Prolanis Program Research Articles

HUBUNGAN SENAM PROLANIS TERHADAP PENURUNAN KADAR GULA DARAH SEWAKTU PADA PASIEN DIABETES MELLITUS TIPE 2 DI PUSKESMAS SEI LEKOP

Background : Type 2 diabetes mellitus is a chronic metabolic disease characterized by elevated blood glucose levels in the body due to insulin resistance or inadequate insulin production. The purpose of this study is to investigatethe relationship between physical activity and blood sugar levels in patients with type 2 Diabetes Mellitus who participated in the PROLANIS program at the Sei Lekop Community Health Center in 2023. Methods : This study is an observational research with an analytical cohort design. Data collection was obtained from the medical records of patients with type 2 diabetes mellitus who are registered under BPJS. The data analysis methods include univariate analysis and bivariate analysis, with a standard error of estimate set at 5% or 0.05 Results : The results of the Wilcoxon test showed that PROLANIS exercise had a relationship with reducing blood sugar levels during type 2 diabetes mellitus patients at the Sei Lekop Community Health Center in 2023. The results of the Wilcoxon test were p = 0.001. Conclusion : Based on the results of this study, it can be concluded that there is a relationship between PROLANIS exercise and random blood sugar levels in patients with type 2 diabetes mellitus at Sei Lekop Health Center in 2023 Keywords : Diabetes Mellitus, Blood Glucose Levels, and PROLANIS Exercise.

Comparative Effectiveness of Single Versus Combination Antihypertensive Therapy in PROLANIS Hypertension Patients: A Retrospective Study in Purbalingga Regency

The PROLANIS program in Indonesia aims to manage chronic diseases like hypertension. While combination antihypertensive therapy is recommended for many patients, evidence on its effectiveness in the PROLANIS setting remains limited. This study investigated the comparative effectiveness of single versus combination antihypertensive therapy in achieving blood pressure control among PROLANIS hypertension patients in Purbalingga Regency. A retrospective cohort study was conducted using data from PROLANIS hypertension patients in Purbalingga Regency from January-December 2023. Patients were categorized into two groups: those receiving single antihypertensive therapy and those receiving combination therapy. The primary outcome was the proportion of patients achieving blood pressure control (<140/90 mmHg). Secondary outcomes included changes in blood pressure, medication adherence, and adverse events. Multivariable logistic regression was used to adjust for potential confounders. A total of 1,250 patients were included, with 680 receiving single therapy and 570 receiving combination therapy. The proportion of patients achieving blood pressure control was significantly higher in the combination therapy group (65%) compared to the single therapy group (52%) (adjusted odds ratio [OR] 1.72, 95% confidence interval [CI] 1.35-2.20). Combination therapy was also associated with greater reductions in systolic and diastolic blood pressure. No significant differences were observed in medication adherence or adverse events between the two groups. Combination antihypertensive therapy is more effective than single therapy in achieving blood pressure control among PROLANIS hypertension patients in Purbalingga Regency. These findings support the use of combination therapy as the preferred approach for managing hypertension in this population.

Factors Influencing Active Participation in the Chronic Disease Management Program (Prolanis)

Non-communicable diseases, such as hypertension and diabetes mellitus, are major contributors to high morbidity and mortality rates globally. To address this, the government has initiated the Prolanis program for BPJS Health participants, aiming to improve the health status of individuals with chronic diseases. However, preliminary studies involving Prolanis program coordinators at a Puskesmas revealed that the participation rate for medical consultations was below the target of 80%. This study aims to identify the factors influencing the activeness of Prolanis participants. Utilizing a quantitative approach with an analytic observational design, the research employed a cross-sectional method. The study was conducted at a community health center in Malang City from September to November 2023. The population comprised all Prolanis participants in the area, totaling 90 individuals, with a research sample of 73 participants. The sampling technique used was consecutive sampling. The independent variables investigated were education level, duration of illness, quality of service, and family support, while the dependent variable was the activeness of Prolanis participants. Data collection instruments included questionnaires for the independent variables and an observation sheet to measure participant activeness. The data were analyzed using a multivariate logistic regression test. The results indicated that family support and service quality were significantly related to the activeness of Prolanis participants, with p-values of 0.000 for both variables. Family support emerged as the most influential factor, with an odds ratio (OR) of 48.706. The study concludes that family support and the quality of health center services are significantly associated with the activeness of Prolanis participants, whereas education level and duration of illness are not related.

The Role of The Chronic Disease Management Program in Indonesia (PROLANIS) As A Diabetes Mellitus Management Strategy: A Scoping Review

Background:Diabetes Mellitus (DM) is a non-communicable disease with an increasing number of sufferers every year, and its negative impacts require special attention. The Indonesian government has taken steps to manage DM by establishing the PROLANIS program. Objective:This study aims to identify the roles of PROLANIS in treating DM in Indonesia. Methods:This study used a scoping review design. We performed extensive searches in CINAHL Plus, Cochrane Library, Embase, PubMed, and Google Scholar. Based on the search results, we found a total of 280 articles. After a selection process, 27 articles met the criteria for review. The papers were grouped by year, study design, setting, and the role of PROLANIS. Results:According to research results, PROLANIS effectively maintains and reduces several essential aspects of DM patients' health, such as body mass index, fasting blood glucose, and HbA1c levels. PROLANIS also plays a positive role in improving the lipid profiles of DM patients. Furthermore, PROLANIS contributes to increasing self-efficacy, self-acceptance, self-management, adherence to therapy, and overall quality of life. Conclusion:PROLANIS positively affects the management of DM by improving physical health and enhancing the quality of life for patients. Keywords:chronic disease; Diabetes Mellitus; non-communicable diseases; PROLANIS

Edukasi Diet Diabetes Puasa untuk Mengendalikan Gula Darah Saat Menjalankan Puasa Ramadhan

Background: Fasting during Ramadan could have negative effects on individuals with Type 2 Diabetes Mellitus (T2DM), as it would lead to hypoglycemia or hyperglycemia. Non-compliance with the recommended diet during fasting is one of the factors that can trigger these conditions. Knowledge about the appropriate diet plays a crucial role in successfully adhering to the diet. Objective: The aim of this study is to assess the effect of providing T2DM education during Ramadan fasting on knowledge and fasting blood glucose levels. Method: This study is an experimental research conducted using a randomized controlled trial design with a pretest-posttest control group design. The participants of this study were T2DM patients from Tlogosari Kulon Community Health Center and Kedungmundu Community Health Center who were enrolled in the Prolanis program and did not have any complications related to kidney failure or stroke. A total of 46 participants were divided into a treatment group and a control group. The treatment group received nutritional education on managing their diet while fasting during Ramadan. This education was provided one week prior to the start of Ramadan fasting. Data collection included assessing knowledge, food intake, nutritional status, and fasting blood glucose levels before and after Ramadan fasting. The collected data will be analyzed using univariate analysis to describe the research data and to test the impact of nutrition education on knowledge and fasting blood glucose levels levels. The independent t-test with a significance level of α=0.05 will be used for this analysis.Result: There was a significant difference before and after being given nutrition education in intervention group on increasing knowledge levels in the intervention group (p=0.029) also lowering the blood glucose levels (p = 0.000). Providing education to the intervention group increased the knowledge score from 68.56 +12.81 to 79.26+9.47. There was an increase in knowledge leves by 10.70+3.34 in the intervention group. Nutritioneducation also reduced fasting blood glucose levels in intervention gropus from 177.78 + 79.61 to 141.35 + 43.78. There was a lowering in the blood glucose levels by -36.43 + 71.89 in the intervention group.Conclusion: There is a relationship between fasting ramadhan diabetes education with knowledge and blood glucose levels.

HUBUNGAN FAKTOR PEMAHUBUNGAN FAKTOR PEMANFAATAN PROGRAM PROLANIS DI WILAYAH KERJA PUSKESMAS SUKAGUMIWANG TAHUN 2023NFAATAN PROGRAM PROLANIS DI WILAYAH KERJA PUSKESMAS SUKAGUMIWANG TAHUN 2023

Diabetes mellitus can cause complications and become a public health problem which is the most important cause of death, morbidity and disability in the world. The prevalence rate of diabetes mellitus continues to increase in the 2013 Riskesdas, namely 6.9%, in 2018 it increased to 8.5%. In Indramayu itself, based on the profile of the Indramayu District Health Service in 2022, there are 17,868 diabetes mellitus sufferers.The aim of this research is to determine the factors associated with prolanis utilization programs.This research uses quantitative methods with a cross sectional approach. The population in this study was 9,332 people, the sample used the Slovin formula with a result of 99 respondents and the sampling technique used incidental sampling. The instrument used was a questionnaire. Using univariate and bivariate design analysis carried out with the Chi-Square Test. The factor that is related to the use of prolanis is support from health workers. It is hoped that the suggestions in this research will help health workers to socialize and motivate the public to take advantage of the prolanis program

Edukasi Upaya Mencegah Kejadian Nyeri Neuropati Diabetik Pada Pasien Diabetes Mellitus Tipe 2 Dengan Dislipidemia di Puskesmas Trowulan Kabupaten Mojokerto

Diabetes mellitus can lead to dyslipidemia, which can increase the risk of vascular obstruction or atherosclerosis. The occurrence of dyslipidemia in people with diabetes mellitus can trigger diabetic neuropathic pain (DNP). Diabetes mellitus with complications of diabetic neuropathic pain became the top 5 disease of the Prolanis program in Puskesmas Trowulan, Mojokerto. DNP is difficult to treat and severely interferes with the quality of the daily lives of patients. The purpose of this Public Service (Pengmas) is to increase public knowledge and understanding of efforts to prevent the occurrence of diabetic neuropathy pain in patients with type 2 diabetes mellitus with dyslipidemia in the Puskesmas Trowulan, Mojokerto. The method used in this activity is carried out in three stages: planning, implementation, evaluation, and follow-up. The results of this activity showed that the average pre- and post-test scores increased significantly before and after education, which is 0.94. This indicates that the public has understood the material submitted in connection with efforts to prevent an increase in the incidence of type 2 diabetes mellitus, dyslipidemia, and diabetic neuropathic pain in the Puskesmas Trowulan, Mojokerto.

Edukasi Urgensi Foot Care sebagai Prevensi Risiko Luka Kaki Diabetic di Wilayah Kerja Puskesmas Tamalanrea Jaya Kota Makassar

The Tamalanrea Jaya Community Health Center has a total of 393 DM sufferers in 2022 with 152 male sufferers and 241 female sufferers. The solution offered is to provide guidance regarding the risk of diabetic foot wounds through educational outreach and counseling. The aim of the guidance is to provide information to the community in the Tamalanrea Jaya Community Health Center working area with diabetes melitus (DM) in adults and the elderly regarding the understanding, causes and prevention of diabetic foot wounds. This activity was held on September 19, 2023, with 29 participants in the community service outreach program. The inclusion criteria were people with diabetes mellitus in the working area of Tamalanrea Jaya Community Health Center in Makassar City. .The results of this activity showed that the majority of respondents (58.6%) suffered from DM for the first time at the age of 30-50 years with the average age when they first suffered from DM being 49 years, the period when most suffered from DM (44.8%) was more from 3 years and most respondents (48.3%) followed the Prolanis program for more than 3 years. And from this activity, it was found that there was an increase in knowledge after the counseling and presentation was carried out and participants were able to spread it well and correctly according to the steps that had been directed by the service team.

PENGARUH SENAM PROLANIS TERHADAP PERUBAHAN KADAR GULA DARAH PADA PASIEN DIABETES MELITUS TIPE II

Prolanis gymnastics is a new program from the government with the aim of one of which is to control blood sugar in DM II patients, so many people do not know about it, even most of the people who already know but are less compliant in participating in the Prolanis program and as health workers have an obligation to socialize and activators in activities. This type of quantitative research design is a Quasi Experiment with a one group pre test and post test design approach. The population in this study were diabetes mellitus patients in the working area of ​​the Seputih Banyak Health Center, Central Lampung Regency, as of January - March 2020, totaling 48 people with a total sample of 48 people. In this study the sampling technique used was the total population. In this study, the paired T test was used. Based on statistical tests, it is known that the p-value is 0.000 or p-value <0.05, which means that there is an effect of Prolanis Exercise on Changes in Blood Sugar Levels in Diabetes Mellitus Patients in the Working Area of ​​the Seputih Banyak Health Center, Central Lampung Regency in 2020, it is hoped that this will increase family insight and knowledge about how to improve hemodynamic conditions in diabetic patients and as a basis for providing information to reduce the percentage of people with diabetes

Pengaruh Edukasi Emo-Demo Terhadap Kepatuhan Minum Obat Pasien Hipertensi Pada Peserta Prolanis

The problem of medication adherence in individuals with hypertension remains a challenge, even in developing countries. The purpose of this study was to determine the effect of Emo demo education on adherence to taking medication in hypertensive patients enrolled in the Prolanis program at Puskesmas Sumbersari Lumajang. This study was conducted at Sumbersari Health Center in March 2023. This study used a quasi-experimental research design with a one group pre-post test design. The purposive sampling technique was chosen to select a sample of 50 respondents. This study used the MMAS-8-4 (Morisky Medication Adherence Scale) questionnaire as a measuring tool for medication adherence. Statistical tests using the Wilcoxon Signed Rank test. Before the emo-demo, most of the 22 (44%) respondents were at a low level of compliance. After emo-demo education, most of the respondents were in moderate compliance 33 (66%) and high compliance 14 (28%). The results of bivariate analysis show that Emo demo education has a significant effect on drug compliance in hypertensive patients participating in Prolanis, with a p-value of 0.000 which is smaller than the predetermined level of significance of 0.05. The provision of Emo Demo in health education with a focus on the target group is expected to be facilitated by the puskesmas. Effective medication adherence among hypertensive patients can improve control of blood pressure and prevent complications of the disease.

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.

DESCRIPTION OF THE MOTIVATION OF HYPERTENSION AND DIABETES MELLITUS PATIENTS IN FOLLOWING PROLANIS ACTIVITIES

Background: Prolanis is a health service system to maintain the health of people with chronic diseases. Prolanis will not run well without community participation, while the participation of people with hypertension and diabetes mellitus in participating in Prolanis activities is influenced by motivation. Objective: The purpose of this study was to describe the motivation of people with hypertension and diabetes mellitus in following Prolanis activities at the Nurwachid Inpatient Primary Clinic. Methods: This research design used descriptive. The research was conducted in August 2022 at the Nurwachid Inpatient Primary Clinic. The population in this research is the Prolanis program participants. The sampling technique used total sampling obtained a sample of 45 respondents, consisting of 25 participants diabetes mellitus and 20 participants sufferer hypertension. Motivational instruments with questionnaires, Analysis of statistical test data with univariate. Result: The results showed that more than half of the respondents had good motivation (53.3%), and most of the respondents had good participation (73.3%). Conclusion: It is hoped that Prolanis officers will improve their special services in carrying out Prolanis activities, so that Prolanis participants are motivated which will lead to increased participation in participating in Prolanis activities. Thus, facilitating monitoring and evaluation in providing guidance and health services.

INCREASING AWARENESS OF CHRONIC DISEASE SUFFERERS IN PARTICIPATING IN THE PROLANIS ACTIVITY PROGRAM AT THE MEUREUBO HEALTH CENTER, WEST ACEH REGENCY

This survey was conducted at the Meureubo Health Center in West Aceh Regency with the aim of seeing the increase in awareness of prolanis sufferers at the Meureubo Health Center in West Aceh Regency in participating in the prolanis activity program. Awareness for people with chronic diseases is very necessary to do so as not to cause complications, by following prolanis. BPJS Kesehatan has also implemented a chronic disease management program (prolanis) for the management of hypertension and type 2 diabetes mellitus. Since 2014. In 2021 the Meureubo Health Center has 217 people with hypertension and type 2 diabetes mellitus, with 32 patients, plus in 2022 the disease hypertension to 543 patients. The purpose of this study was to determine the increase in awareness of chronic disease sufferers in participating in the Prolanis program organized by BPJS Kesehatan Meulaboh Branch and run by the Meureubo Health Center. This type of research is a case study qualitative research design (case study).

39. The Outcome of Prolanis (Program Pengelolaan Penyakit Kronis/Chronic Disease Management Program) in Jatirejo Primary Health Care

Background: Indonesia is one of the fastest-aging countries. The increased elderly population carries the burden of chronic diseases such as hypertension and diabetes mellitus, along with their complications. The reinforcement of lifestyle changes has been promoted in primary healthcare through the Prolanis program to reduce these diseases’ burden, though its effectivity is unknown. Objective: To evaluate the outcome of the Prolanis program in Jatirejo Primary Healthcare. Methods: In this study, 61 patients were recruited from November 2021 – April 2022. Data were obtained from medical records as pre- and post-follow-up in 6 months period. Data pre- and post-follow-up were analyzed using the Wilcoxon and dependent T-test. Results: There were 64.52% patients with systolic hypertension. The median data of pre- and post- follow up showed that: HbA1C was 5.9% (range 3 – 13) and 6.3% (range 5 – 11) (p 0,959); BUN was 15,3 mg/dL (range 10 – 32) and 14,8 mg/dL (range 13 – 25) (p 0,638); serum creatinine was 0,8 mg/dL (range 0,4 – 3,1) and 1,2 mg/dL (range 0,7 – 2,6) (p 0,026); total cholesterol was 183 (range, 123 – 300) and 219 (range 179 – 231) (p 0,008); triglycerides was 133 (range 82 – 326) and 159 (range 135 – 394) (p 0,416); HDL was 40,65 SD ± 2 and 41 SD ± 2,3 (p 0,206); LDL was 117,5 SD ± 35 and 139,7 SD ± 20 (p 0,886); and urine microalbumin was 53 (range 5 – 200) and 63,5 (range 5 – 200) (p 0,721). Conclusion: Improvement in patients’ outcomes has not been shown after Prolanis program. Further study with larger populations and more variables is needed.

Literature Review: Obstacles in Implementation of Chronic Disease Management Program (Prolanis) in Public Health Centers

Introduction: BPJS Kesehatan created a chronic disease management program (Prolanis) to prevent complications of chronic diseases. But in fact, the implementation of prolanis is still not running optimally as evidenced by this activity has not shown a good impact on the community. Objective: This review literature aims to identify constraints in the implementation of chronic disease management programs (Prolanis) at the Center for Public Health. Method: This study is a literature review. The data sources used are from google scholar and garuda portals in the 2017-2022 times frame. The keywords used are constraints, chronic disease management programs, prolanis, Public Health Centers. Result and Discussion: The results of the study showed 10 aspects of communication, namely lack of coordination, clarity in delivering success indicators, and lack of socialization. The human resources aspect of 12 articles is the lack of quantity and quality of officers. The funding aspect was obtained by 12 articles, namely the process of submitting and disbursing old claims and withdrawing service fees. Conclusion: from this literature review, it is found that the implementation of the Center for Public Health in implementing the prolanis program in Indonesia has not run optimally. Advice improves routine health promotion every month

An Overview: Quality of Life of Diabetes Mellitus Type 2 Patients who Participate in The Prolanis Program in Sukoharjo Regency

Prolanis is a health service system and a proactive approach that is implemented in an integrated manner implemented by the Social Health Facility Implementing Agency (BPJS Kesehatan). The program focuses on BPJS Health participants who suffer from chronic diseases including type 2 diabetes mellitus. Participants who take part in Prolanis are expected to achieve optimal quality of life with cost effective and efficient health services. This study aims to describe the quality of life of people with type 2 diabetes mellitus who joined the prolanis program in Sukoharjo Regency. This research is a quantitative study using descriptive methods and survey approaches. The measuring instrument used was the DQOL questionnaire sheet. The sampling technique used in this study was convenience sampling with 95 samples. The results show that as many as 82 people (86.3%) sufferers of type 2 DM who participated in the prolanis program in Sukoharjo regency have a good quality of life with the characteristics of most women, around 61-70 years old, graduated high school, housewife, and suffer from type 2 DM for less than 5 years.

Management of Parung Ponteng Cadres in the Prolanis Program with a DM and Hypertension Preventive Approach

For three years at the Parung Ponten Community Health Center, program activities for chronic disease management have been carried out in the form of sports, health monitoring, and counseling. Community service activities are carried out for BPJS participants who are registered at the Parong Ponteng Health Center who have chronic diseases (hypertension and DM) with the aim of motivating participants to live healthy so that their illnesses are controlled. The method used is in the form of routine counseling to participants on matters related to hypertension and DM, given a leaflet containing a summary of counseling material and disease management. The results of AKPER YJK Community Service were that more participants had their blood pressure and blood sugar levels under control after eight weeks. Participants also experienced other benefits by actively participating in this activity. It is recommended to the management of the Parong Ponten Health Center to continue to carry out this Prolanis activity on a regular basis.

Duration Of Hypertension And Quality Of Life Of People With Hypertension In Aceh, Indonesia

Abstract: Hypertension has affected on a person's quality of life, particularly on elderly people, including their social life, mental health, and psychological function. As a result, the elderly's quality of life will suffer, as will their life expectancy.
 Objectives: This study aimed to determine the relationship between the duration of hypertension and the quality of life of those who have hypertension.
 Patients and methods: A descriptive study with a cross-sectional survey was conducted with participants from the Management of Chronic Diseases Program (Prolanis) in primary care in Muara Dua, Lhokseumawe, Aceh, Indonesia. We employed a total sampling technique (35 participants) and collected data through guided interviews using WHOQOL-Bref questionnaires.
 Results: We discovered that participants with hypertension for less than five years were 45.7%, while those with hypertension for more than five years were 54.3%. Physical domain (57.1%), psychological domain (57.1%), and environmental domain (51.4%) all fall into the "good" category of life quality measurement. Meanwhile, social relationship were in the moderate category (42.9%). The following p values demonstrate the association between the duration of hypertension and quality of life: 0.460; 0.719; 0.635; and 0.975.
 Conclusion: There is no significant relationship between hypertension duration and quality of life among hypertensive patients enrolled in the Prolanis Program in Aceh, Lhokseumawe.

The Effect of Multimedia-Based Education on Knowledge, Attitudes, and Behavior Hypertension Patients in Stroke Prevention

The prevalence of hypertension continues to increase, and various epidemiological studies revealed an increase in the incidence of hypertension in different parts of the world. According to the American Heart Association (AHA), The number of Americans over the age of 20 who suffer from hypertension has risen to 74.5 million, while nearly 90% of cases have no identified cause. If not treated effectively, hypertension may cause damage to blood vessels throughout the body, the most prominent of which is the danger of damage to the brain, eyes, heart, and kidneys. An introduction to stroke is essential for reducing the risk of stroke in people with hypertension. Multimedia is one of the developments in health education media, which is in accordance with the advancement of digital technology, incorporating stroke prevention. This study aims to examine the impact of multimedia-based education on hypertension patients' knowledge, attitudes, and behavior toward stroke prevention. This research is a quasi-experiment with a pre-posttest with a control group design. The sampling technique employed was simple random sampling, and the sample size determination utilized a hypothesis test of the average difference in two independent groups of 60 respondents. Data analysis in this study administered paired t-test and independent t-test. The results unveiled that there were significant differences in knowledge (p=0.022), attitudes (p=0.001), and behavior (p=0.008) of hypertension patients in preventing stroke after intervention in the form of multimedia-based education. Therefore, it is recommended that the community can perform hypertension treatment independently frequently, and the implementation of the prolanis program can be enhanced so that people can receive services easily and regularly to prevent stroke.

3 WHY THEY DON'T TAKE THE PILL: A QUALITATIVE STUDY OF ANTIHYPERTENSIVE MEDICATION NONAHDERENCE IN EAST BORNEO PRIMARY HEALTH CARE

Background: Adherence to antihypertensive medication is one of the key drivers of optimal blood pressure control. We found nonadherence to antihypertensive medication in some patients in the Sempaja Primary Health Care. Objective: To determine the factors that influence the patient's nonadherence to antihypertensive medication. Method: Qualitative study with in-depth interview method. Inclusion criteria are aged >18 year old, diagnosed with hypertension for at least 1 year, nonadherence to antihypertensive medication based on medical record and MMAS-8 (Morisky 8—Item Medication Adherence Questionnaire). In-depth interview was recorded, transcribed, reflected, and identified by triangulation method. Result: We have 9 subjects (67% female, 33% male), age range of 35-35 years (22.2%), 46-55 years (33.3%), >55 years (44.4%). Educational state were elementary school (44.4%), junior high school (11.1%), senior high school (44.4%). All subjects were covered by national health insurance. All subjects had blood pressure >140/90 mmhg. The pattern of antihypertensive prescribed were single oral antihypertensive (33%) and combination oral antihypertensive (67%). The identified factors are patient factors (lack of knowledge, unaware attitude, negative stigma toward primary health care), drug factors (side effect and alternative local herbal alternative), environmental factors (busy to work, wrong information from family and neighbors), healthcare system factors (difficulty in transportation, unfriendly services, low quality of education and counseling, limited drug options). Conclusion: Many factors lead to antihypertensive medication nonadherence in primary health care. We need to systematically identify the causes, optimize education and counseling, optimize prolanis program, treated hypertension with an individual approach, and invite community leaders to participate in solving existing problem.