Primary Health Care In Indonesia Research Articles

The Difference Scores of Positive and Negative Syndrome Scale Exited Components in Psychotic Agitation Patients of Haloperidol Injection and those Prescribed with the Injection of Haloperidol and Diazepam

BACKGROUND: The availability of psychotic medications in primary health care in Indonesia is in a limited number. The center of psychiatric health-care provides varied types of medications. However, the quantities are limited, in which the second generation of psychotic drugs is relatively expensive. Common available drug medications are haloperidol and diazepam.
 AIM: This study aims to investigate the difference scores of Positive and Negative Syndrome Scale (PANSS-EC) in psychotic agitation patients of haloperidol prescription and those who have been prescribed with haloperidol and diazepam injections at Prof. Dr. M. Ildrem Mental Hospital, Medan North Sumatera, Indonesia.
 METHODS: This study involved 64 psychotic agitation patients who were divided into two groups. The first group was 32 patients who have been prescribed by 5 mg of haloperidol injections and the second group was 32 patients who have been injected by 5 mg of haloperidol and 10 mg of diazepam. The PANSS-EC score assessment was performed for 1 h due to the side effects of medication consumption.
 RESULTS: A significant comparison in terms of the decreasing of PANSS-EC scores in psychotic agitation patients who have been injected by the combination of haloperidol and diazepam was confirmed during the assessment of 30 and 60 min (p < 0.001). The extrapyramidal side effects in haloperidol group were found in two subjects, and the reinjections of combination therapy of haloperidol and diazepam were lower than those with one type of drugs medication, which, respectively, were accounted for 56.25% and 84.37%.
 CONCLUSIONS: Combination therapy of haloperidol and diazepam had more accelerating effects in reducing agitation compared to those prescribed by only haloperidol.

Determinants that Influence Relationship between Motivation and Job Satisfaction of Health Workers at Primary Health Care in Indonesia

Determinants that Influence Relationship between Motivation and Job Satisfaction of Health Workers at Primary Health Care in Indonesia

Knowledge and comfort related to palliative care among Indonesian primary health care providers.

This study investigated Indonesian primary health care providers' knowledge and comfort towards palliative care. A descriptive cross-sectional design was used. From August 2017 to February 2018, the research team approached 70 primary care centres in the Yogyakarta province of Indonesia and invited health care providers to complete the Palliative Care Quiz for Nursing - Indonesia and describe their comfort in caring for terminally ill patients. Data were obtained from 516 health care providers. The mean (±s.d.) score of palliative care knowledge was low (7.8±3.3 of a possible score of 20). Current comfort level in providing palliative care was also low (1.6±2.7 of a possible score of 10). Only 11.3% of palliative care knowledge was explained by respondents understanding of palliative care definition, their education levels and experience in providing palliative care in hospital. However, 82.9% of provider comfort was explained by their experiences for caring for terminally ill patients in primary healthcare centres, palliative care training and years of work experience in primary healthcare centres. Indonesian evidence-based palliative care standards and guidelines must be established with education offered to all providers.

Challenges of Shifting Diabetes Mellitus Care From Secondary- to Primary-Level Care in Urban and Rural Districts: A Qualitative Inquiry Among Health Providers.

Objectives: The study aims to understand the acceptability of Prolanis, a program that shifts the diabetes mellitus type 2 (T2DM) patient management from secondary to primary care, among Indonesian primary health care providers. Method: We completed face-to-face semistructured interviews with 14 health professionals from 3 urban and 4 rural government-owned primary health care clinics (Puskesmas) in 4 districts. We performed content analysis using the theoretical framework of acceptability (TFA) to understand which factors could facilitate or reduce acceptability. Results: Our study identifies that lack of health care providers’ acceptability to Prolanis was attributable to the negative affective attitude, low perceived effectiveness, poor self-efficacy, and work burden. The use of Prolanis output as one of the pay-for-performance indicators was deemed unsuitable because it could demotivate health providers to capture more undetected T2DM cases. This, compounded by lacking perceived benefit for the health care providers, leading to negative attitudes. Participants believed that the program improved patients’ adherence to visiting clinics routinely; however, the absence of a formal evaluation of reductions of key T2DM indicators—blood glucose level and HbA1c—causing the health providers to doubt the program effectiveness. Availability of or access to adequate blood glucose testing equipment is also of paramount importance to improve acceptability. Although the significant increase in patient load only occurred to Puskesmas with lacking doctors, an increased workload burden due to clerical works was experienced by the nonmedical workforce. The program appears to be more acceptable for health care providers in urban Puskesmas compared with their rural counterparts, attributable to better geographical accessibility and care-seeking behavior among people living in urban locations. Conclusions: This study highlights critical issues that should be addressed to improve the acceptability of Prolanis among health care professionals. Government or stakeholders play a critical role in improving program acceptability. More study is needed to capture wider variety of health care facilities’ characteristics.

Segmentation of Tuberculosis Bacilli Using Watershed Transformation and Fuzzy C-Means

The easily transmitted Tuberculosis (TB) disease is attributed to the fact that Mycobacterium Tuberculosis (MTB) bacteria/viruses can be transmitted through the air. One of the methods to screen the TB disease is by reading sputum slides. Sputum slides are colored sputum samples of TB patients placed on microscopic slides. However, TB disease microscopic analysis has some limitations since it requires high accuracy reading and well-trained health personnel to avoid errors in the process of interpretation. Furthermore, the number of TB patients in the Primary Health Care (PHC) and the process of manual calculation of bacteria in a field of view often complicate the decision-making in the screening process conducted by the medical staffs. In this paper, the researchers propose the use of Watershed Transformation and Fuzzy C-Means combination to help solve the problem. The researchers collect the photo shooting of three PHC in Indonesia with 55 images of sputum from different TB patients. The assessed results of the proposed method are compared with the opinions of three Microbiology doctors. The comparison shows Cohen’s Kappa Coefficient value of 0.838. It suggests that the proposed method can detect Acid Resistant Bacteria (ARB) although it needs some improvement to achieve higher accuracy.

Social Determinant Factors of Elderly as an Input in Enhancing Primary Health Care in Indonesia

Objective: To analyze the differences of social determinant factors among elderly according to gender, in urban and rural areas in Indonesia. Indonesia is one of the most populated countries in the world, faces an increased number of elderly. This situation leads to the increase of degenerative diseases and demands of caregivers as well. The identification of social determinant factors of elderly has an important role in enhancing primary health care. Methods: A comparative study was carried out in 33 provinces in Indonesia using secondary data from Statistics Indonesia 2013. The variables included in this study were percentage of elderly according to education, marital status, occupation, income and living arrangements, divided in gender, urban and rural areas. The normally distributed data were analyzed using unpaired T test and not normally distributed data were analyzed using Mann-Whitney test. Results: This study showed that there were differences in education, occupation and income between urban and rural areas. In urban area, most of the elderly worked in industry and trade and in rural area they worked in agricultural, indicated huge risks of occupational haxards. Most of them were poor, still married, lived with spouses and family of three generations. Conclusions: It can be concluded that there were differences of social determinant factors (education, occupation and income) in elderly who live in urban and rural areas that can contribute to the risks of disease in elderly and these situations must be considered as an input to enhance the primary health care. Keywords: Elderly, gender, rural, social determinants, urban

Adaptation and Validation of Safety Attitude Questionnaire Ambulatory (SAQ-A) in Indonesian Primary Health Care Facilities

Prevention of patient safety incidence needs to be pursued by the management committee of healthcare institutions by changing the behavior of healthcare providers to create a patient safety culture. Also, safety culture evaluation needs to be done to assess the implementation of the culture by healthcare providers. For this reason, a valid and reliable instrument is required in order to be accepted and used in Indonesia as a tool to measure of safety culture attitude in healthcare facilities. This study aimed to adopt the Safety Attitude Questionnaire – Ambulatory (SAQ-A) instrument to Indonesian. The study was carried out in 5 stages, they were: The translation stage, translation result synthesis, back-translated, review of 3 experts to obtain content validity index (CVI) and questionnaires trial which is conducted in 6 Puskesmas, i.e., Puskesmas Pandak I, Puskesmas Pajangan, Puskesmas Godean I, Puskesmas Kalasan, Puskesmas Tempel I and Puskesmas Minggir. Purposive sampling technique was selected to obtain 30 respondents based on inclusion criteria: She/he works in research location and has experience at least for one month, permanent/ contract employee, and not on sabbatical leave or other permission. Data were analyzed using the Content Validity Index (CVI) and Alpha Cronbach Coefficient. The validity test result of the Indonesian version of SAQ-A based on I-CVI and S-CVI was 1.00 with Cronbach’s alpha reliability value from the six dimensions in the questionnaire within range of α 0.612 – 0.881. The reliability test result of the full item on the Indonesian version of the SAQ-A questionnaire was α 0,914. It was concluded that the Indonesian version of the SAQ-A questionnaire is a valid and reliable questionnaire which can be used as a tool to measure safety culture attitudes of healthcare providers in primary healthcare facilities.

Foetal weight prediction models at a given gestational age in the absence of ultrasound facilities: application in Indonesia

BackgroundBirth weight is one of the most important indicators of neonatal survival. A reliable estimate of foetal weight at different stages of pregnancy would facilitate intervention plans for medical practitioners to prevent the risk of low birth weight delivery. This study has developed reliable models to more accurately predict estimated foetal weight at a given gestation age in the absence of ultrasound facilities.MethodsA primary health care centre was involved in collecting retrospective non-identified Indonesian data. The best subset model selection criteria, coefficient of determination, standard deviation, variance inflation factor, Mallows Cp, and diagnostic tests of residuals were deployed to select the most significant independent variables. Simple and multivariate linear regressions were used to develop the proposed models. The efficacy of models for predicting foetal weight at a given gestational age was assessed using multi-prediction accuracy measures.ResultsFour weight prediction models based on fundal height and its combinations with gestational age (between 32 and 41 weeks) and ultrasonic estimates of foetal head circumference and foetal abdominal circumference have been developed. Multiple comparison criteria show that the proposed models were more accurate than the existing models (mean prediction errors between − 0.2 and 2.4 g and median absolute percentage errors between 4.1 and 4.2%) in predicting foetal weight at a given gestational age (between 35 and 41 weeks).ConclusionsThis research has developed models to more accurately predict estimated foetal weight at a given gestational age in the absence of ultrasound machines and trained ultra-sonographers. The efficacy of the models was assessed using retrospective data. The results show that the proposed models produced less error than the existing clinical and ultrasonic models. This research has resulted in the development of models where ultrasound facilities do not exist, to predict the estimated foetal weight at varying gestational age. This would promote the development of foetal inter growth charts, which are currently unavailable in Indonesian primary health care systems. Consistent monitoring of foetal growth would alleviate the risk of having inter growth abnormalities, such as low birth weight that is the most leading factor of neonatal mortality.

Impact of Drug Related Problems on Blood Pressure Control In Patients With Hypertension In Indonesian Primary Health Care

Impact of Drug Related Problems on Blood Pressure Control In Patients With Hypertension In Indonesian Primary Health Care

International collaboration for implementation of equal access to family-based primary healthcare in Indonesia

[No abstract available]

Policy Brief: Economic Evaluation of the Implementation of the WHO Package of Essential Non-Communicable Disease (PEN) Interventions in Indonesia

A collaborative study was conducted by the representatives from the Ministry of Health’s Directorate of Non-Communicable Disease (NCD) Control and the National Institute of Health Research and Development, the WHO Indonesia office, the WHO Southeast Asia Regional Office, and the Health Intervention and Technology Assessment Program (HITAP) to assess value for money and budget impact of the current PEN interventions compared to “no screening” and other policy options. This economic evaluation assessed the integration of screening and treatment for diabetes and hypertension, which are part of NCD interventions in the Package of NCDs (PEN) program, into primary health care in Indonesia and found that it yields cost saving to the government and society. The findings are expected to be a tool to assist the government in making resource allocations in this area.

The use of insulin for early diagnosed patients with type 2 diabetes mellitus in primary health care in Indonesia: a general practitioner's perspective

The use of insulin for early diagnosed patients with type 2 diabetes mellitus in primary health care in Indonesia: a general practitioner's perspective

Factors Associated with Exclusive Breastfeeding at Primary Health Care in Indonesia

Background: Breastfeeding is recommended as the best form of infant feeding. In Indonesia, despite a high percentages of women (96%) who breastfeed their children, only 42% of infants aged under 6 months are exclusively breastfed. It is important to understand the factors that influence exclusive breastfeeding so that intervention can be directed precisely.Method: We conducted a cross-sectional study of mother who had 7 to 12 months old infants in Puskesmas Curug, Indonesia (2012). Data were collected by face-to-face interviews using a structured questionnaire. Chisquare was used to find risk factors associated with exclusive breastfeeding.Results: Of 60 mothers, 51.2% did exclusive breastfeeding. Factors known to influence exclusive breastfeeding were early breastfeeding initiation (p=0.002), health counselling (p<0.001) and knowledge (p=0.004). Mother’s education and occupation were not associated with exclusive breastfeeding.Conclusion: Opportunities exist for increasing health counselling in primary healthcare in Indonesia to motivate mothers to do exclusive breastfeeding.

Automatic platelets counter for supporting dengue case detection in primary health care in indonesia.

Dengue fever is a major problem in many developing countries, including Indonesia. Laboratory examination is used to diagnose dengue infection and to monitor disease progression. Hematology tests, such as platelet count, are also used for timely recognition of the development of severe dengue. In primary health care centers platelet counting is typically performed manually, which is labor intensive and requires an experienced laboratory technician. To address this challenge, we have developed an automatic platelet counter for primary health care and resource-poor settings. The technology is based on a conventional microscope equipped with a digital camera linked to a personal computer, which can capture and analyze microscope images of blood samples. To evaluate the accuracy of the technology, it was compared to platelet counts performed manual by an experienced laboratory technician. Statistical analysis shows no difference between the techniques with a kappa coefficient of 0.6. This method is judged to have great potential as a tool to help primary health centers and other facilities with limited resources to deal with the burden of dengue.

Translation, adaptation and psychometric testing of a tool for measuring nurses' attitudes towards research in Indonesian primary health care.

AimThe purpose of this study was to translate, adapt and psychometrically test the Nurses’ attitudes towards and awareness of research and development within nursing (ATRAD‐N) version II for measuring nursing research and research utilization in Indonesian primary health care nurses.DesignCross‐sectional survey.MethodThe translation process was conducted by applying the forward and back‐translation method. Adaptation and content validity was assessed by six experts in Indonesia. The psychometric testing was performed using factor analysis and Cronbach's alpha coefficient on a sample of 92 primary health care nurses in South Kalimantan, Indonesia in 2013.ResultsThe translated instrument showed acceptable content validity with index of .97. The factor analysis (Principal Component Analysis with Direct Oblimin rotation) obtained a five‐factor structure that differed from those identified in previous studies. The cumulative percentage of variance was 56.5%. The Cronbach's alpha coefficient for individual factors ranged from .719 ‐ .884. The resulting form of the Indonesian ATRAD‐N was found to have acceptable content validity and homogeneity reliability but not construct valid in Indonesian settings.

Physician's self-perceived abilities at primary care settings in Indonesia.

Background:Southeast Asian countries with better-skilled primary care physicians have been shown to have better health outcomes. However, in Indonesia, there has been a large number of inappropriate referrals, leading to suboptimal health outcomes. This study aimed to examine the reasons underlying the unnecessary referrals as related to Indonesian physicians’ standard of abilities.Materials and Methods:This was a multiple-case study that explored physicians’ self-evaluation of their abilities. Self-evaluation questionnaires were constructed from the Indonesian Standards of Physicians Competences of 2006-2012 (ISPC), which is a list of 155 diseases. This study was undertaken in three cities, three towns, and one “border-less developed” area during 2011-2014. The study involved 184 physicians in those seven districts. Data were collected using one-on-one, in-depth interviews, focus group discussions (FGDs), and clinical observations.Results:This study found that primary care physicians in Indonesia felt that they were competent to handle less than one-third of “typical” primary care cases. The reasons were limited understanding of person-centered care principles and limited patient care services to diagnosis and treatment of common biomedical problems. Additionally, physical facilities in primary care settings are lacking.Discussions and Conclusions:Strengthening primary health care in Indonesia requires upscaling doctors’ abilities in managing health problems through more structured graduate education in family medicine, which emphasizes the bio-psycho-socio-cultural background of persons; secondly, standardizing primary care facilities to support physicians’ performance is critical. Finally, a strong national health policy that recognizes the essential role of primary care physicians in health outcomes is an urgent need.

PM280 Knowledge, Attitude, and Behaviour Regarding Hypertension Among Indonesian Primary Health Care Providers and Hypertensive Patients in Remote Area: Internship Study

PM280 Knowledge, Attitude, and Behaviour Regarding Hypertension Among Indonesian Primary Health Care Providers and Hypertensive Patients in Remote Area: Internship Study

International experts’ perspectives on a curriculum for psychologists working in primary health care: implication for Indonesia

Enhancing primary health care to incorporate mental health services is a key strategy for closing the treatment gap for people with mental disorders. The integration of psychological care into primary health care is a critical step in addressing poor access to mental health specialists. As the psychology profession is increasingly called upon to prepare psychologists for primary health care settings, an international experts' consensus is valuable in guiding the development of a high-quality curriculum for psychologists working in the primary health care context. A Delphi method was used to gain a consensus on the most appropriate roles and training for psychologists. Initial constructs and themes were derived from a detailed literature review and sent to 114 international experts in primary mental health care from five continents. Overall, 52 experts who participated agreed that psychologists should have wide-ranging roles and skills including clinical, health promotion and advocacy skills. This study has identified the specific roles and training needed by psychologists to enable them to work more effectively in primary health care settings. The consensus will inform the development of a curriculum for psychologists working in primary health care in Indonesia, and is part of a broader suite of studies.

Australian experts' perspectives on a curriculum for psychologists working in primary health care: implication for Indonesia

In Indonesia there is a pressing need to scale up mental health services due to a substantial unmet need for mental health care. Integrating psychologists into primary health care can potentially deliver affordable mental health services to communities and help to close the treatment gap. Australia is one of the pioneers in integrating mental health into primary health care, and the mental health reforms in Australia may have some implications for Indonesia. The aim of this paper is to examine the Australian experience and to reflect in particular on lessons that may be learnt to inform the development of curriculum for psychologists working in primary health care in Indonesia. Data were collected through semi-structured interviews with 12 Australian experts in primary mental health care. The focus of the interview was on the roles and skills of psychologists working in primary health care with a particular focus on the appropriate curriculum for psychologists. Overall, the Australian experts agreed that psychologists' roles and training should include both clinical skills and public mental health skills. The experts also agreed that psychologists should be able to educate the community about mental health issues and be capable of undertaking research and evaluation of programs. A central theme was the need for strong collaborations with general practitioners and existing agencies in the community so that psychologists are able to make appropriate referrals and also accept referrals. The lessons learnt from the Australian experience, which are most applicable to the Indonesian setting are: (1) the importance of adequate government funding of psychologists; (2) the value of evidence-based treatments such as Cognitive Behavioural Therapy; (3) the need to specifically train psychologists for primary care; (4) the need for flexibility in the psychologist workforce (e.g. location); and (5) the value of continuing supervision for psychologists to support them in their role.

Indonesian experts' perspectives on a curriculum for psychologists working in primary health care in Indonesia

Mental health is a critical issue in Indonesia, since its population ranks among the top five in the world and the prevalence of common mental disorders is 11.6% of the adult population. However, the need to build an effective mental health-care system that is accessible to the whole population has only been recently addressed. The Aceh tsunami in 2004 brought to the forefront an unexpected window of opportunity to build a mental health-care system. Integration of mental health care into primary health care is a key strategy to close the treatment gap for people with mental disorders. Existing integration of psychologists into primary health care is a big step to meet the shortage of mental health-care specialists. As primary mental health care is an emerging field, the perspectives of Indonesian experts on Indonesian mental health care are needed to develop a curriculum for training psychologists to work in primary health care. In this study, data have been collected through semi-structured interviews with 24 Indonesian mental health experts, and three focus group discussions with 26 psychologists. Overall, experts agreed that to be able to work in primary health-care psychologists should have roles and training ranging from clinical to advocacy skills. Participants also agreed that psychologists should work in the community and contribute to primary health care as service providers and that strong collaborations between psychologists and other primary health-care providers are the key; these can be developed partly through referral and by respecting each other's unique strengths.