Primary Health Care — The Gatekeeper — Dr Noorul Ameen Mohamed Ishack

By CodeBlue | 24 September 2019

Diabetes, hypertension, and asthma can be treated at the primary health care level.

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Primary health care is the first contact you have with the health care delivery system. The health care personnel who sees you could either be a nurse, medical assistant or most likely a doctor.

According to the World Health Organization (WHO), primary health care can cover the majority of a person’s health needs throughout their life including prevention, treatment, rehabilitation and palliative care. In short, primary health care practitioners ensure that you are well on your way on the road to recovery. This kind of primary care facilities are provided both in the public and private sector.

In the private sector, the first encounter for primary healthcare would be through your trusted neighbourhood general practice (GP) clinic. For many decades, we practice frequenting the same clinic, and eventually “labelling” our physician as the ‘family doctor’ as we have gotten familiar with the first-line of care from the clinic.

However, in the digital age today, many of us tend to self-diagnose via the internet, looking up suggested treatments, obtaining medications from a nearby pharmacy. This is also clearly evident in the United States in 2018, where a survey further revealed that 44 per cent of Americans prefer to self-diagnose.

It’s time to review the role primary health care practitioners play in the health care sector.

The Gatekeeper for Better Health

Qualitas Medical Group chairman and managing director Dr Noorul Ameen Mohamed Ishack.

Typically, 75 to 80% medical conditions are treatable by trained doctors and paramedics in the primary healthcare sector, sending them back with or without medication. Only 10 to 15% of patients would then require further investigation and follow-up whilst the remaining 5 to 10% of these patients may require referral to Secondary Care (Specialists) or Tertiary Care (Hospitals).

In a nutshell, primary health care acts as a gatekeeper where most conditions are treated, and also allowing first-line diagnosis and investigations to take place for more complexed conditions before identifying the right specialist.

Today, the “disease model” of the 1970s where the main role for primary health care is to only treat conditions and symptoms as they come, is slowly shifting away from this niche focus. According to a clinical review by WHO on primary healthcare in 2018, ageing, population growth, a rising burden of chronic, non-communicable diseases and multi-morbidity, and technological advances are driving the transformation of primary care.

Manage Cost and Efficiency

In most cases, primary healthcare cost is inevitably lower than of the secondary or tertiary care as the condition being treated by a specialist will naturally result in a higher cost setting. The cost of health care is going up because of various reasons such as ageing population, chronic care diseases, increased medical cost and most of them are unavoidable. The cost can be contained if most of the conditions can be managed in a lower cost setting.

There are significant number of conditions which are managed at the secondary and tertiary care which, by right can, and should be managed at the primary health care level such as diabetes, hypertension and asthma.

If the patients are channelled through the primary health care network and those requiring secondary or tertiary care are consulted and referred by primary health care doctors, the unnecessary congestion at the hospitals and the overall health care cost can be contained.

Respect the Referral System

As such, this system of channelling on a needs basis to the right specialist and hospital is known as the gatekeeper system. This system is in existence in many countries like the United Kingdom and Australia.

The specialists in the secondary or tertiary setting will not see a patient without a referral from the primary healthcare doctor. Additionally, this system works both ways for rehabilitation purposes too. Once the patient’s condition is managed and stabilised, the patient will then be referred back to the primary health care doctor to ensure necessary recovery observation and treatment is continued at a lower cost setting. Ultimately, this manages cost at all levels.

This gatekeeper system has many benefits — less congestion in the hospitals, the specialists in the secondary and tertiary setting will see only patients who need their expertise, and ensuring overall cost is contained.

We don’t have to keep on adding beds both in the public and private sector for a more or less a static population where the beds can be better managed on a real needs basis.

Additionally, the reduction of inpatient in hospitals will naturally see a decrease in hospital-acquired infections and diseases. As reported by WHO, one in 10 patients in a developing country are vulnerable to health issues that are prevalent in the hospital environment.

The Malaysian Ministry of Health has long recognised the importance of Primary Care and its empowerment in the health care delivery system. There has been a lot of discussions and proposals to this effect which requires effective implementation together with various stakeholders.

In the technology-driven world we live in today, while vast information is at our finger tips, it is important for us to understand the primary role of every practitioner and sector in the healthcare landscape, evaluating its contribution and purpose in balancing the healthcare ecosystem.

Primary health care is truly a sector that needs further awareness on its fundamental role as the gatekeeper in preventing chronic ailments, onset of diseases and facilitate rehabilitation.

Dr Noorul Ameen Mohamed Ishack is the Founder, Chairman and Managing Director of Qualitas Medical Group Sdn Bhd, a global network that delivers cost-effective and quality primary health care services to the community comprising GP (General Practice), dental and medical imaging services. Today, Qualitas operates a global network of clinics and medical centres and is supported by over 1,700 medical teams, with a network of over 250 medical and dental clinics and medical imaging centres.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
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