Jurnal Manajemen Pelayanan Kesehatan
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PERAN RESEP ELEKTRONIK DALAM MENINGKATKAN MEDICATION SAFETY PADA PROSES PERESEPAN
Full text linkABSTRACTBackground: Many health organizations pay high attention tomedication safety, because medication errors lead to harmand financial loss. Prescribing error as part of medicationerror could have been prevented. Many interventions are developedto prevent prescribing errors, one of which is theelectronic prescribing system. Since 2007 this hospital alreadyimplemented the electronic prescribing system but not all physicianshave used the system yet.Objective: To describe the use of electronic prescribing systemto improve medication safety through reducing prescribingerror, to analyse other factors causing prescribing errors,and to evaluate physicians acceptance of the electronic prescribingsystem.Methods: Prescriptions were collected from ambulatory patientsreceiving two drug jeniss or more. Prescribing errorsfrom electronic and non electronic prescriptions were identifiedand compared, and Odds ratio were calculated. Acceptanceof the electronic prescribing system was obtained fromin-depth interview and questionnaire.Result: Incomplete prescription was significantly higher in thenon-electronic than the electronic prescribing (OR 1.30; 95%CI1.06-1.58), while illegible prescription was sigficantly found in91 among the the non-electronic prescription. Drug interactionsand other errors such as improper drug selection, polipharmacyand unusual dosage resulted from clinical decisionmakingerrors could not be reduced by electronic prescription.Other factors influencing prescribing errors were professionalbackground, age group of the patients, compounding drug andpolipharmacy. More than 50% physicians agreed and stronglyperceived ease of use and benefits of electronic prescribing.Conclusion: The electronic prescription reduced prescribingerrors due to the writing process, while additional supportsystems and clinical pharmacy interventions are needed toreduce prescribing errors due clinical decision making to improvemedication safety. Perceived benefits influenced utilizationof electronic prescribing greater than perceived ease ofuse.Keywords: medication error, prescribing error, electronic prescribin
Efisiensi pelayanan kesehatan dasar di Kabupaten Pemalang menggunakan data envelopment analysis
No full textLatar Belakang. Ketersediaan sumber daya kesehatan yang terbatas mempengaruhi kinerja pelayanan puskesmas. Di sisi lain dinas kesehatan dan puskesmas dituntut mampu mengelola sumber daya kesehatan yang tersedia untuk menyelenggarakan pelayanan kesehatan secara optimal dengan mengedepankan efisiensi dalam setiap operasional puskesmas. Tujuan penelitian ini adalah untuk menganalisis tingkat efisiensi relatif pelayanan kesehatan dasar puskesmas, mengetahui upaya peningkatan efisiensi bagi puskesmas inefisien dan memperkirakan pengaruh faktor-faktor lingkungan/ kontekstual terhadap efisiensi pelayanan kesehatan dasar puskesmas.Metode. Jenis penelitian deskriptif kuantitatif menggunakan metode data envelopment analysis (DEA) dua tahap. Tahap pertama untuk mengukur efisiensi pelayanan kesehatan dasar. Tahap kedua untuk mengetahui pengaruh faktor-faktor lingkungan/ kontekstual terhadap efisiensi pelayanan kesehatan dasar. Penelitian ini menggunakan data sekunder laporan kinerja pelayanan rawat jalan 22 puskesmas di Kabupaten Pemalang tahun 2013.Hasil. Pengukuran efisiensi menggunakan model DEA VRS orientasi output diperoleh 50% puskesmas efisien teknis dan 50% puskesmas inefisien teknis. Dari upaya peningkataan efisiensi pada puskesmas inefisien diperoleh target pengurangan input sumber daya ketenagaan puskesmas ssebanyak 49 personil dan target peningkatan output pelayanan kesehatan dasar sebanyak 154.911 kunjungan rawat jalan. Hasil analisis regresi tobit menunjukkan populasi penduduk signifikan dengan arah hubungan positif terhadap efisiensi teknis pelayanan kesehatan dasar puskesmas. Sedangkan kepadatan penduduk, proporsi kunjungan masyarakat miskin dan sarana kesehatan dasar lain tidak signifikan dengan arah hubungan positif.Kesimpulan. Ketidakefisienan puskesmas disebabkan oleh penggunaan sumber daya ketenagaan puskesmas yang berlebih dan rendahnya pemanfaatan pelayanan kesehatan dasar oleh masyarakat. Metode DEA dapat digunakan sebagai alat untuk mengukur tingkat efisiensi pelayanan kesehatan dasar puskesmas, memberikan informasi penyebab puskesmas inefisien dan menentukan target peningkatan efisiensi pada puskesmas inefisien. Kata Kunci : efisiensi teknis, pelayanan kesehatan dasar, puskesmas, data envelopment analysis
ANALISIS BESARAN BIAYA KAPITASI DAN PREMI BERDASARKAN BIAYA KLAIM DAN UTILISASI JPK PT JAMSOSTEK DIY
Full text linkIntroduction: Debate on the issue of contributory SocialSecurity Agency (BPJS) for health have yielded disappointingresults. The majority of workers wanting health insurancedues BPJS as lowHowever, the premium that is too lowresulting in payments to health care provider also low. Theamount of the payment of low will affect the quality of servicesand satisf action participants over a health care benefitprogram.Methods: This study is a descriptive research design with acase study involving two data sources, primary and secondarydata. Primary data obtained through interviews and secondarydata obtained from reports the DIY branch office PT.Jamsostek.Results: Based on data of claim costs and utilization of service:In 2008, capitation Rp1.876,00 PMPM and premium Rp11.070,00;in 2009, capitation Rp1.973,00 PMPM and premium Rp11.085,00;in 2010, capitation Rp2.398,00 PMPM and premium Rp13.425,00;in 2011, capitation Rp2.403,00 PMPM and premium Rp14.921,00;in 2012, capitation Rp3.416,00 PMPM and premium Rp15.923,00.Perceptions of the family physician capitation date suggeststhat capitation received lower with the services they have toprovided.Conclusion: The capitation and premium is calculated usingdata cost of claims and the utilization of its value lower thanstandard the capitation and premiums set on PT Jamtsostekbranch DIY and PT Askes. The results of calculation of cost acapitation is also lower than the amount of capitation andpremium on the implementation of the National Health Insurance(JKN) in 2014 who sets capitation Rp8.000,00 to Rp10,000,00PMPM. Need of further studies concerning the benefit serviceclinic 24 hours in effect in jamsostek; an absence of adjustmentbetween magnitudes payment the capitation with the openservice and performance the doctors family.Keywords: capitation, premium, family physician perception
BIAYA PELAYANAN HEMODIALISIS PESERTA ASURANSI KESEHATAN MENURUT PERSPEKTIF PASIEN DI RUMAH SAKIT UMUM DAERAH TIPE B, PROVINSI BALI
Full text linkBackground: Chronic Kidney Disease has become a largeburden of public healthcare in many countries. Incidence andprevalence of patients requiring hemodialysis has increasedcontinuosly and hemodialysis is also high cost. Since healthinsurance takes a bigger role in financing health care, theperspective of insurance and patient are needed to beleaderstood.Aim: The aims of this study were to describe cost ofhemodialysis covered by Askes and out of pocket, and toidentify factors related to hemodialysis costs.Method: Cross sectional study was carried out. Subjectswere 51 Askes patients receiving hemodialysis treatment intype B public hospital Bali Province. A quesionaire was used tocollect data. Descriptive statistic analysis was carried out todescribe the dependent and independentvariables, followedby a linear regression to identify corelation among dependentand independent variables.Result: Average cost of hemodialysis in Askes patient wasRp62.543.379,08 per person per year. Average costs ofhemodialysis covered by PT. Askes and out of pocket wereRp56.501.237,90 and Rp6.042.141,18 respectively. Distancesfrom patient’s house to hospital was significant to predict 11,1%of hemodialysis cost from out of pocket. Frequency ofhemodialysis was significant to predict 12,4% of hemodialysiscost covered by Askes.Conclusion: Distances from patient’s home to the hospital isrelated to out of pocket cost, while frequency of hemodialysisis related to hemodialysis cost covered by Askes.Keywords: cost of hemodialysis, insurance cost, out of pocket,patient perspectiv
Penilaian Kinerja Dokter Sebagai Dasar Sistem Remunerasi di RSUD dr.Soehadi Prijonegoro Sragen
No full textPenelitian dengan metode Action Research untuk mendapatkan kesepakatan mekanisme penilaian kinerja dokter dalam rangka pembagian jasa pelayanan JKN di RSUD dr.Soehadi Prijonegoro Sragen.Mekanisme Penilaian kinerja ini dapat digunakan sebagai dasar sistem remunerasi dokter
IMPLEMENTASI TATA KELOLA KLINIS OLEH KOMITE MEDIK DI RUMAH SAKIT UMUM DAERAH DI PROVINSI JAWA TENGAH
Full text linkBackground: Clinical governance aims to deliver the bestclinical care for patient as stipulated in Law No. 44 of 2009about Hospital and the Minister of Health Decree No. 755/Menkes/Per/IV/2011 about Implementation of Medical Committee.Medical committee is in charge of implementing clinicalgovernance so that the medical staff at the hospital maintainedtheir professionalism.Objective:To measure implementation of clinical governanceby the medical committee at district general hospitals in CentralJava province.Methods: This was a cross-sectional survey study. The subjectswere 48 District General Hospitals in Central Java consistingof 1 class A,17 class B, 26 class Cand 4 class D. Dataobtained using questionnaire which measurestructure andprocess of clinical governance implementation. There are 8variables on structures and 13 variables on processes. Questionnaireswere sent to respondents through a courier serviceand answers were given by interviews or written responsesand analyzed descriptively.Results: Data obtained from 30 hospitals (1 class A, 12 classB,14 classC and 3 class D). The average level of clinical governanceimplementation is 67%.The average fulfillment level ofthe structure is 75 and 58% forthe processes. Implementationof the medical committee assignments is a medical audit 3.3%,credentialing 3.3%, sustainable professional development 50%and medical professional development 70%. There is severalconstraints in implementation the Minister of Health Decree No.755/Menkes/Per/IV/2011 because of the uneven spread ofspecialist and lack of support from hospital management.Conclusions: Implementation of clinical governance by themedical committee in district’s hospitals in Central Java has notbeen in accordance with existing regulations. There is a needto strengthened the medical committee. It would need to manufactureclinical governance guidelines by the authorities andmonitoring its implementation.Keywords: clinical governance, medical committee, districtgeneral hospita
PRAKTIK KESELAMATAN PASIEN BEDAH DI RUMAH SAKIT DAERAH
Full text linkBackground: Surgery is an important care intervention. Indeveloping countries, World Health Organization (WHO)estimates 50% of complication and death due to surgery ispreventable. Therefore, WHO introduces safe surgery andsurgical safety checklist (SSCL) as an attempt to improve patientsafety, reduce mortality and disability. This study aimed todescribe the practice of safe surgery by using SSCL in theoperating room of Sumbawa District hospital.Method: A cross-sectional study was conducted. Subjectswere all patients who had major surgery between May-July2012 were recruited. Ninety three patients, consisting of 44elective and 49 emergency surgeries were recruited.Observation was carried out using SSCL and data wereanalyzed descriptively.Result: Implementation of SSCL was consistent (100%) onthe completeness of anesthesia check and pulse oximeter(sign in phase), and review of sterile surgical equipment (timeout phase). None of the checklist items in sign out phase wasfully implemented.Conclusion: Implementation of safe surgery has not beenfully implemented in major surgery. Therefore, efforts shouldbe made to introduce and disseminate SSCL to the surgicalteams in order to improve patient safety.Keywords: surgical safety checklist, dist rict hospital,observational stud
ANALISIS BIAYA MUTU DALAM PENINGKATAN MUTU LAYANAN KESEHATAN DI PUSKESMAS
Full text linkBackground: Customer complaints and even law suits reflectpoor quality of care. Supports for quality improvement hasbeen low. Therefore calculation of cost of quality in PublicHealth Centers (PHC) is needed to allocated budget. This studyaims to obtain cost of quality and efforts to improve the qualityof PHC through commitment of top management and support ofstakeholders in Sleman PHC, Yogyakarta Special Province.Method: The research used a case study with multiple-casesembedded design. The cases were four PHCs that apply qualitymanagement system (QMS) and two PHCs that have not aplliedit yet. The 2010 budget documents were analyzed with thePAF instrument (prevention, appraisal, failure). Qualitative datawere collected from informant interviews.Result: The average cost of quality in PHCs with QMSimplementation was IDR 70,000,803; while in the non-QMSimplementation reached IDR 31,421,450. The proportion of costof quality in PHCs implementing QMS was 67% for prevention,33% for appraisal and none for internal-external failures. Whilefor the non-implementing QMS, the proportions were 92%,7%, 0%, and 1% sub sequently.Conclusion: The average cost of quality in PHCs with QMS is2.2 times higher than the non-QMS. However, its cost forprevention needs to be improved, through commitment of topmanagement and support from stakeholders.Keywords: cost of quality, QMS, prevention, failure, appraisalcost, Public Health Cente
FAKTOR PENYEBAB MEDICATION ERROR DI INSTALASI RAWAT DARURAT FACTORS AFFECTING MEDICATION ERRORS AT EMERGENCY UNIT
Full text linkBackground: Incident of medication errors is an importantindicator in patient safety and medication error is most commonmedical errors. However, most of medication errors can beprevented and efforts to reduce such errors are available.Due to high number of medications errors in the emergencyunit, understanding of the causes is important for designingsuccessful intervention. This research aims to identify typesand causes of medication errors.Method: Qualitative study was used and data were collectedthrough interviews, observation and secondary document.Result: Prescribing errors identified were dosage error anddosage wri ting error, unclear prescription wr iting, andincomplete administration and prescription. Dispensing errorincludes misreading prescription of look alike sound alike drugs,inaccurate number of drugs, drugs not accordance to theprescriptions, inaccurate dosage given and incorrect form.While for administration error, we found inaccurate time andtechnique of administration, drugs given to a wrong patientwith similar identity. The cause of prescribing error is due todoctor’s knowledge, poor handwriting, and family interruption.The following factors may cause administration error: individualcharacter, workload, collaboration with family, and poor familyknowledge on drug collection procedures.Conclusion: Different forms of medication errors and theirpotential causes were identified from this study. Openness indiscussing this topics and acceptance of different types oferrors are critical in order for the hospital to implementsuggested actions to reduce medication errors.Key Words: patient safety, medication error, emergency uni