Characteristic of Midwife’s who Refer Complex Obstetrics Cases: Karakteristik Bidan yang Merujuk kasus Kebidanan Komplek

Abstract Objective: To identify reasons for referring and characteristics of midwives who practice independently and its relation with complicated cases referred to RSCM.Method: Descriptive analytic case-control. Medical records of patients referred directly to RSCM in January 2016-July 2017 were obtained, then information about midwives and obstetric cases, along with its complications, were collected. Interview and analysis of six characteristics of midwives were conducted. Characteristics analyzed were age, education, training, duration of practice, number of patients ever treated, also distance and travel time of the referral process.Results: All midwives refer due to inadequate facilities. There is a statistically significant correlation between duration of practice and number of patients, with the complicated cases referred directly to RSCM, with OR 7.036 and 6.032, respectively.Conclusion: Midwives refer due to inadequate facilities, and so patients can be treated immediately. Characteristics that affect midwives to refer complicated cases: duration of practice and number of patients. It is necessary to re-evaluate the position of midwives who practiced independently in BPJS, refresher programs, and monitoring by relevant agencies. Further research is needed with more samples and combining midwives' and patients' characteristics in referral cases. Confounding and external factors are identified first in order to do a thorough analysis.Keywords: complicated cases, midwives' characteristics, midwives who practiced independently, referral, referral system. Abstrak Tujuan: Mengetahui alasan rujuk dan karakteristik bidan yang berpraktik mandiri serta hubungannya dengan kasus komplikatif yang dirujuk ke RSCM.Metode: Deskriptif analitik kasus kontrol. Data diambil dari rekam medis pasien yang dirujuk langsung ke RSCM di bulan Januari 2016 hingga Juli 2017, kemudian informasi mengenai data bidan dan kasus obstetri beserta komplikasinya dikumpulkan. Dilakukan wawancara dan analisis enam karakteristik bidan. Karakteristik yang dianalisis yaitu usia, pendidikan, pelatihan, lama waktu berpraktik, jumlah pasien yang pernah ditangani, serta jarak dan waktu tempuh proses merujuk. Hasil: Keseluruhan bidan merujuk karena fasilitas yang tidak memadai. Terdapat hubungan yang bermakna antara waktu praktik dan jumlah pasien yang pernah ditangani, dengan kasus komplikatif yang dirujuk langsung ke RSCM, dengan nilai OR 7.036 dan 6.032.Kesimpulan: Bidan merujuk karena fasilitas tidak memadai dan agar pasien langsung ditangani. Karakteristik bidan yang mempengaruhi dalam merujuk yaitu lama waktu praktik dan jumlah pasien yang ditangani. Perlu dilakukan evaluasi ulang mengenai kedudukan bidan yang berpraktik mandiri di BPJS, program penyegaran bidan, serta monitoring oleh instansi terkait. Perlu penelitian lanjut dengan sampel lebih banyak serta menggabungkan karakteristik bidan dan pasien pada kasus-kasus rujukan. Faktor perancu dan eksternal diidentifikasi terlebih dahulu agar analisis dilakukan menyeluruh.Kata kunci: bidan yang berpraktik mandiri, karakteristik bidan, kasus komplikatif rujukan, sistem rujuka

Evaluation of the Accuracy of Implementation of Obstetric Referral Cases to the Emergency in the JKN Era: Evaluasi Ketepatan Pelaksanaan Rujukan Kasus Gawat Darurat Obstetri ke Instalasi Gawat Darurat dalam Era Jaminan Kesehatan Nasional

Abstract Objective: To investigate the circumstances of the obstetric referral case at the emergency department of the Dr.Cipto Mangunkusumo Hospital as well as the accuracy of the referral implementation. Method: We used cross-sectional study. Medical records of obstetric patients at Emergency department in RSCM in January 2013-July 2014 were obtained, then information about patients and their characteristic were collected. The accuracy of referral cases is based on emergency obstetric criteria by BPJS rules. Results: Primary Health Care became the leading referrer. Inappropriate diagnostic referral cases amounted to 21.2%when JKN first began to be implemented in 2014. Cases with improper diagnoses were more referred when JKN was implemented which amounted to 16.8% and non-emergency referral cases of 6.9% in 2014. Conclusion: Referral implementation has not been efficient and effective, the number of obstetric referral cases to emergency department of RSCM that can actually be handled in the secondary advanced health services after the application of JKN is still high. Monitoring and evaluation is needed by the Local Health Office to improve the quality of the referral system that applied in the newly JKN era.   Keywords:accuracy of referrals,BPJS, JKN, obstetric emergencies, referral system.   Abstrak Tujuan: Mengetahui gambaran kasus rujukan obstetri di IGD RSCM dan ketepatan pelaksanaan rujukan.  Metode: Deskriptif desain studi potong lintang. Data diambil dari rekam medis pasien obstetri di IGD RSCMpada bulan Januari 2013 hingga Desember 2014, kemudian informasi mengenai data dan karakteristik pasien dikumpulkan. Ketepatan pelaksanaan rujukan kasus gaat daraurat obstetri berdasarkan Krietria gawatdarurat bagian kebidanan menurut ketentuan BPJS Kesehatan. Hasil: Perujuk terbanyak adalah Puskesmas (FKTP). Kasus rujukan dengan ketidaksesuaian diagnosa lebih banyakjumlahnya pada saat JKN mulai diterapkan pada tahun 2014 sebesar 21.2%. Kasus dengan diagnosa yang tidak tepat rujuk lebih banyak pada saat JKN di laksanakan yaitu sebesar 16.8% dan kasus rujukan yang bukan gawatdarurat sebesar 6.9% pada tahun 2014. Kesimpulan: Pelaksanaan rujukan belum efisien dan efektif, jumlah rujukan obstetri ke IGD RSCM yangsebenarnya dapat ditangani di fasilitas kesehatan tingkat lanjutan sekunder setelah penerapan JKN masih tinggi. Dibutuhkan monitoring dan evaluasi oleh Dinas Kesehatan setempat untuk meningkatkan kualitas sistem rujukan yang berlaku di era JKN yang baru diterapkan. Kata kunci :  BPJS, gawat darurat obstetri, JKN, ketepatan rujukan, sistem rujukan