Attitudes of Primary Health Care (PHC) Gatekeepers Towards Patient Referral Policy, Machakos County, Kenya
Science Journal of Public Health
Volume 4, Issue 4, July 2016, Pages: 284-288
Received: May 16, 2016;
Accepted: May 28, 2016;
Published: Jun. 13, 2016
Views 4051 Downloads 157
Desire Aime Nshimirimana, Department of Health Systems Management, School of Medicine & Health Sciences, Kenya Methodist University, Nairobi, Kenya
Wanja Mwaura-Tenambergen, Department of Health Systems Management, School of Medicine & Health Sciences, Kenya Methodist University, Nairobi, Kenya
Donald Kokonya, Department of Mental Health, School of Medicine, Masinde Muliro University of Science & Technology, Kakamega, Kenya
Maureen Adoyo, Department of Health Systems Management, School of Medicine & Health Sciences, Kenya Methodist University, Nairobi, Kenya
Primary Health Care (PHC) serves as the foundation for building a working healthcare system that provide good health outcomes. The quality of PHC delivery and the decision to refer patients depends on some behavioural factors (knowledge, skills and behaviour) of primary care providers. The study was conducted at 100 PHC centres sampled using Taro Yamane formula, in Machakos County, Kenya, from March to May 2015. It involved 8 gender-based focus group discussions (FGDs) with patients and their caretakers. Qualitative and quantitative data were collected from emancipated children and adults aged 15-65 years excluding the disabled due to data integrity issues. The Statistical Package for Social Science (SPSS) version 20.0 and Atlas.ti 7 software were used for analysis. A questionnaire return rate of 83% was achieved of whom 84.3% were nurses (p<0.001) and 15.7% were diploma holders in clinical medicine (clinical officers). The health workers were young (P<0.001) and married (p<0.001). About 62% of the respondents reported to know about PHC gatekeeper system and 38% don’t know about PHC gatekeeper system. The gate keepers at a majority rate 86.7% reported to have participated in workshops of which at least 40.3% participated in at least one workshop per year, means that the majority of gatekeepers don’t fill the required continuing professional development (CPD) to renew their licenses. Bad behavior, poor communication, don’t care attitude, long waiting time and no courtesy were mentioned by patients by 60% of respondents as the main contributing factors to non-compliance of patients with the national patient referral policy. Attitudes (knowledge, skills and behaviour) are crucial in primary care gatekeeper policy implementation. It has been made clear that nurses acquire enough knowledge from college to take care of patients but still need more practical knowledge and experience to increase their performance. This study recommends an innovative plan using incentive driven model and performance rewards in the implementation process.
Desire Aime Nshimirimana,
Attitudes of Primary Health Care (PHC) Gatekeepers Towards Patient Referral Policy, Machakos County, Kenya, Science Journal of Public Health.
Vol. 4, No. 4,
2016, pp. 284-288.
Shi L. Impact of Primary Care. A focused review. Hindawi Publishing Corporation Scientifica 2012.DOI: http://dx.doi.org/10.6064/2012/432892. Retrieved October, 5th, 2014.
Hsieh C-R. V, Wu C-L. J, Wu N.T and Chiang L T. Universal Coverage for Primary Health Care Is a Wise Investment. Evidence From 102 Low-and Middle-Income Countries. Asian Journal of Public Health 2013. Taiwan.
Ministry of Health. The State of the Health Referral System in Kenya: Results from a Baseline Study on the Functionality of the Health Referral System in Eight Counties. USAID and MEASURE Evaluation PIMA 2013. Nairobi, Kenya.
Kluge E-H W. Comparing Healthcare Systems: Outcomes, Ethical Principles, and Social Values. Medscape General Medicine 2007, 9(4), 29.
Mosadeghrad AM. Factors influencing healthcare service quality. Int J Health Policy Manag 2014; 3: 77–89.doi: 10.15171/ijhpm.2014.65.
Kebriaei A and Akbari F. Quality Gap of Primary Health Care Services at Kashan District Health Centers, Iran. J. Med. Sci.2006, 6(3): 393-399.
Fachinelli C A, Macke J, Rickenberg J and Fachinelli L. A social approach for the concept of knowledge gatekeepers: the case of the american community colleges. Brazilan Journal of Management & Innovation 2013 v.1, n.1.
Lazaric N, Longhi Cand Thomas C. Gatekeepers of Knowledge Versus Platforms of Knowledge: From Potential to Realized Absorptive Capacity. Regional Studies 2008, Vol. 00.00, pp. 1–16.
Institute of Medicine (US) Roundtable on Evidence-Based Medicine. Olsen LA, AisnerD, McGinnis JM, editors. The Learning Healthcare System: Workshop Summary. Washington (DC): National Academies Press (US) 2007 7, Training the Learning Health Professional. Available from: http://www.ncbi.nlm.nih.gov/books/NBK53499/.
Berger B. Employee/Organizational Communications. Institute of Public relations. The Science Beneath the Art of Public Relations 2007. Retrieved from internet http://www.instituteforpr.org/employee-organizational-communications/.
Petruzzelli M. A. Proximity and knowledge gatekeepers: the case of the Polytechnic University of Turin", Journal of Knowledge Management 2008, Vol. 12 Iss: 5, pp.34–51. http://dx.doi.org/10.1108/13673270810902920.
Petruzzelli M. A, Albino V, Carbonara N, Rotolo D. Leveraging learning behavior and network structure to improve knowledge gatekeeper' performance", Journal of Knowledge Management 2010, Vol. 14 Iss: 5, pp.635–658. Http://dx.doi.org/10.1108/13673271011074818.
Yigitcanlar T & Fachinelli C A. The 4th knowledge cities. World summit. The world capital institute & Ibero-American community for knowledge systems present. Brazil 2011. Retrieved from http://eprints.qut.edu.au on 5th December 2014.
Coiera E. Communication Systems in Healthcare. Clin Biochem Rev 2006 Vol 27. Centre for Health Informatics, University of New South Wales, NSW 2052, Australia
Rivers A and Pand Glover H. S. Health care competition, strategic mission, and patient satisfaction: research model and propositions. J Health Organ Manag. 2013; 22(6): 627–641.
Mitchell HP. Patient Safety and Quality. An Evidence-Based Handbook for Nurses 2008. Retrieved on internet http://www.ncbi.nlm.nih.gov/books/NBK2681/.
Cathy W. Assessing Leadership in Nurse Practitioner Candidates. Australian Journal of Advanced Nursing 2008, vol.26, No.1:67-76.
Ross K., Barr J. and Stevens J. Mandatory continuing professional development requirements: what does this mean for Australian nurses. BMC Nursing 2013 12:9. doi: 10.1186/1472-6955-12-9.
Mannava P, Durrant K., Fisher J, Chersich M. and Luchters S. Attitudes and behaviours of maternal health care providers in interactions with clients: a systematic review. Globalization and Health. 2015 11:36 DOI 10.1186/s12992-015-0117-9.
World Health Organization. Everybody’s Business: Strengthening Health Systems to improve Health Outcomes: WHO’s Framework for Action. WHO Document Production Services 2007, Geneva, Switzerland.
Simou E, Karamagioli E and Rmeliotou A. Reinventing primary health care in the Greece of austerity: the role of health-care workers. Primary Health Care Research and Development. Cambridge University Press 2013. Athens, Greece. Retrieved from http://journals.cambridge.orgon 17th November 2014.
Schlette S, Lisac M and Blum K. Integrated primary care in Germany: the road ahead. International Journal of Integrated Care–Vol. 9, 20 April 2009 – ISSN 1568-4156. Retrieved on internet: http://www.ijic.org/.
Johnson B. and Onwuegbuzie J. A. Mixed Methods Research: A Research Paradigm Whose Time Has Come.
The 2009 Kenya Population and Housing Census. Counting Our People for the Implementation of Vision 2030.Ministry of State for Planning, National Development and Vision 2030.Kenya National Bureau of Statistics 2010 vol IC. Nairobi, Kenya.
Lundvall BA and Nielsen P. Knowledge management and innovation performance. International Journal of Manpower 2007, Vol. 28 Iss: 3/4, pp.207–223. doi: http://dx.doi.org/10.1108/01437720710755218.
Tabenkin H and Gross R. The role of the primary care physician in the Israeli health care system as a ‘gatekeeper’ the viewpoint of health care policy makers. Health Policy 2000Volume 52, Issue 2, Pages 73-85.doi:http://dx.doi.org/10.1016/S0168-8510(00)00070.
Ward R Implementing a gatekeeper system to strengthen primary care in Egypt: Pilot Study. Medical School, Australian National University, Canberra, Australia. Eastern Mediterranean Health Journal 2010. Vol 16 No 6.