Prevalensi diabetes melitus berdasarkan hasil riset kesehatan dasar (Riskesdas, 2013) tertinggi di Indonesia terdapat di provinsi DI Yogyakarta. Diabetes melitus merupakan penyakit kronis yang membutuhkan pengobatan jangka panjang dan kompleks dimana salah satu penentu keberhasilan terapi bergantung pada kepatuhan penggunaan obat. Tujuan penelitian ini untuk mengetahui gambaran karakteristik pasien meliputi jenis kelamin, usia, tingkat pendidikan, durasi penyakit, komorbid, dan penggunaan ADO terhadap kepatuhan pasien diabetes melitus tipe 2. Penelitian ini menggunakan metode observasional dengan rancangan analisis potong lintang yang dilakukan secara retrospektif terhadap 123 pasien diabetes melitus tipe 2 rawat jalan di puskesmas daerah Yogyakarta pada bulan Agustus-September tahun 2015. Metode pengambilan sampel menggunakan teknik accidental sampling. Instrumen penelitian berupa lembar pengambilan data dan kuesioner Morisky Medication Adherence MMAS-8. Data dianalisis menggunakan Chi-Square. Hasil penelitian menunjukkan bahwa secara keseluruhan tingkat kepatuhan pasien diabetes melitus tipe 2 berada pada tingkat kepatuhan rendah. Hubungan antara pengaruh karakteristik pasien: jenis kelamin (p=0,275), usia (p=0,473), tingkat pendidikan (p=0,157), durasi penyakit (p=0,097), jumlah komorbid (p=0,79), dan ADO (p=0,401) terhadap tingkat kepatuhan tidak signifikan (p>0,05). Kata kunci: Diabetes melitus tipe 2, karakteristik pasien, kepatuhan
The increasing prevalence of diabetes mellitus (DM) in Indonesia requires participation of all parties including pharmacists. This study aims to determine the impact of the implementation of home pharmacy service guidelines for patients with type 2 diabetes mellitus on the level of knowledge, medication adherence, therapeurical satisfaction and glycemic control. This study used a quasi-experimental design with one group pre-test and post-test design involving 37 patients with type 2 diabetes mellitus who met the requirements of inclusion and exclusion criterias. The Diabetes Knowledge Questionnaire (DKQ-24) and the Diabetes Medication Satisfaction Tool (DMSAT) were used for collecting the data. Patient adherence was measured using a pillcount method and fasting blood sugar levels (FSB) data were obtained from the laboratory results. The study was conducted in two community health centers and patient’s home in the Yogyakarta Municipality area. The data were analysed using Wilcoxon and Spearman test. The results showed the change of the level of knowledge, medication adherence, therapeutic satisfaction and glycemic control before and after intervention of pharmacy services at home. The average decreasing of fasting blood sugar levels 17.09 mg/dL ± 1.43
Background:
The national health insurance of Indonesia has implemented the Indonesian Case Base Groups (INA-CBGs) tariff rates for healthcare payment. However, there is still problem of difference between the real cost of healthcare and the INA-CBGs tariff rates. This study aimed to evaluate the real cost of healthcare in comparison with the INA-CBG’s tariff rates and to analyze factors associating with the real cost. The study focus on healthcare cost of non-chemotherapy expenditure among patients of high-incidence cancers having chemotherapy covered by the national health insurance.
Methods:
The study was conducted from the perspective of healthcare provider. Costs data was obtained from hospital billing of Sanglah hospital, a referral hospital in Bali Provincein the period of January – July 2014. The data involved 383, 161, and 152 of in-patient breast cancer cases, cervical cancer cases, and nasopharyngeal cancer cases, respectively. Descriptive statistic was used to analyze patients characteristics, one sample t-test was used to analyze the mean difference of healthcare cost based on real cost and INA-CBG’s tariff rates, and finally, bivariate analysis was used to examine relationship between patients’ characteristics and the real cost.
Results:
The study shows there were significant differences of non-chemotherapy expenditures based on the real cost and INA-CBG’s tariff rates, in which the costs were lower for the real cost. Factors which significantly associated with the real cost were number of procedure, type of hospitalized room, and length of stay.
Conclusions:
The study supports the necessary of evaluation of the INA-CBG’s tariff rates to adjust to the real healthcare expenditure. On the other hand, the hospital needs to evaluate the service quality of patient treatment by optimizing budget allocated by the health insurance.
Indonesian Case Based Groups (INA-CBGs) implementation on hospital financing for stroke patient using Jaminan Kesehatan Masyarakat (Jamkesmas) at 3rd class hospitalization requires therapy plan management and cost analysis because stroke is a leading cause of death worldwide and need high treatment cost. It is purposed to skimp the hospital expenditure and avoid deficit suffering. The study objectives was to determine the suitability cost between real stroke treatment cost and health financing based on INA-CBGs, and to determine the highest cost component on stroke treatment at Jogja hospital. This cross sectional observational study used retrospective sampling method. The subjects were taken from all stroke patient population using Jamkesmas insurance at Jogja Hospital, were hospitalized between January 2011-April 2012 and met the inclusion criteria. The subject was then classified based on INA-CBGs. Patient’s length of stay and costs (direct medical and direct non-medical costs) were defined as study variable. Data was analysed using descriptive analysis and Mann Whitney test. Throuh this study we conclude the average rate of real stroke treatment cost at Jogja Hospital was higher insignificantly than INA-CBGs based cost and the highest treatment cost was on the medicine and medical equipment.
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