First-level Health Facilities Research Articles

Maternal and Child Health: The Key to a Better South African Future

South Africa, a country rich in history and natural beauty, also faces serious challenges in the health sector, especially maternal and child health. Maternal and infant mortality rates are still high, inequality in access to health services, low levels of education and knowledge of reproductive health, as well as problems of malnutrition and HIV/AIDS are the main focus of discussion. Although the government has launched programs to improve maternal and child health, funding challenges and disparities in health resources between regions still hinder the achievement of equitable health coverage. This article highlights the importance of increasing health budget allocations, building first-level health facilities, improving the skills of health workers, reproductive health education, nutritional interventions, and multi-stakeholder cooperation to overcome these health challenges.

Analysis of Needs and Service Capacity of BPJS at First-Level Healthcare Facilities in Bandung District

The community's need for BPJS services at Primary Health Facilities (FKTP) can be well met if adequate service capacity is available. This research aims to analyze the gap between the needs and capacity of BPJS services in FKTPs in Bandung District. This quantitative study uses secondary data owned by Dinas Kesehatan Provinsi Jawa Barat and BPJS Kesehatan Kantor Cabang Soreang. The calculation of needs uses the number of BPJS participants registered in each FKTP, and the calculation of service capacity is based on the duration of service and the number of general practitioners in the FKTP. Out of the 187 FKTPs analyzed, 125 FKTPs are experiencing overcapacity, 58 FKTPs are undercapacity, and 4 FKTPs are optimal. FKTPs with optimal conditions have an average ratio of doctors to BPJS participants of 1:6250. The gap between needs and capacity will impact the quality of service and the financial health of these FKTPs. This issue needs to be addressed by redistributing the number of BPJS participants registered in FKTPs so that the primary healthcare needs of the community in Bandung District can be met.

Sosialisasi Rekam Medik Elektronik pada Fasilitas Kesehatan Tingkat Pertama

Electronic medical record is a clinical data storage application, as a clinical decision support system, standardization of medical terms, computerized data entry, as well as medical and pharmaceutical documentation in an organized manner. The First Level Health Facility is one of the places used by patients to request health services so that they have a record of interactions with patients. So this socialization is very important to do to reduce losses in terms of time and energy for both medical record officers and patients. This community service activity is carried out in first-level health facilities by providing education and socialization provided in the form of using Electronic Medical Records. Community service activities are carried out using the presentation/lecture method at IDI Kudus Regency on June 11, 2022. The use of electronic medical records is expected to improve and strengthen services for patients, including clinical (medical) and administrative services. Information generated from electronic medical records is also useful for education, regulation formulation, research, community health management, policy support, and to support referral health services. It is hoped that the application of electronic medical records can be easily used by all officers, both from medical record officers and medical personnel, the creation of integrated patient data, no duplication of medical record numbers that can make it difficult to find patient data at the time of re-treatment and holding further socialization regarding the application electronic medical record. The benefits will be felt optimally if the application of electronic medical records is evenly distributed and is supported by updated information systems and technological materials.

MULTIPHASIC SCREENING: CLINICAL SYMPTOMS AND MENTAL HEALTH PATIENT TUBERCULOSIS IN JAMBI CITY, INDONESIA

Background: Multiphasic screening with GeneXpert MTB/RIF and PHQ-9 is a solution for achieving successful conversion of intensive phase sputum examination. Purpose: To determine the effectiveness and feasibility of multiphasic screening for clinical symptoms and mental health in patients using the Tuberculosis Directly Observed Therapy (TB-DOTS) strategy. Methods: This study used a survey approach with a one-sample multiple testing screening method on the case finding and mental health of patients with TB. This screening was carried out in two stages: Stage I, suspected TB screening, and Stage II, mental health screening of TB patients undergoing intensive treatment (two months). Samples were taken from 160 TB suspects who came to health centers in Jambi City from August 1 to October 1, 2022, using proportionate stratified random sampling. Data were analyzed using statistical software to determine the accuracy and feasibility of screening. Results: Sputum conversion (Smear [-]) was 97.78% and the prevalence of mental health problems in patients was 22.22%. Stage I screening (suspected TB [GeneXpert MTB/RIF]): cough >2 weeks sensitivity, 94.84%; PPV, 97.35%; and accuracy, 92.50%. Stage II screening (patient mental health [PHQ-9]) with a validity of 9 items in the range of 0.17-0.66; ICC (interclass correlation coefficient [ICC], 0.60-0.83; Cronbach's a coefficient, 0.88). Multiphasic yield screening is recommended to achieve a better treatment success rate. Conclusion: Early detection of cases and mental health problems of TB patients in the early phase of treatment is a solution for developing a TB-DOTS strategy at first-level health facilities.

Analysis of The Effect of Chronic Disease Management Program (Prolanis) on Patient Satisfaction Level for Hypertensive Patients at Baros Health Center and Rangkasbitung Health Center in Lebak Regency, Banten Province

In order to overcome hypertension which has become a serious public health problem, the Government through BPJS Health is taking a proactive approach. One of them is by involving first-level health facilities (FKTP), especially Health centers, to carry out promotive and preventive efforts known as the Chronic Disease Management Program (Prolanis). Prolanis' goal is to encourage people with chronic diseases, for example, hypertension, to achieve an optimal quality of life so as to prevent complications.
 This study aims to find out that the implementation of Prolanis can indeed increase patient satisfaction with mild and moderate hypertension at the Health center so that it is feasible to be funded by BPJS Health by knowing the characteristics and satisfaction of hypertensive patients at two Puskesmas, namely the Baros Health Center which has implemented Prolanis and the Rangkasbitung Health Center which has not implemented Prolanis. Data were obtained through questionnaires distributed to hypertensive patients in two health centers, namely the Baros Health Center and Rangkasbitung Health Center. The independent variables used in the study are patient characteristics Meanwhile, the dependent variable is patient satisfaction. Data were analyzed by means of different test analyses using SPSS version 23.0.
 The results showed that the characteristics of the patients were different for the Baros Health Center and Rangkasbitung Health Center. Judging from satisfaction based on its characteristics, age has different satisfaction both at the Baros Health Center and at the Rangkasbitung Health Center. Judging from the patient's satisfaction related to knowledge and also Prolanis services in general for the Baros Health Center area it is higher (satisfied) and similarly, the blood pressure is more controlled compared to the Rangkasbitung Health Center.

Quality of Antenatal Care and its Determinants in the Urban-Rural Environment of Kamina, Democratic Republic of the Congo

Introduction: Every woman should receive quality antenatal care during pregnancy wherever she lives. We carried out this research with the objective of evaluating the quality of antenatal consultations (ANC) in terms of periodicity, screening, and prophylaxis interventions during antenatal consultations in Kamina and to identify the determinants associated with inadequate ANC. Material and methods: This was a descriptive and analytical cross-sectional study carried out in 6 health facilities in Kamina over a period of 17 months with 476 women who had given birth having attended antenatal consultations at least once. A scoring grid of periodicity standards, screening, and prophylactic interventions with a score of 40 was used to qualify the ANC as adequate. Logistic regression was performed to identify the determinants of inadequate ANC. Results: 40.3% of mothers had reached at least 4 antenatal visits (3.4±1.36); 21.2% had started the ANC no later than 16 weeks for an average age of 22.8 weeks ± 6.19. Overall, 72.5% of pregnant women had benefited from ANC qualified as inadequate. After adjustment, the determinants of inadequate ANC were multigestity (aOR=1.86[1.08-3.19]), low level of education of the mother (aOR=3.93; 95% CI=[2, 08-7.42]), and attendance at a first-level health facility (aOR=3.22; 95% CI=[2.06-5.05]. Conclusion: In the majority of cases, the ANC received by pregnant women in Kamina is inadequate. The determinants thus identified should serve the actors to direct the means to improve the quality of antenatal care in Kamina.

Padang State University of Public Nutrition Services Center (Promotion, Quality of Resources, Quantity of Facilities)

The main objective of the PPUPIK program at the community nutrition service center is toencourage Padang State University clinics to provide holistic community nutrition services. Theimplementation of this activity is managed by a group of lecturers who scientifically have a closerelationship with the program to be created. It is hoped that the proposal for a community nutritionservice center will develop well in providing individual and community services based on clinicalnutrition. Community nutrition service centers are oriented towards other health service efforts found inclinics, namely promotive, preventive, curative and rehabilitative. The advantage of this service centercompared to other first-level health facilities such as the puskesmas is that the services provided areaccompanied in the field when carrying out counseling and provision as an integrity service. The maintargets of community nutrition services are children, adolescents, pregnant women and the elderly. Theprograms carried out include nutrition service programs for infants and toddlers, nutrition services foradolescents, nutrition services for pregnant women, nutrition services for the elderly and preparticipation examinations.

Individual Determinant Factors of Patients with Hypertension and the Utilization of Chronic Disease Management Program (Prolanis) Services in First-Level Healthcare Facilities in Pesawaran District, Lampung, Indonesia

Hypertension is estimated to affect 1.28 billion adults aged 30-79 years worldwide. One of the efforts to treat hypertension at first-level healthcare facilities (FKTP) by BPJS Health is the chronic disease management program (Prolanis). Many factors influence the utilization of first-level health services. This study aimed to analyze the relationship between individual determinant factors and the use of Prolanis services at FKTP Pesawaran Regency, Lampung, Indonesia. This cross-sectional study was conducted on 330 patients with hypertension in four FKTPs, with the most participants holding Prolanis activities in the Pesawaran district, Lampung province, Indonesia, from February to April 2023. The chi-square test and logistic regression were used for data analysis. The results showed that there was a relationship between attitude (p-value<0.001), knowledge (p-value<0.001), access (p-value=0.010), level of hypertension (p-value<0.001), and utilization of Prolanis services at FKTP Pesawaran Regency. This study concludes that the individual determinants of hypertension sufferers have a significant relationship with the utilization of Prolanis in the FKTP of Pesawaran Regency, Lampung, Indonesia. It is recommended that patients with hypertension can make better use of Prolanis to maintain their health and prevent further complications.

Literature Review: Outpatient Satisfaction at Health Center During the Covid-19 Pandemic

Background: Satisfaction with various services is determined by the extent to which service providers provide the best for their consumers, including health service providers at the puskesmas. Puskesmas as a first-level health facility should provide satisfactory services for visitors. Satisfactory service can lead to loyalty to visitors, thereby reducing the use of illegal health services that can endanger health. During this Covid-19 pandemic, various puskesmas services have differed in several procedures due to adjustments to the Covid-19 pandemic policy. This difference in service procedures is thought to have an effect on patient satisfaction. Objectives: This journal has the aim of knowing the outpatient satisfaction at the health Center during the Covid-19 pandemic. Methods: The procedure for this research uses a literature review approach using the PRISMA flowchart. Collection of references through several online databases, namely Google Schoolar, ScienceDirect, Proquest, Wiley Online, Sage Publication and Media Neliti. The keywords used in the search were Satisfaction, Outpatient Patients, Puskesmas and Covid-19 Pandemic. Results: The results showed that the results varied with positive and negative responses regarding the loyalty of outpatients during the Covid-19 pandemic which was influenced by considerations of the suitability of the perception of the application of technical control, the perception of the application of administrative control, the perception of the application of PPE (Personal Protective Equipment). Another thing is information about the availability of infrastructure facilities, attitudes of health workers, knowledge and referrals with patient perceptions that affect age and education level. Conclusions: Outpatient satisfaction at the puskesmas during the Covid-19 pandemic was relatively good, but there were several influencing factors including the application of personal protective equipment (PPE), administrative control, technical control, information on the availability of infrastructure, attitudes of health workers, knowledge and referrals with the patient's perception that affects age and education level.

Maternal Mortality Over a Seven-Year Period of Conflict at Jiblah Referral Hospital in Ibb City, Yemen: A Retrospective Observational Study.

Background Fragile and conflict-affected states contribute to more than 60% of the global burden of maternal mortality. There is an alarming need for research exploring maternal health service access, quality, and adaptive responses during armed conflict. This study aims to review all cases of maternal mortality during a seven-year period of conflict at Jiblah Referral Hospital, Ibb, Yemen. Methodology A retrospective, observational study was conducted between 2011 and 2017, including all maternal deaths that occurred at Jiblah Referral Hospital, Ibb, Yemen. Data on maternal demographics, characteristics, intrapartum care, and cause of death were collected. Additionally, we compared patient characteristics according to residency (rural versus urban). Results During the study period, of the 2,803 pregnant women admitted to our hospital, 52 maternal deaths occurred. Their mean age was 29.0 ± 6.2 years, and most (63.5%) were aged less than 30 years. Most (88.5%) did not have a regular antenatal care visit, were referred cases (86.5%), were residents of rural areas (63.5%), and had a low socioeconomic condition (59.6%). The majority of maternal deaths were reported among women with gestational age (GA) of 24-34 weeks (57.7%) and primiparas women (42.3%). At hospital arrival, the majority of cases were in shock (69.2%). The majority of the mothers died during the intrapartum period (46.2%). The main cause of death was severe bleeding (32.7%), followed by eclampsia (25.0%). The mean time from admission to death was 3.0 ± 1.2 days (range = 1-6). Among all maternal deaths, 76.9%, 75.0%, and 26.9% had delays in seeking care, delays in reaching first-level health facilities, and delays in receiving adequate care in a facility, respectively. Additionally, most patients had at least two delays (57.7%). These delays were due to unawareness of danger signs in 57.7% and illiteracy and ignorance in 78.8% of cases. In comparison, according to residency, maternal mortality was statistically significant among mothers living in a rural area with GA of 25-34 weeks (24 vs. 6, p = 0.015). Additionally, maternal mortality due to delay in seeking care, unawareness of danger signs, and having at least two delays were statistically significant among rural mothers (p < 0.05). Conclusions Our study demonstrates that maternal deaths occurred among young women, referred cases, with no regular antenatal care visits, low socioeconomic conditions, and who were residents of rural areas. Delays in seeking care and delays in reaching first-level health facilities were the most common causes of maternal death due to unawareness of danger signs, illiteracy, and ignorance. We recommend that imparting basic skills and improving awareness in the community about the danger signs of pregnancy can be effective measures to detect maternal complications at an earlier stage, especially in rural areas.

Integrated Acetic Acid Visual Inspection with Installation or Examination of Intrauterine Contraception Devices: Literature Review

Cervical cancer is one of the post-translational modification where the incidence has continued to increase in the past 10 years. Cervical cancer screening using a single visit approach (SVA) model for prevention of cervical cancer through an isovaleric acidemia (IVA) examination followed by cryotherapy treatment or referral to a higher service. The SVA approach model is still not effective for increasing cervical cancer screening coverage. The one shot method is an IVA model development design that is integrated with IUD insertion. Based on experience, an IVA examination can be carried out simultaneously with pre-insertion, installation, and post-insertion IUD services. The one shot method for IUD acceptors can provide two benefits in one service and can be done at first-level health facilities.

PRESCRIPTION COST ANALYSIS IN PATIENTS OF TYPE 2 DM AND HYPERTENSION JOINING CHRONIC DISEASE MANAGEMENT PROGRAM (PROLANIS) AT PUSKESMAS AFTER THE IMPLEMENTATION OF NATIONAL HEALTH INSURANCE

To improve the status of public health and carry out social security programs in the health sector, the government started to implement the National Health Insurance. This program covers the participants’ medical care expenses using the capitation system applied in health centers as the First-Level Health Facilities. BPJS Kesehatan has allocated some budget in the form of a capitation rate to first-level health facilities for hypertension and type 2 diabetes mellitus patients after the implementation of National Health Insurance. This research was carried out in 4 health centers, namely Lamper Tengah Health Center, Mangkang Health Center, Mijen Health Center, and Karanganyar Health Center. The data were collected retrospectively from the medical records of 800 patients. The data were analyzed descriptively to determine the prescription cost and Spearman's rho test was used to find the factors that influence the prescription cost. It was revealed that the average prescription cost for type 2 DM patients was IDR 142,293, and for hypertensive patients was IDR 112,735. The prescribing pattern in patients covered by Prolanis program for type 2 DM patients is a combination of glimepiride, metformin with a drug price of IDR 20,670. Factors that have an influence on prescription costs are diagnosis p= 0.033, type of drug (p= 0.000) and drug item (p= 0.000). This study concludes that the factors to influence the drug costs of Prolanis patients at the health centers of Semarang City were the patient's diagnosis, the type of drug given, and the number of drug items given.

ANALISIS PELAKSANAAN KESELAMATAN PASIEN TERKAIT AKREDITASI DI PUSKESMAS (LITERATURE REVIEW)

Puskesmas as a first-level health facility must improve the quality of health services to the maximum so that the accreditation status increases and public trust to carry out health services also increases. One of the important indicators in improving the quality of health services at Puskesmas is patient safety. However, in Indonesia, the development of issues regarding patient safety at the Puskesmas level is not as dynamic as at the hospital level. This study aims to dig deeper and synthesize the scientific literature on patient safety and its relation to accreditation in health centers. This review uses 2 databases namely Google Scholar and Garuda. The main keywords are "Patient Safety in Puskesmas", "Quality of Service" "Accreditation". In conclusion, there are still many health workers who are less compliant and lack high commitment regarding patient safety, not all officers attend training related to patient safety, facilities and infrastructure that are less supportive, lack of funds, and policies that are not well implemented and realized. Keywords: Patient Safety in Puskesmas, Quality of Service, Accreditation.

Case report : abortus with malaria falciparum in pregnancy

Malaria infection is still a global health problem. Malaria can affect all groups including pregnant women. Malaria infection in pregnant women can cause various dangerous complications, one of which is abortion. A 35-year-old pregnant woman was diagnosed with G6P5A0H5 uk 8-9 weeks with falciparum malaria. The patient was given Dihydroartemisin and piperacuine phosphate (DHP) therapy and symptomatic drugs. During observation the patient had no additional complaints and slowly returned to normal. One week later the patient experienced bleeding from the birth canal and was declared an abortion. There are several things that must be considered in the management of malaria in pregnant women such as resources, facilities and infrastructure available at first-level health facilities, and various matters regarding optimal maternal and fetal supervision so as to prevent various complications caused by malaria infection.

Pengaruh Edukasi oleh Apoteker dengan Metode Brief Counseling terhadap Pengetahuan, Kepatuhan dan Glukosa Darah Pasien DM Tipe 2 di Puskesmas Kabupaten Pemalang

The problem currently encountered by Diabetes Mellitus (DM) patients is a decrease interaction in routine activities carried out at first-level health facilities due to the Covid-19 pandemic. This study is to determine the effect of education by pharmacists with media brief counseling on the knowledge, compliance, and clinical outcomes of DM patients. This type of research is a quasi-experimental method with a pretest and posttest design with the control group. This study was conducted prospectively to analyze the effect of brief counseling-based pharmaceutical services by pharmacists on the level of knowledge measured using the Diabetic Knowledge Questionnaire-24 (DKQ-24), the level of compliance was measured using the Morisky Green Levine Scale (MGLS) questionnaire, and the clinical outcomes of type 2 DM patients at the Puskesmas in Pemalang Regency from October to November 2021. The analysis to measure the bivariate differences in one group used the paired sample t-test, and the bivariate differences between groups were measured using the independent sample t-test. This study consisted of 32 patients in each control and intervention groups. The descriptive analysis of this study showed no differences in data on patient characteristics in the control and intervention groups (p&gt;0.05). The results showed that there was an increase in patient knowledge from 12,66±2,43 to 21,75±1,81 (p=0,000) and an increase in patient compliance from 2,03±0,96 to 0,25±0,51 (p=0,000) after being given brief counseling. The clinical outcomes of DM patients showed that there was an improvement from 177,63±82,4 to 159±58,1 (p=0,002). Based on these results, it can be concluded that there is an effect of education by a pharmacist using the brief counseling method on the level of knowledge, compliance, and clinical outcome of type 2 DM patients.

Description of JKN Patient Satisfaction with the Quality of Dental Health Services in Hospitals

The National Health Insurance (JKN) with a pre-payment financing system, which uses a capitation system for primary health services including dental and oral health services. The implementation of JKN also requires increased access and quality of health services, both at the First Level Health Facility and Advanced Health Facilities. The implementation of JKN requires support from promotive and preventive public health efforts so that the community remains healthy and does not get sick easily, and is useful in helping to control the burden of the necessary state budget. First-level health facilities that play a role in providing promotive and preventive health services are important, one of which is the Community Health Center or Puskesmas.&#x0D; The purpose of this study was to determine the description of JKN patient satisfaction with the quality of dental health services. The type of research used is a literature study with the method of collecting library data, reading and recording, and processing materials. The data used comes from textbooks, journals, scientific articles, literature reviews which contain an overview of JKN Patient Satisfaction with the Quality of Dental Health Services at the Hospital.&#x0D; National Health Insurance patient satisfaction in receiving this service is divided based on 5 SERVQUAL dimensions, namely tangibility, reliability, assurance, responsiveness and four. The quality of health services is health services that can satisfy every user of health services in accordance with the average satisfaction level of the population and its implementation in accordance with professional standards and ethical codes.&#x0D; Conclusion: The level of patient satisfaction with health services based on reliability (Reliability), responsiveness (Responsivines), Assurance (Assurance), direct evidence (Tangiable), human relations (Empaty) is a very satisfied category.

ANALISIS IMPLEMENTASI KESELAMATAN PASIEN DI PUSKESMAS KOTA SURABAYA DITINJAU DARI ENAM SASARAN KESELAMATAN PASIEN

&#x0D; &#x0D; &#x0D; &#x0D; Patient safety is one of the essential elements of a health service system that is effective and efficient in improving the quality of health services. Puskesmas as a first-level health facility must improve the quality of health services to the maximum, especially on patient safety indicators, so that accreditation status can increase. However, the development of patient safety issues in Indonesia, especially at the Puskesmas level, is not as dynamic as in hospitals and the reporting of patient safety incidents at Puskemas is still not transparent, especially in Indonesia. This research method uses qualitative research with a case study approach. Data collection was carried out using in-depth interview techniques and secondary data collection. The implementation of the patient safety program has been running well in accordance with the Policy / SOP contained in Permenkes 11 Th.2017 by adjusting the needs of the Puskesmas. In addition, several obstacles were found in implementing patient safety, such as insufficient human resource needs, the absence of special budgeted funds, minimal facilities and infrastructure, ineffective communication between officers so that miscommunication occurred, and human error. So it is necessary to evaluate DKK Surabaya in relation to human resources, funds, facilities, and infrastructure, as well as the need to update the standards/guidelines in Permenkes related to patient safety standards. Finally, there is a need for an IKP data transparency policy, especially in Puskemas.&#x0D; &#x0D; &#x0D; &#x0D;

Systematic Review: Quality and Cost Control of The Back-Referral Program National Health Insurance in Diabetes Mellitus Patients Type 2

Studies show that there are still deficiencies in the level of quality control and the cost of the referral programme in pharmacies, first-level health facilities, advanced referral health facilities, and the Social Security Administration of Health itself. This situation will affect services provided to patients through the referral program. This study was conducted to determine the factors that influence quality control and the cost of the back referral programme (DRR). Literature review studies were conducted on 11 national journals and six international journals, which were uploaded online in the 2016–2021 period. The keywords used are quality control and the cost of the BPJS-K (social security agency of health) Back Referral Program (PRB), which are man (human resources), material-machine (facilities and infrastructure), method (method), market (environment), money (financial), and time. (time). Patients with chronic diseases, in particular those who have diabetes mellitus, take up time that affects BPJS Health's quality assurance and referral programme expenditures. Due to closer proximity and quicker service, PRB allows JKN participants to travel less and wait less. A programme called PRB has the ability to offer BPJS Health participants a wide range of advantages as well as chances for BPJS Health to deliver efficient and effective healthcare.

Overview of Medication Storage at The Limbong Puskesmas UPT Rongkong District, North Luwu District

The community health center, also known as the Puskesmas, is a first-level health facility that provides services for public health efforts and individual health efforts prioritizing promotive and preventive without neglecting curative and rehabilitative efforts. The purpose of this study was to find out how the description of drug storage at UPT Puskesmas Limbong, Rongkong District, North Luwu Regency, based on spatial arrangements, how to store drugs, record stock cards, observe drug quality. Spatial planning obtained good results, but some were not appropriate, namely special cabinets for narcotics and psychotropics which were not guaranteed to be safe and did not have locks. The method of storing medicines at the UPT Puskesmas Limbong, Rongkong District, North Luwu Regency based on FIFO and FEFO and the alphabet, obtained good results. Although there are those that do not meet the requirements, namely the special cupboards for narcotics and psychotropics, their safety is not guaranteed and they do not have a key. Stock cards are used to record drug mutations (receipt, dispensing, damaged and expired). Stock card recording has a good category. Observation of drug quality obtained good results. Description of drug storage in the drug warehouse at the UPT Puskesmas Limbong, Rongkong District, North Luwu Regency in 2022 is in the good category with a percentage value of 92.5% consisting of 80% spatial arrangement, 90% drug storage method, 100% stock card recording and drug quality observation by 100%.

Patient Satisfaction Improvement by Comprehensive Holistic Services at Public Health Centre X Surabaya

Comprehensive holistic health services are a form of improving the quality of health services by measuring IKM. The result of a survey by BPJS Kesehatan is that the IKM has not reached targeted satisfaction in 2016 and 2017. Public Health Center X has an index value that exceeds the existing IKM target, but the index value is lower than the index value in 2016. This study will analyze the decrease in the satisfaction index of BPJS participants towards First-Level Healthcare Facilities (FKTP). Then the low satisfaction index of BPJS participants getting their treatments in Public Health Center X. The study aims to understand the relationship between comprehensive holistic service and the satisfaction of outpatients at Public Health Center X. The research was an analytical observational study with a cross-sectional design. The samples obtained in this study were 242 respondents. The data were next processed using the PLS-SEM application. The results show that comprehensive holistic services affect satisfaction (t=7.983). The holistic service affects loyalty (t=6.112). The customer value affects satisfaction (t=2.155) and loyalty (t=3.527). Satisfaction affects loyalty (t=4.488). This research concludes that comprehensive holistic service and customer value affect satisfaction and loyalty. In addition, satisfaction has a direct effect on loyalty.