Didik Tamtomo, Didik
Bagian Anatomi, Fakultas Kedokteran, Universitas Sebelas Maret
Articles
51
Documents
Perbandingan Efek Penambahan Neostigmin 50 µg dan 75 µg Pada Bupivakain Hiperbarik 0,5% 15 mg Terhadap Lama Kerja Blokade Sensorik dan Efek Samping Mual Muntah Pasca Operasi Anesti Spinal

JAI (Jurnal Anestesiologi Indonesia) Vol 9, No 3 (2017): Jurnal Anestesiologi Indonesia
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

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Abstract

Latar Belakang : anestesi spinal menggunakan bupivakain hiperbarik banyak dipakai pada operasi untuk pasien dengan berbagai kondisi klinik. Kerugian dari bupivakain hiperbarik adalah mula kerja lambat, kejadian mual-muntah dan hipotensi yang tinggi. Intratekal neostigmin dapat menghambat metabolisme dari sumsum tulang belakang, melepaskan  acetylcholine pada tulang belakang dan memproduksi analgesia. Penambahan intratekal neostigmin pada bupivakain menghasilkan analgesia dan mengurangi hipotensi. Tujuan : menganalisa penambahan dosis rendah neostigmin dengan hasil maksimal dan efek samping minimal antara dosis 50 µg dan 75 µg.Metode : penelitian menggunakan percobaan acak buta ganda terkontrol (Randomized Double Blind Controlled Trial) pada 36 pasien yang menjalani operasi dengan teknik anestesi spinal. Secara random subyek penelitian dikelompokkan menjadi dua yaitu kelompok A (penambahan neostigmin 50 mg) dan kelompok B (penambahan neostigmin 75mg). Pengambilan subyek penggunakan kriteria inklusi dan eksklusi, apabila subyek tidak kooperatif dan membutuhkan analgesik tambahan selama pembedahan dikeluarkan dari penelitian ini. Analisis data untuk data numerik menggunakan independent t-test, sedangkan data kategorik menggunakan chi-square, dengan tingkat kemaknaan 95% (p < 0,05, dikatakan bermakna secara statistik).Hasil : Dari hasil perhitungan statistik, lama kerja sensorik pada kedua kelompok tidak terdapat perbedaan bermakna (p > 0,05). Lama kerja sensorik pada kelompok neostigmin 50 mg yang ditambahkan pada bupivakain hiperbarik 0,5% 15 mg (197,78 ± 43,08 menit), sedangkan kelompok 75 mg yang ditambahkan pada bupivakain hiperbarik 0,5% 15 mg (195,17 ± 40,60 menit). Begitu juga lama kerja motorik kedua kelompok tidak terdapat perbedaan bermakna (p > 0,05), pada kelompok neostigmin 50 mg (249,83 ± 44,60 menit), sedangkankelompok neostigmin 75 mg (248,78 ± 33,28 menit). Namun mual dan muntah lebih sedikit pada penambahan neostigmin 50 mg yaitu mual 16,7% dan muntah 22,2% dibandingkan penambahan neostigmin 75 mg yaitu mual 83,3% dan muntah 77,8%.Kesimpulan : Efek penambahan neostigmin 50 mg pada bupivakain hiperbarik 0,5%.

Factors Influencing the Difference between Indonesian Case-Based Group Reimbursement and Medical Cost for Patients with Chronic Renal Disease Cases in Kasih Ibu Hospital, Surakarta

Journal of Health Policy and Management Vol 2, No 2 (2017)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Backgorund: JKN program has stipulated the INA CBGs reimbursement for the payment of treatment in referral health facilities, including for chronic renal disease which is a disease burden. This study aimed to analyze factors influencing the difference between Indonesian case-based group reimbursement and medical cost for patients with chronic renal disease cases in Kasih Ibu Hospital, Surakarta.Subjects and Method: The study design was an analytic observational with cross sectional design. The study was conducted in Kasih Ibu Hospital Surakarta in August-October, 2017. With a total of 231 subjects sample which was selected by using proportional random sampling. The dependent variable was the difference between Indonesian case-based group reimbursement and medical cost. The independent variables were length of stay, type of class, medical treatment/ surgery, ICU treatment, and medication use. The data were analyzed using multiple linear regression.Result: INA CBGs reimbursement (mean= Rp 6,120,000; SD= Rp 2,330,000) paid by BPJS Kesehatan was lower than actual hospital’s medical care cost (mean= Rp 7,070,000; SD= Rp 4,650,000). Factors profitable for hospitals were medical treatments/ surgery (b= 0.032; p= 0.552). Factors that inflicted financial loss were class 1 care (b= -0.104; p= 0.094), class 2 care (b= -0.033; p= 0.590) compared to class 3 care, length of stay (b= -0.541; p<0.001), medication use in accordance with national formulation (b= -0.183; p= 0.008) and the use of ICU (b= -0.045; p= 0.543). Patients who upgraded the class type (mean= Rp 5,526,074; SD= Rp 1,449,621) was higher than hospital’s medical cost for class 2 (mean= Rp 3,933,767; SD= Rp 1,887,900).Conclusion: Mean of INA CBGs reimbursement on inpatient care of chronic renal disease is lower than the mean of hospital’s medical care cost. Length of stay and doctors’ compliance in using national medication formulation are important determinants to increase medical care cost. Hospital obtains profit from patients who upgrade type of class.Key words: care cost, INA CBGs reimbursement, chronic renal diseaseCorrespondence: Mardhatillah. Kasih Ibu Hospital, Surakarta, Central Java. Email: mardhatillah.bws@gmail.com. Mobile: 089510610891.Journal of Health Policy and Management (2017), 2(2): 117-127https://doi.org/10.26911/thejhpm.2017.02.02.03

PENGARUH PELIBATAN KELUARGA DALAM PROGRAM PROLANIS TERHADAP KEPATUHAN MINUM OBAT DAN PENGENDALIAN GULA DARAH PASIEN DIABETES MELITUS TIPE2

Jurnal Manajemen Pelayanan Kesehatan Vol 18, No 1 (2015)
Publisher : Jurnal Manajemen Pelayanan Kesehatan

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Abstract

Latar Belakang: Prevalensi penyakit Diabetes Melitus (‘diabetes’) untuk semua kelompok umur di seluruh dunia terus meningkat. Kepatuhan minum obat dan pengendalian gula darah merupakan masalah umum dalam penanganan penyakit diabetes. Program Pengelolaan Penyakit Kronis (Prolanis) telah dilaksanakan oleh PT Askes (BPJS Kesehatan) pada pelayanan dokter keluarga untuk menangani penyakit kronis secara komprehensif. Kegiatan prolanis dapat dikembangkan dengan melibatkan keluarga dalam kegiatan-kegiatannya.Tujuan: untuk mengukur pengaruh pelibatan keluarga dalam program Prolanis terhadap kepatuhan minum obat dan pengendalian kadar gula darah pada pelayanan dokter keluarga.Metode: Penelitian ini merupakan penelitian eksperimen murni dengan rancangan Single Blind Randomized Controlled Trial yang dilaksanakan dalam bulan November 2013. Subjek penelitian adalah 36 pasien diabetes tipe 2 pada satu klinik dokter keluarga di Surakarta yang ikut sebagai peserta aktif Prolanis dan memenuhi kriteria inklusi. Sampel dibagi menjadi dua kelompok yaitu kelompok perlakuan (dengan pendamping) dan kelompok kontrol (tanpa pendamping) secara random. Analisis bivariat kepatuhan minum obat dan kadar gula darah diukur sebelum dan sesudah pelaksanaan program. Kepatuhan minum obat di analisis dengan uji chi square, sedangkan gula darah dianalisis dengan uji mann-whitney. Analisis perbedaan efek dengan mengendalikan variabel umur, menggunakan regresi logistik multivariat.Hasil: Sebelum pelaksanaan intervensi, tidak terdapat perbedaan signifikan antara kedua kelompok dalam hal kepatuhan minum obat (p=0,182) dan pengendalian kadar gula darah (p=0,798). Sesudah pelaksanaan program tidak terdapat perbedaan signifikan antara kedua kelompok dalam hal pengendalian kadar gula darah (p=0,171) namun diperoleh bahwa kepatuhan minum obat kelompok perlakuan secara signifikan lebih baik dibandingkan kelompok kontrol (p=0,034). Efek pada kepatuhan minum obat tetap signifikan, setelah mengendalikan variabel umur pasien pada analisis regresi logistik multivariate (p=0,013).Kesimpulan: Pelibatan keluarga dalam kegiatan Prolanis meningkatkan kepatuhan minum obat tetapi tidak berpengaruh terhadap pengendalian kadar gula darah pasien diabetes tipe 2. Kata kunci:     Pendampingan keluarga, kepatuhan minum obat, kadar gula darah, diabetes melitus tipe 2

Theory of Planned Behavior Implementation on the Factors Affecting Self-Care Management in Type 2 Diabetes Mellitus Patients

Journal of Health Promotion and Behavior Vol 3, No 2 (2018)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Diabetes mellitus (DM) is one of the largest global health emergencies in the 21st century. Diabetes self-management education (DSME) is a continuous process of knowledge transfer in order to improve skill and ability of diabetic patient to perform self-care management, which reduces blood glucose level and prevent diabetic complications. The success of DSME is determined by behavior changes of diabetic patients, which can be assessed using behavior theories including Theory of Planned Behavior (TPB). This study aimed to analyze the factors affecting self-care management in patients with type 2 DM using TPB.Subjects and Method: A randomized controlled trial study was carried out in 7 community health centers in Tarakan City, North Kalimantan, from March to May, 2018. A sample of 126 type 2 DM patients was selected by simple random sampling. The dependent variable was self-care management. The independent variables were intention, attitude, subjective norm, self-efficacy, and education level. The data was collected by questionnaire and analyzed by path analysis.Results: Self-care management was positively and directly affected by education ?senior high school (b= 7.10; SE= 3.22; p= 0.028) and strong intention (b= 2.40; SE= 0.75; p= 0.001). Self-care management was indirectly affected by self-efficacy, attitude, and subjective norm trough intention.Conclusion: Self-care management in type 2 DM is directly affected by education and strong intention. These findings support the TPB implementation in self-care management.Keywords: self- care management, type 2 DM, Theory of Planned BehaviorCorrespondence:Ana Damayanti. Faculty of Health Science, Universitas Borneo Tarakan, Jl. Amal Lama 1, Tarakan 77115, North Kalimantan. Email: damayanti.titha@gmail.com. Mobile: +6281347727774.Journal Health Promotion and Behavior (2018), 3(2): 139-145https://doi.org/10.26911/thejhpb.2018.03.02.08

Hubungan Aktifitas Fisik, Kepatuhan Mengkonsumsi Obat Anti Diabetik Dengan Kadar Gula Darah Pasien Diabetes Mellitus di Fasyankes Primer Klaten

Jurnal Sistem Kesehatan Vol 2, No 2 (2016): Volume 2 Nomor 2 Desember 2016
Publisher : Universitas Padjadjaran

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Abstract

Diabetes mellitus (DM) merupakan sekelompok penyakit metabolik  berkarakteristik hiperglikemia karena adanya kelainan sekresi insulin. Selain kematian, DM juga menyebabkan kecacatan pasien. 30% pasien DM mengalami kebutaan akibat komplikasi retinopati dan 10% amputasi tungkai kaki, sehingga penatalaksanaan DM sangatlah penting. Keberhasilan pengelolaan DM dapat dicapai melalui kepatuhan mengkonsumsi obat anti diabetik dan aktifitas fisik. Tujuan menganalisis hubungan aktifitas fisik, kepatuhan mengkonsumsi obat anti diabetik, dengan kadar gula darah penderita DM tipe 2 rawat jalan di Fasyankes Primer Klaten. Metode Jenis penelitian adalah analitik observasional dengan desain cross sectional. Populasi adalah pasien DM yang berkunjung di Fasyankes Primer Klaten. Sampel 86 pasein, ditarik secara random sampling. Pengumpulan data menggunakan kuesioner dan dokumentasi. Teknik analisa data menggunakan uji Chi Square dan regresi logistik ganda.Hasil Aktifitas fisik berkategori tinggi berhubungan dengan kadar gula darah (p = 0,021), kategori rendah dan sedang tidak berhubungan dengan kadar gula darah (p=0,061 ). Kepatuhan mengkonsumsi obat anti diabetik berkategori  tinggi, berhubungan dengan kadar gula darah (p = 0,002 ), berkategori rendah dan sedang tidak berhubungan dengan kadar gula darah (p= 0,066). Secara simultan,  kepatuhan mengkonsumsi obat anti diabetik dan aktifitas fisik  berhubungan dengan  kadar gula darah. Kesimpulan kepatuhan mengkonsumsi obat anti diabetik dan aktifitas fisik  berhubungan dengan  kadar gula darah (p=0.001).Kata kunci: Aktifitas fisik, Gula Darah, Kepatuhan

Factors Associated with Healthy Preventive Behavior among the Elderly in Lamongan, East Java

Journal of Health Promotion and Behavior Vol 3, No 4 (2018)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Health promotion behaviors in the elderly have potential effects in promoting health and quality of life and reducing the cost of health care services. Changes in the lifestyle of the people affected by cardiovascular diseases have more potential shares in reducing vascular problems than medicinal treatments of hypertension and high cholesterol. By convincing more people to maintain and obtain healthy lifestyles, there will be considerable reduction in emergence and disabilities due to cardiac problems. This study aimed to determine factors associated with health preventive behavior among the elderly in Lamongan, East Java.Subjects and Method: This was a cross sectional study conducted in Lamongan, East Java, from November to December 2018. A sample of 200 elderly was selected by stratified random sampling. The dependent variable was health behavior. The independent variables were education, attitude, peer support, family support, cadre support, perceived behavioral control, subjective norm, and intention. The data were collected by questionnaire and analyzed by a multiple linear regression.Results: Health behavior in elderly was influenced by education (b = 0.76; 95% CI = 0.27 to 1.24; p = 0.002), intention (b= 0.08; 95% CI = 0.01 to 0.16; p = 0.033), attitude (b = 0.20; 95% CI = 0.07 to 0.33; p= 0.002), perceived behavioral control (b= 0.18; 95% CI= 0.06 to 0.30; p= 0.002), family support (b = 0.19 ; 95% CI = 0.08 to 0.30; p = 0.001), cadre support (b = 0.13; 95% CI = 0.04 to 0.23; p = 0.005), peer support (b = 0.07; 95% CI = - 0.01 to 0.15; p = 0.060), and subjective norm (b = 0.10; 95% CI = - 0.01 to 0.22; p = 0.064).Conclusion: Health behavior in elderly is influenced by education, intention, attitude, perceived behavioral control, family support, cadre support, peer support, and subjective norm.Keywords: health behavior, elderly, linear regressionCorrespondence: Nurul Jannah. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: njannah.31@gmail.com. Mobile: +6282230300405.Journal of Health Promotion and Behavior, 2018, 3(4): 223-229https://doi.org/10.26911/thejhpb.2018.03.04.01

PENGARUH PELIBATAN KELUARGA DALAM PROGRAM PROLANIS TERHADAP KEPATUHAN MINUM OBAT DAN PENGENDALIAN GULA DARAH PASIEN DIABETES MELITUS TIPE2

Jurnal Manajemen Pelayanan Kesehatan Vol 18, No 1 (2015)
Publisher : Jurnal Manajemen Pelayanan Kesehatan

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Abstract

Latar Belakang: Prevalensi penyakit Diabetes Melitus (‘diabetes’) untuk semua kelompok umur di seluruh dunia terus meningkat. Kepatuhan minum obat dan pengendalian gula darah merupakan masalah umum dalam penanganan penyakit diabetes. Program Pengelolaan Penyakit Kronis (Prolanis) telah dilaksanakan oleh PT Askes (BPJS Kesehatan) pada pelayanan dokter keluarga untuk menangani penyakit kronis secara komprehensif. Kegiatan prolanis dapat dikembangkan dengan melibatkan keluarga dalam kegiatan-kegiatannya.Tujuan: untuk mengukur pengaruh pelibatan keluarga dalam program Prolanis terhadap kepatuhan minum obat dan pengendalian kadar gula darah pada pelayanan dokter keluarga.Metode: Penelitian ini merupakan penelitian eksperimen murni dengan rancangan Single Blind Randomized Controlled Trial yang dilaksanakan dalam bulan November 2013. Subjek penelitian adalah 36 pasien diabetes tipe 2 pada satu klinik dokter keluarga di Surakarta yang ikut sebagai peserta aktif Prolanis dan memenuhi kriteria inklusi. Sampel dibagi menjadi dua kelompok yaitu kelompok perlakuan (dengan pendamping) dan kelompok kontrol (tanpa pendamping) secara random. Analisis bivariat kepatuhan minum obat dan kadar gula darah diukur sebelum dan sesudah pelaksanaan program. Kepatuhan minum obat di analisis dengan uji chi square, sedangkan gula darah dianalisis dengan uji mann-whitney. Analisis perbedaan efek dengan mengendalikan variabel umur, menggunakan regresi logistik multivariat.Hasil: Sebelum pelaksanaan intervensi, tidak terdapat perbedaan signifikan antara kedua kelompok dalam hal kepatuhan minum obat (p=0,182) dan pengendalian kadar gula darah (p=0,798). Sesudah pelaksanaan program tidak terdapat perbedaan signifikan antara kedua kelompok dalam hal pengendalian kadar gula darah (p=0,171) namun diperoleh bahwa kepatuhan minum obat kelompok perlakuan secara signifikan lebih baik dibandingkan kelompok kontrol (p=0,034). Efek pada kepatuhan minum obat tetap signifikan, setelah mengendalikan variabel umur pasien pada analisis regresi logistik multivariate (p=0,013).Kesimpulan: Pelibatan keluarga dalam kegiatan Prolanis meningkatkan kepatuhan minum obat tetapi tidak berpengaruh terhadap pengendalian kadar gula darah pasien diabetes tipe 2. Kata kunci:     Pendampingan keluarga, kepatuhan minum obat, kadar gula darah, diabetes melitus tipe 2

Path Analysis on the Relationship Between Bio-psychosocial Factors During Gestational Period and Birthweight, Stimulation and Development in Children Aged 1-3 Years in Salatiga

Journal of Epidemiology and Public Health Vol 1, No 3 (2016)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Bio-psychosocial condition during gestational period, such as maternal nutritional status, stress, education, and family income, may have significant impact on fetal growth and development. The purpose of this study was to determine relationship between bio-psychosocial factors during gestational period and birthweight, and the relationship between stimulation and development in children aged 1-3 years.Subjectsand Method: This was an analytic and observational study with case control design. A sample of 120 children aged 1-3 years was selected by fixed disease sampling with case: control ratio= 1:2. The exogenous variables were gestational maternal education and current maternal education. The endogenous variables were gestational family income, gestational maternal stress, current family income, maternal nutritional status,  birthweight, stimulation, and child development. The data were collected by a set of questionnaire and analyzed by path analysis on STATA 13.Results:Birthweight ≥ 2.500 gram(b= 0.96; 95%CI= –0.15-1.94; p=0.054) and stimulation (b= 0.43; 95% CI=– 0.30-0.89; p=0.067) had direct positive effect on child development. Gestational maternal education, family income, maternal stress, maternal nutritional status, had indirect effect on child development through birthweight.Maternal education and family income had indirect effect on child development through stimulation.Conclusion: Birthweight ≥ 2.500 gram and stimulation have direct positive effect on child development.Keywords: bio-psychosocial, gestational period, birthweight, stimulation, developmentCorrespondence: Vistra Veftisia. Faculty of Health Sciences, Ngudi Waluyo University, Ungaran, Central Java. Email: chan_viez@yahoo.comJournal of Epidemiology and Public Health (2016), 1(3): 154-163https://doi.org/10.26911/jepublichealth.2016.01.03.02

The Association Between Maternal Education, Family Income, House Sanitation, and the Incidence of Acute Respiratory Tract Infection in Children Under Five

Journal of Epidemiology and Public Health Vol 1, No 3 (2016)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: It was estimated that the incidence of Acute Respiratory Tract Infection (ARTI), including pneumonia, was  10-20% in children under five in Indonesia. Therefore ARTI in children under five is a public health important that calls for control and prevention. The purpose of this study was to determine the association between maternal education, family income, house sanitation, and the incidence of ARTI in children under five.Subjects and Method: This was an analytic observational study with case control design. This study was conducted in Wono­giri 1 and Kismantoro Health Centers, Wono­giri, Central Java, from September to October, 2016. A total sample of 200 children under five were selected for this study by fixed disease sampling, consisting of 100 children with ARTI and 100 children without ARTI. The dependent variable was pneumonia. The independent variables were maternal education, family income, house component, and house sanitation. The data were collected by a set of questionnaire, checklist, and medical record at the health centers. The data were analyzed by multiple logistic regression.Results: Maternal education ≥senior high school (OR=0.09; 95% CI= 0.03 to 0.22; p<0.001),  house component meeting the required standard (OR=0.27; 95% CI= 0.13 to 0.57; p<0.001), and good house sanitation (OR=0.15; 95% CI= 0.06 to 0.38; p<0.001) were associated with decreased risk of pneumonia in children under five, and they were statistically significant. The association between family income and the risk of pneumonia was not statistically significant (OR=0.87; 95% CI= 0.42 to 1.79; p=0.703).Conclusion: Maternal education ≥senior high school, house component meeting the required standard, and good house sanitation are associated with decreased risk of pneumonia in children under five.Keywords: maternal education, family income, house sanitation, pneumonia, children under five Correspondence: Anita Sri Sulistyo. District Health Office Wonogiri, Central Java. Email: anitasrisulistyowati@yahoo.comJournal of Epidemiology and Public Health (2016), 1(3): 195-202https://doi.org/10.26911/jepublichealth.2016.01.03.06 

Relationship between Knowledge and Family Support regarding Hypertension with Blood Pressure Control in Elderly

Indonesian Journal of Medicine Vol 2, No 1 (2017)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Hypertension is one of the degenerative diseases that have frequently been found among the group of elderly. If hypertension goes uncontrolled, then it might escalate and cause complication. The level of knowledge for both of patients and their families in terms of preventive actions toward hypertension complication is expected to be able to control blood pressure. Among the hypertension patients, the role of family support is very important in order to maintain and to control that the blood pressure will not increase and to return it to the normal state. In relation to this background, the objective in conducting this study was to analyze the relationship between knowledge and family support regarding hypertension with blood pressure control among the elderly with hypertension in the Sangkrah Center of Public Health, City of Surakarta.Subjects and Method: This was an analytic observational study with cross sectional design. This study was conducted in Sangkrah Community Health Center in the City of Surakarta on November 2016. A total sample of 147 elderly were selected for this study by purposive sampling. The dependent variables in this study was blood pressure and was measured by sphygnomanometer. The independent variables were knowledge and family support and were collected by a set of questionnaire. The data analyzed by logistic regression.Results: Family knowledge (OR= 0.38; 95% CI= 0.13 to 1.08; p= 0.070) increased the likelihood of blood pressure control. Elderly who came from family with good knowledge regarding hypertension had 0.4 times better blood pressure control in comparison to those who came from family with poor knowledge regarding hypertension. Family support (OR= 0.43; 95% CI= 0.18 to 1.02; p= 0.046) increased the likelihood of blood pressure control. Elderly with good family support had 0.4 times better blood pressure than those who had poor family support.Conclusion: Family knowledge and family support increase the probability of blood pressure control among elderly with hypertension.Keywords: knowledge, family support, blood pressure control, elderlyCorrespondence: Iin Kusumawardana. Masters Program in Family Medicine, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: iinkusuma90@gmail.comIndonesian Journal of Medicine (2017), 2(1): 1-9https://doi.org/10.26911/theijmed.2017.02.01.01