Determinants of Internal Medicine Outpatient Service Utilization at Klinik Utama Kasehat Walafiat, Aceh Besar, Indonesia: A Cross-Sectional Study

Maulafi Alhamdi Stivani; Rachmad Suhanda; Nurjannah Nurjannah

doi:10.60084/ijma.v4i1.427

Authors

Maulafi Alhamdi Stivani Master Program of Public Health, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
Rachmad Suhanda Department of Public Health, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
Nurjannah Nurjannah Department of Public Health, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia

DOI:

https://doi.org/10.60084/ijma.v4i1.427

Keywords:

Health service utilization, Health beliefs toward specialist services, Enabling access factors, Health care needs, Health services

Abstract

Utilization of specialist outpatient services is an important indicator of healthcare access and health-seeking behavior. Despite the availability of Internal Medicine Specialist outpatient services at Kasehat Walafiat Primary Clinic, service utilization remains suboptimal. Understanding the factors associated with healthcare utilization is essential for improving access and service planning. This study aimed to examine the associations of health beliefs regarding specialist services, enabling access factors, and healthcare need factors with the utilization of Internal Medicine Specialist outpatient services at Kasehat Walafiat Primary Clinic, Aceh Besar, Indonesia. A quantitative cross-sectional study was conducted among adults residing within the clinic’s service area. Data were collected using a validated and reliable structured questionnaire and analyzed using descriptive statistics and binary logistic regression. The findings showed that health beliefs regarding specialist services, enabling access factors, and healthcare need factors were significantly associated with the utilization of Internal Medicine Specialist outpatient services. Among the study variables, healthcare need factors demonstrated the strongest association with service utilization. These findings suggest that the utilization of specialist outpatient services is influenced by individual perceptions of specialist care, access-related conditions, and perceived healthcare needs. Efforts to improve specialist outpatient service utilization should focus on strengthening community health education, improving access to healthcare services, simplifying service procedures, and promoting the early detection and continuous management of chronic health conditions.

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References

Ameh, S., Gómez-Olivé, F. X., Kahn, K., Tollman, S. M., and Klipstein-Grobusch, K. (2014). Predictors of Health Care Use by Adults 50 Years and over in a Rural South African Setting, Global Health Action, Vol. 7, No. 1. doi:10.3402/gha.v7.24771.
Bernabeu-Wittel, M., Para, O., Voicehovska, J., Gómez-Huelgas, R., Václavík, J., Battegay, E., Holecki, M., van Munster, B. C., Angermann, C., Battegay, E., Bernabeu-Wittel, M., Bryant, C., Elis, A., Ertl, G., Gómez-Huelgas, R., Grine, S., Holecki, M., Kürrle, A., Lidove, O., Para, O., Saglam, B., Santos, L., Tuttolomondo, A., Václavik, J., van Munster, B., and Voicehovska, J. (2023). Competences of Internal Medicine Specialists for the Management of Patients with Multimorbidity. EFIM Multimorbidity Working Group Position Paper, European Journal of Internal Medicine, Vol. 109, 97–106. doi:10.1016/j.ejim.2023.01.011.
Babitsch, B., Gohl, D., and Von Lengerke, T. (2012). Re-Revisiting Andersen’s Behavioral Model of Health Services Use: A Systematic Review of Studies from 1998–2011, GMS Psycho-Social-Medicine, Vol. 9, Doc11. doi:10.3205/psm000089.
Aday, L. A., and Andersen, R. (1974). A Framework for the Study of Access to Medical Care, Health Services Research, Vol. 9, No. 3, 208.
Andersen, R. M. (1995). Revisiting the Behavioral Model and Access to Medical Care: Does It Matter?, Journal of Health and Social Behavior, Vol. 36, No. 1, 1. doi:10.2307/2137284.
Wulandari, R. D., Laksono, A. D., Nantabah, Z. K., Rohmah, N., and Zuardin, Z. (2022). Hospital Utilization in Indonesia in 2018: Do Urban–Rural Disparities Exist?, BMC Health Services Research, Vol. 22, No. 1, 491. doi:10.1186/s12913-022-07896-5.
Kusama, T., Todoriki, H., Osaka, K., and Aida, J. (2020). Majority of New Onset of Dental Caries Occurred from Caries-Free Students: A Longitudinal Study in Primary School Students, International Journal of Environmental Research and Public Health, Vol. 17, No. 22, 8476. doi:10.3390/ijerph17228476.
Janz, N. K., and Becker, M. H. (1984). The Health Belief Model: A Decade Later, Health Education Quarterly, Vol. 11, No. 1, 1–47. doi:10.1177/109019818401100101.
World Health Organization. (2024). Noncommunicable Diseases - Key Facts, from https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases.
Jones, C. L., Jensen, J. D., Scherr, C. L., Brown, N. R., Christy, K., and Weaver, J. (2015). The Health Belief Model as an Explanatory Framework in Communication Research: Exploring Parallel, Serial, and Moderated Mediation, Health Communication, Vol. 30, No. 6, 566–576. doi:10.1080/10410236.2013.873363.
SoleimanvandiAzar, N., Kamal, S. H. M., Sajjadi, H., Harouni, G. G., Karimi, S. E., Djalalinia, S., and Forouzan, A. S. (2020). Determinants of Outpatient Health Service Utilization According to Andersen’s Behavioral Model: A Systematic Scoping Review, Iranian Journal of Medical Sciences, Vol. 45, No. 6, 405. doi:10.30476/ijms.2020.85028.1481.
Chuang, E., and Safaeinili, N. (2024). Addressing Social Needs in Clinical Settings: Implementation and Impact on Health Care Utilization, Costs, and Integration of Care, Annual Review of Public Health, Vol. 45, No. 1, 443–464. doi:10.1146/annurev-publhealth-061022-050026.
Jones, D. H. (1994). Book Review: Statistical Methods, 8th Edition George W. Snedecor and William G. Cochran Ames: Iowa State University Press, 1989. Xix + 491 Pp, Journal of Educational and Behavioral Statistics, Vol. 19, No. 3, 304–307. doi:10.3102/10769986019003304.
van Loenen, T., van den Berg, M. J., Faber, M. J., and Westert, G. P. (2015). Propensity to Seek Healthcare in Different Healthcare Systems: Analysis of Patient Data in 34 Countries, BMC Health Services Research, Vol. 15, No. 1, 465. doi:10.1186/s12913-015-1119-2.
Hajek, A., Kretzler, B., and König, H.-H. (2021). Determinants of Healthcare Use Based on the Andersen Model: A Systematic Review of Longitudinal Studies, Healthcare, Vol. 9, No. 10, 1354. doi:10.3390/healthcare9101354.
Cheng, Q., Fattah, R. A., Susilo, D., Satrya, A., Haemmerli, M., Kosen, S., Novitasari, D., Puteri, G. C., Adawiyah, E., Hayen, A., Mills, A., Tangcharoensathien, V., Jan, S., Thabrany, H., Asante, A., and Wiseman, V. (2025). Determinants of Healthcare Utilization under the Indonesian National Health Insurance System – A Cross-Sectional Study, BMC Health Services Research, Vol. 25, No. 1, 48. doi:10.1186/s12913-024-11951-8.
Agustina, R., Dartanto, T., Sitompul, R., Susiloretni, K. A., Suparmi, Achadi, E. L., Taher, A., Wirawan, F., Sungkar, S., Sudarmono, P., Shankar, A. H., Thabrany, H., Agustina, R., Dartanto, T., Sitompul, R., Susiloretni, K. A., Suparmi, Achadi, E. L., Taher, A., Wirawan, F., Sungkar, S., Sudarmono, P., Shankar, A. H., Thabrany, H., Soewondo, P., Ahmad, S. A., Kurniawan, M., Hidayat, B., Pardede, D., Mundiharno, Nelwan, E. J., Lupita, O., Setyawan, E., Nurwahyuni, A., Martiningsih, D., and Khusun, H. (2019). Universal Health Coverage in Indonesia: Concept, Progress, and Challenges, The Lancet, Vol. 393, No. 10166, 75–102. doi:10.1016/S0140-6736(18)31647-7.
Madyaningrum, E., Chuang, Y.-C., and Chuang, K.-Y. (2018). Factors Associated with the Use of Outpatient Services among the Elderly in Indonesia, BMC Health Services Research, Vol. 18, No. 1, 707. doi:10.1186/s12913-018-3512-0.
Elnegaard, S., Pedersen, A. F., Sand Andersen, R., Christensen, R. de-P., and Jarbøl, D. E. (2017). What Triggers Healthcare-Seeking Behaviour When Experiencing a Symptom? Results from a Population-Based Survey, BJGP Open, Vol. 1, No. 2, bjgpopen17X100761. doi:10.3399/bjgpopen17X100761.
Schlünsen, A. D. M., Christiansen, D. H., Fredberg, U., and Vedsted, P. (2022). Effectiveness of a 24-Hour Access Outpatient Clinic for Patients with Chronic Conditions in Hospital Outpatient Follow-Up: A Registry-Based Controlled Cohort Study of Healthcare Utilisation and Mortality, Integrated Healthcare Journal, Vol. 4, No. 1. doi:10.1136/ihj-2020-000069.