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Djaka Kusnandar; Pembimbing: Budi Utomo; Penguji: Artha Prabawa, Argo Suyono
S-6685
Depok : FKM-UI, 2011
S1 - Skripsi Pusat Informasi Kesehatan Masyarakat
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Aning Hastuti S.; Pembimbing: Ronnie Rivany, Pujiyanto; Penguji: Wachyu Sulistiadi, T Suyono, Atik Nurwahyuni
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Peningkatan kasus HIV/AIDS di Kalimantan Barat sangat tinggi, dari 64 kasus tahun 2004 menjadi 231 kasus tahun 2005, sehingga diperlukan upaya penanggulangan termasuk perhitungan biaya pengobatan HIV/AIDS di rumah sakit dan pengendalian biaya pelayanan kesehatan dengan penetapan DRGs. Tujuan umum penelitian ini adalah untuk mengetahui gambaran variasi biaya pengobatan (cost of treatment) HIV/AIDS berdasarkan DRGs di RSU Dr. Soedarso Pontianak. Penelitian ini adalah survei kuantitatif terhadap cost of treatment pasien HIV/AIDS di RSU Dokter Soedarso tahun 2005 pada rawat jalan dan rawat inap, berdasarkan Clinical Pathway dengan metode analisis biaya ABC (Activity Based Costing) dan Simple Distribution. Jumlah kasus yang diteliti 55 kasus, dikelompokkan berdasarkan Australian Refined Diagnosis Related Groups (AR-DRGs) Classification Version 4.1. Kasus HIV termasuk Major Diagnostic Categories (MDC) 18 Infectious and parasitic diseases, yaitu DRG S61Z HIV dengan CNS disease, S62Z HIV dengan malignancy, S63A HIV related infection dengan penyakit penyerta dan penyulit, S63B HIV related infection tanpa penyakit penyerta dan penyulit, S64A HIV lain dengan penyakit penyerta dan penyulit, S64B HIV lain tanpa penyakit penyerta dan penyulit. Hasil penelitian menunjukkan Clinical Pathway HIV terdiri dari tahapan pendaftaran, penegakan diagnosis, terapi, pulang dan rawat jalan. Cost of treatment rawat inap Kelas III tertinggi S64A sebesar Rp. 6.363.402,- dan terendah S62Z sebesar Rp. 1.547.226,-, Kelas VIP tertinggi S64A sebesar Rp. 8.885.558,- dan terendah S62Z sebesar Rp. 1.871.795,-. Cost of treatment rawat jalan tertinggi S63A sebesar Rp. 431.898,- dan terendah S61Z sebesar Rp. 171.207. Pengelompokan HIV berdasarkan AR-DRGs dapat dilakukan di RSU Dokter Soedarso Pontianak, dengan ditambah satu kelompok untuk pasien status keluar rumah sakit meninggal. Variabel yang digunakan untuk menentukan cost of treatment berdasarkan DRGs HIV di RSU Dokter Soedarso Pontianak tahun 2005 yaitu diagnosis utama, penyakit penyerta dan penyulit (casemix), lama hari rawat, dan pemanfaatan utilisasi. Dalam penyusunan DRGs agar didapatkan angka rata-rata biaya yang lebih stabil perlu dilakukan penelitian lebih lanjut terhadap diagnosis sejenis pada beberapa rumah sakit yang tipenya sama dengan jumlah sampel lebih besar. Perlu pengembangan Clinical Pathway yang baku dan penetapan biaya berdasarkan DRGs disesuaikan kondisi di Indonesia untuk mendapatkan Indonesian DRGs (INA-DRGs), sehingga ada kepastian biaya yang diperlukan bagi pihak rumah sakit, asuransi, konsumen dan pemerintah.
The increasing of HIV/AIDS cases in West Kalimantan in the year 2005 is very high; the cases increased from 64 cases in 2004 to 231 in 2005. Because HIV/AIDS cases increase in West Kalimantan need prevention program and health service, including HIV/AIDS medication cost account in hospital and the control of health services cost with DRGs's stipulating. Main objectives of this research are to find HIV/AIDS cost of treatment based on DRGs in Dr. Soedarso General Hospital Pontianak. This research is quantitative survey toward HIV/AIDS patient cost of treatment in Dr. Soedarso General Hospital year 2005 of outpatient and inpatient, based on Clinical Pathway with cost analysis method using ABC method (Activity Based Costing) and Double Distribution. Total researched cases are 55 cases. Then grouped into Australian Refined Diagnosis Related Groups (AR- DRG) Classification Version 4.1, HIV is belong to Major Diagnostic Categories (MDC) 18 Infections and parasitic diseases, which is DRG S61Z HIV with CNS disease, S62Z HIV with malignancy, S63A HIV related infection with complicated diseases, other S64A HIV with complicated diseases, other S64B HIV without complicated diseases. Research result shows that Clinical Pathway of HIV i.e.: admission, to get the main diagnosis, therapy, discharge and inpatient. One episode HIV/AIDS outpatient cost of treatment based on Clinical Pathway as according to AR-DRG grouping for the highest of ffl class was in S64A equal to Rp. 6,363,402,- and the lowest in S62Z equal to Rp. 1,547,226,-. The highest HIV cost of treatment for VIP class was in S64A equal to Rp. 8,885,558,- and the lowest in S61Z equal to Rp. 1,871,795,-. The highest cost of treatment in inpatient in S63A equal to Rp. 431,898,- and the lowest in S61Z equal to Rp. 171,207. HIV grouping based on AR-DRG done in Dr. Soedarso General Hospital Pontianak, with one group addition for patient with out from hospital status died. Variable that affect HIV DRGs settlement in Dr. Soedarso General Hospital Pontianak year 2005 i.e.: main diagnosis, patient characteristic, casemix disease, inpatient length, and utilization use. In arranging DRG, to get more stabilize cost mean number need advanced research toward equal diagnose on some hospital with same type with larger number of samples. Need basic Clinical Pathway development and cost settlement based on DRGs that apropiate with condition in Indonesia and finally created Indonesia DRGs (INADRG). Therefore, there is cost certainty that needed by hospital, assurance, consumer, and government.
T-2255
Depok : FKM-UI, 2006
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Dessi Marantika Nilam Sari; Pembimbing: Mondastri Korib Sudaryo; Penguji: Syahrizal, Helwiah Umniyati, Suyono
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Kurangnya kepatuhan terhadap pengobatan menjadi faktor risiko munculnya jenis HIV yang resisten terhadap obat, yang dapat ditularkan kepada orang lain. Kepatuhan terhadap pengobatan yang buruk tidak hanya membahayakan kesehatan individu tetapi juga meningkatkan penularan. Penelitian ini bertujuan untuk mengamati faktor-faktor yang berhubungan dengan terjadinya ketidakpatuhan minum obat ARV pada ODHIV yang mendapatkan terapi ARV di Rumah Sakit Umum Daerah Kabupaten Tangerang. Jenis penelitian ini menggunakan penelitian observasional dengan rancangan cross sectional. Penelitian dilakukan di poli HIV Rumah Sakit Umum Daerah Kabupaten Tangerang dan waktu penelitian dilakukan pada bulan November 2023 menggunakan data sekunder. Populasi penelitian berjumlah 1.337 ODHIV yang aktif menjalani pengobatan antiretroviral di Rumah Sakit Umum Daerah Kabupaten Tangerang dengan menggunakan total sampling sesuai dengan kriteria inklusi dan ekslusi sehingga sampel penelitian berjumlah 1.286 ODHIV. Hasil analisis univariat menunjukan bahwa usia ≥ 35 tahun (56,45), laki-laki (61,20%), pendidikan rendah (87,10%), belum kawin atau cerai (51,92%), domisili dalam kabupaten Tangerang (55,88%), mendapatkan konseling kepatuhan (63,73%), memiliki jaminan kesehatan (51,92%), ≥5km akses layanan kesehatan (54,07%), IO non TB (40,90%), stadium lanjut (63,69%), viral load ≥40 mL (46,73%), tidak ada efek samping obat (53,34%), lamanya pengobatan >5 tahun (72,01%), masuk kedalam populasi kunci (88,01%) dan tidak mendapat dukungan (61,12%). Hasil analisis kai kuadrat secara statistik ada hubungan antara umur, jenis kelamin, status pendidikan, status perkawinan, domisili, pelayanan konseling kepatuhan, stadium klinis WHO, viral load, lamanya pengobatan ARV, kelompok populasi kunci dan dukungan teman sebaya (P-Value<0,05) dengan ketidakpatuhan minum obat ARV. Hasil analisis cox regression dengan faktor yang secara statistik berhubungan terhadap ketidakpatuhan minum obat antiretroviral pada ODHIV adalah umur (P-Value=0,01) nilai PR 1,20 dengan 95% CI (1,05-1,38), status perkawinan (P-Value=0,02) nilai PR 1,18 dengan 95% CI (1,03-1,36), domisili (P-Value=0,01) nilai PR 1,19 dengan 95% CI (1,04-1,36), viral load (P-Value=0,001) nilai PR 1,27 dengan 95% CI (1,10-1,43), lamanya pengobatan ARV (P-Value=0,005) nilai PR 1,25 dengan 95% CI (1,07-1,47), kelompok populasi kunci (P-Value=0,02) nilai PR 1,27 dengan 95% CI (1,04-1,56), dukungan teman sebaya (P-Value=0,04) nilai PR 1,15 dengan 95% CI (1,00-1,32). Faktor umur, status perkawinan, domisili, viral load, lamanya pengobatan, kelompok populasi kunci dan dukungan teman sebaya memiliki pengaruh terhadap ketidakpatuhan minum obat antiretroviral (ARV) pada ODHIV di Rumah Sakit Umum Daerah Kabupaten Tangerang.
Lack of treatment adherence becomes a risk factor for the emergence of drug-resistant strains of HIV, which can be transmitted to others. Poor adherence to treatment harms the individual’s health and increases the risk of transmission. This study aims to observe the factors associated with the occurrence of non-adherence to taking ARV drugs in PLHIV who receive ARV therapy at the Regional General Hospital of Tangerang Regency. This type of study uses observational research with a cross-sectional design. The study was conducted at the HIV Specialist of the Regional Govern Hospital of Tangerang Regency and the time of the study was carried out in November 2023 using secondary data. The study population amounted to 1,337 PLHIV who were actively undergoing antiretroviral treatment at the Regional General Hospital of Tangerang Regency using total sampling by inclusion and exclusion criteria so that the study sample amounted to 1,286 PLHIV. The results of the univariate analysis showed that the age of ≥ 35 years (56.45), male (61.20%), low education (87.10%), unmarried or divorced (51.92%), domiciled in Tangerang district (55.88%), received compliance counselling (63.73%), had health insurance (51.92%), ≥5km of health service access area (54.07%), non-TB IO (40.90%), advanced stage (63.69%), viral load ≥40 mL (46.73%), no drug side effects (53.34%), duration of treatment ≥5 years (72.01%), entered into key populations (88.01%) and received no support (61.12%). The results of the kai squared analysis statistically showed there was an association between age, sex, educational status, marital status, domicile, adherence to counselling services, WHO clinical stage, viral load, duration of ARV treatment, key population groups and peer support (P-Value<0.05) with non-adherence to taking ARV drugs. The results of Cox Regression analysis with factors statistically related to non-adherence to taking antiretroviral drugs in ODHIV were age (P-Value = 0.01), PR value 1.20 with 95% CI (1.05-1.38), marital status (P-Value = 0.02), PR value 1.18 with 95% CI (1.03-1.36), domicile (P-Value = 0.01), PR value 1.19 with 95% CI (1.04-1.36), viral load (P-Value = 0.001), PR value 1.27 with 95% CI (1.10-1.43), duration of ARV treatment (P-Value = 0.005), PR value 1.25 with 95% CI (1.07-1.47), key population group (P-Value = 0.02), PR value 1.27 with 95% CI (1.04-1.56), peer support (P-Value = 0.04), PR value 1.15 with 95% CI (1.00-1.32). Factors such as age, marital status, domicile, viral load, duration of treatment, key population groups and peer support have an influence on non-adherence to taking antiretroviral drugs (ARV) in PLHIV at the Regional General Hospital of Tangerang Regency.
T-6876
Depok : FKM-UI, 2024
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Talitha El Zhafira Hadi; Pembimnbing: Helda; Penguji: Nurhayati Adnan, Alfons M. Letelay, Suyono
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Angka mortalitas HIV/AIDS hingga saat ini masih menjadi permasalahan kompleks di tingkat global, terutama pada negara berkembang. Terapi Antiretroviral (ARV) menjadi salah satu bentuk pencegahan berkembangnya kasus HIV menjadi AIDS. Tetapi tidak dapat dipungkiri bahwa ODHA yang telah memulai terapi ARV pun masih berisiko tinggi untuk mengalami kematian. Penelitian ini bertujuan untuk mengetahui pengaruh kepatuhan terapi antiretroviral terhadap kejadian mortalitas pada pasien HIV/AIDS di RSUD Kabupaten Tangerang periode tahun 2006 – 2022. Desain studi yang digunakan adalah kohort restrospektif. Jumlah sampel pada penelitian ini adalah 924 pasien yang diobservasi melalui rekam medis pasien. Kelompok exposed yaitu 510 pasien yang patuh terapi ARV dan kelompok non-exposed yaitu 414 pasien yang tidak patuh terapi ARV. Berdasarkan hasil analisis, diketahui bahwa probabilitas kumulatif survival dan median survival time secara keseluruhan adalah 52,3% dan 7 tahun. Rata-rata waktu pengamatan survival pada tahun ke 8 dan median survival time pada tahun ke 7 pengamatan. Selain itu, diketahui pula terdapat pengaruh antara kepatuhan terapi ARV terhadap kejadian mortalitas pasien HIV/AIDS dengan nilai adjHR = 1,71 (95% CI: 0,03 - 3,18) setelah mengendalikan variabel usia dan infeksi oportunistik. Hasil penelitian ini dapat menjadi acuan dan pertimbangan dalam meningkatkan kepatuhan ODHA dalam menjalankan terapi ARV di kemudian hari supaya tren kematian dapat ditekan.
The mortality rate of HIV/AIDS is still being a complex problem at the global level, especially in developing countries. Antiretroviral Therapy (ARV) is one form of prevention of the development of HIV cases into AIDS. However, it is undeniable that people living with HIV who have started ARV therapy are still at high risk of death. This study aims to determine the effect of adherence to antiretroviral therapy on the survival of HIV/AIDS patients at General Hospital of Tangerang Regency for the period 2006 – 2022. The study design used a retrospective cohort design. The exposed group was 510 patients who were adherent to ARV therapy and the non-exposed group was 414 patients who were not adherent to ARV therapy. Based on the results of the analysis, it is known that the cumulative probability of survival and median survival time as overall are 52.3% and 7 years. The average survival observation time at year 8 and median survival time at year 7 observation. In addition, it is also known that there is an correlation between adherence to ARV therapy on the mortality incidence of HIV/AIDS patients with adjHR = 1.71 (95% CI: 0,03 - 3,18) after controlling for age and opportunistic infection variables. The results of this study can be a reference and consideration in improving the compliance of PLHIV in carrying out ARV therapy in the future so that the mortality trend can be suppressed.
T-6670
Depok : FKM-UI, 2023
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Apreh Ristanasari; Pembimbing: Wiku Bakti Bawono Adisasmito; Penguji: Prastuti Soewondo, Wachyu Sulistiadi, Suyono, Noviani
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Covid-19 berdampak pada berbagai aspek sehingga perlu upaya pengendalian. Selain melakukan protokol kesehatan maka perlu vaksinasi. Cakupan vaksinasi covid-19 dosis ketiga di Indonesia masih rendah sebesar 37,99%. Cakupan Provinsi Lampung masih rendah sebesar 28,58%. Provinsi Lampung juga berisiko tinggi apabila dilihat dari angka CFR covid-19 sebesar 5,59%. Berbagai strategi dilakukan untuk upaya percepatan vaksinasi dengan melibatkan berbagai aktor namun cakupan masih rendah. Dari studi pendahuluan diketahui bahwa terdapat hambatan pada unsur fungsi manajemen. Tujuan penelitian ini untuk mengidentifikasi manajemen program vaksinasi covid-19 dari penyedia layanan yang mempengaruhi cakupan vaksin covid-19 dosis ketiga. Penelitian ini menggunakan metode penelitian kualitatif dengan jenis penelitian Rapid Assesment Procedures (RAP). Hasil penelitian ini menunjukkan bahwa ada pengaruh aspek kontek meliputi pembiayaan, logistik vaksin, regulasi serta sarana dan prasarana terhadap cakupan vaksin covid-19 dosis ketiga. Terdapat pengaruh mekanisme dalam aktor meliputi pelaksanaan, pencatatan pelaporan, monitoring dan evaluasi serta koordinasi terhadap cakupan vaksin covid-19 dosis ketiga. Diketahui pada aspek hasil masih rendah yaitu rata-rata pemakaian vaksin perhari sebesar 277 dosis dan cakupan vaksin dosis ketiga sebesar 28,58%. Kesimpulan Peningkatan cakupan vaksinasi covid-19 dosis ketiga di Provinsi Lampung terkendala oleh manajemen program penyedia layanan terutama dari aspek pembiayaan, logistik vaksin, regulasi, koordinasi, pencatatan, dan pelaporan
Covid-19 has an impact on various aspects so it needs control efforts. In addition to carrying out health protocols, it is necessary to vaccinate. Coverage of the third dose of Covid-19 vaccination in Indonesia is still low at 37.99%. Lampung Province coverage is still low at 28.58%. Lampung Province is also at high risk when viewed from the CFR co-19 figure of 5.59%. Various strategies have been implemented to accelerate vaccination by involving various actors but the coverage is still low. From the preliminary study it is known that there are obstacles to the elements of the management function. The purpose of this study was to identify the management of the covid-19 vaccination program from service providers that affect coverage of the third dose of the covid-19 vaccine. This study used a qualitative research method with the type of Rapid Assessment Procedures (RAP) research. The results of this study indicate that there is an influence of context aspects including financing, vaccine logistics, regulations and facilities and infrastructure on the coverage of the third dose of the covid-19 vaccine. There is the influence of mechanisms within actors including implementation, recording of reporting, monitoring and evaluation as well as coordination of coverage of the third dose of the covid-19 vaccine. It is known that the yield aspect is still low, namely the average use of vaccine per day is 277 doses and the third dose vaccine coverage is 28.58%. Conclusion Increasing coverage of the third dose of covid-19 vaccination in Lampung Province is constrained by program management of service providers, especially from the aspects of financing, vaccine logistics, regulation, coordination, recording and reporting.
T-6651
Depok : FKM-UI, 2023
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Haris Kadarusman; Pembimbing: Tris Eryando; Penguji: Besral, Sutanto Priyo Hastono, Rosadi Nazir, Suyono
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Dari penelitian terdahulu diketahui cascade yang terbaik dalarn menurunkan Fe adalah berbentuk anak tangga dengan aliran air yang baik adalah menggunakan selang/pipa berdiameter 4 mm, namun penelitian-penelitian tersebut tidak sampai memperoleh model prediksi penurunan Fe daiam air menggunakan metode cascade. Selain itu dalam penelitian terdahulu menggunakan bahan cascade yang mengandung unsur logam karena itu perlu adanya penelitian lanjutan yang dapat menghasilkan model prediksi penurunan Fe dalam air menggunakan cascade dengan bahan kayu berlapis plastik/karet dengan diameter aliran air menggunakan selanypipa 3/ 16 inchi, 5/ I6 inchi dan 7/?16inchi. Penelitian yang dilakukan merupakan eksperiman dengan menggunakan 75 buah sampel air yang berasal dari sumiir gali atau sumur pompa tangan kemudian dialirkan melalui cascade yang memiliki kriteria tertentu dengan variabel penelitian meliputi Variabel Dependen yaitu Penurunan Fe dan Variabel Independen yaitu Debit air, Derajat Keasaman Air, Suhu Air, Oksigen Terlarut dan Kandungan Fe dalam Air sebelum aerasi kemudian dianalisa dengan menggunakan rnetode statistik Regresi Linier Ganda. Didalam penelitian ini tidak melakukan pengukuran! pengamatan terhadap kelembaban, suhu udara dan kandungan oksigen di udara. Seleksi variabel dilakukan dengan analisa bivaiiat dengan korelasi (pearson) dan regresi linier sederhana serta metode Forward untuk memperoleh kandidat model. Unluk variabel Debit Air dilakuklan Dummy Variabel yang terdiri dari Variabel Debit 1 dan Debit 2. Dari hasil penelitian diperoleh kandidat model yang berisi empat variabel dasar yaitu variabel Debit I dan debit 2, Derajat Keasaman, Oksigen Terlarut dan Fe Awal serta dua variabel intraksi yaitu interaksi anlara Debit Air dan Fe Dalam Air serta lnteraksi antara Oksi gen Terlarut dengan Fe Dalam Air. Hasil diagnostik pemenuhan asumsi menyatakan bahwa kandidat model dapat memenuhi asumsi-asumsi regresi linier ganda namun dari diagnostik kolinearitas diketahui terdapat gejala kolinearitas dalam model, tetapi karena model bertujuan untuk prediksi maka masalah kolineraitas bukan merupakan masalah serius. Uji reliabilitas Model memberikan hasil nilai Shrinkage = 0,21 atau = 21 %, dengan demikian kandidat model cukup reliabel untuk ditetapkan sebagai model prediksi penurunan Fe Dalam Air menggunakan Metode cascade. Persamaan fungsi matematis Penurunan Fe yang diperoleh sebagai hasil akhir dari penelitian adalah: Penurunan Fe = - 695 + (- 0,166(debit 3,7 L/menit)) + (- 0,334(Debit 1,06 L/'menit)) + 0,329 (pH Air) + (-0,108 (Oksigen Ter1an1t)) + (-0,664 (Fe Awal)) 4 0,I42(Debit1*Fe Awal) + 0,5S8(Debit 2 * Fe Awal) + 0,134 (Oksigen Terlarut * Fe Awal). Persamaan fungsi matematis tersebut hendaknya digunakan dimasyarakat Iuas dalam upaya menurunkan kandungan Fe dalam air menggunakan metode cascade agar penggunaan cascade dapat efektif dan efisien.
Previous researchs showed that the stairs shape is the best cascade for Water Fe reduction which used of 4 mm pipe will give good water flowing. But the researches did not meet the prediction model of Water Fe reduction. Because the previous researches metal cascade was used, it is necessary to perform further research which able to produce prediction model of water Fe reduction by applying rubber coated wood cascade with 3/16 inches ,5/16 inches and 7/16 inches of flowing pipe. This is an experiment study using 75 of water sample derived from dig well or pump well flowed through certain cascade. Research variables are : Water debit, Water Acidity, Water temperature, Dissolved Oxygen, Water Fe water before aeration, then analyzed by using Linear Regression Statistic- This Research did not put humidity, temperature and air contained oxygen in the measurement. Variable is selected through bivariate analysis with correlation (Pearson) and simply linear regression, used forward method as well to obtain candidate model. Dummy variable was given in the form of 1st and 2nd debit variable. This research resulted candidate model containing four basic variable of 1st variable, 2nd variable and initial Fe also two interaction variable that is water debit and water Fe interaction and interaction between Dissolved Oxygen and Water Fe. Diagnostic assumption stated that model candidate was able to fulhll the Multiple Linear Regression, meanwhile from co-linearity diagnostic is found the co-linearity indication within model. However, because the purpose of the model is a prediction, then co-linearity did not become a serious problem. Model reliability test resulted the Shrinkage of 0.21 or 21 %, it might be said that the candidate is reliable enough to be assessed as the prediction model of water Fe reduction, using the cascade method.
T-1472
Depok : FKM UI, 2002
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Aldilla Youthiana Oktavanny; Pembimbing: Wahyu Sulistiadi; Penguji: Anhari Achadi, Ascobat Gani, Moch. Yudi Arifin, Joko Suyono
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RSD Kertosono mengalami kenaikan jumlah pasien tidak kembali dalam beberapa tahun terakhir. Penelitian ini bertujuan untuk mengetahui hubungan karakteristik pasien dan persepsi nilai pasien dengan retensi pasien di RSD Kertosono serta faktor yang paling dominan berhubungan dengan retensi pasien. Penelitian ini adalah penelitian eksplanatori dengan pendekatan kuantitatif. Penelitian dilakukan di RSD Kertosono Nganjuk. Waktu pelaksanaan pengumpulan data yaitu pada bulan April 2022. Data dikumpulkan dengan kuesioner. Karakteristik pasien yang berhubungan dengan retensi pasien pada RSD Kertosono adalah faktor pendapatan dan faktor sumber biaya pengobatan sedangkan juenis kelamin, usia, pekerjaan, dan pendidikan tidak memiliki hubungan dengan retensi pasien. Persepsi nilai pasien, kepercayaan, dan retensi pasien berhubungan dengan retensi pasien pada RSD Kertosono. Persepsi nilai pasien merupakan variabel yang paling dominan berhubungan dengan retensi pasien pada RSD Kertosono.
RSD Kertosono has experienced an increase in the number of patients not returning in recent years. This study aims to determine the relationship between patient characteristics and perceived patient values with patient retention at RSD Kertosono and the most dominant factor associated with patient retention. This research is an explanatory research with a quantitative approach. The research was conducted at RSD Kertosono Nganjuk. The time for data collection was April 2022. Data was collected using a questionnaire. Patient characteristics related to patient retention at RSD Kertosono are income factors and sources of medical expenses, while gender, age, occupation, and education have no relationship with patient retention. Perceived patient value, trust, and patient retention are related to patient retention at RSD Kertosono. The patient's perceived value is the most dominant variable related to patient retention at RSD Kertosono.
B-2328
Depok : FKM-UI, 2023
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Hendro Darmawan; Promotor: Bambang Sutrisna; Ko-Promotor: Dede Kusmana, Slamet Suyono; Penguji: Budhi Setianto, Djanggan Sargowo, Ratna Djuwita, Irawan Yusuf
D-215
Depok : FKM-UI, 2007
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
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Sudijanto Kamso; Promotor: Johanna S.P. Rumawas; Kopromotor: Widjaja Lukito, Slamet Suyono, Sudarto Ronoatmodjo; Penguji: Hadi Pratomo, Kemal Nazaruddin Siregar, Idrus Jus`at
Abstrak:
Cardiovascular disease has become the first cause of death. Highest morbidity is found in the age, and among cardiovascular diseases, prevalence of hypertension is the highest. Many studies on the relationship between nutritional factors and hypertension have been done, but studies to observe determinants of hypertension in Indonesia are lacking. Therefore, there is an urgent need to elaborate information on various hypertension risk factors in the Indonesian elderly, which will allow the policy makers to provide appropriate intervention programs. The primary purpose of this study was to investigate various determinants of hypertension in the Indonesian elderly with different nutritional status. A cross sectional study was undertaken in Jakarta and 5 other cities with total sample of 1261 elderly using multistage random sampling. Subjects were recruited from elderly population in Jakarta, Padang, Bandung, Jogyakarta, Denpasar and Makasar. Data were collected through interview using structured questionnaires, anthropometrics measurements, biochemical blood and urine analysis, and blood pressure measurements. Daily nutrients intake was analyzed using WorldFood2 Dietary Assessment Program. Data were analyzed by using SPSS programs for Windows version 7.5; General Linear Model, Multiple linear regression and logistic regression analysis were performed to determine the predictive power of independent variables for outcome variables. Prevalence of hypertension found in the study was quite high, more than 50% of the study population for both men and women. This study showed significant differences of determinant and predictive factors of blood pressure between elderly with Body Mass Index (BMI) < 25 kg/m2 and BMI? 25 kg/m2. Prevalence of systolic and diastolic hypertension was higher in the elderly with BMI < 25 kg/lm2 than in the elderly with BMI 25 kg/m2. BMI was a significant determinant for diastolic blood pressure in elderly with BMI > 25 kg/m2. There was a positive association between blood pressure and Waist to hip ratio (WHR) irrespective of BMI value. Plasma LDL cholesterol >160 mg/dl increased the risk of having systolic hypertension 1.5 to 2 times in the elderly with BMI < 25 kg/m2 after the age of 65 years and increased the risk of having diastolic hypertension 1.5 times. Plasma triglycerides > 200 mg/dl increased the risk of having systolic hypertension 1.7 and 2.5 times in elderly with BMI 25 kg/m2 and in elderly with BMI? 25 kg/m2 respectively, after the age of 65 years and increased the risk of having diastolic hypertension Ft, 1.7 times. Ratio of total cholesterol to HDL cholesterol > 5 increased the risk of having hypertension 1.8 times in elderly with BMI? 25 kg/m2. Plasma HDL cholesterol < 35 mg/dl in elderly with BMI < 25 kg/m2 increased the risk of hypertension approximately 2.4 times. In elderly with BMI < 25 kgmm2, monounsaturated fatty acid (MUFA) had negative correlation (protecting effect) with diastolic and systolic blood pressure. Saturated fatty acid (SFA) had positive correlation with diastolic blood pressure and systolic blood pressure. Cholesterol intake had positive correlation with diastolic blood pressure. Multivariate analyses in this study did not find significant correlation between energy intakes with blood pressure. Although no significant correlation was found between protein intakes with blood pressure, this study showed that arginine intake had protecting effect against hypertension. The study also showed that calcium and potassium intake had negative correlation with DBP and SBP respectively in elderly with BMI > 25 kg/m2. In elderly with BMI < 25 kg/m2 sodium intake had positive correlation with SBP. This study also demonstrated that sport index had negative correlation (protecting effect) with diastolic blood pressure. Nutrition education to elderly group should emphasize healthy nutrients with protecting effect against hypertension and avoid nutrients with positive correlation to hypertension. Suggestion for sodium restriction especially in the elderly with BMI < 25 kg/m2, and proper physical/sport activity as a protecting factor against hypertension is very important for the elderly. Regular check of blood pressure and plasma lipid should be conducted and Public Health Centers equipped with appropriate laboratory facilities, for early detection of hypertensive risk factors. BMI category should be considered in hypertension program since there were differences of determinant factors of hypertension between different categories of BMI. Future studies should be directed on public health and nutrition intervention to the elderly community.
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D-67
Jakarta : FKUI, 2000
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
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