Perceived barriers to management of patients with diabetes mellitus and hypertension in primary care centers in Indonesia

TL;DR

This study identifies challenges in managing diabetes and hypertension in Indonesian primary care and suggests ways to improve care.

Contribution

The study provides insights into provider knowledge gaps and systemic barriers in managing chronic diseases in Indonesia.

Findings

Healthcare providers showed knowledge gaps in referral practices and diagnostic criteria.

Implementation of the PROLANIS program was suboptimal, with limited screening and medication availability.

Three major barriers—patient-related, provider-related, and structural—were identified as hindering care.

Abstract

This study aimed to explore provider knowledge, barriers, and opportunities for improving chronic disease management in Indonesian primary health care.

A descriptive cross-sectional mixed methods study was conducted from December 1, 2022 to March 31, 2023 across 14 primary care centers in Jakarta. Multidisciplinary healthcare providers responsible in hypertension and diabetes mellitus (DM) care were involved. Data were collected using a semi-structured, interviewer-administered questionnaire consisting of both closed- and open-ended questions, structured across five domains: referral system knowledge, referral pathway implementation, hypertension management knowledge, DM management knowledge, and delivery of chronic disease care. Quantitative data were complemented with qualitative responses to provide contextual insight.

A total of 59 healthcare providers participated in the study, the majority of whom were female (89.8%). Participants included physicians (42.4%), nurses (35.6%), and midwives (10.2%). Most participants (71.4%) had over three years of practice. Notable knowledge gaps were identified in referral practices, diagnostic criteria, and monitoring protocols. Referrals were often delayed until complications occurred. Implementation of the national chronic disease (PROLANIS) program was suboptimal, particularly in patient selection and defining outcome targets. Screening for kidney complications was limited and medication availability was restricted. Poor adherence to national guidelines, short consultation times, and staffing shortages further hindered care and education efforts. Three major barriers—patient-related, provider-related, and structural—were identified.

Improving chronic disease care in primary settings requires addressing provider knowledge gaps, strengthening referral systems, and enhancing PROLANIS implementation through targeted training and resource allocation.