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Hospital Wastewater Pharmaceutical Residues and Their Impact on Community Microbial Resistance: An Epidemiological and Pharmaceutical Systematic Review Giyantolin, Giyantolin; Subiakto, Yuli; Simorangkir, Timbul Partogi Haposan; Widyati, Widyati
Indonesian Journal of Global Health Research Vol 7 No 3 (2025): Indonesian Journal of Global Health Research
Publisher : GLOBAL HEALTH SCIENCE GROUP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/ijghr.v7i3.7148

Abstract

Releases from healthcare facilities account for a large portion of environmental pollution, with wastewater carrying a cocktail of pharmaceutical contaminants, especially antibiotics. These compounds accelerate the accumulation of antimicrobial resistance. Objective: The study synthesizes the scientific record on the concentration, fate, and effects of pharmaceutical compounds within hospital wastewater; it foregrounds the links to growing microbial resistance and delineates the threat to public health. The review adhered to the 2020 PRISMA framework. The search strategy applied a combination of keywords ("pharmaceutical residues" OR "antibiotic residues") AND ("hospital wastewater") AND ("antimicrobial resistance") AND ("environmental impact" OR "community"). The search was restricted to titles and abstracts of studies published 2015-2025. The article selection process consisted of title and abstract screening, full-text evaluation, and consensus-based discussion. Of the 405 articles initially identified, 21 met the eligibility criteria and were narratively synthesized. Hospital wastewater was found to contain a variety of antibiotics, particularly β-lactams, fluoroquinolones, tetracyclines, macrolides, and sulfonamides, at concentrations higher than those observed in domestic wastewater. Several ARGs including blaNDM, blaKPC, blaOXA, sul1, sul2, qnr, tet, and mcr were frequently detected, alongside resistant pathogenic isolates such as Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Conventional wastewater treatment processes were shown to be only partially effective, achieving removal efficiencies of 16-50% for pharmaceutical residues and ARGs. Consequently, resistant bacteria and ARGs were still detected in receiving water bodies several kilometers downstream from discharge points. Hospital wastewater serves as a major source of pharmaceutical contamination and plays a critical role in the amplification of microbial resistance in the environment. These findings highlight the urgent need for advanced wastewater treatment technologies, strengthened antibiotic stewardship programs, and the integration of environmental and epidemiological surveillance within the One Health framework to curb the spread of antimicrobial resistance.
Implementasi Program BPJS Kesehatan pada Pelayanan Kesehatan Penyakit Tidak Menular di Indonesia: Systematic Review antindi, Meita; Sanjaya, Michael Benedict; Netar, Brigita Marza Naveli; Giyantolin, Giyantolin
Jurnal Rekam Medis & Manajemen Infomasi Kesehatan Vol. 5 No. 2 (2025): Desember
Publisher : Universitas Nasional Karangturi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53416/jurmik.v5i2.481

Abstract

Penyakit tidak menular (PTM) hingga saat ini masih menjadi tantangan utama dalam sistem kesehatan Indonesia karena tingginya angka kejadian, kebutuhan pengobatan jangka panjang, serta dampaknya terhadap pembiayaan kesehatan nasional. Pemerintah melalui Jaminan Kesehatan Nasional (JKN) yang dikelola oleh BPJS Kesehatan berupaya menjamin akses pelayanan kesehatan bagi masyarakat, termasuk dalam penanganan PTM di berbagai fasilitas pelayanan kesehatan. Namun demikian, implementasi program BPJS Kesehatan dalam mendukung pelayanan PTM masih menghadapi sejumlah kendala di berbagai wilayah. Penelitian ini bertujuan untuk menganalisis secara sistematis implementasi program BPJS Kesehatan dalam menunjang pelayanan penyakit tidak menular di Indonesia. Metode penelitian yang digunakan adalah systematic review dengan mengacu pada pedoman PRISMA. Pencarian artikel dilakukan melalui database PubMed, Google Scholar, dan ScienceDirect dengan rentang publikasi lima tahun terakhir (2021–2025). Artikel yang dipilih diseleksi berdasarkan kriteria inklusi dan eksklusi yang relevan dengan topik penelitian. Hasil telaah menunjukkan bahwa program BPJS Kesehatan berkontribusi dalam meningkatkan akses dan kontinuitas pelayanan pengobatan bagi pasien PTM. Meskipun demikian, masih ditemukan berbagai tantangan, antara lain keterbatasan fasilitas kesehatan mitra, ketimpangan pembiayaan rujukan, serta belum optimalnya pelaksanaan pelayanan promotif dan preventif. Kesimpulan dari penelitian ini menunjukkan bahwa BPJS Kesehatan memiliki peran penting dalam memperkuat pelayanan PTM di Indonesia. Oleh karena itu, diperlukan penguatan kebijakan, peningkatan kapasitas fasilitas pelayanan kesehatan, serta optimalisasi upaya promotif dan preventif guna mendukung pelayanan PTM yang berkelanjutan.