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Characteristic of Midwife’s who Refer Complex Obstetrics Cases: Karakteristik Bidan yang Merujuk kasus Kebidanan Komplek Arietta R.D. Pusponegoro; Astrid M. P. Iskandar
Indonesian Journal of Obstetrics and Gynecology Volume 8 No. 2 April 2020
Publisher : Indonesian Socety of Obstetrics and Gynecology

Abstract Objective: To identify reasons for referring and characteristics of midwives who practice independently and its relation with complicated cases referred to RSCM.Method: Descriptive analytic case-control. Medical records of patients referred directly to RSCM in January 2016-July 2017 were obtained, then information about midwives and obstetric cases, along with its complications, were collected. Interview and analysis of six characteristics of midwives were conducted. Characteristics analyzed were age, education, training, duration of practice, number of patients ever treated, also distance and travel time of the referral process.Results: All midwives refer due to inadequate facilities. There is a statistically significant correlation between duration of practice and number of patients, with the complicated cases referred directly to RSCM, with OR 7.036 and 6.032, respectively.Conclusion: Midwives refer due to inadequate facilities, and so patients can be treated immediately. Characteristics that affect midwives to refer complicated cases: duration of practice and number of patients. It is necessary to re-evaluate the position of midwives who practiced independently in BPJS, refresher programs, and monitoring by relevant agencies. Further research is needed with more samples and combining midwives' and patients' characteristics in referral cases. Confounding and external factors are identified first in order to do a thorough analysis.Keywords: complicated cases, midwives' characteristics, midwives who practiced independently, referral, referral system. Abstrak Tujuan: Mengetahui alasan rujuk dan karakteristik bidan yang berpraktik mandiri serta hubungannya dengan kasus komplikatif yang dirujuk ke RSCM.Metode: Deskriptif analitik kasus kontrol. Data diambil dari rekam medis pasien yang dirujuk langsung ke RSCM di bulan Januari 2016 hingga Juli 2017, kemudian informasi mengenai data bidan dan kasus obstetri beserta komplikasinya dikumpulkan. Dilakukan wawancara dan analisis enam karakteristik bidan. Karakteristik yang dianalisis yaitu usia, pendidikan, pelatihan, lama waktu berpraktik, jumlah pasien yang pernah ditangani, serta jarak dan waktu tempuh proses merujuk. Hasil: Keseluruhan bidan merujuk karena fasilitas yang tidak memadai. Terdapat hubungan yang bermakna antara waktu praktik dan jumlah pasien yang pernah ditangani, dengan kasus komplikatif yang dirujuk langsung ke RSCM, dengan nilai OR 7.036 dan 6.032.Kesimpulan: Bidan merujuk karena fasilitas tidak memadai dan agar pasien langsung ditangani. Karakteristik bidan yang mempengaruhi dalam merujuk yaitu lama waktu praktik dan jumlah pasien yang ditangani. Perlu dilakukan evaluasi ulang mengenai kedudukan bidan yang berpraktik mandiri di BPJS, program penyegaran bidan, serta monitoring oleh instansi terkait. Perlu penelitian lanjut dengan sampel lebih banyak serta menggabungkan karakteristik bidan dan pasien pada kasus-kasus rujukan. Faktor perancu dan eksternal diidentifikasi terlebih dahulu agar analisis dilakukan menyeluruh.Kata kunci: bidan yang berpraktik mandiri, karakteristik bidan, kasus komplikatif rujukan, sistem rujukan

Evaluation of the Accuracy of Implementation of Obstetric Referral Cases to the Emergency in the JKN Era: Evaluasi Ketepatan Pelaksanaan Rujukan Kasus Gawat Darurat Obstetri ke Instalasi Gawat Darurat dalam Era Jaminan Kesehatan Nasional Omo A. Madjid; Arietta R.D. Pusponegoro; Immanuel S. Margatan
Indonesian Journal of Obstetrics and Gynecology Volume 7 No. 3 July 2019
Publisher : Indonesian Socety of Obstetrics and Gynecology

Abstract Objective: To investigate the circumstances of the obstetric referral case at the emergency department of the Dr.Cipto Mangunkusumo Hospital as well as the accuracy of the referral implementation. Method: We used cross-sectional study. Medical records of obstetric patients at Emergency department in RSCM in January 2013-July 2014 were obtained, then information about patients and their characteristic were collected. The accuracy of referral cases is based on emergency obstetric criteria by BPJS rules. Results: Primary Health Care became the leading referrer. Inappropriate diagnostic referral cases amounted to 21.2%when JKN first began to be implemented in 2014. Cases with improper diagnoses were more referred when JKN was implemented which amounted to 16.8% and non-emergency referral cases of 6.9% in 2014. Conclusion: Referral implementation has not been efficient and effective, the number of obstetric referral cases to emergency department of RSCM that can actually be handled in the secondary advanced health services after the application of JKN is still high. Monitoring and evaluation is needed by the Local Health Office to improve the quality of the referral system that applied in the newly JKN era. Keywords:accuracy of referrals,BPJS, JKN, obstetric emergencies, referral system. Abstrak Tujuan: Mengetahui gambaran kasus rujukan obstetri di IGD RSCM dan ketepatan pelaksanaan rujukan. Metode: Deskriptif desain studi potong lintang. Data diambil dari rekam medis pasien obstetri di IGD RSCMpada bulan Januari 2013 hingga Desember 2014, kemudian informasi mengenai data dan karakteristik pasien dikumpulkan. Ketepatan pelaksanaan rujukan kasus gaat daraurat obstetri berdasarkan Krietria gawatdarurat bagian kebidanan menurut ketentuan BPJS Kesehatan. Hasil: Perujuk terbanyak adalah Puskesmas (FKTP). Kasus rujukan dengan ketidaksesuaian diagnosa lebih banyakjumlahnya pada saat JKN mulai diterapkan pada tahun 2014 sebesar 21.2%. Kasus dengan diagnosa yang tidak tepat rujuk lebih banyak pada saat JKN di laksanakan yaitu sebesar 16.8% dan kasus rujukan yang bukan gawatdarurat sebesar 6.9% pada tahun 2014. Kesimpulan: Pelaksanaan rujukan belum efisien dan efektif, jumlah rujukan obstetri ke IGD RSCM yangsebenarnya dapat ditangani di fasilitas kesehatan tingkat lanjutan sekunder setelah penerapan JKN masih tinggi. Dibutuhkan monitoring dan evaluasi oleh Dinas Kesehatan setempat untuk meningkatkan kualitas sistem rujukan yang berlaku di era JKN yang baru diterapkan. Kata kunci : BPJS, gawat darurat obstetri, JKN, ketepatan rujukan, sistem rujukan.

Obstetric Referral System during COVID-19 Pandemic : Tertiary Referral Hospital Perspective: istem Rujukan Obstetri dalam Masa Pandemi COVID-19 : Perspektif Rumah Sakit Rujukan Tersier Arietta R. D. Pusponegoro; Chakti A. Swastika; Junita Indarti
Indonesian Journal of Obstetrics and Gynecology Volume 10 No. 2 April 2022
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32771/inajog.v10i2.1651

Abstract Objective : To evaluate the effectiveness of obstetric referrals to the dr. Cipto Mangunkusumo National Central General Hospital (RSCM), a tertiary hospital in Indonesian referral system, during the COVID-19 pandemic. Methods : A cross-sectional descriptive-analytic study that compared the effectiveness of referrals before (July-December 2019) and during the COVID-19 pandemic (March-August 2020) at the National Central General Hospital dr. Cipto Mangunkusumo (RSCM). Referral effectiveness is assessed based on two criteria, namely the suitability of the diagnosis and procedural compliance which includes communication through the integrated emergency response system (SPGDT), delivery by ambulance, and attachment of a referral letter. Results: The study found 198 referral cases from 464 obstetric cases (42.67%) before the pandemic and 231 referral cases from 486 obstetric cases (47.53%) during the pandemic. The diagnostic concordance increased from 57.58% before the pandemic to 71.00% during the pandemic (p = 0.004). Referral procedural compliance increased from 28.28% before the pandemic to 45.45% during the pandemic (p < 0.001). Based on these criteria, the effectiveness of referrals at the RSCM during the COVID-19 pandemic era was found to be significantly higher, namely before the pandemic by 21.72% and during the pandemic by 40.26% (p < 0.001). Conclusion : The effectiveness of referral to the RSCM based on the suitability of the diagnosis and the accuracy of the procedure during the COVID-19 pandemic was found to be better than before the pandemic. Keywords: COVID-19, obstetric referral system, pandemic. Abstrak Tujuan : Untuk menilai efektivitas rujukan obstetri ke Rumah Sakit Pusat Nasional dr. Cipto Mangunkusumo, rumah sakit tersier dalam sistem rujukan Indonesia, selama pandemi COVID-19 Metode: Penelitian deskriptif-analitik berdesain potong lintang yang membandingkan efektivitas rujukan sebelum (Juli-Desember 2019) dan saat pandemi COVID-19 (Maret-Agustus 2020) di Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo (RSCM). Efektivitas rujukan dinilai berdasarkan dua kriteria, yakni kesesuaian diagnosis dan kepatuhan prosedur yang meliputi komunikasi melalui sistem penanggulangan gawat darurat terpadu (SPGDT), pengantaran dengan ambulans, dan pelampiran surat rujukan. Hasil: Penelitian menemukan 198 kasus rujukan dari 464 kasus obstetri (42,67%) sebelum pandemi dan 231 kasus rujukan dari 486 kasus obstetri (47,53%) saat pandemi. Kesesuaian diagnosis meningkat dari 57,58% sebelum pandemi menjadi 71,00% saat pandemi (p = 0,004). Kepatuhan prosedur rujukan meningkat dari 28,28% sebelum pandemi menjadi 45,45% saat pandemi (p < 0,001). Berdasarkan kriteria tersebut, efektivitas rujukan di RSCM pada era pandemi COVID-19 ditemukan lebih tinggi secara signifikan, yakni sebelum pandemi sebesar 21,72% dan saat pandemi sebesar 40,26% (p < 0,001). Kesimpulan: Efektivitas rujukan ke RSCM berdasarkan kesesuaian diagnosis dan kepatuhan prosedur saat pandemi COVID-19 ditemukan lebih baik. Kata kunci: COVID-19, pandemi, sistem rujukan obstetri

Qualitative Study on Maternal and Perinatal Health Services in Primary Health Care Facility in Banten Province: Kajian Mutu Pelayanan Kesehatan Maternal Perinatal Fasilitas Kesehatan Tingkat Primer di Provinsi Banten Omo Abdul Madjid; Simon Fongana; Dwiana Ocviyanti; Junita Indarti; Seno Adjie; IPG Kayika; Arietta Pusponegoro; Siti R. F. Harun
Indonesian Journal of Obstetrics and Gynecology Volume 11 No. 2 April 2023
Publisher : Indonesian Socety of Obstetrics and Gynecology

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32771/inajog.v11i2.1892

Objective: To determine the effect of clinical governance in PHCs on maternal and perinatal health in Banten Province, Indonesia.Methods: This was an observational analytic study with cross sectional method performed on the PHCs on Banten Province, Indonesia. All PHCs in Banten Province having maternal and perinatal health services were included in the study. Clinical governance and services were measured using a self-made questionnaire filled by the representative of the PHC. Characteristics analyzed in this study were age, education level, completed training, and occupation. Clinical governance aspects analyzed in this study were leadership, culture, competence, governance, and readiness. The services analyzed in this study were antenatal, pathology, and emergency service. Results: There were 117 PHC representatives who were recruited to the study. The PHC which were categorized as “outstanding” for leadership, culture, competence, governance, and readiness were 23.1%, 41%, 98%, 81.2%, and 83.8%, respectively. The PHC which were categorized as having “good” antenatal, pathology, and emergency services were 92.3%, 51.3%, and 90.6%, respectively. The PHCs with better clinical governance aspects delivered better antenatal, pathology, and emergency services for maternal and perinatal care.Conclusions: Primary health cares with better clinical governance aspects delivered better antenatal, pathology, and emergency services for maternal and perinatal care. Therefore, improving clinical governance is essential to improve maternal and perinatal health services quality in Banten Province, IndonesiaKeywords: clinical governance, health service, maternal health, quality assurance.AbstrakTujuan: Untuk mengetahui pengaruh tata kelola klinik di Puskesmas terhadap kesehatan ibu dan perinatal di Provinsi Banten, Indonesia.Metode: Penelitian observasional analitik dengan metode potong lintang yang dilakukan di Puskesmas di Provinsi Banten, Indonesia. Semua Puskesmas di Provinsi Banten yang memiliki layanan kesehatan ibu dan perinatal diikutsertakan dalam penelitian ini. Tata kelola dan layanan klinis diukur menggunakan kuesioner buatan sendiri yang diisi oleh perwakilan Puskesmas. Karakteristik yang dianalisis dalam penelitian ini adalah usia, tingkat pendidikan, pelatihan yang diselesaikan, dan pekerjaan. Aspek tata kelola klinis yang dianalisis dalam penelitian ini adalah kepemimpinan, budaya, kompetensi, tata kelola, dan kesiapan. Pelayanan yang dianalisis dalam penelitian ini adalah pelayanan antenatal, patologi, dan gawat darurat.Hasil: Terdapat 117 perwakilan Puskesmas yang direkrut untuk penelitian. Puskesmas yang dikategorikan “sangat baik” untuk kepemimpinan, budaya, kompetensi, tata kelola, dan kesiapan masing-masing adalah 23,1%, 41%, 98%, 81,2%, dan 83,8%. Puskesmas yang memiliki pelayanan antenatal, patologi, dan gawat darurat yang tergolong “baik” berturut-turut adalah 92,3%, 51,3%, dan 90,6%. Puskesmas dengan aspek tata kelola klinis yang lebih baik memberikan layanan antenatal, patologi, dan darurat yang lebih baik untuk perawatan ibu dan perinatal.Kesimpulan: Pelayanan kesehatan primer dengan aspek tata kelola klinis yang lebih baik menghasilkan pelayanan antenatal, patologi, dan kegawatdaruratan yang lebih baik untuk pelayanan ibu dan perinatal. Oleh karena itu, peningkatan tata kelola klinis sangat penting untuk meningkatkan kualitas pelayanan kesehatan maternal dan perinatal di Provinsi Banten, IndonesiaKata kunci: kesehatan ibu, pelayanan kesehatan, penjaminan mutu, tata kelola klinik.

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