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Salah satu masalah dalam Program Pengendalian TB di Indonesia adalah ketidakpatuhan pasien dalam pengobatan sehingga putus obat dan mengakibatkan gagal konversi dan gagal pengobatan serta risiko menjadi kasus TB kebal obat. Salah satu provinsi dengan angka putus berobat melebihi angka nasional adalah Provinsi Riau, khususnya Kota Pekanbaru, terlebih pada angka putus berobat di Rumah sakit yang telah menerapkan strategi DOTS mencapai 15%. (Surveilens TB nasional, 2011). Angka putus berobat yang tinggi di Rumah sakit disebabkan antara lain oleh jarak yang jauh dari rumah, tidak ada petugas yang melacak pasien putus obat, jejaring yang tidak kuat antara Rumah sakit dan Puskesmas dan petugas TB Kabupaten/Provinsi. Tujuan Penelitian ini adalah melihat hubungan fasilitas pelayanan kesehatan TB DOTS dengan kesintasan kejadian putus berobat TB paru di Kota Pekanbaru. Desain Penelitian ini adalah menggunakan desain kohort retrospektif dengan melihat data surveilens pasien TB kota Pekanbaru yang terdaftar sepanjang tahun 2010 serta analisis yang digunakan adalah analisis survival menggunakan metode Kaplan Meier untuk melihat hubungan antara variabel dependen dan independen dan untuk pemodelan multivariatnya dilakukan dengan Regresi Cox. Sampel penelitian ini adalah 334 pasien yang berobat ke Puskesmas dan 120 pasien yang berobat ke Rumah sakit. Angka putus berobat pasien TB paru kasus baru di Kota Pekanbaru adalah 14,4%, dengan median waktu putus berobat 75 hari dan 73% pasien putus berobat tersebut tidak mengalami konversi atau sudah putus obat sebelum dievaluasi hasil pengobatan tahap intensifnya. Probabilitas kelangsungan pasien menyelesaikan pengobatannya adalah 62%. Angka putus berobat pasien TB paru kasus baru di Puskesmas sebesar 9% dengan probabilitas kumulatif kesintasan menyelesaikan pengobatannya sebesar 72%, sedangkan angka putus berobat pasien TB paru kasus baru di Rumah sakit sebesar 29%, dengan probabilitas kumulatif kesintasan menyelesaikan pengobatannya sebesar 50%. Pasien TB yang berobat di Fasyankes Rumah sakit memiliki kemungkinan untuk putus berobat sebesar 4.21 kali dibandingkan dengan pasien TB yang berobat di Puskesmas setelah dikontrol oleh variabel ketersediaan tenaga terlatih, dan jarak (Nilai p = 0.000). Untuk mengatasi masalah tersebut, diperlukan jejaring eksternal yang kuat antara Rumah sakit dengan dengan Dinas Kesehatan, laboratorium daerah, Puskesmas dan fasilitas pelayanan kesehatan lainnya untuk meningkatkan keberhasilan pengobatan, serta diharapkan Rumah sakit dapat memberikan pilihan tempat pengobatan kepada pasien pada sesaat setelah diagnosis, di Puskesmas wilayah tempat pasien tinggal atau tetap berobat di Rumah sakit dengan syarat harus patuh pada saat jadwal minum obat maupun harus datang ke RS pada waktu mengambil obat. Kata Kunci: Kesintasan, Putus obat, Rumah sakit, Puskesmas
One of the problems in the TB Control Program in Indonesia is a non-compliance of patients in the treatment of drug withdrawal and thus lead to failed conversions and failed treatment and Multi Drugs Resistance TB. One of the provinces with treatment dropout rate exceeds the national rate is Riau Province, Pekanbaru City in particular, especially in the hospitals that have implemented the DOTS strategy reached 15%. The purpose of this study is to see the relationship of health care facilities with a survival rate of TB patients that have treatment in DOTS Health Facility, in the city of Pekanbaru. The study design was a retrospective cohort design using by looking at the data surveillance of TB patients in Pekanbaru city registered during the year 2010 as well as the analysis used is the analysis of survival using the Kaplan-Meier to see the relationship between the dependent and independent variables for multivariate modeling performed with Cox regression. The research sample was 334 patients who went to health centers and 120 patients who went to the hospital. Treatment drop-out rate of new cases of pulmonary TB patients in the city of Pekanbaru in this study was 14.4%, with median treatment time of 75 days and drop in survival probability of new cases of pulmonary TB patients in the city of Pekanbaru in a complete treatment for 6 months was 87%. Treatment drop-out rate of new cases of pulmonary TB patients at health center by 9% with a median time of default of 120 days and the cumulative probability of survival in the complete treatment period of 6 months by 92%, while the dropout rate for treatment of new cases of pulmonary TB patients in the hospital for 29 % with a median time of 60-day default and the cumulative survival probability of complete treatment within 6 months by 73%. TB patients who seek treatment at hospital have a chance to drop out 4.21 times compared with TB patients who seek treatment at health centers once controlled by the variable availability of trained personnel and the distance (p-value = 0.000). To overcome these problems, it takes a strong external network of hospitals by the district health office, local laboratories, clinics and other health care facilities to improve treatment success, as well as the hospital is expected to provide treatment options to patients in shortly after diagnosis, the health center areas where patients live or stay for treatment at the Hospital but have to comply with the requirements at the time of the schedule to take medication and have come to the hospital at the time of taking the drug. Keyword: Survival, default, hospital, health center
Hospital is a health facility that organizes health service activities. Apart from having a positive impact, hospitals also have a negative impact, namely the presence of waste generated from hospital activities, which if not handled properly will have an impact on public health and the environment. In March 2020 there was a non-natural disaster from the Covid-19 pandemic in Indonesia which caused the production of solid medical waste in hospitals to increase significantly, thus requiring an increase in its management capacity in terms of quantity and quality. Dr. Rumkital Mintohardjo as one of the covid19 referral hospitals has implemented waste management even though it is not optimal. This study aims to analyze the management of solid hazardous and toxic (B3) waste through a systems approach at Dr. Rumkital. Mintohardjo. This type of research is observational, which describes the B3 solid waste management system starting from the input, process, and output to find out the problems that exist in the hazardous solid waste management system at Dr. Rumkital. Mintohardjo. The types of data used are primary data and secondary data. Primary data were obtained from in-depth interviews and direct observations, while secondary data were obtained from reviewing existing documents. The problem at the input stage is the lack of officers in the environmental health department, while at the process stage the problem lies in the implementation procedure for B3 solid waste management which is still not optimal (not in accordance with the established standards) and the capacity of the incinerator machine which is not proportional to the amount of B3 waste generation. solid. At the output stage, it is expected that all solid hazardous waste generation will be managed properly. Because there are problems in the management of B3 solid waste, it is necessary to improve the management of B3 solid waste and regular management evaluations in order to create a healthy hospital environment
Background: During the current COVID-19 pandemic, the use of personal protective equipment is the best way to minimize infection risk. Although the benefits have been proven, compliance with the use of PPE still encounters obstacles. The aims of this study is to determine the compliance of nurses in wearing PPE in the COVID-19 inpatient room. Method: This research is a quantitative research with a cross-sectional design with research instruments are questionnaires and observation forms. There are109 nurse where selected based on the total sample who served in P. Selayar, P. Pagai, P. Tarempa, P. Sangeang, P. Numfor, P. Sibatik wards. Data were collected using a questionnaire share via a Google Form link and observation checklist form that is guided by the applicable SOP. Bivariate analysis used Independent T-test and Correlation test. Multivariate analysis of research variables in the form of ordinal and interval tested using Multivariable Linear Regression. by the Data analysis using Linear Regression test. Results and Conclusions: Nurses' compliance in wearing PPE needs to be improved in hand-hygiene activities. Good knowledge and positive attitudes are shown by most of the nurses in the COVID-19 inpatient room. Recomendation: Raise nurses' awareness of HH performance between activities when doffing PPE. Develop training/socialization through digital media such as making teaching videos. Provide availability of PPE for all size. Optimizing the role of IPCLN in the ward.
Latar Belakang. Pada Renstra 2010-2014 men-targetkan pencapaian persentase RS yang melaksanakan Jamkesmas sebesar 95% pada 2014. Pelaksanaan Jamkesmas di RS swasta dapat dilaksankan setelah ada bentuk kemitraan melalui perjanjian kerja sama (PKS). Namun kondisi saat ini menunjukkan minat RS bentuk privat sangat rendah, hanya seperempat dari RS publik, sedangkan pertumbuhan RS privat sangat pesat. Pada tahun 2008 tercatat jumlah RS privat di Indonesia sebanyak 85, dan pada tahun 2010 meningkat menjadi 191. Hal ini diperburuk kecenderungan RS publik berubah menjadi privat. Maka dari itu, pertumbuhan RS yang didominasi oleh rumah sakit privat tidak akan sejalan dengan peningkatan RS yang mau bermitra dengan Jamkesmas. Menurut Notoadmodjo (2005), dalam menjalin suatu kemitraan yang harmonis perlu diketahui calon mitra ataupun karakteristik dari rumah sakit swasta, untuk itu, perlu diketahui bagaimana karakteristik rumah sakit swasta di Indonesia saat ini, dan apa upaya yang dilakukan pemerintah untuk dapat menjalin suatu kemitraan publik-privat. Metode. Jenis Penelitian ini adalah kualitatif, dan k uantitatif dengan rancangan cross sectional. Data primer melalui kuesioner kepada direktur RS swasta di Indonesia. Informan adalah pemegang kebijakan atau pengelola Jamkesmas dan perumahsakitan di Kemenkes. Wawancara mendalam diarahkan untuk menggali informasi terhadap hasil data kuantitaf sehingga dapat ditemukan jawaban maupun kesenjangan yang ada. Studi pendahuluan dengan menganalisis data sekunder unit pengaduan masyarakat tahun 2007-2010, dikategorisasi sebagai dasar penyusunan kerangka konsep dan pertanyaan kuesioner. Faktor yang diukur adalah faktor internal individu direktur RS swasta sebagai pembuat keputusan dan faktor karakteristik rumah sakit, serta kebijakan suprastruktur rumah sakit yang diduga berpengaruh terhadap pelaksanaan Jamkesmas. Hasil. Sampel yang masuk sebanyak 159 RS (20,7%) merepresentasikan RS kelas C dan D (93,7%). Semua RS berpandangan tarif INA-CBG terlalu rendah, disamping juga bahwa RS swasta masih memiliki mind set fee for service. Uji diskriminan didapatkan faktor-faktor yang paling berpengaruh berturut-turut adalah keterbatasan sarana-prasarana rumah sakit, pengetahuan direktur, persyaratan Jamkesmas, fungsi sosial rumah sakit dan administrasi klaim. Hasil uji Chi Square didapatkan minat tetap rendah pada RS privat dimana memiliki pengaruh suprastruktur yang kuat, jenis RS Khusus, RS dengan BOR tinggi serta RS dengan target pasar menengah keatas. Diketahui tidak ada bentuk kegiatan IX “pemasaran” secara khusus dari Tingkat Pusat (Kemenkes) kepada PPK yang belum bermitra sehingga pencapaian target Renstra sangat tergantung dari kontribusi pemerintah daerah. Uji statistik membandingkan antara kelompok yang hanya terpapar informasi dari pemerintah dengan yang tidak (umum), terbukti menurunkan perbedaan mean serta meningkatkan OR terhadap kemitraan Jamkesmas, hal tersebut berarti faktor informasi (sosialisasi) meningkatkan minat RS swasta untuk bermitra. Kecenderungan perubahan publik ke privat, bahkan RS publik kian berprilaku seperti privat disinyalir karena tidak ada pengawasan khusus ataupun insentif yang cukup bagi RS publik, sehingga perlu segera merealisasikan merealisasikan Badan Pengawas Rumah Sakit. Kepustakaan 90 (1992- 2010), Gambar 18, Tabel 48, Lampiran 6 Kata Kunci : Jamkesmas, privat, publik, Kementerian Kesehatan, kemitraan
Background. In the 2010-2014 Strategic Plan (Renstra), MoH targeting the percentage of hospitals that perform Jamkesmas by 95% in 2014. Implementation Jamkesmas in private hospitals can be carried after there is a form of partnership through a memorandum of understanding (MoU). However, current conditions indicate low interest from the for profit (PT) hospitals, only a quarter of the public (not for profit) hospitals interest, while the growth of for profit (PT) hospitals increased rapidly. In 2008, recorded number of for profit( PT) hospitals in Indonesia is 85, and by the year 2010 increased up to 191. This exacerbated the tendency of not for profit hospitals become for profit (PT) ho spital. Therefore, the growth of the hospital which is dominated by for profit hospitals will not be in line with the number of hospitals that want to partner with Jamkesmas. According Notoadmodjo (2005), in establishing a harmonious partnership need to know the partners characteristics of private hospitals, for that, it is important to know the characteristics of private hospitals in Indonesia, and what the government's efforts to forge public-private partnerships. Methods. This type of study is qualitative and quantitative research with cross sectional design. Primary data through questionnaire to directors (CEO) of private hospitals in Indonesia. The informants are policy holder and/or the program manager of Jamkesmas and hospitals regulator in MoH. In-depth interviews aimed to collect information towards the kuantitatives outcomes analysis, in order to discover answers and gaps that might exist. Preliminary studies done by analyzing the public complaints unit data from 2007-2010, categorized, as the basis for the conceptual framework and questionnaire questions. Factors that measured consists internal factors of CEO include perception to Jamkemas, hospital characteristics, and governing body policies that allegedly affect the implementation of Jamkesmas in private hospitals. . XI Results. Samples reached 159 (20,7%) hospitals representing hospitals C and D class (93.7%). All hospital agreed that INA-CBG rates are too low, as the private hospitals still have the “fee for service” mind set. Discriminant test obtained the factors that most effect are the unavailability of hospital infrastructure, CEO knowledge, requirements of Jamkesmas partnership, social functions and claims administration. From thr Chi Square test results obtained low-interest fixed at a for profit (PT) hospital which has strong influenced by their governing body, special hospitals, hospitals with high utilization (BOR) and the hospital that has middle upper markets. Furthur, it is note there is no special form of "marketing" activities by the MoH to hospitals that have not partnered, so that, the achievement of target in Renstra is dependen on the local governments contribution. Statistical test to compare between the exclusive exposure (informed) by government group and those “whose not exclusive” group, evidence could lowering the mean differences and add OR value, which means socialisation from government can increase the interest of private hospitals to partner with Jamkesmas. The trend of changes public hospitals become private reduced their social function is presumably because there is no special monitoring form the government and the incentives are sufficient, so it required immediately realize the Supervisory Board of the Hospital. Lite rature 90 (1992-2010), Picture 18, Table 48, Attachme nt 6 Keyword : Jamkesmas, for profit hospital, not for profit hospital, MoH, partnership