Primary Health Care In Indonesia Research Articles

Cardiovascular emergency in indonesian primary health care (PUSKESMAS): a national multicentre service evaluation study based on ESC guidelines adherence

Abstract Background Early diagnosis and prompt treatment are crucial in reducing cardiovascular (CVD) burden in the global level, especially in Indonesia with more than a half million CVD death annually. As frontliner, more than 10,000 primary healthcare (PUSKESMAS) spreading around Indonesia are pivotal in delivering CVD emergency care. However, due to the scarcity of healthcare resources, significant disparities exist between guideline recommendations and their implementation in Indonesian primary health care. Purpose Our study aims to describe current cardiovascular emergency care, assess guideline adherence, and identify key factors influencing the trend. Methods This multicentre study was conducted in 40 PUSKESMAS across Indonesia from October to December 2023. Data related to cardiovascular emergencies diagnosis, work-ups, treatment, and outcomes were gathered and then evaluated according to the ESC Guidelines. Recommendations, particularly Class I, were converted into points with respect to diagnostic and treatment domains. Guideline adherence scores were then calculated based on the percentage of accomplished points. Linear regression analysis was employed to identify factors that could explain variations in guideline adherence across all PUSKESMAS. Results 215 CVD emergency patients were reported. The most prevalent diagnosis was hypertensive crisis (n=137; 64%) with ECG done in only 26% of cases and none underwent imaging. Oral amlodipine (59%) and captopril (55%) were mostly used as antihypertensive, with none receiving intravenous. The second most common diagnosis was ACS (n=42; 20%), with ECG performed in only 71% of cases. Among 13 patients with STEMI, 69% only received aspirin, and 46% were given DAPT. Malignant arrhythmia occurred in 26 patients, with none receiving cardioversion. The most used anti-arrhythmic are bisoprolol, propranolol, and atropine. Among 23 cases of acute HF, only 39% received oxygen, while IV furosemide was used in only one case. Cardiac arrest occurred in two patients, both received CPR and epinephrine. In terms of guideline adherence, mean diagnostic score (%) was demonstrated highest in Cardiac Arrest at 100 and the lowest in Hypertensive Crisis and Acute HF at 53, while mean treatment score (%) was highest in Hypertensive Crisis at 86 and lowest in arrhythmia at 25. Linear regression suggests that human resources have a positive and significant association with diagnostic adherence scores (R2: 0.3485, p-value: 0.0450), whereas essential medicine has a strong but non-significant correlation with treatment adherence score (R2: 1.0768, p-value: 0.460). Conclusion This study has demonstrated a huge disparity between the current CVD emergency practices and guidelines in Indonesian primary healthcare. These gaps emphasised the need for improved human resources and essential medicine for primary healthcare along with the implementation of data-driven policy making concerning cardiovascular disease in Indonesia.Cardiovascular Emergency Diagnosis in InCardiovascular Emergency Work-up and Tre

An Analysis Study on the Effect of the Use of Electronic Medical Records on the Effectiveness and Efficiency of Services at Public Health Centers (Puskesmas) in Indonesia: A Systematic Review

Background: EMR utilize electronic systems to store, manage, and share patient health information more efficiently and accurately. Given the importance of using EMR in improving the quality and efficiency of health services in Indonesia, this study aims to systematically review the existing evidence related to the effectiveness of EMR implementation on the effectiveness and efficiency of services at Puskesmas in Indonesia. This study follows the PRISMA 2020 standard, examining English literature from 2014 to 2024. The study excluded editorials, reviews from the same journal, and submissions without DOI. PubMed, SagePub, SpringerLink, and Google Scholar are used as literary sources. Results: Initially getting 360 articles from online databases (PubMed, SagePub, SpringerLink, and Google Scholar), eight relevant papers were selected after three rounds of screening for full-text analysis. Conclusion: Overall, the use of Electronic Medical Records at primary healthcare in Indonesia provides many advantages in terms of the effectiveness and efficiency of health services, especially in accelerating queue waiting time, registration, service in the police, and drug taking. However, to achieve optimal implementation, efforts to improve technology infrastructure, training for health workers, and good network management are needed to overcome technical obstacles and ensure smooth service flow at the primary healthcare.

Optimizing Postpartum Depression Prevention in Primary Health Care Services

Post-partum depression (PPD) is a post-natal disorder that not only impacts the mental health of the mother but also has long-term effects on the development and well-being of the child and family. PPD is a preventable disorder, starting from interventions at primary health care facilities. As one of the developing countries with a PPD incidence of 22% per 100,000 births, PPD is considered an urgent public health issue in Indonesia. In practice, evaluation, and improvement of services at primary health care facilities are needed. This study aims to identify and adapt international intervention strategies to reduce post-partum depression prevalence in Indonesian primary health care. A scoping review analysis method was used, involving previous studies on activities from pregnancy to post-partum that can prevent and reduce post-partum depression. The reviewed articles employed Randomized Controlled Trials or Randomized Clinical Trials (RCT) methods with specific inclusion and exclusion criteria. Data were collected from relevant sources, and a synthesis was conducted on 16 articles that met the inclusion criteria. The results show that direct psychological support activities (through health professionals or groups) and indirect support using digital platforms and applications are effective in reducing depression. Strategies such as digital technology, direct support programs, physical therapy, pharmacological therapy, community involvement, and strengthening health services, particularly post-partum psychological counseling, are recommended to enhance prevention. This research supports the expansion of evidence-based strategies that can be implemented in primary healthcare facilities to address post-partum depression.

Artificial Intelligence-Based Chronic Disease Detection Application Among Hypertension and Diabetes Mellitus Risk Group in Indonesian Primary Healthcare: A Usability and User Experience Evaluation

This study aims to considering the assessment of the usability and user experience of applications based on artificial intelligence (AI) for early detection of chronic diseases. Health data is recorded and chronic disease risk is classified using an AI-based early detection of chronic disease application. The study was conducted in Semarang city/regency health service facilities, using quantitative research methodology. The study's inclusion criteria were individuals with a history of diabetes mellitus and hypertension. Using the System Usability Scale (SUS) and User Experience Question (UEQ) surveys, 131 respondents were studied in May–July 2023. The study's findings showed that respondents who were older than 60, female, had not completed their education, worked for a living or were self-employed, did not use a mobile phone, and had never used health applications scored poorly for usability and user experience. The system satisfation aspect receives the lowest grade in terms of system usability, while the memorability aspect has the best score. The efficiency aspect of the system receives the greatest score in terms of user experience, while the novelty aspect receives the lowest. It is known that the AI-based early detection of chronic disease application has a reasonably acceptable usability and user experience based on the findings of the SUS and UEQ questionnaires for patients at risk of hypertension and diabetes mellitus. It is necessary to design an AI-based chronic disease detection application that is easier to learn and more innovative so that it can be used by the wider community.

Emergency Psychiatric Care in Primary Healthcare in Indonesia.

Emergency Psychiatric Care in Primary Healthcare in Indonesia.

Family Coping Strategies and Quality of Life of Patients with Type-2 Diabetes Mellitus in Primary Health Care in Indonesia

Background: The intricate caregiving responsibilities undertaken by family caregivers in the care of patients with chronic diseases induce stress, potentially reducing the family’s ability to provide effective care. In instances where family caregivers of patients with type-2 diabetes mellitus (T2DM) are unable to employ effective coping mechanisms, there exists the potential for an adverse impact on the patient’s quality of life. Purpose: This study aimed to analyze the relationship between family coping strategies and the quality of life of patients with T2DM undergoing treatment in primary health care in Malang, Indonesia. Additionally, it sought to investigate the influence of demographic factors on both family coping strategies and the quality of life of these patients.Methods: The study employed an observational analytic design with a cross-sectional approach. The participants included 327 individuals with T2DM and 327 family caregivers, selected from 16 primary healthcare centers using cluster random sampling techniques. Data were collected using the COPE Brief questionnaire to assess coping strategies and the DQOL (Diabetes Quality of Life) questionnaire to measure the quality of life. Statistical analysis was conducted using the Spearman rank test and multivariable logistic regression. Results: The findings of the study revealed that a majority of family caregivers employed adaptive coping strategies (93.9%), while a significant proportion of individuals with T2DM reported having a good quality of life (84.1%). The analysis demonstrated a positive relationship between family coping strategies and the quality of life among T2DM patients. Specifically, better family coping strategy was associated with higher quality of life in T2DM patients (p=0.000; r=0.447; α=0.05). Also, a comprehensive demographic analysis revealed that education significantly influences both the variables of family coping strategies and patient quality of life, with odds ratios of 1.284 and 1.561, respectively.Conclusion: The research findings emphasize the mutual influence between family coping strategies and quality of life of T2DM patients. Nurses should prioritize attention to demographic factors such as education, age, gender, and duration of diabetes to enhance family coping strategies and improve the patients’ quality of life.

Corrigendum to Telemedicine Homecare Among the Hypertension and Diabetes Mellitus Risk Elderly Group in Indonesian Primary Healthcare: A Technology Acceptance Model

Corrigendum to Telemedicine Homecare Among the Hypertension and Diabetes Mellitus Risk Elderly Group in Indonesian Primary Healthcare: A Technology Acceptance Model

Digital Literacy Improvement and Patient Registration System Training Through of Good Care Application at Primary Healthcare in Indonesia and Timor Leste

Digital Literacy Improvement and Patient Registration System Training Through of Good Care Application at Primary Healthcare in Indonesia and Timor Leste

Pulmonary Function Assessment in Myasthenia Gravis Patients in a National Referral Hospital in Indonesia.

Myasthenia gravis (MG) can cause respiratory muscle weakness and the need of ventilator support. Spirometry as the gold standard for pulmonary function examination has limited availability, especially in our hospital which is only available in outpatient clinic during work hours (not in emergency room or patient room). Furthermore, all primary healthcare in Indonesia do not have spirometry equipment, thus other alternatives are required. This study aimed to analyze the relationship between a single breath counting test (SBCT), peak flow meter (PFM), and spirometry to assess pulmonary function in MG patients in a national referral hospital in Indonesia. A single-center, cross-sectional study was conducted and SBCT, PFM, and spirometry examination were performed in MG patients and healthy controls. Seventy patients, aged 47.7 ± 13.4 years old, participated in this study. SBCT, forced vital capacity first second (FVC1), and forced expiratory volume first second (FEV1) value between MG patients and healthy controls showed a significant difference, in which healthy controls have higher SBCT, FVC1, and FEV1 values (p = 0.000, p = 0.000 and p = 0.001 respectively). There was a significant difference between PFM with SBCT and FVC1 value in MG patients. Strong correlation was found between SBCT and FVC1 in MG patients. MG patients had worse pulmonary function compared to healthy controls. SBCT and PFM examination have a significant correlation with FVC1 in MG patients. Therefore, SBCT and PFM can be used as a bedside tool to detect respiratory impairment in MG patients.

PELAKSANAAN PENCEGAHAN DAN PENGENDALIAN INFEKSI (PPI) DI PUSKESMAS TEMANGGUNG SELAMA MASA PANDEMI COVID-19

The spread of COVID-19 has also affected primary health services, including the Puskesmas Temanggung, or Indonesian Primary Health Care which is located in Temanggung Regency, Central Java Province. Based on the regulation of the Minister of Health Number 43 of 2019 concerning Community Health Centers, it is known that the Puskesmas, is responsible for implementing health policies, including policies for preventing and controlling COVID-19 infections. The research, which was conducted from October to November 2022, adapted a qualitative research design with an analytic descriptive approach. Based on this research, it was found that the communication aspects that affected Infection Prevention and Control, namely transmission, clarity and consistency, were good. While in the aspect of resources found deficiencies in infrastructure and capabilities of human resources. Dispositional aspects are less found in implementing commitment. Meanwhile, in the aspect of bureaucratic structure, there are deficiencies in the Standart Operating Procedure (SOP) for several precautions.

Challenges on Standardized Diabetes Mellitus Care Implementation in the Primary Health Care in Indonesia: A Narrative Review

Aims: The prevalence of diabetes mellitus remains high worldwide and has long-term health implications and impacts on the quality of life of those affected. As a catastrophic disease, diabetes mellitus has the potential to burden national healthcare financing, including in Indonesia. Improving standardized diabetes mellitus services, starting from primary healthcare facilities, is a critical effort that is hoped to address this potential burden. The aim of this study is to synthesize and obtain information on the challenges of implementing minimum standards for diabetes mellitus services in Indonesia. Method: This study is a narrative literature review using the PRISMA framework. In this review, inclusion and exclusion criteria to gather articles from Pubmed, ScienceDirect, Google Scholar, ProQuest, and Emerald. The MMAT instrument was used to select eligible articles in study. Results: Our findings indicate that 19 eligible journal articles related to the challenges of implementing minimum standards for diabetes mellitus services in Indonesia. The synthesis results showed that there are challenges in implementing minimum standards for diabetes mellitus services in Indonesia, particularly in the internal and external aspects of patients, primary healthcare facilities, and the government. Conclusions: The challenges of implementing minimum standards for diabetes mellitus services in Indonesia need to be addressed through enhancing the interpersonal and practical skills of healthcare providers, strengthening the role of primary healthcare facilities and the government, ensuring adequate funding support, and establishing appropriate indicators that reflect the field's conditions as a reference for achieving the implementation of minimum standards for diabetes mellitus services in Indonesia.

Cognitive Function in Type 2 Diabetes Mellitus Patients Taking Metformin and Metformin-Sulfonylurea

The most prescribed antidiabetic drugs in Indonesian primary health care are metformin or a combination of metformin and sulfonylurea. Studies on metformin have shown various impacts on cognitive decline in patients with type 2 diabetes mellitus, whereas sulfonylurea has been shown to reduce this impact. This study aimed to compare the impacts of metformin and metformin-sulfonylurea on cognitive function and determine what factors affected it. This cross-sectional study was conducted at Pasar Minggu Primary Health Care involving 142 type 2 diabetes mellitus patients taking metformin or metformin-sulfonylurea for > 6 months and aged > 36 years. Cognitive function was assessed using the validated Montreal Cognitive Assessment Indonesian version. The effects of metformin and metformin-sulfonylurea on cognitive decline showed no significant difference, even after controlling for covariates (aOR = 1.096; 95% CI = 0.523–2.297; p-value = 0.808). Multivariate analysis showed age (OR = 4.131; 95% CI = 1.271–13.428; p-value = 0.018) and education (OR = 2.746; 95% CI = 1.196–6.305; p-value = 0.017) affected cognitive function. Since a lower education and older age are likely to cause cognitive decline, health professionals are encouraged to work with public health experts to address these risk factors for cognitive function.

Technology acceptance model of Tuberculosis Integrated Information System in Indonesian primary healthcare

: This article investigates the acceptance model of the technology of tuberculosis integrated information system (TIIS) adopted and its effects on the actual use in the Indonesian healthcare facility. Some factors such as the perceived usefulness and ease of use are investigated to understand their relationship with the system’s actual use. Quantitative research has been done in this study using a structural equation model (SEM) and partial least square. This study shows that respondents’ perceived usefulness and the ease of use of TIIS positively affect the adopted system’s actual use. The evaluation of the influence of perceived usefulness and perceived ease of use and external variables such as subjective, image, job relevance, and facilitating condition on the intention to use using TIIS to support the implementation of the program of prevention of infectious diseases in a developing country such as Indonesia would help the government to treat the tuberculosis disease better.

Behind open doors: Patient privacy and the impact of design in primary health care, a qualitative study in Indonesia.

The importance and attention to patient privacy in recent decades have been directed mostly toward medical data protection in electronic means. Hence, other aspects of patients' privacy were overlooked, particularly in the primary health care (PHC) level. In the attempt of many countries, including Indonesia, to strive toward universal healthcare provision, a strong and accessible PHC is essential. This situation may create a tension in privacy provision where patients who need to disclose secrets may opt for other facilities, such as hospitals. This study aimed to describe and discuss patients' and doctors' perspectives and experiences about privacy in PHC in Indonesia, particularly since the universal coverage started. We used in-depth interviews and observations to gather information. Inductive and thematic data analyses were conducted. We interviewed PHC users (n = 17), doctors (n = 16), other PHC staff (n = 7), and non-PHC users (n = 5) and observed the PHC activities. We found that privacy is imperative for both patients and doctors. Design and conditions in PHC, including consultation room doors open, separate rooms for treatment, and patients' symptoms asked by other staff were aspects that undermine privacy in PHC. Inadequate physical and informational privacy protection during a patient's visit has affected the quality of care negatively in ways that impede proper anamneses and physical examination. Ensuring patients' and doctors' physical and informational privacy is essential to creating PHC as the primary source of care that responds to the privacy values of its users, but it has been overlooked. The PHC building designs and care provision guidelines should incorporate the privacy needs of patients and doctors.

Teledentistry and Online Referral System in Indonesian Primary Health Care Center During the COVID-19 Pandemic: A Narrative Review.

ABSTRACTAims:This review aims to map the needs and challenges in the application of teledentistry and online referral system encountered by dental health care professionals in Indonesian primary health care centers (puskesmas) to provide safe dental health service to the population during the COVID-19 pandemic.Materials and Methods:Literature search was undertaken of both in Indonesian and overseas context related to teledentistry. Narrative review of the literature was written to present the challenges, solutions, and application of teledentistry at Puskesmas to optimize oral health services during the COVID-19 pandemic.Results:Online referral system and teledentistry are options to help dental health service delivery in the pandemic era. While it has been adopted in many private clinics, there are many challenges to adopt it at the puskesmas level due to a lack of infrastructure, human resources, and budget allocation. While the Indonesian government has plans to support the digitization in the education and health sector, this pandemic shall pose an opportunity for Indonesian health department to develop and facilitate the use of teledentistry and online referral system. During this situation, health cadres can bridge the relationship between Puskesmas and the poor community through the help of teledentistry.Conclusions:The government commitment in applying online referral system and teledentistry in Puskesmas is needed. Dental education institutions can help to supply human resources, who are capable of developing and carrying out the most suitable teledentistry application for all stakeholders.

A Study of Chronic Disease Management in Indonesian Primary Health Care

Chronic disease management program in Indonesia(Prolanis) is a preventive and promotive programdeveloped by Indonesian national health insurance. The initial survey showed thatonly 37.04% ofprimary health careperformchronic disease management programsoptimally. Prolanis can succeed andbe sustained if health care services included health care teams effectively address patient needs as wellas increasing the quality of health services.For this reason, physicians as key roles in primary health careshould enhance their competencies to deliver high-quality care. This study aimed to identify the impactof physician competencies on patient satisfaction in Indonesian primary health care. This study useda cross-sectional designwith multistage random sampling which included 90 chronic disease patientsin primary health care. The results revealed that the average physician competencies in providinghealth services to patients were 73.57%. In addition to this, as many as 73.64% of patients expressedsatisfaction with physician skills. Lambda correlation test obtained a value of r = 0.76, so it was statedthat the physician competencies had a strong influence on chronic disease patient satisfaction. It canbe concluded that the more physicians master their competencies,the more confident patients seektreatment at primaryhealth care.

Poor quality for the poor? A study of inequalities in service readiness and provider knowledge in Indonesian primary health care facilities

BackgroundFor many low and middle-income countries poor quality health care is now responsible for a greater number of deaths than insufficient access to care. This has in turn raised concerns around the distribution of quality of care in LMICs: do the poor have access to lower quality health care compared to the rich? The aim of this study is to investigate the extent of inequalities in the availability of quality health services across the Indonesian health system with a particular focus on differences between care delivered in the public and private sectors.MethodsUsing the Indonesian Family Life Survey (wave 5, 2015), 15,877 households in 312 communities were linked with a representative sample of both public and private health facilities available in the same communities. Quality of health facilities was assessed using both a facility service readiness score and a knowledge score constructed using clinical vignettes. Ordinary least squares regression models were used to investigate the determinants of quality in public and private health facilities.ResultsIn both sectors, inequalities in both quality scores existed between major islands. In public facilities, inequalities in readiness scores persisted between rural and urban areas, and to a lesser extent between rich and poor communities.ConclusionIn order to reach the ambitious stated goal of reaching Universal Health Coverage in Indonesia, priority should be given to redressing current inequalities in the quality of care.

Effect of Pharmacist Intervention on Medication Adherence and Clinical Outcomes of Type 2 Diabetes Mellitus Outpatients in Primary Healthcare in Indonesia.

Objective:In Indonesia, the role of pharmacists in primary healthcare is still very limited or even absent. This study evaluates the effectiveness of programs delivered for type 2 diabetes mellitus (T2DM) patients by pharmacists in primary healthcare through counseling, short message service (SMS) reminders, and medication booklets.Methods:A quasi-experimental study with a pretest–posttest design was conducted from April to August 2018 at Merdeka and Dempo primary health-care centers, Palembang, South Sumatra Province, Indonesia. Counseling and medication booklets were distributed three times during the study period, while SMS reminders were sent once a week. Counseling was given for the management of diabetes mellitus (DM), including during the Ramadan fasting period, together with management for acute and chronic complications. The medication adherence level was measured using a medication adherence questionnaire (MAQ) and pill count adherence (PCA). The study sample comprised 80 T2DM patients, who were allocated into either the control group (CG) (n = 40) or intervention group (IG) (n = 40). Clinical outcomes were determined by measuring glycated hemoglobin (HbA1c), blood pressure, and lipid profiles.Findings:After the intervention, the IG showed significant improvements in most parameters, except for high-density lipoprotein cholesterol and systolic and diastolic blood pressure. HbA1c levels were reduced, while MAQ scores and PCA scores were improved. Lipid parameters were significantly reduced total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and triglyceride (TG). Compared with the CG, most parameters were significantly improved in the IG. Pharmacist counseling significantly improved almost all clinical parameters (HbA1c, TC, LDL-c, and TG). Pharmacist counseling was 7.1 times greater in lowering HbA1c compared with no counseling, after adjusted by other variables. The variable that most influenced the lowering of HbA1c was infrequent (“not often”) consumption of unhealthy foods (OR 14.9; 95% CI 3.5-63.7).Conclusion:The pharmacist primary health-care intervention program implemented in this study significantly improved HbA1c, TC, LDL-c, TG, and medication adherence in outpatients with T2DM.

Educational Video to Improve Glycemic Control of Type 2 Diabetes Mellitus Patients

Glycemic control is a critical point in the management of type 2 diabetes mellitus (T2DM). The limited number of pharmacists in primary health care in Indonesia is one of the reasons that a simple alternative method is needed for managing T2DM patients. Objective: This study aimed to measure the effectiveness of an education diabetes video as a simple method of improving glycemic control of T2DM patients. Methods: This was a quasi-experimental pre-test/post-test study involving T2DM patients from one randomly selected public healthcare centre in East Jakarta. Glycated haemoglobin (A1C) levels were examined before and 12 weeks after the video intervention. Results: Thirty of T2DM patients enrolled in this study. The educational video was found to decrease the A1C level significantly (p = 0.001) from an average±SD of 7.930±1.262 to 5.517±0.614. Conclusions: This study found the educational was effective at improving the glycemic control of patients with T2DM. However, further investigation with control group still needed to confirm that the video that did it.

Relationship between Training Intensity and Doctor’s Job Satisfaction at Primary Health Care in Indonesian

A doctor’s job satisfaction is important because it will improve the quality of health services. This study aimed to determine the relationship between intensity training and doctors satisfaction. This research was a cross-sectional study using data from Risnakes 2017. The sample was 5,140 doctors primary health care with civil servant status in Indonesia that was randomly selected. The data were analyzed using the Spearman correlation. This study showed that mean job satisfaction was 70.07 and intensity of the training was 3.98. There is a positive correlation between the training intensityand the doctor's job satisfaction of primary health care in Indonesia (p-value <0.000 and r = 0.063). More doctor's training will improve the ability of doctors to care for the patient's clinical according to the standards of competence.