Patterns of Outpatient Referral Cases before and after Implementation of National Health Coverage Program: Pola Kasus Rujukan Rawat Jalan sebelum dan sesudah Pelaksanaan Program Jaminan Kesehatan Nasional

AbstractObjective: To understand the pattern of referral cases (accuracy of referral diagnosis, the accuracy of referral health facility and consistency of referral diagnosis) in obstetrics and gynaecology outpatient clinic before and after the implementation of JKN.Methods: This is an observational cross-sectional study using medical records of patients who were referred to obstetrics and gynaecology outpatient clinic in Dr. Cipto Mangunkusumo General Hospital in 2013 and 2014. Data were analyzed with bivariate analysis with chi-square, consisting of the accuracy of referral cases, accuracy of referral health facility, and consistency of referral cases before and after implementation of JKN.Results: There is a growing number of patients in obstetrics and gynaecology outpatient clinic after the implementation of JKN in 2014, which is 4.311 patients. Subjects were 222 cases, 104 cases from 2013 and 118 cases from 2014. From the analyzed data, the accuracy of referral diagnosis before JKN is 81.7% and after JKN 72.9%. (p=0.118), the accuracy of referral health facility before JKN is 63.5% and after JKN 71.2% (p=0.220), and the consistency of referral diagnosis before JKN is 89.4% and after JKN 84.7% (p=0.302).Conclusion: There is no statistically significant difference between the accuracy of referral diagnosis, the accuracy of referral health facility, and consistency of referral diagnosis before and after the implementation of JKN.Keywords: national health coverage program, obstetrics and gynaecology, outpatient clinic, referral AbstrakTujuan: Untuk memahami pola kasus rujukan (ketepatan diagnosis rujukan, ketepatan asal fasyankes perujuk, dan kesesuaian diagnosis rujukan) di Poliklinik Obstetri dan Ginekologi sebelum dan setelah pelaksanaan JKN.Metode: Penelitian ini adalah observasional potong lintang dengan menggunakan data rekam medis pasien yang dirujuk ke Poliklinik Obstetri dan Ginekologi RSUPN Dr. Cipto Mangunkusumo selama tahun 2013 dan 2014. Analisis dilakukan dengan analisis bivariat dengan chi square untuk membedakan ketepatan diagnosis rujukan, ketepatan asal fasyankes perujuk, dan kesesuaian diagnosis rujukan sebelum dan setelah pelaksanaan JKN.Hasil: Terdapat peningkatan jumlah kunjungan Poliklinik Obstetri dan Ginekologi sejak dilaksanakannya program JKN pada tahun 2014, yaitu sebanyak 4.311 pasien. Jumlah subjek adalah sebanyak 222 subjek, terdiri dari 104 subjek pada tahun 2013 dan 118 subjek pada tahun 2014. Dari analisis data, didapatkan tingkat ketepatan diagnosis sebelum JKN adalah 81,7% dan setelah JKN 72,9% (p=0,118), tingkat ketepatan fasyankes perujuk sebelum JKN adalah 63,5% dan setelah JKN 71,2% (p=0,220), serta tingkat kesesuaian diagnosis sebelum JKN adalah 89,4% dan setelah JKN 84,7% (p=0,302).Kesimpulan: Tidak ada perbedaan yang bermakna secara statistik antara ketepatan diagnosis rujukan, ketepatan fasyankes perujuk, dan kesesuaian diagnosis fasyankes rujukan sebelum dan sesudah pelaksanaan JKN.Kata kunci: jaminan kesehatan nasional, obstetri dan ginekologi, poliklinik, rujuka

Family Planning Problem in Indonesia

N/

Levonorgestrel Concentration in a Single Rod Implant Users for Six Months

Objective: This research was conducted to measure levonorgestrel serum concentration Monoplant® after six months of usage. Method: Thirty healthy women, 20 - 40 years old, and after been proven for fertility, had implants on their body. Levonorgestrel serum levels were measured monthly from the first month to the sixth month. Result: Levonorgestrel serum concentration was still above 200 pg/ml until the sixth month. First month and second month serum concentration was not recorded while data for the following months were 338.9 pg/ml, 424.8 pg/ml, 320.3 pg/ml, and 337.5 pg/ml. Conclusion: Levonorgestrel serum concentration in Monoplant® users was still above contraceptive level until six months. [Indones J Obstet Gynecol 2011; 35-3: 122-7] Keywords: single rod implant Monoplant®, levonorgestrel serum concentratio

Monoplant® the Indonesian Implant: The Overview of Implant and Its Development

Norplant®, as a first-generation levonorgestrel implant and containing six capsules, has been shown to be effective as long-term contraception since more than 25 years ago. In the process, then the number of implants was reduced to two rods called Norplant-2®, which is then updated into Jadena® (in Indonesia) or Jadelle® (in America). As a country with the largest implant acceptors in the world, Indonesia has developed its own implant method consisting of two rods called Indoplant®. Currently being developed implant that consists of single rod called Monoplant®. Monoplant® is expected to be the best option because it only consists of a single rod implant that is easy to insertion and remove, effective and safe for at least three years. [Indones J Obstet Gynecol 2011; 35-1: 40-6

Profile Changes in Weight and Body Mass Index of Single Rod Levonorgestrel Implant Acceptor (Monoplant®): Profil Perubahan Berat Badan dan Indeks Masssa Tubuh Akseptor Implan Levonorgestrel Satu Batang (Monoplant®)

AbstractObjective: To finding out the change of weight and body mass index (BMI) of single rodlevonorgestrel implant acceptor (Monoplant®).Methods: A cross-sectional descriptive study was conductedusing data changes of weight and BMI obtained from series of measurement which is recorded in patients’ medical record in three years of Monoplant® placement in Raden Saleh Clinic, Jakarta. This method is the part of a research of a bigger phase two in clinical test.Results: From 21 subjects of this research, the average weight and BMI before and after 3 years of Monoplant® placement is gained, i.e. 53.1 (SD 11,0) kg and 22.4 (SD 4.5) kg/m2, and 54.8 (SD 9.4) kg and 23.1 (SD 3.9) kg/m2. Despite the tendency of increasing, statistically the increasing of weight and BMI, however, is meaningless (p=0.09) and (p=0.08). There is a difference of weight in series of measurement, particularly after the 12th month (Repeated test ANOVA p=0.024). Even though there is no difference in BMI average, there is a difference in subject's proportion based on BMI categories before and after Monoplant® placement (Marginal homogeneity test p=0.046). The increasing of levonorgestrel level occurs in the 6th month and subsequently followed by the increase of BMI in the 12th month.Conclusions: There is a tendency of increasing weight and BMI in Monoplant® users, specifically after one year despite statistically insignificant.Keywords: levonorgestrel, monoplant®, weight, body mass index. AbstrakTujuan: Untuk mengetahui perubahan berat badan dan indeks massa tubuh pada akseptor implan levonorgestrel satu batang (Monoplant®).Metode: Studi deskriptif dengan desain potong lintang mengambil data perubahan BB dan IMT diperoleh dari pengukuran serial yang tercatat dalam rekam medis pasien selama tiga tahun pemasangan Monoplant® di Klinik Raden Saleh, Jakarta. Penelitian ini merupakan bagian dari suatu penelitian uji klinis fase 2 yang lebih besar.Hasil: Dari 21 subjek penelitian ini, didapatkan rerata BB dan IMT sebelum dan setelah 3 tahun pemasangan Monoplant®yakni 53,1 (SB 11,0) kg dan 22,4 (SB 4,5) kg/m2, serta 54,8 (SB 9,4) kg dan 23,1 (SB 3,9) kg/m2. Meskipun ada kecenderungan naik, tetapi secara statistik kenaikan BB dan IMT tersebut tidak bermakna (p=0,09) dan (p=0,08). Terdapat perbedaan berat badan dalam pengukuran serial, terutama setelah bulan ke-12 (Uji repeated ANOVA p=0,024). Walaupun tidak terdapat perbedaan rerata IMT, terdapat perbedaan proporsi subjek berdasarkan kategori IMT sebelum dan setelah pemasangan Monoplant® (Uji Marginal homogeinity p=0,046). Peningkatan kadar levonorgestrel terjadi pada bulan ke-6 yang kemudian diikuti oleh kenaikan IMT pada bulan ke-12.Kesimpulan: Terdapat kecenderungan peningkatan BB dan IMT pengguna Monoplant®, khususnya setelah satu tahunmeskipun secara statistik tidak bermakna.Kata kunci: berat badan, indeks massa tubuh, levonorgestrel, monoplant®

A Red Card for Plagiarism

N/

Profile of Women with Late Menstrual Period

Objective: To know the profile of women with late menstrual period in Raden Saleh Clinic Jakarta in 2008 - 2011. Method: This was a descriptive study with 400 samples from medical records, choosen by random sampling. The data of age, education, occupation, marital status, residence, religion, parity, age of the youngest kid, cause of pregnancy, attempt to abort, referral, reason to end pregnancy, and contraceptive method post menstrual induction were collected. Result: The majority of women who underwent menstrual induction were 18 - 35 years old (57.25%), followed by women aged more than 35 years old (40.5%) and below 18 years old (2.25%). Most women were graduated from middle school (51.25%), unemployed (65.25%), and married (90.8%). They mostly came from Jakarta and satellite cities such as Depok, Bogor, Tangerang, and Bekasi, which accounted for 88% clients. Most of them have two children (32.3%) with the youngest kid aged more than 12 months old (60%). The causes of pregnancy were neglecting to use contraception (87.5%), failure of contraception (12%), and sexual assault (0.5%). As much as 44% of the clients had tried to end the pregnancy before they came to Raden Saleh Clinic and 87.5% of all 400 women came without referral. The most common reason was having had enough children in 74% of the women to end the pregnancy, followed by 12.25% of clients who wanted to pursue higher education. After treated by menstrual induction, 75.8% of them used IUD as contraception. Conclusion: Our data showed that mean age of women who were underwent menstrual induction is 32.94 ± 0.35 years old and the main reason to do menstrual induction in this research is the consideration of having enough children. [Indones J Obstet Gynecol 2013; 37-1: 41-5] Keywords: age, contraception, late menstrual period, menstrual inductio

User Profile and Factors Correlating to Duration of Intrauterine Device Use

Objective: To determine the demographic and clinical profile of intrauterine device (IUD) users and factors correlating to duration of IUD use. Method: We conducted a prospective observational study of 867 patients who underwent IUD insertion in Raden Saleh Outpatient Clinic during the period of January - December 2011. All patients were followed for 1 year to ascertain any complaint of discharge after insertion. Spearman correlation test was conducted to inves- tigate the strength of correlation and significance between age, parity, and discharge, with duration of IUD use. Result: During year 2011, 867 patients (median of age=34 [range=14-49]; median parity=2 [range=0-7]) underwent IUD insertion in Raden Saleh Clinic. The majority of subjects were aged between 31-35 years old and were willing to use IUD for 4 years. Bivariate analysis revealed a significant correlation between age, parity, and vaginal discharge with duration of IUD use. The strongest correlation was identified between age and duration of use (r=0.25, p0.002 for parity and duration of use; r=0.05 p=0.045 for discharge and duration of use). Conclusion: Most IUD users were aged 31-35 years, who were willing to use IUD for 4 years. Factors that correlated with duration of IUD use were age, parity, and vaginal discharge. Keywords: contraceptive, duration of use, family planning, intrauterine devic

The Efficacy of Monoplant® and Indoplant® as Contraceptive Methods: A Comparative Study

Objective: To determine the effectiveness, safety, and time of insertion between Monoplant® with Indoplant® to prevent pregnancy. Methods: Data were collected from November 2015 until May 2016 in Raden Saleh Clinic. A total of 153 patients met the inclusion and exclusion criteria for the study and were divided into 77 patients who received Monoplant® and 76 patients received Indoplant®. The study period was 6 months. Results: The data obtained showed no significant difference in the effectiveness of both contraceptive methods. In addition, side effects such as menstrual disorders and weight gain did not differ significantly in those study groups. However, the time of insertion between Monoplant® and Indoplant® was siginificantly different (162.91 + 197.04 + 49.81 seconds versus 44.96 seconds, p<0.001). For complications such as skin irritation, inflammation, there are no differences between Monoplant® (0.0%) and Indoplant® users (0.0%). Conclusion: There are no significant differences in efficacy and side effects using Monoplant® and Indoplant® during the 6-month follow-up. However, the insertion time of Monoplant® is shorter compared to Indoplant®’s. Monoplant® can be considered for use as contraception with the effectiveness and side effects are almost the same, but with shorter time of insertion compared to Indoplant ®. [Indones J Obstet Gynecol 2017; 5-2: 94-98] Keywords: contraception, implant, indoplant®, monoplant