Peranan Pelatihan Learning Organization pada Perubahan Individu dan Institusi: Pengalaman Kabupaten Cianjur

In order to support local government capacity to implement their role and capacity after the implementation of decentralization policy, The Decentralization Unit of Ministry of Health RI has developed several strategic plans which directed to anticipate decentralization transition, such as learning organization. To objective of this study is to understand the effect of training program on individual and institutional changes in a more strict bureocratic environment. This study is a quasi-experimental study with pre and post intervention study design, several times measurements, and unequally distributed control. The first group receive SLLO training (Xa) and assistance (Xb). The second group is a control group. The study result show that: (1) the LO training is efective to increase knowledge and understanding of the trainees on job perspective, problem solving, self improvement need and distribution to group member (2) The individual level changes include the need to job behavioral improvement, the openness and readiness to record behaviour, more problem analysis, more dialogue and not trapped in surface symptoms, want and need to distribute LO in seminar and training (3) the group and institutional changes has not been seen yet (4) only small effect of individual changes to group level changes, communication needs plenty of time, difficult to conduct dialogue among team members. In sub-district level situation has chenged to a better situation, more effect of individual level cahnges to group level changes, faster communication between group members and easier dialogue

Analisis Demand dan Supply Konsumsi Garam Beryodium Tingkat Rumah Tangga

Nasionaly, the consumption of iodized salt is 62,3% and in Province of West Jawa is 58,3%. The coverage consumption of iodezed in household level in Bekasi city only about 62,14%. The monitoring iodezed salt in household level by district health departemen in 2004 showed that the enough iodezed salt is 51%.This research was conducted to determine the factor analysis of demand and supply of iodized salt consumption at household level in the District of West Bekasi. This iodesed salt udy used cross sectional design. The population that was studied was 110 mothers using chi square test. On the demand factor, the result shows that there is a relationship between knowledge and the consumption of iodized salt at household level. However, there is no relationship between the revenue and the consumption of iodized salt at household level. While in the supply factor, shows that there is no relationship between availability and price in the market and the con- sumption of iodized salt at household level. To improve the coverage of iodized salt consumption at household level, it is required cooperation from various partie

Sumber Daya Manusia dan Manajemen Organisasi dalam Pelaksanaan Upaya Kesehatan Masyarakat di Dua Kecamatan di Jakarta Timur

Latar belakang: Prioritas dan fokus kebijakan kesehatan yang berkembang saat ini makin menunjukkan bahwa program public health adalah sama atau bahkan jauh lebih penting daripada tekanan pengobatan dalam meningkatkan status kesehatan penduduk. Meski pemerintah telah meminta puskesmas dan kelurahan fokus pada pengembangan dan pelaksanaan program-program public health, sedikit studi melaporkan kemampuan organisasi pemerintah yang benar-benar mengerjakan fungsi ini. Penelitian ini mengevaluasi hubungan capaian program public health dan apakah capaian itu didukung oleh ketersediaan sumber daya manusia dan kapasitas implementasi program dari organisasi pemerintah. Metode: Data berasal dari “standar pelayanan minimal” kesehatan masyarakat dan “perilaku hidup bersih dan sehat” (PHB), survei dan wawancara mendalam terhadap 46 responden dari 17 puskesmas dan 14 kelurahan di dua kecamatan - Matraman dan Jatinegara - di Jakarta Timur. Hasil: Penelitian ini menemukan bahwa indikator capaian kesehatan di daerah penelitian di kota besar seperti Jakarta adalah lebih rendah dari capaian rata-rata nasional meskipun memiliki ketersediaan sdm yang memadai. Selain itu, kapasitas administrasi dan manajemen proses implementasi di lapangan tidak seperti yang diharapkan. Simpulan: Studi ini menunjukkan paradoks antara ketersediaan sumber daya dan kapasitas yang lemah dalam kolaborasi lintas sektoral dan dalam manajemen implementasi program. Kami mendiskusikan 3 faktor penting yang harus menjadi perhatian dalam pengembangan dan implementasi upaya public health di Jakarta. Pertama, peran lintas sektoral yang jadi kewenangan dari walikota harus mendapat advokasi yang besar dari masyarakat public health. Kedua, administrator kelurahan memiliki kapasitas manajemen implementasi agar program-program dirasakan oleh penduduk setempat. Ketiga, puskesmas memiliki sdm dengan kemampuan manajerial dan bekerja sama dengan sektor lain yang bekerja fokus untuk upaya kesehatan masyarakat

Adherence in Pulmonary Tuberculosis Patients Based on King's Interacting Systems Theory

Introduction: Indonesia is one of largest contributor countries to pulmonary TB cases in the world. One of the factors that cause it is no adherence in the treatment. It is necessary to develop a model in order to improving compliance in patient. For an initial step, it is necessary to explore patient's adherence that based on King's interacting systems theory. The objective of this study was to explore the patients experience that cause them obedient the treatment based on King's interacting systems theory. Method: This research was a qualitative research with descriptive explorative approach. The samples were selected through purposive sampling method. Participants in this study were 8 patients who met the inclusion criteria. In this study, participants were pulmonary TB patients who have undergone treatment for 5-6 months. Results: There were 12 themes in patients compliance based on King's interacting systems theory; (1) true perception of pulmonary tuberculosis, (2) self-awareness, (3) optimal growth and development, (4) positive self-image, (5) a healthy environment, (6) discipline to take medication, (7) effective coping, (8) open communication with the patient's health workers and family, (9) to perform its role optimally, (10) balancing stress during illness, (11) knowing the health care bureaucracy and (12) able to take decisions. Discussion: The 12 themes describe that adherent patients have interaction systems that were personal systems, interpersonal systems and social systems

Cost-Effectiveness Analysis of CPOE in Hospital Setting: A Systematic Review

Background: Medication administration process is subject to error. In many cases it can lead to adverse drugs events (ADEs). An implication of ADEs is increased cost due to extended length of stay. Based on several studies, the use of computerized physicians order entry (CPOE) system can reduce the incident of ADEs in hospital which can indirectly reduce the ADEs related cost. A way to examine the efficiency of cost is to observe the number of cost incurred due to the effects of error that occur. This study aimed to systematically review articles related to the cost-effectiveness analysis of CPOE in hospital setting. Subjects and Method: This was a systematic review study using online databases, such as PubMed, Embase, and other sources. The main theme of this study was costs related CPOE implementation. The inclusion criteria were studies cost savings from the effects of ADEs and cost effectiveness related to the use of a computerized system on the CPOE. The exclusion criteria were studies with descriptive analysis and studies without reporting on CPOE and cost effectiveness. This data were collected and analyzed with PRISMA flow diagram. Results: A total of 11 studies met the inclusion criteria. Ten studies obtained cost efficiency due to the use of computerized system. The decrease in cost were incurred as a result of the decrease in the incidence of EDAs converted into annual cost. Comparison of cost reduction was done by comparing cost incurred when using a CPOE system with a paper-based system. However, there was a study conveyed ineffectiveness in small size hospital and located at rural area, because the cost was higher than the revenue obtained. Conclusions: CPOE is proven to be cost-effective in lowering the hospital costs incurred owing to the ADEs. Keywords: cost-effectiveness, cost analysis, CPOE, ADEs, medication administration process, hospital

Patient Centered Care Model to Improve the Quality and Safety of Patient Care in Hospital: A Systematic Review

Background: Patient Centered Care (PCC) is a health care system focused on pa­ti­ents. This system places patients as subjects in each care provided. This study aimed to systematically review the PCC model to improve the quality and safe­ty of patient care in hospital. Subjects and Method: This was a systematic review conducted by searching articles in the period of 2010 to 2018, using PubMed, Google Scholar, and Scopus databases. The keywords were “Patient Centered Care”, “quality”, and “patient safety”. The arti­cles were reviewed by using PRISMA flow diagram. Results: Seven studies reported that PCC was carried out in the attitudes of respecting the dignity of patients and families; maintaining safety and comfort; allowing active fa­mi­ly participation; providing information, communication, and education; providing the best services; and benefiting team collaboration. The core concept of PCC to treat patients as a unique individual, res­pec­t­ing their value ​​and belief, and responding fle­xi­bly to patient’s need and choice. The PCC approach was proven to improve patient sta­tus through improved communication, to foster a positive cli­mate, and to encourage in­teraction between patients and service providers. Interaction was car­ried out on an ongoing basis that might improve communication so as to avoid unexpected things. Conclusion: Patient Centered Care (PCC) increases the outcomes of health services and minimizes unexpected things. Keywords: patient centered care, quality, and patient safet

The Effect of Referral and Treatment of Severe Preeclampsia on Maternal Death at Sultan Imanudin General Hospital Pangkalan Bun, Central Kalimantan

Background: Severe preeclampsia is an obstetric emergency, requiring a rapid app­ro­priate re­ferral and treatment. Emergency obstetrics are still facing three phenomena belated recog­ni­zing and deciding. Preeclamsia is also often belated reaching a reference place, and belated getting and adequate treatment. This study aimed to determine the effect of referral and treatment of severe preeclampsia on maternal death at Sultan Imanudin General Hospital Pangkalan Bun, Central Kalimantan. Subjects and Method: This was retrospective cohort study conducted at Sultan Ima­nudin Hospital, Pangkalan Bun, Central Kalimantan, from January to December 2017. A sample 0f 94 pregnant women with preeclamsia was selected for this study by purposive sampling. The dependent variable was maternal death. The independent va­ri­ables were referring, early treat­ment, referral travel time, operating room response time, delivery room, delivery time, and delivery, emergency response time, MgSO4, and Nifedipine. The data was obtained from medical records and analyzed by multiple lo­gistic regression. Results: The risk of maternal death increased with complicated delivery (OR=27.66; 95%CI = 3.71 to 206.26; p= 0.001), incompetent referal (OR= 21.80; 95%CI= 2.70 to 175.60; p= 0.004), and late treatment (OR=13.62; 95%CI= 2.25 to 82.45; p= 0.004), long referral travel time (OR= 9.99; 95% CI= 1.76 to 56.75; p= 0.009), long operating room response time (OR=0.05; 95%CI <0.01 to 0.56; p= 0.014), and long delivery room response time (OR=9.80; 95% CI=1.56 to 61.51; p= 0.015). Conclusion: The risk of maternal death increases with complicated delivery, incompetent re­feral, late treatment, long referral travel time, long operating room response time, and long de­livery room response time. Keywords: maternal death, severe preeclamsia, complicated delivery, late treatment