NEW MODEL OF ‘GATEKEEPER’ AT TERTIARY HEALTH CARE:ELECTRONIC REFERRAL FORM FOR IMPROVING REFERRAL SYSTEMS
It is argued in many studies that benefits of referral systems are twofold. First, it controls health expenditure and second, referral toward a gatekeeper ensures appropriateness of health facility or specialist encounter. However, in reality the mechanism of the ideal patient’s referral faces many obstacles such as the insufficient of health resources, poor communication mechanisms amongst health care providers and inadequate regulations. Although information technology is seen as a tool to improve quality of referral services, the implementation depends mostly on how prepared the health facilities at all levels to adopt this technology. To that end, the study was conducted to assess the ability of primary, secondary and tertiary health care facilities in using information technology for referral system. It is also as a means to build a model of appropriate referral information systems in Indonesia context. Qualitative approach was conducted to assess existing condition of referral services at two primary health care facilities, a secondary care hospital and a tertiary care hospital. The data was collected through observations, interviews, focus group discussions and document review. Data were analyzed qualitatively. The most significant constraint on referral services in Indonesia are accumulation of patients services in tertiary care facility due to sub-optimal role of gatekeeper in primary and secondary facilities. Around 30-40% patients who visit at tertiary health facility can actually be handled at the lower level health facility. Approximately 50% of patients attending a tertiary facility are self-referral patients without prior to a primary care or general practitioner. Only patients with social health insurance are following the pattern of referral services as recommended by WHO. In addition, although primary and secondary health care facilities are capable to manage certain cases, referring patients to higher facilities are still being conducted, especially patients with previously referred to tertiary care. This is due to the absence of twoway communication for continuing medical care between health care providers in all level health care facilities. Communication mechanism based solely on patient referral letter with minimal information. Furthermore,direct communication through telephone call is mostly conducted for any emergency cases that are perceived needed higher facility, particularly to confirm the availability of beds at referred hospital. Technically, the majority of primary and secondary health facilities have not been able to optimize its computer based systems to be used for electronic data exchange. A web-based referral portal is the most likely mechanism that could be applied in Indonesia. This can also strengthen through telephone communication between referring physicians with emergency room staff to ensure its appropriateness. These new ‘gatekeeper’ have role to reduce ‘unnecessary’ patient referral. Information technology is also potential to enable two-way communications amongst all level of health care facilities to ensure continuity of patient care.
Referral systems electronic referral form referral decision support systems continuity of patient care
Guardian Y.Sanjaya Yupitri Pitoyo Eka Dian Safitri Laili Khairiyah Dyana Santika Aria Kekalih Agus Mutamakin Tifauzia Tyassuma
Health Management Information Systems Faculty of Medicine Gadjah Mada University Clinical Epidemiology and Evidence Based Medicine Faculty of Medicine University of Indonesiaand Cip Community Medicine Faculty of Medicine University of Indonesia Information Technology Unit Ciptomangunkusumo Hospital
国际会议
The 7th Asia Pacific Association for Medical Informatics Conference(第七届亚太医药信息学大会(APAMI2012))
北京
英文
1-9
2012-10-24（万方平台首次上网日期，不代表论文的发表时间）