258) and preferred self-referral to specialists (55%, n = 253). Only 19.5% (n = 89) referred to specialists upon the family physician's advice, who would coordinate all services, and 23% (n = 103) have used both family physicians and self-referral. Private health insurance companies were more interested in implementing cost reducing mechanisms rather than the Social Service Agency (which is responsible for the Universal Health Care Programme). Conclusions. It is appropriate to share private health insurance experiences for developing the model of a gatekeeper in the UHCP. In order to improve a family physician institute and increase confidence in it, it is recommended to raise the level of family physicians' skills in their relations with patients, as this has a significant effect on patient preferences. It is advisable to develop a flexible and voluntary gatekeeper model which will better suit the needs of both patients and physicians.

The Approach to the COVID-19 Pandemic in Georgia—A Health Policy Analysis

“…Despite recent increases in healthcare spending, Georgia’s total annual per capita spending on health has remained at the equivalent of just over 300 USD since about 2015. While almost 5 hospital beds per 1,000 population are available, the primary care sector is underdeveloped and lacks gatekeeping capacity, as people in Georgia rarely visit primary care physicians [ 19 – 21 ]. With 30,000 practicing physicians nationwide, including over 500 ICU specialists, Georgia has one of the highest physician rates per capita globally at 8 per 1,000 population.…”

Patients’ perceptions about access to health care and referrals to family physicians in Georgia

“…Of course, such patients were less likely to have a continuous medical surveillance by their family physician. In many European countries with a general practitioner system (GP), the patient's self-referral was less noticeable and as a rule, general practitioners as gatekeepers, made a professional decision and referred the patient to the specialists in case of need 31,32 . In the primary care system of Georgia, a patient more often applied to specialized medical services (hospital, physician specialists) by him/herself.…”

Evaluation of exposure to primary care clinics during Family Medicine residency: evidence from a training program in Riyadh, Saudi Arabia

“…This rotation schedule is drafted at the beginning of each academic session, following the SCFHS guidelines for training requirements. The recommended duration of family medicine rotations includes 12 weeks during the first, second, and third year and 42 weeks during the fourth year [3]. This study was conducted as a retrospective data analysis of data collected during the routine supervision of clinical training during the family medicine rotations.…”

“…Because the family physician has an integrated role in all these systems, either as the sole provider or as a care coordinator [2], it is highly desirable to ensure proper exposure to primary medical encounters dur-ing a family medicine residency training period to improve their skills. Furthermore, patient preferences have been found to be significantly affected by family physician skill levels [3].…”