IMPLEMENTASI TATA KELOLA KLINIS OLEH KOMITE MEDIK DI RUMAH SAKIT UMUM DAERAH DI PROVINSI JAWA TENGAH

Background: Clinical governance aims to deliver the bestclinical care for patient as stipulated in Law No. 44 of 2009about Hospital and the Minister of Health Decree No. 755/Menkes/Per/IV/2011 about Implementation of Medical Committee.Medical committee is in charge of implementing clinicalgovernance so that the medical staff at the hospital maintainedtheir professionalism.Objective:To measure implementation of clinical governanceby the medical committee at district general hospitals in CentralJava province.Methods: This was a cross-sectional survey study. The subjectswere 48 District General Hospitals in Central Java consistingof 1 class A,17 class B, 26 class Cand 4 class D. Dataobtained using questionnaire which measurestructure andprocess of clinical governance implementation. There are 8variables on structures and 13 variables on processes. Questionnaireswere sent to respondents through a courier serviceand answers were given by interviews or written responsesand analyzed descriptively.Results: Data obtained from 30 hospitals (1 class A, 12 classB,14 classC and 3 class D). The average level of clinical governanceimplementation is 67%.The average fulfillment level ofthe structure is 75 and 58% forthe processes. Implementationof the medical committee assignments is a medical audit 3.3%,credentialing 3.3%, sustainable professional development 50%and medical professional development 70%. There is severalconstraints in implementation the Minister of Health Decree No.755/Menkes/Per/IV/2011 because of the uneven spread ofspecialist and lack of support from hospital management.Conclusions: Implementation of clinical governance by themedical committee in district’s hospitals in Central Java has notbeen in accordance with existing regulations. There is a needto strengthened the medical committee. It would need to manufactureclinical governance guidelines by the authorities andmonitoring its implementation.Keywords: clinical governance, medical committee, districtgeneral hospita

EVALUASI IMPLEMENTASI REKAM MEDIS TERINTEGRASI DI INSTALASI RAWAT INAP RSUP DR. SARDJITO YOGYAKARTA

ABSTRACTBackground: There was an interview with medical forensicsub-committee at Dr. Sardjito Hospital that stated no medicalrecord was complete. Separated patient-monitoring reflectedpoor colaboration among medical staffs. Hence, Dr. SardjitoHospital had implemented integrated medical records forinpatients and there should be an evaluation f or theimplementation.Objective: This study aimed to evaluate documentation processof integrated medcal records for inpatients at Dr. SardjitoHospital through completeness, patient-centered care, interprofesionalcollaboration and confidentiality aspects. Second,it aimed to explore barriers and enablers of implementation ofintegrated medical records.Methods: T his study is a case study with descriptiveexplanatorydesign. Main data source was documentation onmedical records of three to six days inpatients. T hedocumentation proess was aimed for obtaining quantitativedata of medical records-completeness. Triangulation ofobservation and focus group discussion was done f orobtaining qualitative data.Results: Implementation of integrated medical records waspoor. None of medical records had standard abbreviation.Medical records which had no signed correction were 29.7%and only 41.6% of medical records had date and time written,while those with non-clear and simplified notes were 61.5%.However, most medical records had complete progress note(85.4%) and equipped with clear name and signed by thecaregivers (81.3%). Focus group discussion resulted thatintegrated medical records was giving benefit. Integrated medicalrecords provided better service to patients.Conclusion: Dr. Sardjito Hospital has to obliged its medicalstaffs to implement integrated medical records for betterservices to patients.Keywords: evaluation, integrated notes, medical record

FAKTOR-FAKTOR YANG MEMPENGARUHI RUJUKAN BALIK PASIEN PENDERITA DIABETES MELLITUS TIPE 2 PESERTA ASURANSI KESEHATAN SOSIAL DARI RUMAH SAKIT KE DOKTER KELUARGA

Background: Increased number of Askes insurance memberswith type 2 diabetes mellitus (DM) may have an impact of costof health care. Since 2010, PT Askes (Persero) implementedthe Chronic Disease Management Programme (Prolanis),especially for type 2 DM disease. However, back referral frominternal medicine specialist to primary care physician was notwell implemented.Aim: This study aims to identify perceptions of internal medicinespecialist and patients affecting implementation of back referralfor patients with type 2 DM from the hospital to primary carephysician.Method: A qualitative study was employed, using in-depthinterviews, observation and focus group discussions. In-depthinterviews were conducted with eight internal medicinespesialists in three hospitals in Kudus district and two primarycare physicians. Focus group discussions were conductedwith four groups of patients with type 2 DM, and observationwas made to describe the working environment at the hospital.Result: This study found that implementation of back referralswere influenced by physicians’ workload at the hospital,perceived competence of primary care physician, lack ofcommunication and coordination between the specialists andprimary care physicians, as well as patient demands towardspecialist doctor. Patients felt that access to a specialist doctorwas limited due to referrals made by the primary physicians.Conclusion: Both the internal medicine specialists and patientsfactors affect poor implementation of back referrals, despitetheir perceived understanding of the importance.Keywords: back referral, Askes insurance members, type 2diabetes mellitus, qualitative stud

PERAN RESEP ELEKTRONIK DALAM MENINGKATKAN MEDICATION SAFETY PADA PROSES PERESEPAN

ABSTRACTBackground: Many health organizations pay high attention tomedication safety, because medication errors lead to harmand financial loss. Prescribing error as part of medicationerror could have been prevented. Many interventions are developedto prevent prescribing errors, one of which is theelectronic prescribing system. Since 2007 this hospital alreadyimplemented the electronic prescribing system but not all physicianshave used the system yet.Objective: To describe the use of electronic prescribing systemto improve medication safety through reducing prescribingerror, to analyse other factors causing prescribing errors,and to evaluate physicians acceptance of the electronic prescribingsystem.Methods: Prescriptions were collected from ambulatory patientsreceiving two drug jeniss or more. Prescribing errorsfrom electronic and non electronic prescriptions were identifiedand compared, and Odds ratio were calculated. Acceptanceof the electronic prescribing system was obtained fromin-depth interview and questionnaire.Result: Incomplete prescription was significantly higher in thenon-electronic than the electronic prescribing (OR 1.30; 95%CI1.06-1.58), while illegible prescription was sigficantly found in91 among the the non-electronic prescription. Drug interactionsand other errors such as improper drug selection, polipharmacyand unusual dosage resulted from clinical decisionmakingerrors could not be reduced by electronic prescription.Other factors influencing prescribing errors were professionalbackground, age group of the patients, compounding drug andpolipharmacy. More than 50% physicians agreed and stronglyperceived ease of use and benefits of electronic prescribing.Conclusion: The electronic prescription reduced prescribingerrors due to the writing process, while additional supportsystems and clinical pharmacy interventions are needed toreduce prescribing errors due clinical decision making to improvemedication safety. Perceived benefits influenced utilizationof electronic prescribing greater than perceived ease ofuse.Keywords: medication error, prescribing error, electronic prescribin

EFEKTIVITAS PELAYANAN SELAMA PENERAPAN CLINICAL PATHWAY SKIZOFRENIA RAWAT INAP DI RSUP DR. SARDJITO YOGYAKARTA

Background Clinical pathway is a requirement for quality andcost control, especially on cases potentially exhausting onavailable resources. Schizophrenia is a mental disorder with apotency to exhaust available resources, therefore requiresevaluation for its service effectiveness.Method and Aims This study was a quasi experimentalstudy with qualitative approach. The aims of this study wereto assess the effectiveness of clinical pathway applicationand patient service during three months application of clinicalpathway for schizophrenia in the inpatient service in SardjitoHospital, Yogyakarta. The data for this study was obtainedfrom both primary and secondary sources.Result: Our results showed that the preparation phase forthe clinical pathway was appropriate with guideline providefor clinical pathway development in Sardjito Hospital.Nevertheless the application was still ineffective. T hecompleteness of the clinical pathway forms was only 33.11%.This was because the information about the clinical pathwayapplication was not properly disseminated to the informant.The design of the forms was difficult to read due to its smallfonts. The planning concepts for the inpatient service forschizophrenia according to the clinical pathway had not wellapplied. The verification and validation of the service providedby the residents in training by home psychiatrist were notconsisted and were not well documented.Conclusion: To solve this, dissemination of the clinical pathwaywith personal approach is required. The design of the clinicalpathway needs also to be improved. Commitment of eachmembers of the multidisciplinary team needs to be improved sothat the application of the planning concept and patient servicefor schizophrenia can fulfill the clinical pathway and theminimum service requirement.Keywords: effectiveness, clinical pathway, schizophreni

BIAYA LANGSUNG DAN TIDAK LANGSUNG PASIEN TUBERKULOSIS DI KABUPATEN KULON PROGO

Latar belakang : Penyakit tuberkulosis (TB) masih menjadi masalah di Kabupaten Kulon Progo dan menyerang semua kelompok umur dengan persentase kasus tertinggi pada kelompok umur produktif. Angka kematian kasus selama tiga tahun terakhir mengalami kenaikan. Informasi tentang biaya langsung dan tidak langsung pasien TB di Kabupaten Kulon Progo sampai saat ini masih terbatas. Berbagai penelitian menunjukkan bahwa pasien TB menghadapi sejumlah kendala finansial. Metode : Tools to Estimate Patient Costs yang telah dialihbahasakan ke dalam bahasa Indonesia diadaptasi dalam penelitian ini. Survei dilakukan terhadap seluruh pasien DOTS dari puskesmas, rumah sakit,dan BP4. Hasil survei pada pasien dikumpulkan, dimasukkan ke dalam database dan dilakukan analisis. Hasil : Rerata biaya pasien TB pada fase diagnosis di Kabupaten Kulon Progo sebesar Rp. 2.508.881,00 sedangkan pada fase pengobatan sebesar Rp. 1.882.395,00. Komponen biaya yang paling besar pada fase diagnosis adalah biaya rawat inap diikuti biaya medis langsung selama diagnosis dan biaya tambahan makanan sedangkan pada fase pengobatan adalah biaya tambahan makanan diikuti biaya perjalanan dan biaya medis langsung selama rawat inap. Strategi mengatasi masalah biaya bagi pasien TB di Kabupaten Kulon Progo adalah dengan asuransi, sumbangan, dan melakukan pinjaman atau penjualan aset. Pembebasan biaya pengobatan dan pemberian jaminan kesehatan bagi penduduk belum dapat membebaskan pasien TB dari pengeluaran biaya yang tinggi. Kesimpulan : Pemberian jaminan untuk diagnosis dan pengobatan TB belum dapat menyelesaikan permasalahan biaya pada pasien TB. Pemerintah masih perlu meningkatkan pelayanan kesehatan kepada masyarakat melalui peningkatan program promosi pemanfaatan jaminan kesehatan serta pemberian bantuan makanan tambahan dan bantuan biaya perjalanan. Kata kunci : tuberkulosis, evaluasi pembiayaan, biaya langsung, kulon progoMahasiswa Program Pasca Sarjana KPMAK, FakultasKedoteran, Universitas Gadjah Mada.Bagian Ilmu Kesehatan Masyarakat, Fakultas Kedokteran, Universitas Gadjah Mada.Bagian Ilmu Kesehatan Masyarakat, Fakultas Kedokteran, Universitas Gadjah Mada.

MOTIVASI DOKTER DALAM PENULISAN RESEP DI RUMAH SAKIT RISA SENTRA MEDIKA, MATARAM

Backgroud: Selection process and selection of drugs shouldbe done rationally and follow the guidelines by the World HealthOrganization. However, 70% of prescriptions at Risa HospitalMedical Center.Aim:This study aims to explore physician motivation in writingprescription.Methods: The research was conducted with a qualitativeapproach. Primary data obtained f rom interviews andobservations and were equipped with a document review asa from of triangulation.Result: Motivation of physicians in prescribing was influencedby many factors, such as, the diagnosis of diseases, financialcondition of the patient, and rewards from the pharmaceuticalindustry. Remuneration from pharmaceutical industry provideda strong influence on physician in writing prescription.Conclusion: External rewards from pharmaceutical industryis the most inf luential factor. Increasing rewards andpunishments are needed to improve motivation of physician inwriting prescription according to drug formulary.Keywords: motivation, formulary, prescription, physician

KOORDINASI PELAYANAN KESEHATAN PENGUNGSI BENCANA GUNUNG MERAPI

Background: The eruption of Mount Merapi in Yogyakartahas caused dangerous impact to the people’s health. It is importantto provide a good health care services during emergencyresponse. Maguwoharjo is a shelter with the largestnumber of refugees, but health care staff are not well distributed.The coordination on health care service is important toovercome the health problems during emergency response.Aim: To describe effetiveness of coordination of care providedfor the refugees.Methods: This was a qualitative study using in-depth interviewsmethod to collect data. The informants were representativesfrom Yogyakarta provincial health office, Sleman districthealth office, primary health care center of Depok, NonGovernment Office/NGO, and former refugees. To ensure thevalidity of data, triangulation was carried out.Results: The coordination of health care service to refugeesis studied from its communication and organization. The communicationwas done by regular meetings in the morning andin the afternoon involving shelter’s coordinator, volunteer’scoordinator, and representative from both provincial and districthealth office. Not only by the regular meeting, but also byusing SMS gateway and skype (internet-based). There wasalso a hierarchial structure to organize all health care staffand their responsibilities during emergency response. Untilend of the evacuation, there was no outbreaks, incidence ofdisease was decreased, and infectious diseases were controlled.However, health care personels and adequate facilitieswere lacking, and standard operating procedure to providegood health services to refugees was not available.Conclusion: The coordination of health services for refugeesduring the emergency was effective but still needs toimprove information and use of SOP.Keywords: effectiveness, coordination, health care, refugee

PENGARUH PELIBATAN KELUARGA DALAM PROGRAM PROLANIS TERHADAP KEPATUHAN MINUM OBAT DAN PENGENDALIAN GULA DARAH PASIEN DIABETES MELITUS TIPE2

Latar Belakang: Prevalensi penyakit Diabetes Melitus (‘diabetes’) untuk semua kelompok umur di seluruh dunia terus meningkat. Kepatuhan minum obat dan pengendalian gula darah merupakan masalah umum dalam penanganan penyakit diabetes. Program Pengelolaan Penyakit Kronis (Prolanis) telah dilaksanakan oleh PT Askes (BPJS Kesehatan) pada pelayanan dokter keluarga untuk menangani penyakit kronis secara komprehensif. Kegiatan prolanis dapat dikembangkan dengan melibatkan keluarga dalam kegiatan-kegiatannya.Tujuan: untuk mengukur pengaruh pelibatan keluarga dalam program Prolanis terhadap kepatuhan minum obat dan pengendalian kadar gula darah pada pelayanan dokter keluarga.Metode: Penelitian ini merupakan penelitian eksperimen murni dengan rancangan Single Blind Randomized Controlled Trial yang dilaksanakan dalam bulan November 2013. Subjek penelitian adalah 36 pasien diabetes tipe 2 pada satu klinik dokter keluarga di Surakarta yang ikut sebagai peserta aktif Prolanis dan memenuhi kriteria inklusi. Sampel dibagi menjadi dua kelompok yaitu kelompok perlakuan (dengan pendamping) dan kelompok kontrol (tanpa pendamping) secara random. Analisis bivariat kepatuhan minum obat dan kadar gula darah diukur sebelum dan sesudah pelaksanaan program. Kepatuhan minum obat di analisis dengan uji chi square, sedangkan gula darah dianalisis dengan uji mann-whitney. Analisis perbedaan efek dengan mengendalikan variabel umur, menggunakan regresi logistik multivariat.Hasil: Sebelum pelaksanaan intervensi, tidak terdapat perbedaan signifikan antara kedua kelompok dalam hal kepatuhan minum obat (p=0,182) dan pengendalian kadar gula darah (p=0,798). Sesudah pelaksanaan program tidak terdapat perbedaan signifikan antara kedua kelompok dalam hal pengendalian kadar gula darah (p=0,171) namun diperoleh bahwa kepatuhan minum obat kelompok perlakuan secara signifikan lebih baik dibandingkan kelompok kontrol (p=0,034). Efek pada kepatuhan minum obat tetap signifikan, setelah mengendalikan variabel umur pasien pada analisis regresi logistik multivariate (p=0,013).Kesimpulan: Pelibatan keluarga dalam kegiatan Prolanis meningkatkan kepatuhan minum obat tetapi tidak berpengaruh terhadap pengendalian kadar gula darah pasien diabetes tipe 2. Kata kunci:     Pendampingan keluarga, kepatuhan minum obat, kadar gula darah, diabetes melitus tipe

RESPON PEMIMPIN RUMAH SAKIT TERHADAP PENERAPAN AKREDITASI RUMAH SAKIT KARS VERSI 2012

Background: The role of hospital leader is key for thesuccessful implementation of KARS version 2012 accreditationwhich puts patient safety as the focus of hospital management.Aim: This study aimed to explore the understanding andresponses of hospital leades toward hospital accreditation2012.Method: This was a qualitative research design using casestudy. Data were gathered through 1) semi structuralquestionnaire interview of Hospital Director, Nursing Chief andCoordinator of Care Services (3 informants); 2). directobservation at medical services activities, patient transfer,Medical Support Services, patient’s identity writing and patientsidentification on treatment; and 3) data obtained from minutesof meeting, Standard Operational Procedure, policy, patient’sdocument related with standard implementation of hospitalaccreditation.Result: Accreditation preparation at this hospital used a topdown approach with limited dissemination. Director’sunderstanding limited to the purposes, scoring method andassessed chapter, meanwhile the Nursing Chief only mentionedthe quality improvement purposes and care, and Coordinatorof care stated quality improvement accreditation. The leaderhas not built a structured planned for overall hospital activity,but only reactive responses. In the service level there is onlya minor change found. For example writing patient identitydiffers in each unit, hand washing practice has no properstandard operational procedure, and hand washing facilitywas not available in every patient bed.Conclusion: There is a gap of understanding and responseson accreditation due to unstructured preparation. Responseswere only on hand washing aspect and personal identity.There is still no written policy on implementation of KARS 2012accreditation.Keywords: accreditation, hospital leader, understanding andresponses, KARS 2012 accreditatio