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"Pada tahun 2015 kematian akibat PTM sebanyak 68 dan diproyeksikan di tahun 2030 meningkat menjadi 74 . Indonesia tahun 2013 berdasarkan data Riskesdas menunjukkan bahwa 69,6 dari diabetes melitus dan 63,2 dari hipertensi masih belum terdiagnosis. Upaya proaktif pemerintah ialah melalui pelaksanaan Posbindu PTM dimana menunjukkan jumlah kunjungan yang sangat berbeda di wilayah binaan Puskesmas Pasir Mulya. Tujuan penelitian ini adalah mengetahui lebih dalam gambaran manajemen, komunikasi, kemitraan dan inovasi dalam pelaksanaan Posbindu PTM dan faktor yang menentukan hasil evaluasi pelaksanaan Posbindu PTM. Penelitian ini merupakan studi kualitatif dengan metode wawancara mendalam, focus group discussion FGD, telaah dokumen dan observasi di dua Posbindu PTM dengan kunjungan tertinggi dan terendah pada masyarakat dengan karakteristik yang hampir sama. Hasil penelitian ini menunjukkan bahwa manajemen SDM menjadi faktor yang memberikan banyak kontribusi dalam pelaksanaan Posbindu PTM, kemudian komunikasi dan inovasi perlu didukung oleh kemitraan. Pelaksanaan Posbindu PTM didukung oleh optimalisasi faktor-faktor manajemen, komunikasi, kemitraan dan inovasi yang saling berkaitan dalam meningkatkan keberhasilan pelaksanaan.

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By 2015 the deaths due to PTM are 68% and projected in 2030 to increase to 74%. Indonesia in 2013 based on Riskesdas data shows that 69.6% of diabetes mellitus and 63.2% of hypertension are still undiagnosed. The government's proactive efforts are through the implementation of Posbindu PTM which shows a very different number of visits in the target area of the Pasir Mulya Public Health Center. The purpose of this study is to know more in the description of management, communication, partnership and innovation in the implementation of Posbindu PTM and the factors that determine the results of the evaluation of the implementation of Posbindu PTM. This study is a qualitative study with in depth interviews, focus group discussions FGD, document review and observation at two Posbindu PTM with the highest and lowest visits to people with similar characteristics. The results of this study indicate that human resource management is a contributing factor in the implementation of Posbindu PTM, communication and innovation need to be supported by partnership. The implementation of Posbindu PTM is supported by the optimization of management, communication, partnership and innovation factors that are interrelated in improving the successful implementation. "

"Selain tingkat morbiditas dan mortalitas yang tinggi, pembiayaan penyakit katastropik (gagal ginjal, kardiovaskular, kanker, thalassemia dan hemophilia) yang menyerap biaya sangat tinggi harus menjadi perhatian serius. Penelitian bertujuan untuk menganalisis biaya penyakit katastropik berdasarkan karakteristik peserta. Jenis penelitian kuantitatif analitik menggunakan data klaim di BPJS Kesehatan berupa data peserta dan biaya tahun 2014 berjumlah 309.301 klaim. Hasil analisis menunjukkan ada perbedaan bermakna rata-rata biaya penyakit katastropik menurut length of stay, kelas perawatan dan kelas rumah sakit. Upaya promotif, preventif serta manajemen penyakit penderita perlu ditingkatkan untuk mencapai efektivitas dan efisiensi biaya pelayanan kesehatan dalam menjamin keberlangsungan program jaminan kesehatan nasional.

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In addition to morbidity and mortality are high, financing catastrophic diseases (kidney failure, cardiovascular disease, cancer, thalassemia and hemophilia) that absorb very high cost should be a serious concern. The study aims to analyze the cost of catastrophic diseases based on the characteristics of participants. Quantitative research analytical uses claims data in the form of data BPJS participants and costs in 2014 amounted to 309 301 claims.

The analysis showed significant difference in the average cost of catastrophic illness according to length of stay, classes and class hospital care. Promotive, preventive and disease management of patients need to be improved to achieve cost effectiveness and efficiency of health care in ensuring the sustainability of national health insurance program."

"Latar belakang: Program Pengendalian Penyakit Kronis (Prolanis) merupakan garda terdepan penanganan DMT2 di Indonesia sejak 2014. Kontrol metabolik DMT2 yang dikenal dengan ABC: (A) A1c, (B) blood pressure, dan (C) low-density lipoprotein-cholesterol merupakan parameter metabolik utama pencegahan primer PKV pada DMT2.Tujuan: Mengetahui dan mempelajari peran Prolanis pada pengendalian parameter metabolik dan kesusuaian implementasi kegiatan Prolanis secara bersamaan pada populasi DMT2 di Puskesmas.Metode: Studi mixed-method ini menggunakan desain penelitian potong lintang di 10 Puskesmas Kecamatan DKI Jakarta menggunakan cluster random sampling. Pengambilan sampel analisis kualitatif dilakukan secara purposive sampling pada penanggung jawab Prolanis lewat wawancara terpimpin serta telaah dokumen pada pemegang program Prolanis. Analisis kuantitatif menggunakan sampel peserta Prolanis di Puskesmas lewat data rekam medis Puskesmas untuk menilai kendali parameter metabolik ABC.Hasil: Dari 376 peserta Prolanis, 47,9% memiliki nilai HbA1c <7%. Proporsi pengendalian tekanan darah dan kolesterol LDL mencapai 69,7% dan 32,2% secara berturut-turut. Hanya 12,5% subjek yang memiliki kontrol ABC yang baik. Hanya usia >60 tahun yang secara independen berhubungan bermakna dengan pencapaian kontrol HbA1c pada analisis multivariat dengan OR 1,68 (1,11 – 2,56), nilai p 0,015. Analisis kualitatif menunjukkan belum adanya standard operating procedure (SOP) Prolanis yang seragam, keterbatasan obat-obat di Puskesmas, tidak terlaksananya kegiatan kunjungan rumah atau pengingat SMS, dan hambatan-hambatan dalam pelaksanaan Prolanis sejak 2014.Kesimpulan: Pengendalian HbA1c <7% peserta Prolanis DMT2 mencapai 47,9% di Puskesmas DKI Jakarta. Ketercapaian pengendalian TD, kolesterol LDL, dan IMT secara berturut-turut adalah 69,7%, 32,4%, dan 26,9%. Usia >60 tahun berhubungan dengan kontrol HbA1c yang lebih baik. Tidak didapatkan hubungan antara jenis kelamin, komorbiditas, durasi keikutsertaan dalam Prolanis dan kepatuhan terhadap Prolanis dengan kontrol HbA1c yang baik. Terkait kesesuaian aktivitas Prolanis, seluruh Puskesmas di DKI Jakarta tidak menjalankan kegiatan pengingat SMS dan kunjungan rumah kepada peserta Prolanis. Kualitas Prolanis DMT2 berdasarkan aspek input, proses, output dan luaran masih dirasa kurang baik penerapannya di Puskesmas DKI Jakarta.

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Background: A National Chronic Disease Management Program, Prolanis, has been launched to manage T2DM cases Indonesia primary health care facilities since 2014. Managing ABC (HbA1c <7%, blood pressure <140/90 mmHg, and low-density lipoprotein-cholesterol <100 mg/dL) acts as the primary prevention of cardiovascular disaease. Unfortunately, no study has ever evaluated the ABC control and the quality of Prolanis implementation concomitantly.

Aim: To identify the Prolanis’ role in controlling metabolic ABC parameters altogether with the quality of its implementation of Prolanis activities.

Methods: This was a mixed-method study using a triangulation design conducted in 10 primary healthcare facilities in Jakarta, the capital city of Indonesia. A quantitative approach using cross- sectional method was used to analyze the ABC and its affecting factors using T2DM patients’ data in each Puskesmas. Qualitative analysis was conducted using an in-depth interview with the program coordinator to evaluate the implementation of the program activities.

Results: A total of 376 T2DM patients were included in this study. Only 47.9% of subjects reached good glycemic control while only 12.5% met the ABC control criteria. Older age (>60 year) was significantly associated independently with HbA1c <7%, OR 1.68 (95% CI 1.13 – 2.56), p-value 0.015). No significant association was observed in other factors related to HbA1c control. Qualitative analysis showed no similar standard operating procedure on Prolanis implementation, lacking adequate T2DM medications including insulin, inappropriate Prolanis activities, and myriad obstacles that might be associated with poor glycemic control and other metabolic parameters.

Conclusion: Good glycemic control was achieved in 47.9% of Prolanis members. The proportions of subjects who achieved BP, LDL cholesterol, and BMI targets were 69.7%, 32.4%, and 26.9% respectively. Older age (>60 years) was independently associated with desired HbA1c target <7%. No association between sex, comorbidity, duration of Prolanis involvement, and compliance in Prolanis activities with good glycemic control was found in this study. All Puskesmas did not implement SMS reminders and home visits to Prolanis members. The quality of Prolanis at the Puskesmas in DKI Jakarta was not properly implemented based on the input, process, output, and outcome analysis."