GAMBARAN SITUASI KERASIONALAN PENGGUNAAN OBAT DI INDONESIA

Penggunaan obat rasional memiliki peran strategis untuk menurunkan angka kesakitan dan angka kematian masyarakat karena obat merupakan komponen utama dalam pengobatan penyakit. Tujuan dari kerasionalan penggunaan obat adalah “Untuk menjamin pasien mendapatkan pengobatan yang sesuai dengan kebutuhannya, dengan dosis yang tepat, untuk periode waktu yang adekuat dengan harga yang terjangkau”. Tulisan ini bertujuan untuk memperlihatkan gambaran situasi kerasionalan penggunaan obat di Indonesia. Metode studi merupakan kajian terhadap survey nasional yang dilakukan  Badan Litbang Kesehatan Kemenkes terkait penggunaan obat baik di masyarakat maupun di puskesmas dan rumah sakit. Sumber data dan informasi adalah Riset Kesehatan Daerah (Riskesdas)(2013), Studi penggunaan antibiotik di Indonesia (2014 sd 2015) dan Survey Indikator Kesehatan Nasional (Sirkesnas)(2016). Metode study ke 3 penelitian tersebut adalah potong lintang dan survey dilakukan di seluruh kota dan kabupaten di Indonesia. Hasilnya situasi penggunaan obat rasional di Indonesia masih jauh dari harapan, baik di masyarakat maupun di puskesmas dan rumah sakit. Untuk itu pemerintah perlu melakukan upaya yang komprehensif serta melibatkan seluruh stakeholders antara lain dengan melakukan edukasi dini secara terus menerus dan komprehensif kepada masyarakat serta melakukan monitoring dan evaluasi yang intensif dengan disertai intervensi yang dibutuhkan

Faktor yang Berpengaruh terhadap Pemanfaatan Fasilitas Pelayanan Kesehatan Swasta

Abstrak Studi terhadap faktor yang berpengaruh terhadap pemanfaatan fasyankes swasta dengan analisis lanjut terhadap data Riskesdas 2013 diikuti oleh studi kualitatif yaitu wawancara mendalam terhadap pengguna layanan rawat jalan di 7 fasilitas pelayanan kesehatan swasta masing-masing 5 orang di Kota Tangerang. Tujuan studi ini adalah untuk mengetahui faktor yang berpengaruh terhadap pemanfaatan fasyankes swasta. Kerangka konsep mengikuti kerangka Green L, yaitu melakukan penilaian terhadap faktor predisposing, enabling dan reinforcing. Hasilnya adalah faktor yang berpengaruh signifikan terhadap pemanfaatan fasyankes swasta adalah usia, pekerjaan, kepemilikan asuransi dan untuk penyakit TB paru, diabetes, hepatitis dan hipertensi. Hasil studi kualitatif memperlihatkan faktor yang berpengaruh terhadap pemanfaatan fasyankes swasta tidak berbeda dengan hasil analisis lanjut, yaitu: jarak (akses) dan kepemilikan asuransi kesehatan. Studi ini merekomendasikan bahwa pemerintah perlu intens mendorong peningkatan kualitas fasyankes baik fasyankes pemerintah maupun swasta agar sama-sama memenuhi ekspektasi dan kebutuhan masyarakat dan juga pengaturan, distribusi dan pembinaan terhadap fasyankes swasta. Kata kunci: fasyankes, rawat jalan, asuransi kesehatan, Riskesdas 2013 Abstract It has been conducted study about factors influencing the utilization of private health facilities by further analyses towards Riskesdas 2013 data and followed by qualitative study i.e in-depth interviewed on outpatients in 7 private health care facilities that 5 people respectively in Tangerang city. The aim of this study was to find out factors that influence significantly to the utilization of private health services facilities. Conceptual framework followed Green L concept that is assessment to predisposing, enabling dan reinforcing factors. The results was that ages, occupation and having health insurance were factors that influencing significantly to th the utilization. In addition, TB pulmonary, diabetes, hepatitis and hypertension diseases was also significant. The qualitative study showed factors that influence the utilization of private health services facilities were not far different with the results of further study of Riskesdas 2013 i.e. access (distance) and having health insurance. This study recommended that government should push intensively the improvement of quality health services in public and private health facilities to fulfilled expectation and need of people. In addition, the Government should also continuing to regulate and to guidance private health facilities. Keywords: health services facilities, outpatients, health insurance, Riskesdas 201

Analysis of Prescribing Pattern and the Availability of Medicines at General Hospitals in Indonesia

Objective: The study aim to provide description analyses of prescribing pattern and the availability of medicines ingeneral hospital as access components to medicines. Methods: This is non-intervention analysis using data from national health facilities research 2011. Samples: 40 items of essential medicines were surveyed at all general hospitals that belong to government in all districts in Indonesia. Bivariate and descriptive analyses intent to analyses the availability of medicines in hospital in Indonesia and pattern of drug prescription. Results: The availability of drugs in the government\u27s hospital is quite good, except fixed dose combination for tuberculosis, vitamin A and vaccines. Those are program\u27s medicines of health ministries. The results also show that the prescription using generic medicines for adults and childrenin the hospital were 62.1% and 62.6%. The prescription using essential medicines for adults and children were 32.6% and 35.2%. Conclusion: Drug prescription pattern have not been rational. Recommendation: Based on the results, the use of rational medicines should be keep promoting by the government. In line with this the incentive should be provided to thedoctors and pharmacist who serve the patient with the rational use medicines

Gambaran Pembiayaan Farmasi di Rumah Sakit Pemerintah dengan Pengelolaan BLU/BLUD

Pharmacy costs are one of the components that absorb the largest costs from the hospital's health budget. At present, there is still little information and data on the percentage of pharmaceutical costs to the costs of medical devices and non-medical devices. It is very useful in making financial planning. It can illustrate of pharmaceutical financing against other operational costs in hospitals, as financial planning, as scientific evidence for improving drug policy. This research was an analysis on the Indonesia Health Financing Survey data in the referral health care Facilities (FKRTL) in 2016. Data from 84 hospitals in 3 regions. The details were 9 class A hospitals, 37 class B hospitals, 38 class C hospitals. The analysis used a descriptive statistical approach. Pharmacy costs in 3 types of hospitals were 169.07 Billion, 23.66 Billion, 10.79 Billion. The percentage of the proportion of pharmaceutical costs to the cost of non-medical equipment in 3 types of hospitals is 1073.05%, 665.42%, 292.29%. The proportion of pharmaceutical costs to the cost of medical devices in 3 types of hospitals is 208.12%, 172.20%, 148.96%. In all types of hospitals the total pharmaceutical costs are greater than the costs of medical equipment and non-medical equipment costs. The proportion of pharmaceutical costs to the costs of non-medical devices and medical devices is high. This is due to the depreciation of the cost of medical devices and non-medical devices while the pharmaceutical costs always increase in price from the previous year. Abstrak Biaya farmasi merupakan salah satu komponen yang menyerap biaya terbesar dari anggaran kesehatan Rumah Sakit. Saat ini masih sedikit informasi dan data mengenai prosentase biaya farmasi terhadap biaya alat medis dan alat non-medis. Prosentase biaya di rumah sakit sangat bermanfaat dalam membuat perencanaan pembiayaan. Data penelitian sebagai gambaran pembiayaan farmasi terhadap biaya operasional lain di rumah sakit, sebagai perencanaan pembiayaan, sebagai bukti ilmiah untuk penyempurnaan kebijakan obat. Data riset merupakan analisis lanjut hasil Riset Pembiayaan Kesehatan Fasilitas Kesehatan Rawat Tingkat Lanjut (FKRTL) Tahun 2016. Data dari 84 rumah sakit yang di 3 regional. Dengan rincian adalah 9 rumah sakit kelas A, 37 rumah sakit kelas B, 38 rumah sakit kelas C. Data riset dimasukkan dalam dumy tabel untuk analisa lanjut. Analisis menggunakan pendekatan kuantitatif statistik diskriptif. Biaya farmasi pada 3 tipe RS masing-masing sebesar 169,07 Milyard, 23,66 Milyard, 10,79 Milyard. Prosentase proporsi biaya farmasi terhadap biaya alat non medis pada 3 tipe RS adalah 1073,05%, 665,42%, 292,29%. Prosentase proporsi biaya farmasi terhadap biaya alat medis pada 3 tipe RS adalah 208,12%, 172,20%, 148,96%. Di semua tipe RS total biaya farmasi lebih besar dibanding biaya alat medis dan biaya alat non medis. Prosentase proporsi biaya farmasi terhadap biaya alat non medis dan alat medis menjadi tinggi. Hal ini disebabkan terjadi penyusutan terhadap biaya alat medis dan alat non medis sedangkan biaya farmasi selalu terjadi peningkatan harga dari tahun sebelumnya.    &nbsp

Pengetahuan Sikap dan Perilaku Anak Remaja Usia 15-18 Tahun terhadap Penggunaan Sunscreen di SMK Kesehatan Yannas Husada Bangkalan

UV rays can have a negative impact on human skin if exposed for too long (BPOM, 2009). The lack of knowledge and the low level of use of sunscreen in adolescents so that better and more optimal education is needed. Therefore, to get an overview of this, research is needed on Knowledge of Attitudes and Behaviors of Adolescents Aged 15-18 Years Against the Use of Sunscreen at the Yannas Husada Health Vocational School in the Bangkalan area. Data was collected by distributing questionnaires to 63 respondents. The data obtained were then performed with univariate analysis using IBM SPSS software and chi square test. The results of the univariate analysis showed that as many as (4.8%) of respondents had a good level of knowledge, (47.6%) had a fairly good knowledge and (47.6%) had a poor knowledge of the use of sunscreen. Then as many as (3.17%) respondents have a good attitude, (50.79%) have a fairly good attitude and (46.03%) have a bad attitude towards the use of sunscreen. Then (0%) respondents have good behavior, (30.2%) have quite good behavior and (69.8%) have bad behavior towards the use of sunscreen. The chi square test shows that all variables have a value of more than 0.05 so there is no relationship between them. Teenagers or students of Yannas Husada Health Vocational School have a fairly good level of knowledge, attitude and behavior towards the use of sunscreenSinar UV dapat memberikan dampak buruk bagi kulit manusia apabila terpapar terlalu lama (BPOM, 2009). Minimnya pengetahuan dan rendahnya tingkat penggunaan sunscreen pada remaja sehingga dibutuhkan edukasi yang lebih baik dan lebih maksimal. Oleh karena itu, untuk mendapatkan gambaran mengenai hal tersebut dibutuhkan penelitian tentang Pengetahuan Sikap Dan Perilaku Anak Remaja Usia 15-18 Tahun Terhadap Penggunaan Sunscreen Di SMK Kesehatan Yannas Husada di daerah Bangkalan. Pengumpulan data dilakukan dengan menyebarkan kuesioner kepada responden sejumlah 63 orang. Data yang diperoleh kemudian dilakukan analisis univariat menggunakan perangkat lunak IBM SPSS dan uji chi square. Hasil analisis univariat menunjukkan sebanyak (4,8%) responden memiliki tingkat pengetahuan yang baik, (47,6%) memiliki pengetahuan yang cukup baik dan (47,6%) memiliki pengetahuan yang kurang baik terhadap penggunaan sunscreen. Kemudian sebanyak (3,17%) responden memiliki sikap yang baik, (50,79%) memiliki sikap yang cukup baik dan (46,03%) memiliki sikap yang kurang baik terhadap penggunaan sunscreen. Lalu (0%) responden memiliki perilaku yang baik, (30,2%) memiliki perilaku yang cukup baik dan (69,8%) memiliki perilaku yang kurang baik terhadap penggunaan sunscreen. Uji chi square menunjukkan seluruh variabel memiliki nilai lebih dari 0,05 sehingga tidak ada hubungan diantara hal tersebut. Anak remaja atau siswa-siswi SMK Kesehatan Yannas Husada memiliki tingkat pengetahuan, sikap dan perilaku yang cukup baik terhadap penggunaan sunscree

Identifikasi Praktik Kefarmasian Yang Sesuai Dengan Kebutuhan Pasien Dan Fasilitas Pelayanan Kesehatan

The study of pharmaceutical practices in health care facilities was conducted in 2016. It aimed to identify pharmaceutical practices needed by patients and health care facilities. The study sites were in Central Java, Bali, South Kalimantan, and South Sulawesi. In each provinces, the study was conducted in one urban and one rural district areas. The sample locations were both government and private hospitals, health centers and pharmacies. The study design study was cross sectional. Data collection was carried out by in-depth interview to responsible pharmacists who did medicines management, and exit interview to patients after they received medicines services from government hospitals and primary health cares. The results showed that pharmaceutical practices needed by the health care facilities were good medicines planning andprocurement that can maintain the continuity of the availability of medicine stocks needed for patients, and the ability in managing medicines effi ciently and eff ectively. Moreover, the pharmaceutical practices needed by the communities were medicines completeness, quick services, as well as simple and complete medicines information. It is recommended that pharmacists should be trained on comprehensive medicines planning, strategy to anticipate the emptiness of medicines including lead times, and communication skills to the patients. In addition, IT supports for pharmacy services development is also needed. Abstrak Telah dilakukan studi mengenai praktik kefarmasian di fasilitas pelayanan kesehatan yang bertujuan mengidentifikasi pelayanan kefarmasian yang dibutuhkan pasien dan fasilitas pelayanan kesehatan. Kegiatan studi dilaksanakan di Jawa Tengah, Bali, Kalimantan Selatan, Sulawesi Selatan. Dari masing-masing propinsi di atas dipilih satu kota dan satu kabupaten. Studi dilakukan pada tahun 2016. Lokasi penelitian adalah rumah sakit pemerintah, rumah sakit swasta, puskesmas dan apotek dengan desain potong lintang. Pengumpulan data dilakukan melalui wawancara mendalam terhadap apoteker penanggung jawab/pengelola obat, dan exit interview terhadap pasien rumah sakit pemerintah dan puskesmas yang baru selesai menerima pelayanan obat. Hasil penelitian menunjukkan praktik kefarmasian yang dibutuhkan oleh fasilitas pelayanan kesehatan adalah perencanaan dan pengadaan obat yang baik yang dapat menjaga kesinambungan ketersediaan stok obat yang diperlukan bagi pelayanan ke pasien serta pengelolaan obat yang efektif dan efi sien. Praktikkefarmasian yang dibutuhkan masyarakat adalah tersedianya obat lengkap, kecepatan pelayanan, dan informasi obat yang singkat padat. Disarankan perlunya pelatihan perencanaan obat yang lebih komprehensif, kiat-kiat mengantisipasi kekosongan obat dan lamanya pengiriman, serta pelatihan cara berkomunikasi yang baik kepada pasien secara menyeluruh. Selain itu, dukungan teknologi informasi bagi pengembangan pelayanan farmasi juga dibutuhkan. &nbsp

Studi Kebijakan Pengembangan Tanaman Obat di Indonesia

Abstract Indonesia is rich in biodiversity. The treatment that uses herbs or medicinal plants (MP) by the community is an effort of the community to live a healthy life independently. Therefore, the Government should encourage the development of MP in the multi-sector areas, among others: health, agriculture, forestry and the informal sector, therefore policies related to MP should be implemented coordinatively, so that the MP development program can run well. The policy for the development of the MP study carried out in 2013 was aimed at analyzing policies and coordination across sectors of the MP development program. It is a qualitative study whose information is obtained from managers and implementers of policies related to MP in the health sector, agriculture, forestry, central & regional government, PKK administrators, research bodies and universities. The study was conducted in Jakarta, West Java, Central Java and Yogyakarta. The study results show that policies related to the development of MP in each sector have different priority levels. The central policy in the health sector is more directed at how treatment with MP can integrate with formal health services and self-medication, while the agricultural and forestry sectors lead to industrialization to improve the economic level of the community. At the regional level, the development of MP still expects. AbstrakIndonesia kaya dengan keanekaragaman hayati. Pengobatan yang menggunakan herbal atau tanaman obat (TO) oleh masyarakat merupakan upaya masyarakat untuk hidup sehat secara mandiri. Oleh karena itu, seyogyanya pemerintah mendorong pengembangan TO yang berada pada wilayah multisektor antara lain: sektor kesehatan, pertanian, kehutanan, dan sektor informal. Karena itu kebijakan terkait TO seharusnya dapat diimplementasikan secara koordinatif, sehingga program pengembangan TO dapat bejalan baik. Studi kebijakan pengembangan TO yang dilaksanakan tahun 2013 bertujuan untuk menganalisis kebijakan dan koordinasi lintas sektor program pengembangan TO. Studi ini merupakan studi kualitatif yang informasinya diperoleh dari pengelola dan pelaksana kebijakan terkait TO pada sektor kesehatan, pertanian, kehutanan, pemerintahan pusat dan daerah, pengurus PKK, badan penelitian, dan universitas. Studi dilakukan di Jakarta, Jawa Barat, Jawa Tengah, dan Yogyakarta. Hasil studi memperlihatkan kebijakan terkait pengembangan TO di masing-masing sektor memiliki tingkat prioritas yang berbeda-beda. Kebijakan pusat di sektor kesehatan lebih mengarah bagaimana pengobatan dengan TO bisa berintegrasi dengan pelayanan kesehatan formal dan swamedikasi, sementara sektor pertanian dan kehutanan mengarah kepada industrialisasi untuk meningkatkan taraf ekonomi masyarakat. Pada tingkat daerah, pengembangan TO masih mengharapkan dukungan dari pusat terutama untuk anggaran dan pembinaan. Hasil analisis menunjukkan masih ada gap antara kebijakan dengan pelaksanaan pengembangan TO. Secara umum, koordinasi masih menjadi kelemahan setiap sektor, baik koordinasi lintas sektor maupun koordinasi dari pusat ke daerah. Program-program yang sudah baik di tingkat pusat menjadi kurang berarti karena kurangnya sosialisasi dan pelaksanaan di lapangan. Diperlukan adanya kebijakan terobosan untuk peningkatan pemanfaatan TO baik untuk kesehatan maupun peningkatan ekonomi

Kebijakan Harga Obat di Indonesia dan Perbandingannya dengan Negara-negara Lain

Indonesia is facing challenge of medicines prices. Many people complaining about high price of medicines. Several efforts have been done by the government, however access people to the medicines is still a big issue. To improve the affordability of medicines for public, the policy related to the medicines prices need to be revised. In addition, the appropriate of this policy would lead to the efficient of medicines expenditure. Study from other countries experience is a good way to do in order to understand the issues comprehensively, anticipate the pitfall of the policy, and address to solve the key problems of medicines prices. Based on the study, it can be concluded that medicines prices cannot be lower without government intervention. Indonesia that following to the market mechanism for medicines prices can intervene the price indirectly through several policies such as providing reference prices and pharmaco-economic evaluation for new drugs, oblige pharmacy industries to be transparent in term of their policy for fixing the medicines prices in the market, limited "mee too" medicines, adding the item number of generic medicines, and keep promoting the use of generic medicines which connecting with incentives for physicians and pharmacies. Furthermore, the management of public medicines should be more efficient and accountable. Key words: medicines prices, medicines prices policy, medicines prices expenditur

Analisis Implementasi Kebijakan Program Pengendalian Resistensi Antimikroba (PPRA)

Antimicrobial resistance has become a problem in Indonesia. The Ministry of Health has established a policy ofAntimicrobial Resistance (AMR) Control Program in hospitals to resolve the issue. A qualitative case study was conducted at Dr. RSUP Wahidin Sudirohusodo hospital, Makassar in 2018 to analyze the implementation of AMR control program. The data were collected through in-depth interviews and analyzed descriptively. The study showed that policy AMR control program has not be carefully implemented. The function of AMR control program team is to make policies and guidelines for antibiotic use, to make surveillance of germ patterns and antibiotic sensitivity, clinical audits of antibiotic use, to conduct studies/research and to make evaluation that is reported to the Hospital Director. However, this AMR control program has not been optimally implemented due to many challenges such as lack of budget, lack of commitment and internal coordination between the AMR control program team members. Implementation of AMR control program in this hosptal management is not optimal. The Program dissemination and AMR team activities were not evenly distributed. High workload, inadequate infrastructure and antibiotic resistance issues of the referred patients. As a conclusion AMRcontrol program policy in RSUP. Wahidin Sudirohusodo, Makassar, has not been properly disseminated and implemented. Coordination, dissemination and discussion forums on PPRA policies internally and externally with cross-sectoral hospitals are needed to improve antimicrobial resistance control commitment.    &nbsp