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

Can General Practitioners manage mental disorders in primary care? A partially randomised, pragmatic, cluster trial

BackgroundFor a decade, experts have suggested integrating mental health care into primary care to help bridge mental health Treatment Gap. General Practitioners (GPs) are the first port-of-call for many patients with mental ill-health. In Indonesia, the WHO mhGAP is being systematically introduced to its network of 10,000 primary care clinics as an add-on mental health training for pairs of GPs and Nurses, since the end of 2015. In one of 34 provinces, there exists an integrated care model: the co-location of clinical psychologists in primary care clinics. This trial evaluates patient outcomes among those provided mental health care by GPs with those treated by clinical psychologists in primary care.MethodsIn this partially-randomised, pragmatic, two-arm cluster non-inferiority trial, 14 primary care clinics were assigned to receive the WHO mhGAP training and 14 clinics with the co-location framework were assigned to the Specialist arm. Participants (patients) were blinded to the existence of the other pathway, and outcome assessors were blinded to group assignment.All adult primary care patients who screened positive for psychiatric morbidity were eligible. GPs offered psychosocial and/or pharmacological interventions and Clinical Psychologists offered psychosocial interventions. The primary outcome was health and social functioning as measured by the HoNOS and secondary outcomes include disability measured by WHODAS 2.0, health-related quality of life measured by EQ-5D-3L, and resource use and costs evaluated from a health services perspective, at six months.Results153 patients completed the outcome assessment following GP care alongside 141 patients following Clinical Psychologists care. Outcomes of GP care were proven to be statistically not inferior to Clinical Psychologists in reducing symptoms of social and physical impairment, reducing disability, and improving health-related quality of life at six months. Economic analyses indicate lower costs and better outcomes in the Specialist arm and suggest a 50% probability of WHO mhGAP framework being cost-effective at the Indonesian willingness to pay threshold per QALY.ConclusionGeneral Practitioners supported by nurses in primary care clinics could effectively manage mild to moderate mental health issues commonly found among primary care patients. They provide non-stigmatising mental health care within community context, helping to reduce the mental health Treatment Gap.Trial registrationClinicalTrials.gov NCT0270049

Can General Practitioners manage mental disorders in primary care? A partially randomised, pragmatic, cluster trial.

BACKGROUND:For a decade, experts have suggested integrating mental health care into primary care to help bridge mental health Treatment Gap. General Practitioners (GPs) are the first port-of-call for many patients with mental ill-health. In Indonesia, the WHO mhGAP is being systematically introduced to its network of 10,000 primary care clinics as an add-on mental health training for pairs of GPs and Nurses, since the end of 2015. In one of 34 provinces, there exists an integrated care model: the co-location of clinical psychologists in primary care clinics. This trial evaluates patient outcomes among those provided mental health care by GPs with those treated by clinical psychologists in primary care. METHODS:In this partially-randomised, pragmatic, two-arm cluster non-inferiority trial, 14 primary care clinics were assigned to receive the WHO mhGAP training and 14 clinics with the co-location framework were assigned to the Specialist arm. Participants (patients) were blinded to the existence of the other pathway, and outcome assessors were blinded to group assignment. All adult primary care patients who screened positive for psychiatric morbidity were eligible. GPs offered psychosocial and/or pharmacological interventions and Clinical Psychologists offered psychosocial interventions. The primary outcome was health and social functioning as measured by the HoNOS and secondary outcomes include disability measured by WHODAS 2.0, health-related quality of life measured by EQ-5D-3L, and resource use and costs evaluated from a health services perspective, at six months. RESULTS:153 patients completed the outcome assessment following GP care alongside 141 patients following Clinical Psychologists care. Outcomes of GP care were proven to be statistically not inferior to Clinical Psychologists in reducing symptoms of social and physical impairment, reducing disability, and improving health-related quality of life at six months. Economic analyses indicate lower costs and better outcomes in the Specialist arm and suggest a 50% probability of WHO mhGAP framework being cost-effective at the Indonesian willingness to pay threshold per QALY. CONCLUSION:General Practitioners supported by nurses in primary care clinics could effectively manage mild to moderate mental health issues commonly found among primary care patients. They provide non-stigmatising mental health care within community context, helping to reduce the mental health Treatment Gap. TRIAL REGISTRATION:ClinicalTrials.gov NCT02700490

Dukungan sosial untuk orang dengan gangguan jiwa di daerah miskin: studi kasus di Gunungkidul

Social support for people with mental disorders in poor areas: a case study in GunungkidulPurposeThe purpose of this study was to describe the role of mental health cadres in the effort of community based mental health service at Wonosari II Health Center Gunungkidul.MethodsQualitative research was done by case study approach. The cadres were chosen purposively with the criteria of: having attended training or socialization of mental health, having at least 2 years work experience related to community mental health service, and still active. Data collection was done through in-depth interviews and document utilization.ResultsCadres play an important role in providing social support. First, the cadre can show empathy to the family of people with mental disorders by building close relationships and facilitating the social acceptance of the community. Secondly, the cadres provide socialization related to mental disorders and mental health services. Third, approaches through home visits, referral assistance to health services, and health insurance and social assistance suggest that cadres facilitate access to care for people with mental disorders.ConclusionThere was a high social awareness of cadres to families with mental disorders in poor neighborhoods. We found that poverty does not limit people to share with others, and social support helps prevent mental illness from getting worse.Latar belakang: Gangguan jiwa memiliki pengaruh besar terhadap status sosial seseorang atau sekelompok orang dalam masyarakat. Jika mereka miskin, maka kehadiran gangguan jiwa berdampak pada makin buruknya situasi kesehatan dan sosial mereka. Penelitian ini ingin mengeksplorasi peran kader kesehatan jiwa di daerah berpenduduk miskin dalam sistem kesehatan masyarakat yang berbasis masyarakat. Penelitian ini bertujuan untuk mendeskripsikan dukungan sosial pada peran kader kesehatan jiwa dalam upaya pelayanan kesehatan jiwa berbasis masyarakat di Puskesmas Wonosari II Kabupaten Gunungkidul.Metode: Penelitian ini adalah penelitian kualitatif dengan pendekatan studi kasus. Purposive sampling digunakan untuk memilih kader yang pernah mengikuti pelatihan atau sosialisasi kesehatan jiwa, memiliki minimal 2 tahun pengalaman kerja yang berkaitan dengan pelayanan kesehatan jiwa di masyarakat, dan masih aktif.  Pengumpulan data dilakukan melalui wawancara mendalam dan pemanfaatan dokumen.Hasil: Kader menunjukkan peran penting dalam dukungan sosial. Pertama, kader menunjukkan empati mereka pada keluarga orang dengan gangguan jiwa dengan membangun hubungan yang akrab dengan orang dengan gangguan jiwa dan memfasilitasi penerimaan sosial oleh masyarakat yang pada gilirannya meningkatkan rasa percaya diri mereka. Rasa percaya diri merupakan faktor penting dalam proses pemulihan dari kondisi mengalami gangguan jiwa.  Kedua, kader memudahkan akses informasi dengan memberikan sosialisasi mengenai gangguan jiwa di masyarakat dan menyampaikan informasi tentang pelayanan kesehatan jiwa. Ketiga, pendekatan melalui kunjungan rumah, bantuan dalam rujukan ke pelayanan kesehatan, serta pengupayaan jaminan kesehatan dan bantuan sosial menunjukkan bahwa kader telah memudahkan akses terhadap sumber daya yang terkait dengan perawatan orang dengan gangguan jiwa.Kesimpulan: Penelitian ini mengungkapkan adanya kepedulian sosial yang tinggi dari kader terhadap keluarga dengan gangguan jiwa di lingkungan berpenduduk miskin. Kemiskinan tidak membatasi warga masyarakat untuk berbagi dengan sesama mereka. Dukungan sosial membantu mencegah kondisi mereka semakin terpuruk

Can General Practitioners manage mental disorders in primary care? A partially randomised, pragmatic, cluster trial.

BACKGROUND:For a decade, experts have suggested integrating mental health care into primary care to help bridge mental health Treatment Gap. General Practitioners (GPs) are the first port-of-call for many patients with mental ill-health. In Indonesia, the WHO mhGAP is being systematically introduced to its network of 10,000 primary care clinics as an add-on mental health training for pairs of GPs and Nurses, since the end of 2015. In one of 34 provinces, there exists an integrated care model: the co-location of clinical psychologists in primary care clinics. This trial evaluates patient outcomes among those provided mental health care by GPs with those treated by clinical psychologists in primary care. METHODS:In this partially-randomised, pragmatic, two-arm cluster non-inferiority trial, 14 primary care clinics were assigned to receive the WHO mhGAP training and 14 clinics with the co-location framework were assigned to the Specialist arm. Participants (patients) were blinded to the existence of the other pathway, and outcome assessors were blinded to group assignment. All adult primary care patients who screened positive for psychiatric morbidity were eligible. GPs offered psychosocial and/or pharmacological interventions and Clinical Psychologists offered psychosocial interventions. The primary outcome was health and social functioning as measured by the HoNOS and secondary outcomes include disability measured by WHODAS 2.0, health-related quality of life measured by EQ-5D-3L, and resource use and costs evaluated from a health services perspective, at six months. RESULTS:153 patients completed the outcome assessment following GP care alongside 141 patients following Clinical Psychologists care. Outcomes of GP care were proven to be statistically not inferior to Clinical Psychologists in reducing symptoms of social and physical impairment, reducing disability, and improving health-related quality of life at six months. Economic analyses indicate lower costs and better outcomes in the Specialist arm and suggest a 50% probability of WHO mhGAP framework being cost-effective at the Indonesian willingness to pay threshold per QALY. CONCLUSION:General Practitioners supported by nurses in primary care clinics could effectively manage mild to moderate mental health issues commonly found among primary care patients. They provide non-stigmatising mental health care within community context, helping to reduce the mental health Treatment Gap. TRIAL REGISTRATION:ClinicalTrials.gov NCT02700490