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All Journal Jurnal Respirologi Indonesia Journal of Indonesian Health Policy and Administration
Nurmadani, Labbaika
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Decision Sciences, Operations Research & Management Health Professions Medicine & Pharmacology Public Health

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Analysis of Non-Prescription Drug Services Via Telemedicine Using the Lean Six Sigma Method: Case Study in a Company Clinic Nurmadani, Labbaika; Basabih, Masyitoh
Journal of Indonesian Health Policy and Administration Vol. 9, No. 3
Publisher : UI Scholars Hub

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Abstract

The non-compounded prescription drug service via telemedicine became an alternative solution to continue providing pharmaceutical services while simultaneously controlling physical contact in hospitals during the COVID-19 pandemic. However, after its implementation, hospitals still need to improve the effectiveness of this telemedicine service. This study aims to propose improvements to enhance the effectiveness and efficiency of non-compounded drug services via telemedicine using the Lean Six Sigma method. This method is used to identify and eliminate all waste in the business process (service) to make efficient use of time and other resources. The study uses both quantitative and qualitative approaches, with data collection through observation, document review, and in-depth interviews. The quantitative approach was used to calculate service times, while the qualitative approach was employed to explore and examine the implementation of telemedicine for non-compounded drug services. The interview results revealed at least three main problems that cause significant delays in drug service processes, namely: drug requests not being processed through the system, incomplete patient data, and delays in doctors' confirmations regarding medication changes. Observations showed that the average service time for non-compounded drug prescriptions via telemedicine is 1 hour, 37 minutes, and 11 seconds, with value add activities taking 32 minutes and 39 seconds (33.6%) and non-value-added activities taking 1 hour, 4 minutes, and 32 seconds (66.4%). The identified waste includes overprocessing, waiting, motion, and defects, leading to proposed improvements such as work standardization, flowchart refinement, 5S, and Kaizen.
ALK and PD-L1 Expression in Non-Small Cell Lung Cancer through Immunohistochemical Assays in Indonesia Syahruddin, Elisna; Sayekti, Mutia A.; Yuliyanti, Sayekti; Thabrany, Hasbullah; Nurmadani, Labbaika
Jurnal Respirologi Indonesia Vol 45 No 3 (2025)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/jri.v45i3.794

Abstract

Background: Advanced therapies for non-small cell lung carcinoma (NSCLC), such as targeted therapy and immunotherapy, are available; however, their use depends on biomolecular testing. In the Indonesian context, EGFR testing is covered by the national health insurance (JKN). According to the Indonesian Clinical Guideline for Lung Cancer, if the EGFR test is negative, further testing, including ALK and PD-L1 immunohistochemistry, is required. Nevertheless, the JKN does not currently cover ALK and PD-L1 IHC tests, which restricts access to the appropriate therapies. This study aims to determine the positivity rates of ALK and PD-L1 IHC tests. Method: This study employs a cross-sectional approach to analyze 2,553 ALK and PD-L1 IHC tests conducted from 2019 to 2023, sourced from four major provinces in Indonesia Results: The positivity of ALK IHC tests is 8% with a median age of 52 years. The positivity rate for PD-L1 IHC in all patients is 49%, while based on the tumour proportion score (TPS), TPS ≥50% is 17% and TPS 1-49% is 32%. ALK positivity correlates with age and female gender (P<0.001 and P=0.006). Conversely, PD-L1 positivity was significantly associated with cancer type (P=0.008). Conclusion: ALK positivity in NSCLC in Indonesia is relatively high (8%), with a relatively young median age of 52 years and is predominantly found in females. PD-L1 positivity does not significantly differ by gender and age, but positively correlates with adenocarcinoma cancer type.
Co-Authors Basabih, Masyitoh Elisna Syahruddin Hasbullah Thabrany Sayekti, Mutia A. Yuliyanti, Sayekti