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All Journal Paediatrica Indonesiana Review of Primary Care Practice and Education (Kajian Praktik dan Pendidikan Layanan Primer) Jurnal Ekonomi Kesehatan Indonesia
Nugraha, Ryan Rachmad
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Decision Sciences, Operations Research & Management Economics, Econometrics & Finance Education Health Professions Medicine & Pharmacology Public Health

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Cost Effectiveness Analysis Between Hemodialysis and Peritoneal Dialysis Novelia, Elsa; Nugraha, Ryan Rachmad; Thabrany, Hasbullah
Jurnal Ekonomi Kesehatan Indonesia Vol. 1, No. 3
Publisher : UI Scholars Hub

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Abstract

The number of patients with End Stage Renal Disease (ESRD) in Indonesia is growing. Increasing prevalence of hypertension and diabetes mellitus contributes to higher prevalence of ESRD. The majority of patients (94%) with ESRD are undertaking hemodialysis (HD) at public and private hospitals. However, continuous ambulatory Peritoneal Dialysis (PD) has been prescribed to small portion of patients with ESRD. The aim of this study was to examine the cost effectiveness between HD and PD on ESRD patients. This study compared 78 HD patients at Hospital X in Bogor and 10 PD patients at Hospital Y in Jakarta. Patient’s quality of life (QoL) was measured using SF 36 questionnaires. The costs were measured by direct medical costs using CBGs prices, direct non-medical costs (transportation, food for patient and family), and indirect medical costs (opportunity costs). The study found that the HD cost per year per patient was IDR 133.4 million and the comparative cost for PD was IDR 81.7 million. The study found lower QoL of HD patients (46.2%) compared to QoL of PD patients (90%). In addition, PD patients had significant better quality of physical activities, emotional states, social function, and sanity. The study found the incremental costs for to HD to reach similar emotional states was IDR 2.0 million compared to PD and IDR 1.8 million for extra physical role gained. It is concluded that PD was more cost-effective than HD in achieving a certain level of quality of life among patients with ESRD in two hospitals in Indonesia.
TELEMEDICINE PAYMENT SYSTEM BASED ON QUALITY:A SCOPING REVIEW Fatma, Zuhaira Husna; Nugraha, Ryan Rachmad
Jurnal Ekonomi Kesehatan Indonesia Vol. 7, No. 2
Publisher : UI Scholars Hub

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Telemedicine has been proven to improve access to care. However, it is still not sure how a payment system can accommodate high-quality telemedicine services. This paper aims to study the available payment system to accommodate telemedicine with a focus on health services quality. We conducted a scoping review of the telemedicine payment system and telemedicine quality through the PubMed and CINAHL databases including primary research, literature reviews, and expert opinion, aside from policy documents. The number of records identified through the database was 286. In addition, 195 were screened after removing duplicates, and 28 papers were included in the review after meeting the inclusion criteria. From a close look, it is concluded that, in its vast options of care, telemedicine practice can be tailored to payment systems that can be accommodated to quality. According to our review, the type of payment model used to fund telemedicine services could either bolster or hinder quality improvement, depending on the setting. Furthermore, concerns such as lack of standard reimbursement policy and privacy concerns need to be mitigated early to accommodate the integration of telemedicine into the existing payment system.
Improving stunting prevention program through community healthcare workers training and home-based growth monitoring: A quality improvement model Miranda, Adriana Viola; Nugraha, Ryan Rachmad; Sirmareza, Trio; Rastuti, Maritta; Asmara, Rindang; Astuti, Sri Puji; Nasytha, Safarah Risvie; Petersen, Zack
Paediatrica Indonesiana Vol. 64 No. 6 (2024): November 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.6.2024.536-45

Abstract

Background Over 1.5 million community healthcare workers (CHWs) work in pos pelayanan terpadu (posyandu) in Indonesia. They are in charge of growth monitoring and counseling, as part of a community-based stunting prevention program. Recent literature suggests that the program requires quality improvements to maximize its potential. Objective To understand the impacts of a quality improvement model comprising capacity building for CHWs and home-based growth monitoring using smart charts on posyandu performance, particularly related on its stunting prevention components. Methods This cross-sectional study was conducted in two rural villages in Lombok, Indonesia in May 2023. We interviewed 130 CHWs and 317 mothers with children under-five with a pre-validated questionnaire on posyandu performance that was developed using an input-process-output framework. We evaluated the CHWs dan mothers performances in the height measurement and counseling process. Results Both CHWs and mothers perceived performance improvements in the height measurement and counseling processes, with statistically significant differences between pre- and post-intervention performance scores for height measurement [mean differences of 0.38 points; 95%CI 0.188 to 0.566; P<0.000 (CHWs) and 0.276 points; 95%CI 0.469 to 0.846; P<0.000 (mothers)]; for counseling [mean differences of 0.285 points; 95%CI 0.149 to 0.42; P<0.001 (CHWs) and 0.142 points; 95%CI 0.098 to 0.186; P<0.000 (mothers)]. Performance improvements were also found across all posyandu components, including those related to stunting. Conclusion Capacity building for CHWs and home-based growth monitoring using smart charts are beneficial in improving community-based stunting prevention programs.
Culturally Sensitive Primary Care in Indonesia: How Should It Work? Nugraha, Ryan Rachmad; Claramita, Mora
Review of Primary Care Practice and Education Vol 8, No 1 (2025): January
Publisher : Faculty of Medicine, Public Health, and Nursing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/rpcpe.112542

Abstract

The Need for a Culturally-Sensitive Primary CareAs globalization rises and populations grow, cultures intermingle, prompting us to understand culture in the way we interact with each other, and most importantly, in care and practice. This coins the term “culturally sensitive primary care,” or often referred to cultural competence or cultural humility, which is the ability of providers to understand and respond to patients’ cultural belief, values, and language needs. Embracing this culture is critical for improving patients’ outcomes and reducing health disparities. Studies have shown when care is tailored to patients' cultural context, it leads to better communication and therefore higher patient satisfaction and adherence to treatment, and even enhanced clinical outcomes1,2. Doctors who have been trained on culturally adapted communication were found to be associated with patients who were more satisfied, had better understanding of their condition, and showed improved health indicators, such as blood pressure and glucose. Conversely, when cultural understanding is not considered in interacting with patients, miscommunication may occur, such as misunderstanding due to language barriers or difference in health beliefs, which may result in distrust and poorer health outcomes3.Cultural sensitivity is especially important in primary care, particularly as primary care physicians (PCP) become the patients’ first point of contact within the health system. Patients’ health beliefs and behavior are driven by their culture, and thus failure to acknowledge this phenomenon might lead to missed critical information. For example, cultural practices may influence patients’ behavior and shift away patients from accessing appropriate care. A study proved that the higher Traditional Birth Attendants (TBAs) density in a given area is linked with higher odds of mothers not utilizing cascades of maternal services4. On the other hand, PCPs that are culturally adept may use it to their advantage to improve care. A meta-analysis showed that, across interventions targeting underrepresented adults, those with cultural relevance tailoring significantly improved medication adherence compared with non-tailored approaches5. 
Primary Care-Led Health System in Indonesia Nugraha, Ryan Rachmad; Claramita, Mora; Josef, Hari Kusnanto
Review of Primary Care Practice and Education Vol 6, No 2 (2023): July
Publisher : Faculty of Medicine, Public Health, and Nursing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/rpcpe.95657

Abstract

It is a general consensus that investing more in primary care will lead to better health outcomes overall, and therefore, primary care should be the focus of development for health services. A body of evidence that intervention in primary care is cost-effective and reduces health system burden and disparities (1–7). Making primary care the focus of health development is crucial for the sustainability of the health system, particularly amidst the changing demographic landscape and disease burden. Designing health service or needs to start at primary care at its heart. This is concurrent with WHO 2008 report on Primary Care (8): “… focus of reform that reorganizes health services as primary care, i.e., around people’s needs and expectations so as to make them more socially relevant and more responsive to chancing world while produced better outcomes –  service delivery reforms.” 
Co-Authors Asmara, Rindang Fatma, Zuhaira Husna Hasbullah Thabrany Josef, Hari Kusnanto Miranda, Adriana Viola Mora Claramita Nasytha, Safarah Risvie Novelia, Elsa Petersen, Zack Rastuti, Maritta sri puji astuti Trio Sirmareza, Trio