17 research outputs found
Pengembangan Kuisioner Kepuasan Pasien untuk Pelayanan Farmasi Klinik
Latar belakang: Survey kepuasan pasien adalah salah satu metode evaluasi yang dapat digunakan untuk menilai kualitas pelayanan farmasi klinik. Penelitian ini bertujuan untuk mengembangkan kuisioner penelitian dalam Bahasa Indonesia untuk mengukur kepuasan pasien terhadap pelayanan kefarmasian pada fasilitas kesehatan tingkat pertama dan tingkat lanjut terutama mengenai pelayanan farmasi klinik.
Metode: Pernyataan ā pernyataan dalam kuisioner disusun berdasarkan peraturan Perundang-undangan yang berlaku di Indonesia mengenai standar pelayanan kefarmasian di pusat kesehatan masyarakat (Puskesmas), apotek dan rumah sakit. Pernyataan dalam kuisioner dibagi menjadi lima kategori kualitas pelayanan yaitu keandalan, responsif, sarana, jaminan, dan empati. Kuisioner kemudian diuji kepada 90 orang responden (masing ā masing 30 orang untuk setiap kelompok kriteria) untuk menilai validitas dan reliabilitas instrument kuisioner.
Hasil: Terdapat 39 pernyataan untuk kuisioner pelayanan kefarmasian di Puskesmas, 41 pernyataan untuk kuisioner pelayanan farmasi klinik di apotek maupun di rumah sakit. Uji validitas menggunakan korelasi momen produk yang menghasilkan nilai r untuk masing ā masing pernyataan > 0,361 (valid). Tes reliabilitas dilakukan dengan menggunakan uji Cronbach Alpha. Hasil uji Cronbach Alpha > 0,6 (reliabel) untuk masing ā masing item kuisioner.
Kesimpulan: Berdasarkan uji validitas dan reliabilitas menunjukkan kuisioner kepuasaan pasien terhadap pelayanan farmasi klinik yang disusun valid dan reliabel
Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990ā2021: a systematic analysis for the Global Burden of Disease Study 2021
Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 riskāoutcome pairs. Pairs were included on the basis of data-driven determination of a riskāoutcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each riskāoutcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of riskāoutcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2Ā·5th and 97Ā·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8Ā·0% (95% UI 6Ā·7ā9Ā·4) of total DALYs, followed by high systolic blood pressure (SBP; 7Ā·8% [6Ā·4ā9Ā·2]), smoking (5Ā·7% [4Ā·7ā6Ā·8]), low birthweight and short gestation (5Ā·6% [4Ā·8ā6Ā·3]), and high fasting plasma glucose (FPG; 5Ā·4% [4Ā·8ā6Ā·0]). For younger demographics (ie, those aged 0ā4 years and 5ā14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20Ā·7% [13Ā·9ā27Ā·7]) and environmental and occupational risks (decrease of 22Ā·0% [15Ā·5ā28Ā·8]), coupled with a 49Ā·4% (42Ā·3ā56Ā·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15Ā·7% [9Ā·9ā21Ā·7] for high BMI and 7Ā·9% [3Ā·3ā12Ā·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1Ā·8% (1Ā·6ā1Ā·9) for high BMI and 1Ā·3% (1Ā·1ā1Ā·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71Ā·5% (64Ā·4ā78Ā·8) for child growth failure and 66Ā·3% (60Ā·2ā72Ā·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions
Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990ā2021: a systematic analysis for the Global Burden of Disease Study 2021
Background: Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. Methods: The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2Ā·5th and 97Ā·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. Findings: Global DALYs increased from 2Ā·63 billion (95% UI 2Ā·44ā2Ā·85) in 2010 to 2Ā·88 billion (2Ā·64ā3Ā·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14Ā·2% (95% UI 10Ā·7ā17Ā·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4Ā·1% (1Ā·8ā6Ā·3) in 2020 and 7Ā·2% (4Ā·7ā10Ā·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212Ā·0 million [198Ā·0ā234Ā·5] DALYs), followed by ischaemic heart disease (188Ā·3 million [176Ā·7ā198Ā·3]), neonatal disorders (186Ā·3 million [162Ā·3ā214Ā·9]), and stroke (160Ā·4 million [148Ā·0ā171Ā·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47Ā·8% (43Ā·3ā51Ā·7) and for diarrhoeal diseases decreased by 47Ā·0% (39Ā·9ā52Ā·9). Non-communicable diseases contributed 1Ā·73 billion (95% UI 1Ā·54ā1Ā·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6Ā·4% (95% UI 3Ā·5ā9Ā·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16Ā·7% [14Ā·0ā19Ā·8]), depressive disorders (16Ā·4% [11Ā·9ā21Ā·3]), and diabetes (14Ā·0% [10Ā·0ā17Ā·4]). Age-standardised DALY rates due to injuries decreased globally by 24Ā·0% (20Ā·7ā27Ā·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61Ā·3 years (58Ā·6ā63Ā·6) in 2010 to 62Ā·2 years (59Ā·4ā64Ā·7) in 2021. However, despite this overall increase, HALE decreased by 2Ā·2% (1Ā·6ā2Ā·9) between 2019 and 2021. Interpretation: Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. Funding: Bill & Melinda Gates Foundation