Recognition of primary healthcare workers on gatekeeping and influencing factors in Shandong

Objective To investigate the recognition of primary healthcare workers (PHWs) on the gatekeeping and its influencing factors. Methods From June to September 2016, eight hundred and seventy-nine PHWs were surveyed with stratified cluster sampling method in Qingdao, Zibo and Heze, Shandong province. The multivariate logistic regression analysis was used to analyze the factors that influenced primary healthcare workers on gatekeeping. Results About 59.50% of primary healthcare workers approved of the implementation of gatekeeping. They believed that it played a positive role in guiding residents to seek medical treatment at the grassroots level, improved the consultation rate at the primary level and conducive to chronic disease management (48.46%), believed that medical resources could be optimized and rationally utilized (36.52%), reduced the cost of diagnosis and treatment of patients (35.15%). Lack of medical equipment (48.24%), shortage of general practitioners (36.86%), relatively low residents' trust in grassroots medical and health institutions (36.41%) were main obstacles to the implementation of the gatekeeping. The result shows that the differences exist in length of employment and average monthly earnings of PHWs, the proportion of reimbursement for medical treatment in primary medical and health institutions, professional training, the professional competence of the primary medical and health. And the difference of recognition of gatekeeping by PHWs was statistically significant (all P<0.05). Conclusion The PHWs have a higher recognition of gatekeeping. This suggests that from the point of view of PHWs it is feasible to implement the gatekeeping.