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All Journal International Journal of Public Health Science (IJPHS) Majalah Kedokteran Bandung Jurnal Kebijakan Kesehatan Indonesia Jurnal Kesehatan Masyarakat Althea Medical Journal Majalah Kedokteran Gigi Indonesia Global Medical and Health Communication Dental Journal (Majalah Kedokteran Gigi) Jurnal Sistem Kesehatan Padjadjaran Journal of Dentistry Jurnal Kesehatan GIZI INDONESIA Jurnal Gizi Klinik Indonesia Jurnal Kesehatan Prima Jurnal Pendidikan dan Pelayanan Kebidanan Indonesia (Indonesian Journal of Education and Midwifery Care) JKM (Jurnal Kebidanan Malahayati) Jurnal Ilmu Kebidanan (Journal of Midwivery Science) Jurnal Riset Kesehatan Poltekkes Depkes Bandung Padjadjaran Journal of Dental Researchers and Students Poltekita : Jurnal Ilmu Kesehatan Best Journal (Biology Education, Sains and Technology) Pediomaternal Nursing Journal Sehat Masada Jurnal Abdimas Kartika Wijayakusuma Jurnal Ilmu Kebidanan (Journal of Midwivery Science) Nutrition Scientific Journal Media Penelitian dan Pengembangan Kesehatan Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal)
Dewi Marhaeni Diah Herawati
Departemen Gizi Medik Ilmu Kesehatan Masyarakat, Fakultas Kedokteran Universitas Padjadjaran
Agriculture, Biological Sciences & Forestry Humanities Biochemistry, Genetics & Molecular Biology Chemistry Decision Sciences, Operations Research & Management Dentistry Education Environmental Science Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health Social Sciences Veterinary Other

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Journal : Jurnal Kebijakan Kesehatan Indonesia

 1 
Kebijakan Medik pada Pasien Gagal Ginjal Kronik dengan Hemodialisis di RS Hasan Sadikin Bandung Dewi Marhaeni Diah Herawati; Eko Fuji Ariyanto
Jurnal Kebijakan Kesehatan Indonesia Vol 3, No 2 (2014)
Publisher : Center for Health Policy and Management

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (230.669 KB) | DOI: 10.22146/jkki.36360

Abstract

Background: Prevalence of Chronic Kidney Disease in dialysis’s patients in Indonesia has increased. Some of them occurred with malnutrition inflammation complex syndrome and lead to death. This study aims to determine the intake of protein and energy, and determine factors that cause the low intake of nutrition. Methods: Design of the study was mixed methods using embedded concurrent strategy. Research paradigm was constructivism whereas qualitative research conducted in-depth interviews and observations. Quantitative research has been done with a descriptive approach, observational, using secondary data and perform 24 Hour Recall and Food Frequency Questionnaire (FFQ). The study was conducted at Hemodialysis Unit, Hasan Sadikin Hospital from June to September 2013, with a total sampling. Qualitative and quantitative data analysis has been done, followed by analysis of policy and analysis for policy for establishing a medical policy for chronic kidney disease patients receiving medical hemodialysis. Result: The average protein intake of the patients was 1.32 g/ kg/day. Interval of protein intake of 0.5 g/kg /day (lowest) until 2.8 g/kg/day (highest). 24% of patients had protein intake under 1 g /kg BW/day and 22.8% was above 1.5 g/kg BW/day. Average energy intake was 2001 kcal patient/day (930 kcal/ day - 3196.9 kcal/day). The qualitative analysis resulted in seven themes which causes nutrient low intake. The themes were underlying diseases (such as diabetes mellitus and hypertension), length of dialysis, frequency and number of dialysis, effects of dialysis, body’s response, cost factor, counseling, and education. Most of the respondents felt suffer from anemia and complained of nausea and vomiting. Body responses varied widely among them. Conclusion: Protein intake of dialysis patients as recommended by K/DOQI, but not in accordance with energy intake. Protein and energy intake of Jakeman's holder patients were lower than the recommendation of K/DOQI. The cause of lower intake of nutrients due to the underlying disease, length of dialysis, frequency and number of dialysis, effects of dialysis, body responses, cost factors and lack of counseling and education. Counseling and education of the patient's hospital are needed. The government should encourage medical policy in the management of patients with chronic kidney failure are comprehensive, in primary care, secondary and tertiary. The government must provide competent personnel, facilities and supporting infrastructure, service standards and standard operating procedures are required for each level of service. Latar Belakang: Prevalensi pasien Penyakit Ginjal Kronik (PGK) yang menjalani hemodialisis di Indonesia mengalami peningkatan. Beberapa diantaranya terjadi malnutrition inflammation complex syndrome dan berujung pada kematian. Penelitian bertujuan untuk mengetahui asupan protein dan energi, serta mengetahui faktor-faktor yang menyebabkan rendahnya asupan nutrisi. Metode: Desain penelitian adalah mixed method dengan menggunakan strategi conccurent embedded. Paradigma penelitian adalah constructivisme. Penelitian kuantitatif dengan pendekatan deskriptif, observational menggunakan data skunder dan melakukan 24 Hour Recall dan Food Frequency Questionaire (FFQ). Penelitian kualitatif dilakukan dengan wawancara mendalam dan observasi. Penelitian dilakukan di Unit Hemodialisis Rumah Sakit Hasan Sadikin Bandung bulan Juni-September 2013 dengan total sampling. Dilakukan analisis data kualitatif dan kuantitatif yang diikuti analysis of policy dan analysis for policy untuk merumuskan kebijakan medik pada pasien PGK yang menjalani hemodialisis. Hasil: Rata-rata asupan protein pasien adalah 1,32 gr/kg BB/ Hari. Asupan protein terendah 0,5 gr/kg BB/hari, tertinggi 2,8 gr/kg BB/hari. Asupan protein pada 24% pasien dibawah 1 gr/ kg BB/hari; 22,8% diatas 1,5 gr/kg BB/hari. Rata-rata asupan energi pasien 2001 kkal/hari, asupan terendah 930 kkal/hari, tertinggi 3196,9 kkal/hari. Analisis kualitatif menghasilkan 7 tema yang menjadi penyebab rendahnya asupan nutrisi yaitu penyakit dasar (diabetes mellitus, hipertensi), lama dialisis, frekuensi dan jumlah dialisis, efek dialisis, respon tubuh, faktor biaya dan konseling serta edukasi. Efek dialisis yang paling dikeluhkan adalah anemia, mual dan muntah. Respon tubuh diantara pasien sangat bervariasi. Konseling dan edukasi dari pihak rumah sakit sangat dibutuhkan pasien. Kesimpulan: Asupan protein pasien sesuai rekomendasi K/ DOQI, namun belum sesuai untuk asupan energi. Asupan protein dan energi pasien Jamkesmas lebih rendah dari rekomendasi K/DOQI. Penyebab rendahnya asupan nutrisi disebabkan karena penyakit dasar yang menjadi penyebab PGK, lama dialisis, frekuensi dan jumlah dialisis, efek dialisis, respon tubuh, faktor biaya dan tidak adanya konseling dan edukasi. Pemerintah harus mendorong kebijakan medik dalam penanganan pasien gagal ginjal kronik yang komprehensif, di pelayanan primer, skunder dan tertier. Untuk tercapainya kebijakan medik tersebut pemerintah harus menyediakan tenaga yang kompeten, sarana dan prasarana pendukung, standar dan protap yang dibutuhkan untuk masing-masing level pelayanan.
Co-Authors Ahmad Yani ahmad yani Aldi Harry Ramdani, Aldi Harry Alfi Syahri Amani Sakinah Augiani Ananda Sagita Anggraeni, Erizvina Marisa Anggun Rafisa Ari Andriyani Ari Andriyani Arief S. Kartasasmita Augiani, Amani Sakinah Aziz, Muhammad Alamsyah Bambang Sasongko Noegroho Budi Handono Dadi Argadiredja Dadi Argadiredja, Dadi Dany Hilmanto Dedeh Dedeh Dedeh Dedeh, Dedeh Dedi Rachmadi Dedi Rachmadi Deni Kurniadi Sunjaya Deni Sunjaya Deni Sunjaya, Deni Devi Pratiktowati Dewi Kania Intan Permatasari Dida Akhmad Gurnida Dida Akhmad Gurnida Dida Akhmad Gurnida Dida Gurnida Dwi Kusumayanti Dwi Kusumayanti Dwi Prasetyo Dzulfikar Djalil Lukmanul Hakim Eddy Fadlyana Eko Fuji Ariyanto Elly Yana, Elly Elsa Pudji Setiawati Elsa Pudji Setiawati Erizvina Marisa Anggraeni Erna Herawati, Erna Farid Husin Farid Husin Farid Husin Fauzah Cholashotul I’anah Fedri Rinawan, Fedri Firman Fuad Wirakusumah Fitria Nurwulansari Fiva Aprilia Kadi Fiva Aprilia Kadi Fransisca Sri Susilaningsih Fransisca Sri Susilaningsih Ginna Megawati Ginna Megawati Gizella Gizella Guswan Wiwaha Heda Melinda Nataprawira Herry Herman Ibnu Suryatmojo Ida Siti Nurparida Ieva Baniasih Akbar Ignatius Setiawan Iis Rosita Ika Murtiyarini Insi Farisa Desy Insi Farisa Desy Arya Insi Farisa Desy, Insi Farisa Irna Sufiawati Irvan Afriandi Irvan Afriandi Ita Susanti Johannes C. Mose Julistio T.B. Djais Julistio TB Djais Jusuf Sulaeman Jusuf Sulaeman Jusuf Sulaeman Kamilah, Kiki Kusnandi Rusmil Kusumaningrum, Hesti Lani Gumilang Lastri Asmuniati Lazuardi Dwipa Linasari, Desy Lulu Eva Rakhmilla Lulu Eva Rakhmilla, Lulu Eva M Aris Rizqi Majid, Tita Husnitawati Miftahurachman Miftahurachman Miftahurachman Miftahurachman, Miftahurachman Nanan Nur'aeny Nanan Nur'aeny Nendhi Wahyunia Utami Nilavenmalar Perianan nina triana Nina Triana Ningsih, Nining Ade Nita Arisanti Noormarina Indraswari Nugraha, Gaga Irwan Nur Eva Aristina Nurdiani Rakhmayanthie, Nurdiani Oktarina Sri Iriani Palomina Caesarea Nurhasanah Palomina Caesarea Nurhasanah, Palomina Caesarea Perianan, Nilavenmalar Priyo Sulistiyono puteri fadillah zahra puteri fadillah zahra, puteri fadillah Raden Tina Dewi Judistiani Rahmatia Djou Ravika Khaila Arrum Resnaldi Resnaldi Resnaldi, Resnaldi Santi Suarsih, Santi Saparuddin Latu Setiawan . Shinta Tresna Fujianti Shinta Tresna Fujianti, Shinta Tresna Siti Damayanti Sri Endah Rahayuningsih Sulistiyono, Priyo Sunardhi Widyaputra Sunjaya, Deni i Kurniad Susiarno, Hadi Syahruddin, Akmal Novrian Tenny Setiani Dewi Tisnasari Hafsah Tisnasari Hafsah, Tisnasari Tita Husnitawati Majid Viramitha Kusnandi Rusmil Vita Murniati Terawan Wardani, Yusrima Syamsina Yopi Suryatim Pratiwi Yudi Wahyudi Yusrima Syamsina Wardani Zulvayanti Zulvayanti