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Indah Sri Wahyuni; Promotor: Tris Eryando; Kopromotor: Martya Rahmaniati Makful, Meiwita Paulina Budiharsana; Penguji: Besral, Kemal Nazaruddin Siregar, Popy Yuniar, Wendy Hartanto, Harimat Hendarwan
Abstrak:
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Pemanfaatan pelayanan kesehatan dalam persalinan sangat penting karena proses persalinan merupakan fase krusial dalam kehidupan ibu dan anak. Persalinan ditolong oleh tenaga kesehatan terlatih di fasyankes merupakan salah satu intervensi kunci dan terbukti untuk mengurangi 16-33% kematian ibu. Di Indonesia, cakupan pemanfaatan persalinan di fasyankes berdasarkan SKI 2023 sebesar 89.9% namun cakupan tersebut belum mencapai target dari renstra kemenkes 2020-2024 sebesar 95%. Data riskesdas 2013, 2018 dan SKI 2023 menunjukkan adanya variasi dalam cakupan persalinan di fasyankes antar kabupaten/kota di Pulau Jawa sehingga mencerminkan adanya disparitas wilayah. Tujuan penelitian ini mengetahui model spasial pemanfaatan persalinan di fasyankes untuk setiap kabupaten/kota di Pulau Jawa, Indonesia. Studi ekologi dilakukan pada 118 kabupeten/kota di Pulau Jawa tahun 2023. Data berbentuk agregat dan bersumber dari publikasi SKI 2023, data sebaran tenaga medis dan tenaga kesehatan, buku publikasi BPS dan profil kesehatan masing-masing provinsi di Pulau Jawa. Analisis data menggunakan Spatial Error Model (SEM) dan Geographically Weighted Regression (GWR). Hasil penelitian menunjukkan terdapat autokorelasi spasial positif dan membentuk pola pengelompokan spasial. Hasil SEM menunjukkan adanya dependensi spasial yang signifikan dan mampu menjelaskan 77,78% variasi antarwilayah dan membentuk pola residual yang mengelompok. Pada Model GWR mampu menjelaskan 87,28% variasi spasial pemanfaatan persalinan melalui kombinasi variabel independen. Hasil model menunjukkan bahwa determinan yang memengaruhi pemanfaatan persalinan di fasyankes yaitu penolong persalinan, kepemilikan jaminan kesehatan, penduduk miskin, kunjungan ANC, pendidikan ibu, rasio dokter dan rasio PKM memiliki pengaruh yang bervariasi secara spasial antar kab/kota. Variabel-variabel tersebut memiliki kekuatan pengaruh yang berbeda antar kab/kota di Pulau Jawa. Dari hasil penelitian ini diharapkan dapat menjadi bahan perencanaan bagi program kesehatan ibu yang lebih terarah khususnya dalam penetapan wilayah prioritas intervensi di Pulau Jawa.
The utilization of healthcare services during delivery is essential, because process is a crucial phase in the lives of both mother and child. Delivery assisted by skilled birth attendant in healthcare facilities is a key intervention proven to reduce maternal mortality by 16–33%. In Indonesia, the coverage of healthcare facility delivery based on the 2023 Indonesian Health Survey (SKI) is 89.9%; however, this has not yet reached the 95% target set by the Ministry of Health's 2020–2024 strategic plan. Data from Riskesdas 2013, 2018, and SKI 2023 indicate variations in facility-based delivery coverage across regencies/cities on Java Island, reflecting regional disparities. This study aims to determine the spatial model of healthcare facility delivery utilization for each regency/city on Java Island, Indonesia. An ecological study was conducted across 118 regencies/cities in Java in 2023. Aggregate data were sourced from the 2023 SKI publications, medical and health personnel distribution data, BPS (Statistics Indonesia) publications, and health profiles from each province in Java. Data were analyzed using the Spatial Error Model (SEM) and Geographically Weighted Regression (GWR).The results indicate a positive spatial autocorrelation, forming a spatial clustering pattern. The SEM results show significant spatial dependency, explaining 77,78% of the inter-regional variation and forming clustered residual patterns. The GWR model was able to explain 87,28% of the spatial variation in delivery utilization through a combination of independent variables. The model results demonstrate that determinants affecting healthcare facility delivery utilization namely skilled birth attendants, health insurance ownership, poverty levels, ANC (Antenatal Care) visits, maternal education, physician ratios, and community health center ratios have spatially varying influences across regencies/cities. These variables exhibit different levels of influence across different regions in Java. The findings of this study are expected to serve as a planning resource for more targeted maternal health programs, particularly in identifying priority areas for intervention on Java Island.
D-607
Depok : FKM-UI, 2026
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
☉
Martya Rahmaniati Makful; Promotor: Sudijanto Kamso; Kopromotor: Tris Eryando, Purnawan Junadi, Ratna Djuwita, Purwantyastuti, Raldi H. Koestoer, Artha Budi Duarsa, Suwarta Kosen
Abstrak:
Tuberkulosis masih merupakan masalah kesehatan masyarakat yang utama di dunia, termasuk di Indonesia. Menemukan dan menyembuhkan pasien merupakan cara terbaik dalam upaya pencegahan penularan TB, dengan menerapkan strategi DOTS. Sejalan dengan kebijakan pembangunan nasional, pelaksanaan strategi pengendalian TB nasional diprioritaskan pada daerah terpencil, perbatasan dan kepulauan terutama yang belum memenuhi target penemuan kasus dan keberhasilan pengobatan. Terdapat lima provinsi dengan TB paru tertinggi dan dua tertinggi yaitu Provinsi Jawa Barat (0.7%), Papua (0.6%). Akses pelayanan kesehatan pasien TB menunjukan ketidakmerataan, dimana hanya ada di wilayah perkotaan dan berada pada ekonomi tinggi. Permasalahan dalam penelitian ini adalah masih ditemukan pasien TB yang tidak mendapatkan akses pelayanan kesehatan. Keterbatasan akses pelayanan kesehatan pasien TB dapat disebabkan oleh kondisi individu yang berbeda-beda serta adanya perbedaan kondisi fisik (geografis). Tujuan penelitian ini adalah mendapatkan model spasial akses pelayanan kesehatan di provinsi Jawa Barat dan Papua. Penelitian ini menggunakan desain potong lintang dan menggunakan data yang berasal dari Riset Kesehatan Dasar 2013. Lokasi penelitian di 2 provinsi yaitu di provinsi Jawa Barat dan provinsi Papua. Analisis penelitian dengan menggunakan regresi logistik untuk melihat pengaruh karakteristik individu terhadap akses pelayanan kesehatan dan analisis spasial statistik menggunakan Geographically Weighted Regression (GWR) untuk melihat spasial akses pelayanan kesehatan. Akses pelayanan kesehatan adalah pasien TB yang melakukan pemeriksaan dahak, foto rontgen dan mendapatkan obat anti TB. Akses pelayanan kesehatan pasien TB di provinsi Papua masih rendah. Karakteristik individu yang mempengaruhi akses pelayanan kesehatan adalah asuransi kesehatan, pekerjaan, menikah, mengetahui ketersediaan fasilitas kesehatan. Model spasial akses pelayanan kesehatan menghasilkan dua jenis variabel pembentuknya, yaitu adanya variabel lokal dan variabel global. Variabel lokal adalah variabel yang mempunyai pengaruh unsur kewilayahannya terhadap akses pelayanan kesehatan, sedangkan variabel global merupakan variabel yang berpengaruh di tingkat provinsi. Masih rendahnya pasien TB yang melakukan akses pelayanan dapat disebabkan oleh sulitnya pasien TB dalam mencapai fasilitas kesehatan, terutama di wilayah dengan perbedaan geografis. Sehingga perlunya ada kebijakan dalam menyiapkan sarana dan prasarana kesehatan pasien TB, yaitu dengan mulai memasukan tenaga kesehatan terlatih di bidang tuberkulosis pada seluruh fasilitas pelayanan kesehatan.
Tuberculosis is a major public health problem in the world, including in Indonesia. Finding and curing the patients are the best way of preventing transmission of TB by implementing the DOTS strategy. Implementation of the national TB control strategy prioritized in remote, border and island especially TB patients who do not meet the target case detection and treatment success. There are two of provinces with the highest and second highest TB namely west Java province (0.7%) and Papua (0.6%). Accessibility to health services of TB patients showed inequality, which only exist in urban areas and at high economic status. The problem in this research is find the of TB patients who do not get accessibility to health services. Limited accessibility to health services of TB patients could be caused by conditions different individuals as well as differences in physical conditions (geographic). The purpose of this study is to setup a spatial model of accessibility to health services in the province of West Java and Papua. This study used a cross-sectional design and data derived from the Basic Health Research in 2013 (RISKESDAS). Research sites in the provinces of West Java and Papua. Research analysis applied logistic regression to determine the effect of individual characteristics of accessibility to health services and statistical spatial analysis using the Geographically Weighted Regression (GWR) for a model of spatial accessibility to health services. Accessibility to health care is the patient of TB sputum examination, x-rays and getting anti-TB. Accessibility to health services of TB patients in the province of Papua remains low. Individual characteristics that affect accessibility to health care are health insurance, employment, marriage, the availability of health facilities. Spatial models of accessibility to health services generate two types of constituent variables, the local variables and global variables. Local variables are variables that influence the spatial element of accessibility to health services, while global variables are variables that influence at the provincial level. The low TB patients who do accessibility services may be caused by the difficulty in the of TB patients to health facilities, especially in the areas with geographical differences. Thus the need for a policy in preparing health facilities TB patients, i.e. to start entering trained health personnel in the field of tuberculosis in the entire health care facility.
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Tuberculosis is a major public health problem in the world, including in Indonesia. Finding and curing the patients are the best way of preventing transmission of TB by implementing the DOTS strategy. Implementation of the national TB control strategy prioritized in remote, border and island especially TB patients who do not meet the target case detection and treatment success. There are two of provinces with the highest and second highest TB namely west Java province (0.7%) and Papua (0.6%). Accessibility to health services of TB patients showed inequality, which only exist in urban areas and at high economic status. The problem in this research is find the of TB patients who do not get accessibility to health services. Limited accessibility to health services of TB patients could be caused by conditions different individuals as well as differences in physical conditions (geographic). The purpose of this study is to setup a spatial model of accessibility to health services in the province of West Java and Papua.
D-389
Depok : FKM-UI, 2018
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
☉
Eko Setyo Pambudi; Promotor: Budi Utomo; Ko promotor: Budi Hidayat, Endang L Achadi; Penguji: Anhari Achadi, Soewarta Kosen, Prastuti Soewondo, Mardiati Nadjib
D-307
Depok : FKM-UI, 2015
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
☉
Machrumnizar; Promotor: Tris Eryando; Kopromotor: Adang Bachtiar, Rina Kurniasri Kusumaratna; Penguji: Anhari Achadi, Dumilah Ayuningtyas, Nastiti Kaswandani, Maxi Rein Rondonuwu, Dedy Sugiarto
Abstrak:
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Tuberkulosis (TB) tetap menjadi masalah kesehatan utama di Indonesia dengan angka kejadian yang tinggi, termasuk pada anak-anak yang berkontribusi sekitar 16,68% dari total kasus TB nasional. Untuk mencapai target eliminasi TB pada tahun 2030, salah satu upaya strategis adalah optimalisasi deteksi dini melalui pemanfaatan teknologi digital dalam proses skrining dan diagnosis. Penelitian ini bertujuan mengembangkan model skrining TB anak berbasis machine learning dengan sistem skoring otomatis guna meningkatkan cakupan deteksi dan notifikasi kasus secara lebih efisien. Penelitian menggunakan pendekatan kuantitatif dengan rancangan kohort retrospektif dan dilaksanakan pada April–Agustus 2025 di delapan Puskesmas Kecamatan di wilayah Jakarta Barat. Data penelitian diperoleh dari rekam medis elektronik (RME) puskesmas dan database sistem informasi tuberkulosis (SITB) tahun 2023–2024. Model dikembangkan melalui empat skenario menggunakan lima algoritma, yaitu Logistic Regression, Decision Tree, Random Forest, K-Nearest Neighbor, dan Support Vector Machine. Evaluasi kinerja model dilakukan menggunakan cross-validation k-fold = 5 dengan metrik akurasi, sensitivitas, spesifisitas, dan Area Under the Receiver Operating Characteristic (AUROC). Hasil penelitian menunjukkan bahwa variabel dengan kontribusi prediktif terbesar meliputi pembesaran kelenjar, malaise ≥ dua minggu, penurunan atau stagnasi berat badan dua bulan terakhir, status gizi, dan riwayat kontak TB. Berdasarkan variabel tersebut, Decision Tree menjadi algoritma dengan performa terbaik karena menghasilkan nilai AUROC > 0,90. Nilai AUROC yang sangat tinggi (mendekati 1) menunjukkan bahwa kedua model memiliki kemampuan yang sangat baik dalam membedakan pasien anak dengan TB positif dan negatif berdasarkan skoring, serta sesuai untuk karakteristik data yang bersifat non-linear dengan interaksi antar gejala. Prototype aplikasi berbasis web yang dikembangkan mampu memberikan estimasi risiko secara cepat dan interaktif, sehingga berpotensi mendukung skrining TB anak di fasilitas layanan primer.
Tuberculosis (TB) remains a major public health challenge in Indonesia, with a high incidence rate, including among children who account for approximately 16.68% of all national TB cases. To achieve the 2030 TB elimination target, optimizing early detection through the use of digital technologies in screening and diagnosis is a key strategic approach. This study aims to develop a machine learning–based pediatric TB screening model equipped with an automated scoring system to enhance the efficiency of case detection and notification. A quantitative approach with a retrospective cohort design was employed, conducted from April to August 2025 across eight sub-district primary health centers (Puskesmas) in West Jakarta. Data were obtained from electronic medical records (RME) and the tuberculosis information database system (SITB) database for the years 2023–2024. The model was developed under four scenarios using five algorithms: Logistic Regression, Decision Tree, Random Forest, K-Nearest Neighbor, and Support Vector Machine. Model performance was evaluated using 5-fold cross-validation with accuracy, sensitivity, specificity, and Area Under the Receiver Operating Characteristic (AUROC) as the evaluation metrics. The findings indicate that the variables with the strongest predictive contributions include lymph node enlargement, malaise lasting ≥ two weeks, weight loss or stagnation over the past two months, nutritional status, and TB contact history. Based on these variables, Decision Tree demonstrated the best performance, achieving AUROC values > 0.90. Such high AUROC values (approaching 1) suggest excellent discriminatory ability in distinguishing TB-positive from TB-negative pediatric patients, particularly given the non-linear patterns and interactions among clinical symptoms. A prototype web-based application was developed and demonstrated the ability to generate rapid and interactive risk estimations. This tool shows strong potential to support pediatric TB screening efforts in primary healthcare settings.
D-615
Depok : FKM-UI, 2026
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
☉
Ratu Dini Nurasih; Pembimbing: Sabarinah Prasetyo; Penguji: Martya Rahmaniati, Wahyuni Khaulah
Abstrak:
Angka Kematian Ibu di Indonesia masih tinggi. Salah satu penyebabnya yaitu persalinan yang tidak dilakukan di fasilitas kesehatan. Penelitian ini bertujuan untuk mengetahui faktor yang berhubungan dengan persalinan pada non fasilitas kesehatan di Indonesia tahun 2013. Data yang digunakan yaitu data Riset Kesehatan Dasar (Riskesdas) 2013 pada 42.587 wanita usia subur yang melahirkan terakhir kali pada kurun waktu 3 tahun terakhir. Analisis data menggunakan uji Chi Square, Chi Square Mantel Haenzel dan regresi logistik. Hasil menunjukkan peningkatan risiko persalinan di non fasilitas kesehatan pada responden berumur muda, paritas tinggi, pendidikan rendah, status ekonomi terbawah, tinggal di perdesaan. Ada hubungan antara tempat persalinan dengan waktu tempuh, jaminan kesehatan, perencanaan kehamilan, tempat ANC, frekuensi ANC, trimester mulai ANC dan pelayanan ANC. Perlu peningkatan komunikasi, informasi, dan edukasi mengenai perencanaan persalinan yang aman di fasilitas kesehatan.
Kata kunci: persalinan, fasilitas kesehatan, Riskesdas
Maternal mortality rate in Indonesia is still high. Non facility based delivery is known as one of the linked factor. This study aims to show factors associated with non facility based delivery in Indonesia 2013. The data used is from the Riset Kesehatan Dasar (Riskesdas) 2013, there are 42.587 women age 15-49 who gave birth to her latest pregnancy in the 3 years preceding the survey. The data was analysed using Chi Square, Chi Square Mantel Haenzel and logistic regression model. Result shows higher risk of giving birth at non healthcare facilities when mother is younger, have higher parity, lower education, at the lowest quintile of economic status, lives in the rural area. There is association between the place of delivery with time needed to reach facilities, health insurance, pregnancy planning, place of antenatal care, frequency of antenatal care, trimester of first antenatal care visit and the antenatal care services. Communication, information and education about safer delivery planning in healthcare facilities are greatly needed.
Keywords: delivery, healthcare facilities, Riskesdas
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Kata kunci: persalinan, fasilitas kesehatan, Riskesdas
Maternal mortality rate in Indonesia is still high. Non facility based delivery is known as one of the linked factor. This study aims to show factors associated with non facility based delivery in Indonesia 2013. The data used is from the Riset Kesehatan Dasar (Riskesdas) 2013, there are 42.587 women age 15-49 who gave birth to her latest pregnancy in the 3 years preceding the survey. The data was analysed using Chi Square, Chi Square Mantel Haenzel and logistic regression model. Result shows higher risk of giving birth at non healthcare facilities when mother is younger, have higher parity, lower education, at the lowest quintile of economic status, lives in the rural area. There is association between the place of delivery with time needed to reach facilities, health insurance, pregnancy planning, place of antenatal care, frequency of antenatal care, trimester of first antenatal care visit and the antenatal care services. Communication, information and education about safer delivery planning in healthcare facilities are greatly needed.
Keywords: delivery, healthcare facilities, Riskesdas
S-8635
Depok : FKM UI, 2015
S1 - Skripsi Pusat Informasi Kesehatan Masyarakat
☉
Fery Rahman; Promotor: Amal Chalik Sjaaf; Kopromotor: Purnawan Junadi, Budi Wiweko; Penguji: Anhari Achadi, Ahmad Syafiq, Sutanto, Trihono, Zulfikar As'ad
Abstrak:
Current world developments have entered industrial revolution 4.0, which is a phenomenon where collaboration occurs between cyber technology and automation technology. This opens up opportunities for medical practitioners and the public to carry out health consultations, medical practice diagnoses in virtual space, without reducing the essence of health services commonly known as Telemedicine. Some of the benefits of Telemedicine in services are effectiveness and efficiency in health services without geographical distance restrictions, patients can also save time and travel costs, as well as increase access to health services. Telemedicine is also used by fellow health practitioners to get advice or further treatment plans for a patient. The most obvious use during the COVID-19 pandemic is being able to provide health services remotely because it reduces exposure to the SARS-CoV-2 virus. With obvious benefits especially in terms of accessibility and convenience, telemedicine also raises problems related to implementation, data security and patient satisfaction. Many countries have not developed a comprehensive regulatory framework, which also hinders the adoption of telemedicine in the health care system. In Indonesia, Minister of Health regulation no. 20/2019 is still considered general, but does not address comprehensive issues such as legal risks, unclear financing schemes, other policies for the continuation of effective, widespread and ethical telemedicine. The aim of this research is to analyze the telemedicine service model at the Nahdlatul Ulama network of hospitals. The research design used is descriptive qualitative with a descriptive interpretive approach. This qualitative research used in-depth interview methods with 14 leaders of NU network hospitals, implementing doctors, leaders of the Association which oversees all members of NU Hospitals and the Head of the Health Service. The information obtained is used for comprehensive analysis to obtain determinant factors that influence the implementation of telemedicine services in hospitals. The telemedicine service model at NU network hospitals is telemedicine in the form of teleconsultation and teleradiology with the basis used being WhatsApp / hospital hotline, personal cell phone and additional applications such as zoom meetings and google-meeting. Factors that influence this service include the creation of SOPs by hospital leaders, adequate internet infrastructure (> 200 Mbps), the existence of an Electronic Medical Record (EMR) that is integrated with telemedicine services, telemedicine literacy and competency of health workers, market share mapping is also needed. community needs and adequate and appropriate payment for medical services, so as not to cause resistance from health workers. Meanwhile, for the determination of units that provide guidance and supervision, there needs to be uniformity based on applicable regulations
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Penelitian ini adalah penelitian kualitatif dengan desain deskriptif. Hasil penelitian menyarankan bahwa perpustakaan perlu dilibatkan dalam pengembangan kurikulum; materi pendidikan pemakai perpustakaan harus dikembangkan sesuai dengan komponen-komponen yang ada dalam information literacy; perpustakaan juga harus menyediakan sarana dan fasilitas yang mendukungpeningkatan literacy mahasiswa. Perkembangan dunia saat ini sudah memasuki revolusi industri 4.0 yang merupakan fenomena dimana terjadinya kolaborasi antara teknologi siber dengan teknologi otomatisasi. Hal ini membuka peluang bagi praktisi kedokteran dan masyarakat untuk melakukan konsultasi kesehatan, diagnosa praktik kedokteran dalam ruang virtual, tanpa mengurangi esensi pelayanan kesehatan yang biasa dikenal dengan Telemedisin. Beberapa manfaat Telemedisin dalam pelayanan yaitu efektifitas dan efisiensi dalam Pelayanan kesehatan tanpa batasan jarak geografis, pasien juga dapat menghemat waktu dan ongkos biaya perjalanan, serta meningkatkan akses ke Pelayanan kesehatan. Telemedisin juga dimanfaatkan oleh sesama praktisi kesehatan dalam mendapatkan saran atau rencana pengobatan lanjutan bagi seorang pasien. Pemanfaatan selama pandemik COVID-19 dirasakan paling nyata yakni mampu menyediakan pelayanan kesehatan dari jarak jauh karena mengurangi paparan virus SARS-CoV-2. Dengan manfaat yang nyata terutama dalam hal aksesibilitas dan kenyamanan, Telemedisin juga menimbulkan permasalahan terkait implementasi, keamanan data, dan kepuasan pasien. Banyak negara belum mengembangkan kerangka peraturan yang menyeluruh, hal ini juga yang menghambat adopsi Telemedisin dalam sistem pelayanan kesehatan. Di Indonesia, peraturan Permenkes No. 20/2019 masih dianggap umum, namun tidak menjawab persoalan menyeluruh seperti adanya resiko hukum, ketidakjelasan skema pembiayaan, kebijakan lain untuk keberlangsungan Telemedisin yang efektif, luas dan etis. Tujuan penelitian ini menganalisis model pelayanan Telemedisin di Rumah Sakit jejaring Nahdlatul Ulama. Desain penelitian yang digunakan adalah deskriptif kualitatif dengan pendekatan Interpretatif Deskriptif. Penelitian kualitatif ini menggunakan metode wawancara mendalam dari 14 pimpinan rumah sakit jejaring NU, Dokter pelaksana, pimpinan Asosiasi yang menaungi seluruh anggota RS NU serta Kepala Dinas Kesehatan. Informasi-informasi yang diperoleh digunakan untuk dianalisis secara komprehensif guna mendapatkan faktor-faktor determinan yang mempengaruhi penerapan layanan Telemedisin di RS. Model layanan Telemedisin pada RS – RS jejaring NU didapatkan jenis Telemedisin berupa telekonsultasi dan teleradiologi dengan basis yang digunakan adalah WhatsApp / hotline RS, Ponsel pribadi serta aplikasi tambahan seperti zoom meeting dan google-meeting. Faktor yang mempengaruhi layanan ini antara lain adanya pembuatan SOP oleh pimpinan RS, Infrastruktur internet yang memadai (> 200 Mbps), Adanya Rekam Medis Elektronik (RME) yang terintegrasi dengan layanan Telemedisin, literasi Telemedisin dan kompetensi tenaga kesehatan, Diperlukan juga pemetaan pangsa pasar / kebutuhan masyarakat serta Pembayaran jasa medis yang layak dan berkesesuaian, sehingga tidak menimbulkan resistensi dari kalangan tenaga kesehatan. Sedangkan untuk penetapan unit yang memberikan pembinaan dan pengawasan (binwas) perlu ada keseragaman berdasarkan peraturan yang berlaku
Current world developments have entered industrial revolution 4.0, which is a phenomenon where collaboration occurs between cyber technology and automation technology. This opens up opportunities for medical practitioners and the public to carry out health consultations, medical practice diagnoses in virtual space, without reducing the essence of health services commonly known as Telemedicine. Some of the benefits of Telemedicine in services are effectiveness and efficiency in health services without geographical distance restrictions, patients can also save time and travel costs, as well as increase access to health services. Telemedicine is also used by fellow health practitioners to get advice or further treatment plans for a patient. The most obvious use during the COVID-19 pandemic is being able to provide health services remotely because it reduces exposure to the SARS-CoV-2 virus. With obvious benefits especially in terms of accessibility and convenience, telemedicine also raises problems related to implementation, data security and patient satisfaction. Many countries have not developed a comprehensive regulatory framework, which also hinders the adoption of telemedicine in the health care system. In Indonesia, Minister of Health regulation no. 20/2019 is still considered general, but does not address comprehensive issues such as legal risks, unclear financing schemes, other policies for the continuation of effective, widespread and ethical telemedicine. The aim of this research is to analyze the telemedicine service model at the Nahdlatul Ulama network of hospitals. The research design used is descriptive qualitative with a descriptive interpretive approach. This qualitative research used in-depth interview methods with 14 leaders of NU network hospitals, implementing doctors, leaders of the Association which oversees all members of NU Hospitals and the Head of the Health Service. The information obtained is used for comprehensive analysis to obtain determinant factors that influence the implementation of telemedicine services in hospitals. The telemedicine service model at NU network hospitals is telemedicine in the form of teleconsultation and teleradiology with the basis used being WhatsApp / hospital hotline, personal cell phone and additional applications such as zoom meetings and google-meeting. Factors that influence this service include the creation of SOPs by hospital leaders, adequate internet infrastructure (> 200 Mbps), the existence of an Electronic Medical Record (EMR) that is integrated with telemedicine services, telemedicine literacy and competency of health workers, market share mapping is also needed. community needs and adequate and appropriate payment for medical services, so as not to cause resistance from health workers. Meanwhile, for the determination of units that provide guidance and supervision, there needs to be uniformity based on applicable regulations
D-540
Depok : FKM UI, 2024
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
☉
Musafah; Promotor: Tris Eryando; Kopromotor: Martya Rahmaniati Makful, Meiwita Paulina Budiharsana; Penguji: Besral, Kemal Nazaruddin Siregar, Wendy Hartanto, Sudibyo Alimoeso
Abstrak:
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Unmet need KB di Indonesia belum mencapai target khususnya di Pulau Kalimantan. Penurunan unmet need KB dapat mencegah kematian ibu. Adanya desentralisasi menuntut pemerintah daerah membuat kebijakan kesehatan seperti program KB. Analisis spatio-temporal dibutuhkan untuk menyelidiki unmet need KB yang berguna untuk memantau program KB. Tujuan penelitian ini adalah mengetahui pola spasial dan faktor-faktor yang mempengaruhi unmet need KB tahun 2018-2021 di tingkat Kabupaten/Kota di Pulau Kalimantan, Indonesia. Studi ekologi dilakukan pada 56 Kabupaten/kota di Pulau Kalimantan pada tahun 2018-2021. Data berbentuk agregat dan bersumber dari Laporan Pengendalian dan Pelayanan Kontrasepsi BKKBN, Buku Publikasi Badan Pusat Statistik (BPS) dan Website Dewan Jaminan Sosial Sistem Informasi Terpadu. Analisis data dengan menggunakan Geographically Temporal Weighted Regression. Hasil penelitian menunjukkan Bulungan, Malinau, Nunukan, Tana Tidung, Kota Tarakan, Bontang, Kutai Kartanegara, dan Kutai Timur konsisten berada pada klaster I (High-high) pada tahun 2018-2021. Pemodelan unmet need KB yang didapatkan pada tingkat Kabupaten/kota di Pulau Kalimantan selama 2018-2021 adalah kemiskinan, pendapatan, non cakupan JKN, rasio praktik bidan mandiri, rasio faskes KB pemerintah, rasio faskes KB swasta, rasio penyuluh KB dengan nilai adjusted R square sebesar 46,06%. Kemiskinan berpengaruh dalam meningkatkan unmet need KB di 43 Kabupaten/Kota (76,8%) di Pulau Kalimantan, Indonesia selama 2018-2021. Non cakupan JKN berpengaruh dalam meningkatkan unmet need KB di 35 Kabupaten/kota (62,5%) di Pulau Kalimantan, Indonesia selama 2018-2021. Rasio praktik bidan mandiri, rasio faskes KB pemerintah dan rasio faskes KB swasta berpengaruh terhadap unmet need KB tetapi belum dapat menurunkan unmet need KB di Pulau Kalimantan, Indonesia selama 2018-2021. Rasio penyuluh KB berpengaruh dalam menurunkan unmet need KB di 22 Kabupaten/kota (39,3%) di Pulau Kalimantan, Indonesia selama 2018-2021. Berdasarkan hasil penelitian tersebut direkomendasikan kepada SKPD-KB di Kabupaten/kota untuk memprioritaskan program KB pada penduduk miskin dalam menurunkan unmet need KB dengan mendekatkan program KB seperti pelayanan KB dan penyuluhan KB khususnya pada Kabupaten/kota yang konsisten tergolong kemiskinan tertinggi selama 2018-2021, yaitu Kapuas Hulu, Melawi, Kayong Utara, Paser, Kutai Barat, Kutai Timur, Mahakam Ulu dan Bulungan.
Unmet need for family planning in Indonesia has not yet reached the target, especially on the island of Kalimantan. Reducing the unmet need for family planning can prevent maternal deaths. Decentralization requires local governments to create health policies such as family planning programs. Spatio-temporal analysis is needed to investigate unmet need for family planning which is useful for monitoring family planning programs. The aim of this research is to determine the spatial patterns and factors that influence the unmet need for family planning in 2018-2021 at the district/city level on the island of Kalimantan, Indonesia. Ecological studies were carried out in 56 districts/cities on Kalimantan Island in 2018-2021. Aggregate data is used and comes from the BKKBN Contraception Control and Services Report, the Central Statistics Agency (BPS) Publication Book and the Social Security Council's Integrated Information System Website. Data analysis using Geographically Temporal Weighted Regression. Poverty has an influence in increasing the unmet need for family planning in 43 districts/cities (76.8%) on Kalimantan Island, Indonesia during 2018-2021. Non-coverage of JKN has an influence in increasing the unmet need for family planning in 35 regencies/cities (62.5%) on Kalimantan Island, Indonesia during 2018-2021. The ratio of independent midwife practices, the ratio of government family planning health facilities and the ratio of private family planning health facilities have an influence on the unmet need for family planning but have not been able to reduce the unmet need for family planning on the island of Kalimantan, Indonesia during 2018-2021. The ratio of family planning instructors has an influence in reducing the unmet need for family planning in 22 districts/cities (39.3%) on Kalimantan Island, Indonesia during 2018-2021. Based on the results, it is recommended for SKPD-KB in districts/cities to prioritize family planning programs for the poor in reducing the unmet need for family planning by bringing family planning programs closer together such as family planning services and family planning counseling, especially in districts/cities which consistently have the highest poverty level during 2018-2021 namely Kapuas Hulu, Melawi, North Kayong, Paser, West Kutai, East Kutai, Mahakam Ulu and Bulungan.
D-510
Depok : FKM-UI, 2024
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
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Efriza; Promotor: Meiwita P. Budiharsana; Ko Promotor: Tris Eryando; Penguji: Sabarinah B. Prasetyo, Muhammad Nur Aidi, Dewi Susanna, Martya Rahmaniati Makful, Nana Mulyana, Harimat Hendarwan
Abstrak:
Demam berdarah dengue (DBD) disebabkan oleh virus dengue yang ditularkan melalui nyamuk Aedes sp. Provinsi Sumatera Barat termasuk salah satu provinsi endemis DBD. Penelitian ini bertujuan untuk memperlihatkan pola dan model spasial determinan kasus DBD tahun 2015-2017 dengan analisis Geographically Weighted Generalized Poisson Regression (GWGPR). Hasil analisis memperlihatkan 68% kecamatan endemis DBD dan 41%-47% kecamatan dengan incidence rate > 49. Pola sebaran kasus DBD berbentuk clustered pada lokasi yang berdekatan (I>0). Teridentifikasi 18 kecamatan yang konsisten selama 3 tahun dengan jumlah kasus tinggi dan sekitarnya juga tinggi, sembilan kecamatan merupakan hot spot area dan 10 kecamatan adalah low spot area. Model GWGPR determinan kasus DBD (PHBS, rumah sehat, sarana air bersih, jamban, kepadatan penduduk, suhu, kelembaban udara dan curah hujan) mampu menjelaskan variasi naik turunnya jumlah kasus DBD sebesar 73,28%-78,61% sedangkan sisanya ditentukan oleh variabel lain diluar model. Model GWGPR spesifik di setiap kecamatan dan dapat dijadikan rujukun menyusun strategi penanggulangan kasus DBD dan dapat direplikasi untuk monitoring dan evaluasi program.
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D-434
Depok : FKM-UI, 2021
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
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Ari Dwi Aryani; Promotor: Adang Bachtiar; Kopromotor: Ali Ghufron Mukti, Fachmi Idris; Penguji: Dumilah Ayuningtyas, Kemal Nazaruddin Siregar, Mardiati Nadjib, Sabarinah, Rizanda Machmud
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Inekuitas pelayanan kesehatan masih terjadi setelah pelaksanaan Jaminan Kesehatan Nasional (JKN). Pemantauan secara berkala Kinerja Fasilitas Kesehatan Tingkat Pertama (FKTP) merupakan kunci untuk menurunkan inekuitas pelayanan kesehatan sebagai tujuan utama JKN. Penerapan Kapitasi Berbasis Kinerja (KBK) dengan tiga indikator sejak tahun 2016, menunjukkan terjadi perbaikan kinerja FKTP dalam meningkatkan kualitas dan efisiensi di pelayanan tingkat pertama. Penelitian ini bertujuan untuk mengembangkan model indikator kinerja, kapasitas FKTP dan indikator ekuitas agar dapat mengukur ekuitas pelayanan kesehatan. Desain penelitian menggunakan exploratory sequential-mixed method. Penelitian dibagi menjadi tiga tahapan. Tahap satu adalah systematic review untuk mengidentifikasi indikator yang dapat digunakan dalam mengukur kapasitas, kinerja FKTP dan ekuitas pelayanan kesehatan. Tahap dua dilakukan dengan pendekatan kualitatif dengan teknik Consensus Decision Making Group (CDMG) untuk menentukan indikator yang dapat dipakai dalam pengukuran kapasitas dan kinerja FKTP serta pengukuran ekuitas pelayanan kesehatan dengan para pakar. Tahap tiga adalah membuat pengembangan model indikator kinerja FKTP berdasarkan skema kapitasi yang dapat mengukur ekuitas akses layanan kesehatan, menggunakan analisis Structural Equation Modelling (SEM). Berdasarkan hasil SR, CDMG dan analisis SEM, indikator terpilih untuk mengukur kapasitas FKTP terdiri dari tiga indikator yaitu rasio dokter umum, sumberdaya sarana dan manusia (skor rekredensialing) dan pembiayaan (persen pembayaran KBK yang diterima). Indikator kinerja terpilih delapan indikator yaitu angka kontak, proporsi penderita DM diperiksa gula darah, proporsi penderita Hipertensi diperiksa tekanan darah, proporsi pasien tidak rujuk RS, proporsi rujukan non spesialistik, proporsi pasien rujuk balik, proporsi skrining penyakit jantung, DM dan Hipertensi, rasio pasien prolanis terkendali. Ekuitas pelayanan kesehatan dilihat dari rate utilisasi peserta FKTP berdasarkan jenis kelamin, usia dan sosial ekonomi (PBI-Non PBI). Analisis SEM menunjukan terdapat hubungan yang positif dan signifikan antara kapasitas dan kinerja FKTP dengan ekuitas pelayanan.
Healthcare inequities still occur after the implementation of the National Health Insurance (JKN). Regular monitoring of the performance of primary healthcare facilities (FKTP) is key to reducing healthcare inequities as the main goal of JKN. The implementation of Performance-Based Capitation (KBK) with three indicators since 2016 has shown improvements in the performance of primary healthcare facilities in improving the quality and efficiency of first-level services. Their capacity influences the performance of primary care facilities and impacts primary care performance outcomes (health service equity). This study objective was to develop a model of performance indicators, FKTP capacity and equity indicators to measure health service equity. The research design utilized an exploratory sequential-mixed method. The study was divided into three phases. Phase one was a systematic review to identify indicators that can be used in measuring capacity, FKTP performance and health service equity. Phase two was carried out by a qualitative approach with the Consensus Decision Making Group (CDMG) technique to determine indicators that can be used in measuring FKTP capacity and performance as well as measuring health service equity with experts. Phase three was the development of a model for FKTP performance indicators based on a capitation scheme that can measure the equity of health service access. This phase was carried out using Structural Equation Modeling (SEM) analysis. The SR, CDMG and SEM analysis show that there are three selected indicators to measure the capacity of primary health care facilities: general practitioner ratio, facility sufficiency(recredentialing score) and financing (percentage of KBK payments received). Eight performance indicators were selected, namely contact rate, proportion of DM patients checked for blood sugar, proportion of Hypertension patients checked for blood pressure, proportion of patients not referred to hospital, proportion of non-specialistic referrals, proportion of patients referred back to primary care providers, proportion of screening for heart disease, diabetes mellitus, and hypertension; and ratio of controlled Prolanis patients. Health service equity was analyzed from the utilization rate of participants based on gender, age and socioeconomic factors(PBI-Non PBI). SEM analysis showed a positive and significant relationship between the capacity and performance of primary health care facilities and equity.
D-508
Depok : FKM-UI, 2024
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
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Bob Andinata; Promotor: Adang Bachtiar; Kopromotor: Besral, Mondastri Korib Sudaryo; Penguji: Evi Martha, Rizanda Machmud, Eva Susanti, Denni Joko Purwanto, Emma Rachmawati, Mahlil Ruby
Abstrak:
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ABSTRAK
Latar Belakang: Kanker payudara merupakan jenis kanker dengan insidensi tertinggi di Indonesia, dengan sebagian besar pasien terdiagnosis pada stadium lanjut salah satunya karena keterlambatan diagnosis di fasilitas kesehatan primer. Rendahnya kemampuan dokter umum dalam menegakkan diagnosis klinis kanker payudara serta alur rujukan yang panjang juga berkontribusi memperberat keterlambatan tersebut. Tujuan: Menghasilkan model prediksi diagnosis klinis kanker payudara di pelayanan kesehatan primer menggunakan skor malignansi “Probability of Breast Cancer (BOBAN)” Metode: Studi ini menggunakan mixed method, dengan pendekatan desain explanatory sequential, penelitian kuantitatif menggunakan desain potong lintang dilanjutkan penelitian kualitatif dengan desain studi kasus. Penelitian ini melibatkan 1.169 wanita usia ≥30 tahun yang melakukan deteksi dini di RS Kanker Dharmais (2020–2022). Variabel prediktor dianalisis dengan uji multivariat regresi logistik untuk penyusunan model skoring. Tahap kedua berupa uji akurasi (sensitivitas-spesifisitas) dan nilai probabilitas prediksi. Tahap ketiga berupa uji kualitatif melalui diskusi kelompok terfokus (FGD) dengan dokter umum di puskesmas. Hasil: Model prediksi terdiri dari tujuh variabel terpilih, yaitu usia, riwayat keluarga tingkat I, riwayat melahirkan, riwayat menyusui, benjolan payudara, kelenjar getah bening aksila, dan gejala lanjut kanker. Model ini memiliki nilai kalibrasi yang baik (p-value 0.826) dan nilai AUC pada ROC sebesar 0,920 (CI 95% 0,892 - 0,947; p-value 0,00) menunjukkan diskriminasi yang sangat baik. Total skor antara 0–177, dengan titik potong optimal pada skor 69 (sensitivitas 86,7%, spesifisitas 82,9%, dan nilai probabilitas 10,45%). Skor rendah (0-68) didiagnosis bukan kanker payudara dan skor tinggi (69-177) didiagnosis curiga kanker payudara. Evaluasi kualitatif menunjukkan bahwa skor malignansi BOBAN dapat diaplikasikan oleh dokter umum di fasilitas kesehatan pelayanan primer. Kesimpulan: Skor malignansi ini dapat memprediksi diagnosis klinis dan menghitung nilai probabilitas kanker payudara. Skor malignansi BOBAN direkomendasikan untuk digunakan sebagai instrumen deteksi dini kanker payudara di faskes primer dan dapat menjadi solusi bagi dokter umum untuk mempemudah skrining rujukan tatalaksana kanker payudara di Indonesia.
ABSTRACT
Background: Breast cancer is the most prevalent type of cancer in Indonesia, with the majority of patients diagnosed at an advanced stage, partly due to delayed diagnosis in primary healthcare settings. Limited diagnostic capabilities among general practitioners and lengthy referral processes contribute significantly to these delays. Objective: To develop a clinical prediction model for breast cancer diagnosis in primary healthcare using the "Probability of Breast Cancer (BOBAN)" malignancy score. Methods: This study employed a mixed-method approach, consisting of a quantitative cross-sectional study followed by a qualitative explanatory sequential design. A total of 1,169 women aged ≥30 years who underwent early detection at Dharmais Cancer Hospital (2020–2022) were included. Predictor variables were analyzed using multivariate logistic regression to construct the scoring model. The second phase involved evaluating the model’s diagnostic accuracy (sensitivity-specificity) and predictive probability values. The third phase included qualitative assessment through focus group discussions (FGDs) with general practitioners at community health centers (puskesmas). Results: The prediction model comprised seven selected variables: age, first-degree family history of breast cancer, childbirth history, breastfeeding history, presence of a breast lump, axillary lymph nodes, and advanced cancer symptoms. The model demonstrated good calibration (p-value = 0.826) and excellent discrimination with an AUC of 0.920 (95% CI: 0.892–0.947; p-value < 0.001). The total score ranged from 0–177, with an optimal cutoff score of 69 (sensitivity 86.7%, specificity 82.9%, predictive probability 10.45%). A low score (0–68) indicated a non-breast cancer diagnosis, while a high score (69–177) indicated suspected breast cancer. Qualitative evaluation indicated that the BOBAN malignancy score is feasible for implementation by general practitioners in primary care settings. Conclusion: The malignancy score is capable of predicting clinical diagnosis and estimating the probability of breast cancer. The BOBAN score is recommended as a screening tool for early detection in primary healthcare facilities and offers a practical solution for general practitioners to facilitate breast cancer management referrals in Indonesia.
D-598
Depok : FKM-UI, 2025
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
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