Attitudes of Primary Health Care (PHC) Gatekeepers Towards Patient Referral Policy, Machakos County, Kenya

Desire Aime Nshimirimana

doi:10.11648/j.sjph.20160404.13

Abstract

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.

Highlights

Primary Health Care (PHC) is the foundation for building a working healthcare system that leads to good health outcomes [1]
These arguments were backed by the large number (38%) of health workers who had no idea about gatekeeper system in the PHC settings in Kenya
They need to attend workshops, seminars and scientific conferences to gain practical skills as well as continuing professional development (CPD) according to the nursing council which normally require some CPDs to renew their licenses

Summary

Introduction

Primary Health Care (PHC) is the foundation for building a working healthcare system that leads to good health outcomes [1]. PHC services providers [5] The contributions of these factors play a big role in influencing the decision to treat or refer a patient to the higher level of the health system [1, 6]. Health workers acting as gatekeepers through creating platforms of knowledge sharing can fulfill many functions at a time [9] As gatekeepers expand their networks of interactions, they can access valuable knowledge from their networks and bring it into the operation of their daily formal way of treating patients [10]. There is little research on what additional skills and competencies nurses should acquire to enhance their performance effectively [17] It is important for nurses undertake continuing professional development (CPD) to update their knowledge and skills in order to deliver safe and effective health care [18]. These clinicians and their systems are answerable to their patients and communities for addressing all of their personal health needs through a sustainable partnership with patients in the context of a family, community and the quality of PHC, patient satisfaction, efficient use of resources and ethical behavior [21]

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Discussion

Conclusion