Factors influencing the role of primary care providers as gatekeepers in the Malaysian public healthcare system
- Author:
Ang KT
;
Ho BK
;
Mimi O
;
Salmah N
;
Salmiah MS
;
Noridah MS
- Publication Type:Journal Article
- Keywords:
Referral pattern;
gatekeeping;
primary care;
public healthcare system
- MeSH:
Gatekeeping;
Primary Health Care
- From:Malaysian Family Physician
2014;9(3):2-11
- CountryMalaysia
- Language:English
-
Abstract:
Primary care providers play an important gatekeeping role in ensuring appropriate referrals to
secondary care facilities. This cross-sectional study aimed to determine the level, pattern and rate
of referrals from health clinics to hospitals in the public sector, and whether the placement of
resident family medicine specialist (FMS) had made a significant difference.
The study was carried out between March and April in 2012, involving 28 public primary
care clinics. It showed that the average referral rate was 1.56% for clinics with resident FMS
and 1.94% for those without resident FMS, but it was not statistically significant. Majority of
referred cases were considered appropriate (96.1%). Results of the multivariate analysis showed
that no prior consultation with senior healthcare provider and illnesses that were not severe
and complex were independently associated with inappropriate referrals. Severity, complexity
or uncertain diagnosis of patients’ illness or injury significantly contributed to unavoidable
referrals. Adequate facilities or having more experienced doctors could have avoided 14.5%
of the referrals. The low referral rate and very high level of appropriate referrals could indicate
that primary care providers in the public sector played an effective role as gatekeepers in the
Malaysian public healthcare system.
- Full text:P020150529519344363031.pdf
