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Jurnal Manajemen Pelayanan Kesehatan
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Search results for , issue " Vol 12, No 01 (2009)" : 7 Documents clear
MEDICAL ERROR DAN PERILAKU KLINIS PETUGAS KESEHATAN DALAM PENATALAKSANAAN MALARIA DI RSU GUNUNG SITOLI NIAS Hulu, Oktavianus
Jurnal Manajemen Pelayanan Kesehatan Vol 12, No 01 (2009)
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Background: Malaria is a major health problem in Nias. Inrecent, resistance to Choroquin has occurred in Nias. One ofthe potential factors is provider behaviour in diagnosing andtreating malaria cases. In Nias district hospital, malaria is oneof the ten most frequent diseases. This hospital functions asreferral for 18 health centres in the area.Objective: This study focused on malaria case managementand aimed to: (1) describe occurrence of diagnostic andtreatment errors; (2) describe occurrence of error of omissionand error of commission; (3) to explore provider behaviour inmanaging the disease; and (4) identify predisposing,enabling,and enforcing factors to medical errors.Method: A combination of quantitative and qualitative researchwas applied in this study. One hundred forty six (146) bloodslides available in May 2007 were re-examined in UniversitasGadjah Mada (UGM) laboratory to measure diagnosticagreement. In addition, all medical record of malaria caseswere used to identify diagnosis and treatment errors.Interviews were carried out with general practitioners,specialists, laboratory staff and nurses who dealt with malariacase management.Result: Kappa index was low (0.04). Among all patientsdiagnosed or treated as malaria (n=92), the occurrence ofmedical error was 1.87 per patient. Among these, this studyidentified 98 diagnostic errors, consisting of 16 cases of errorof ommission (17.39%) and 82 cases of error of commission(89.13%). Treatment errors occurred in 92 cases, i.e. 19 casesof error of ommission (20.65%) and 73 cases of error ofcommission (79.35%). Provider behaviour contributed tomedical errors. The behaviour was supported by lack oftraining on malaria for the hospital staff, absence of standardoperational procedure in managing malaria cases, incompetentlaboratory staff and lack of reward for good performance.Conclusion: The occurrence of medical error in casemanagement of malaria was high. Improvements in clinicalquality should be prioritized, taken into account the underlyingfactors.Keywords: medical errors, malaria case management, hospital,Nias
CLINICAL PATHWAY DALAM PELAYANAN STROKE AKUT: APAKAH PATHWAY MEMPERBAIKI PROSES PELAYANAN? Pinzon, Rizaldy
Jurnal Manajemen Pelayanan Kesehatan Vol 12, No 01 (2009)
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Background: The stroke care pathway is a simple resourcethat provides the user with a summary of the key aspects ofcare that should be considered for people with stroke at anystage in their care. There is very limited study about the use ofclinical pathway in Indonesia.Aim: This study described the process of developing clinicalcare pathway and the trial of pathway for 50 patients withacute stroke.Method: The method of this study is after-before analysis.We compare the process and outcome of non haemorrhagicstroke patients before and after the pilot implementation of thepathway. The data was obtained randomly from the medicalrecord of stroke patients. The data was analyzed descriptively.Result: The data from 50 non haemorrhagic stroke patientsafter the pilot implementation of clinical pathway were comparedwith the data from previous year. The analysis showed thatthere are improvement in the tracing for stroke risk factors,swallowing assessment, nutritional consultation, and functionalstatus measurement after the pathway implementation. Thereare not significant reductions on the average length of stayand mortality rate between the two periods.Conclusion: Our study showed that clinical pathway isimproving the indicator of stroke care services. The furtherstudy for evaluating the effectiveness of stroke care pathwayin longer period is warranted.Keywords: clinical pathway, stroke, process of care, outcome
COMMUNITY EMPOWERMENT THROUGH INTER-SECTORAL ACTION, A CASE STUDY OF GERBANGMAS IN LUMAJANG DISTRICT Siswanto, Siswanto
Jurnal Manajemen Pelayanan Kesehatan Vol 12, No 01 (2009)
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The objective of this case study was to learn the policyprocess of the Gerbangmas movement in Lumajang districtas an innovation within decentralized system. Using qualitativeapproach, data was collected by in-depth interview of keyinformants and review of documents, then analyzedthematically. The study has revealed that the policy change ofGerbangmas initiative is not a radical but incremental processwhich takes around five years period. It started from“conventional Posyandus” to be “Balai Posyandu Mandiri”,then revived by the Bupati into Gerbangmas movement. Healthsector has successfully advocated the Bupati to create acommon vehicle for all sectors. The study has identified thatthe essences of Gerbangmas movement were (i) neutralvehicle, (ii) shared goals, (iii) all sectors could be passengers,(iv) strong power of the referee, (v) government financialstimulants, (vi) self management by community, and (vii) neutralcadres as the implementer (PKK). Gerbangmas movementhas encouraged multi sectors to set programs for communityempowerment. The study recommended that in conductingcommunity empowerment for addressing social determinantsof health, it is of importance to set a neutral vehicle that canaccommodate multi sectors’ interests.Keywords: community empowerment, Posyandu,Gerbangmas, inter-sectoral action, social determinants ofhealth
PERAN DEPARTEMEN KESEHATAN SEBAGAI REGULATOR DAN OPERATOR RUMAH SAKIT Trisnantoro, Laksono
Jurnal Manajemen Pelayanan Kesehatan Vol 12, No 01 (2009)
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Sistem ekonomi di Indonesia memberikankesempatan kepada lembaga pelayanan kesehatanswasta untuk bekerja, dan pihak masyarakat diberikesempatan pula untuk memberikan sumberdayanya bagi pelayanan kesehatan. Keadaan inisudah ada sejak jaman kolonial Belanda.Konsekuensinya, sektor kesehatan di Indonesiasaat ini sudah berkembang menjadi industri dengandasar hukum pasar.Selama 10 tahun terakhir pertumbuhan RumahSakit (RS) Swasta di Indonesia lebih besar (2,91%rata-rata per tahun) dari RS pemerintah (1,25% ratarataper tahun). Pada tahun 1998, jumlah RSPemerintah (589) lebih banyak dari RS Swasta (491)dengan selisih 98 buah. Sejalan dengan pesatnyaperkembangan RS Swasta, pada tahun 2008 jumlahRS swasta meningkat menjadi 653 buah dan sakitpemerintah menjadi 667 Buah. Dengan demikian,selisih semakin mengecil yaitu 14 buah.Dalam waktu lima tahun terakhir, RS swastaberbentuk perseroan terbatas naik dua kali lipatmenjadi 85. Pertambahan terutama di daerah-daerahdengan ekonomi kuat. Rumah Sakit (RS) Yayasanmengalami pertumbuhan antara tahun 1998 sampaidengan 2002. Setelah itu, jumlah RS yayasan tidakbertambah secara signifikan. Rumah Sakit (RS)Perkumpulan sedikit bertambah pada tahun2001.Selama 10 tahun terjadi perpindahan bentuk(migrasi) RS Swasta. Ada 26 RS Yayasan berubahmenjadi RS PT. Sebaliknya 5 RS PT berubahmenjadi RS Yayasan. Sebagian besar RS yangmelakukan migrasi berada di kota-kota besar.Data ini menggambarkan dinamika kuat dalamsektor RS di Indonesia. Dinamika ini terpengaruholeh kekuatan pasar yang besar di Indonesia.Sebagaimana suatu sektor yang dipengaruhi olehpasar, akan terjadi variasi dalam mutu pelayanan.Pertanyaan pentingnya adalah bagaimana mutupelayanan RS Swasta di Indonesia. Apakah samamutunya atau bervariasi dari mutu baik sampai mutuburuk. Pertanyaan yang sama juga dapat diberikanke RS Pemerintah. Sayang pertanyaan ini sulitdijawab karena memang belum ada sistempencatatan mutu RS yang dapat diandalkan.Mengapa hal ini terjadi?Sampai saat ini belum ada sistem yangmemisahkan antara regulator dan operator di sektorkesehatan. Tanpa adanya regulator yang tepat makamonitoring mutu pelayanan bukan hal yang mudahuntuk dilakukan. Hal ini berbeda dengan sektorpenerbangan yang sudah tegas memposisikanDepartemen Perhubungan sebagai regulatorsementara berbagai perusahaan transportasi(termasuk Garuda) berfungsi sebagai operator.Departemen Perhubungan tentunya mempunyaicatatan tentang mutu pelayanan penerbangantermasuk angka kecelakaan. Perbandingan dengansektor perhubungan merupakan hal penting karenasektor kesehatan dan sektor transportasimenempatkan keselamatan (safety) sebagai isupenting.Departemen Kesehatan sendiri saat ini, masihrancu dalam memposisikan diri apakah sebagairegulator ataukah operator sistem pelayanankesehatan. Sebagai gambaran Direktorat JenderalBina Pelayanan Medik masih bersifat rangkap:sebagai operator sekitar 40-an RS pemerintah pusat,sekaligus sebagai regulator lebih dari seribu RS diIndonesia. Keadaan ini diharapkan tidak berlangsunglama lagi. Perlu ada kebijakan jelas untukmemisahkan kedua fungsi tersebut di pemerintah.Kebijakan hal ini tidak hanya menyangkut aspekteknis kesehatan namun juga politis dimana pastibanyak pihak yang akan diuntungkan olehperubahan ini, sementara itu juga ada banyak pihakyang akan dirugikan. Namun, membiarkan DirektoratJenderal Pelayanan Medik Departemen Kesehatanmempunyai fungsi rangkap, jelas merupakan halyang tidak baik untuk pembangunan kesehatan.Laksono Trisnantoro, trisnantoro@yahoo.com
PERSEPSI STAKEHOLDERS TERHADAP LATAR BELAKANG SUBSIDI PREMI, SISTEM KAPITASI DAN PEMBAYARAN PREMI PROGRAM JAMINAN KESEHATAN JEMBRANA Januraga, Pande Putu
Jurnal Manajemen Pelayanan Kesehatan Vol 12, No 01 (2009)
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Background: Premium subsidy of Jaminan KesehatanJembrana or Jembrana Health Insurance (JKJ) in JembranaDistrict has a rising trend since it began and needs toredistribute, it’s critical to apply the cost containment programsby introducing capitation system to primary health careproviders and premium payment to the member of JKJ.Purpose: To examine perceptions of policy makers towardbackground of premium subsidy, capitation system and premiumpayment of JKJ and perceptions of providers toward capitationsystem.Method: Research was using cross sectional design anddata was taken by qualitative method. The subject was policymakers and primary health care providers of JKJ. Instrumentbeing use was deep interview guidance.Result and Conclusion: Generally policy makers of JKJ hadmisinterpretation about the concept of basic needs and equityegaliter in health, that causing resistance on premium payment.Generally policy makers and providers of JKJ had badperception about capitation system.Keywords: health insurance, capitation, premium payment
USULAN-USULAN UNTUK MENGHADAPI PERMASALAHAN NON – PATEN YANG MEMPENGARUHI DISTRIBUSI DAN KETERSEDIAAN OBAT-OBAT ESENSIAL DI INDONESIA Utomo, Tomi Suryo
Jurnal Manajemen Pelayanan Kesehatan Vol 12, No 01 (2009)
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Background: Access to affordable essential medicines iscritical for management of public health in Indonesia. This isbecause the government budget for medications is limited.Furthermore, Indonesian sale of generic drugs, which wouldbe an effective strategy of providing cheaper drugs to thepublic, is only 10% of drug sales. This is lower than othercountries in Asia. Relating to HIV prevalence, there is asignificant increase number, particularly in some regions inIndonesia. It is not impossible that it will increase at alarminglevels in the near future. Finally, the enforcement ofpharmaceuticals patent law in Indonesia has created a tensionbetween national needs and domestic developmental policyand international patent standards. This tension has particularlyaffected Indonesia, since the TRIPS Agreement was introducedin 1994. The TRIPS Agreement’s protection of pharmaceuticalpatent has had adverse consequences for the health needsof Indonesia since many patients cannot afford expensivepatented drugs.Objective: This paper will consider the options or alternativesopen to the Indonesian government to address the access toessential medicine issues that confront Indonesia as a memberof the WTO. A number of questions will be considered. First,what factors are major influences on access to essentialmedicines, in Indonesia? Second, what strategies and policieswill be recommended to the Indonesian Government to managethe problems of limited access to affordable essential medicines?Result: Patent law is not the only factor reducing access toessential medicines. Non-patent issues that affect access toessential medicines include: rational selection and use ofmedicines; sustainable adequate financing; affordable pricesand reliable health and supply systems are issues that mustbe prioritized by the Indonesian Government. Several optionalstrategies and policies also need to be considered such ascontrolling drugs promotion, maximizing the use of genericdrugs, improving administrative competence, drugprocurement, distribution and storage. Finally, prescribingpractices by physicians, pharmacists and drug vendors shouldbe a priority. Meanwhile more complex long-term goals, suchas establishing an industry to produce raw materials forpharmaceuticals, can be considered. This could reduce theimpact of international pharmaceutical patents on price andavailability of essential medicines.Conclusion: This paper concludes that the Indonesiangovernment must assess a set of non-patent issues affectingthe use of available drugs, particularly generic drugs. Therecommended policies and strategies will require carefulconsideration by a multi-disciplinary committee for selectionand use of essential medicines.Keywords: patent law, distribution and availability of essentialmedicines, access to essential medicines, public health
PROFIL KOMITE MEDIS DI INDONESIA DAN FAKTOR-FAKTOR YANG MEMPENGARUHI KINERJANYA DALAM MENJAMIN KESELAMATAN PASIEN Herkutanto, Herkutanto
Jurnal Manajemen Pelayanan Kesehatan Vol 12, No 01 (2009)
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Background:  People awareness to patient safety issues isrecently raising a long with the increase of malpractice claims.Unsafe medical practice plays an important role to the issues.The occurrence of unsafe medical practice could be preventedif the medical staff committe in hospitals implement the medicalprofessionalism by overseeing the medical practitioners inhospitals. Up to now, there are no valid information regardingteh performance of the medical staff conmmittee, particularlycredentialing, audit, and disciplinary mechanism in hospitals.Objectives: This study will explore the profile of the medicalstaff committee and their performance in terms of theirorganizational structure, credentialing and clinical privileging,continuing professional development and medical audit, anddisciplinary measures.Method: A cross sectional study was conducted to examinethe performance of the medical staff committees throughstructured questionaires. The responders wererepresentatives of hospital managements of 133 hospitals whoagreed to fill in the questionaires. The scoring forms wereapplied to score the several main functions of the medicalstaff committee, i.e., structure, credentialing and clinicalprivileging, continuing professional development and medicalaudit, disciplinary measures, and management involvement inthe clinical governance.Results:  91 % of the participating hospitals were GeneralHospitals and the medical staff committee of 15% of the totalparticipants were absent. This research revealed that the meanof the total score of the medical staff committees performancewere 17,9 + 4,9.Conclusion: The study revealed that their performance wasstill below the expected outcome since the delineation of clinicalprivilege was not properly conducted by the hospitals. Theexistence of credentialing and clinical privileging, continuingprofessional development and medical audit, and disciplinarymeasures reflects a better performance of the medical staffcommittees.Keywords: patient safety, medical staff committee,performance

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