Barriers of Back-referral program Implementation for Diabetes Mellitus Care in Primary Health Care Settings: A Case Study in Surakarta City, Central Java Province, Indonesia
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Abstract
Introduction: Back-referral is a key component in the management of diabetes mellitus (DM) within Indonesia’s health system, aiming to strengthen continuity of care at the primary level. However, its implementation remains suboptimal in many areas. In response, the Indonesian government launched the Chronic Disease Management Program (Prolanis) in 2014 to promote integrated care in Primary Health Care (PHC) facilities, including back-referral mechanisms. Materials and Methods: This qualitative case study explored barriers to implementing the back-referral program for DM care among Prolanis patients in Surakarta City, Central Java Province, Indonesia. Results: Barriers were identified at multiple levels, including: limited hospital engagement in initiating referrals back to PHC, inefficiencies in the hospital–PHC referral process, technical issues with the digital referral system, and poor patient adherence to program protocols. Conclusions: Barriers to back-referral implementation were found at the patient level, provider level, and in inter-facility coordination. To improve program sustainability, clearer and more enforceable standard operating procedures (SOPs) are needed across stakeholders.
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