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ORIGINAL ARTICLE
Year : 2015  |  Volume : 4  |  Issue : 4  |  Page : 551-558

Physician's self-perceived abilities at primary care settings in Indonesia


1 Department of Family and Community Medicine, Gadjah Mada University, Yogyakarta, Indonesia
2 Department of Medical Education, Gadjah Mada University, Yogyakarta, Indonesia
3 Department of Family Medicine, Carver College of Medicine, the University of Iowa, USA

Correspondence Address:
Mora Claramita
Department of Medical Education, Family Medicine Graduate Program, Faculty of Medicine, Gadjah Mada University, Radiopoetro Building, 6th Floor, Jalan Farmako Sekip Utara, Yogyakarta - 55281
Indonesia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4863.174286

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Background: Southeast Asian countries with better-skilled primary care physicians have been shown to have better health outcomes. However, in Indonesia, there has been a large number of inappropriate referrals, leading to suboptimal health outcomes. This study aimed to examine the reasons underlying the unnecessary referrals as related to Indonesian physicians' standard of abilities. Materials and Methods: This was a multiple-case study that explored physicians' self-evaluation of their abilities. Self-evaluation questionnaires were constructed from the Indonesian Standards of Physicians Competences of 2006-2012 (ISPC), which is a list of 155 diseases. This study was undertaken in three cities, three towns, and one "border-less developed" area during 2011-2014. The study involved 184 physicians in those seven districts. Data were collected using one-on-one, in-depth interviews, focus group discussions (FGDs), and clinical observations. Results: This study found that primary care physicians in Indonesia felt that they were competent to handle less than one-third of "typical" primary care cases. The reasons were limited understanding of person-centered care principles and limited  patient care services to diagnosis and treatment of common biomedical problems. Additionally, physical facilities in primary care settings are lacking. Discussions and Conclusions: Strengthening primary health care in Indonesia requires upscaling doctors' abilities in managing health problems through more structured graduate education in family medicine, which emphasizes the bio-psycho-socio-cultural background of persons; secondly, standardizing primary care facilities to support physicians' performance is critical. Finally, a strong national health policy that recognizes the essential role of primary care physicians in health outcomes is an urgent need.


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