FAKTOR-FAKTOR YANG MEMPENGARUHI RUJUKAN BALIK PASIEN PENDERITA DIABETES MELLITUS TIPE 2 PESERTA ASURANSI KESEHATAN SOSIAL DARI RUMAH SAKIT KE DOKTER KELUARGA

Abstract

Background: Increased number of Askes insurance members
with type 2 diabetes mellitus (DM) may have an impact of cost
of health care. Since 2010, PT Askes (Persero) implemented
the Chronic Disease Management Programme (Prolanis),
especially for type 2 DM disease. However, back referral from
internal medicine specialist to primary care physician was not
well implemented.
Aim: This study aims to identify perceptions of internal medicine
specialist and patients affecting implementation of back referral
for patients with type 2 DM from the hospital to primary care
physician.
Method: A qualitative study was employed, using in-depth
interviews, observation and focus group discussions. In-depth
interviews were conducted with eight internal medicine
spesialists in three hospitals in Kudus district and two primary
care physicians. Focus group discussions were conducted
with four groups of patients with type 2 DM, and observation
was made to describe the working environment at the hospital.
Result: This study found that implementation of back referrals
were influenced by physicians’ workload at the hospital,
perceived competence of primary care physician, lack of
communication and coordination between the specialists and
primary care physicians, as well as patient demands toward
specialist doctor. Patients felt that access to a specialist doctor
was limited due to referrals made by the primary physicians.
Conclusion: Both the internal medicine specialists and patients
factors affect poor implementation of back referrals, despite
their perceived understanding of the importance.
Keywords: back referral, Askes insurance members, type 2
diabetes mellitus, qualitative study