How Is Telehealth Currently Being Utilized to Help in Hypertension Management within Primary Healthcare Settings? A Scoping Review

Telehealth has improved patient access to healthcare services and has been shown to have a positive impact in various healthcare settings. In any case, little is understood regarding the utilization of telehealth in hypertension management in primary healthcare (PHC) settings. This study aimed to identify and classify information about the types of interventions and types of telehealth technology in hypertension management in primary healthcare. A scoping review based on PRISMA-ScR was used in this study. We searched for articles in four databases: Pubmed, Scopus, Science Direct, and Embase in English. The selected articles were published in 2013-2023. The data were extracted, categorized, and analyzed using thematic analysis. There were 1142 articles identified and 42 articles included in this study. Regarding the proportions of studies showing varying trends in the last ten years, most studies came from the United States (US) (23.8%), were conducted in urban locations (33.3%), and had a quantitative study approach (69%). Telehealth interventions in hypertension management are dominated by telemonitoring followed by teleconsultation. Asynchronous telehealth is becoming the most widely used technology in managing hypertension in primary care settings. Telehealth in primary care hypertension management involves the use of telecommunications technology to monitor and manage blood pressure and provide medical advice and counselling remotely.

Smoking behavior and hypertension among health workers during the COVID-19 pandemic: a case study in Java and Bali-Indonesia

Background

Health workers who should be role models for the community not to smoke and live a healthy life are still consuming cigarettes. Java and Bali (especially Java) are the biggest contributors to health worker deaths due to COVID-19 in Indonesia. This study aims to determine the association of smoking behavior and hypertension among health workers in Java and Bali. The researchers conducted this study in 2021 and designed it with a cross-sectional design. Data was collected online using the Lime Survey as a data collection tool. The data analysis used was logistic regression to determine the association of smoking and hypertension.

Result

A number of 7.6% of health workers were still smoking and 10.4% were suffering from hypertension during the COVID-19 pandemic. This study shows that the proportion of health workers with hypertension is two times that of smokers (18.0%) compared to non-smokers (9.8%). Logistic regression showed that smoking has a 20% higher risk of developing hypertension (OR = 1.97; 95%CI = 1.01-1.41; p = 0.034).

Conclusion

Among health workers on the islands of Java and Bali, there are still many who smoke, and this puts them at a higher risk of experiencing hypertension.

Effects of the COVID-19 pandemic on cardiovascular disease financing in Indonesia (JKN claims data analysis 2019–2020)

The disease burden related to non-communicable diseases is a major public health problem in Indonesia. About one-third of all deaths in Indonesia are caused by cardiovascular disease. This study describes the cost of cardiovascular disease from claims data for Advanced Referral Health Facilities at BPJS Kesehatan before and during the COVID-19 pandemic. We analyzed claims data on the National Health Insurance system managed by BPJS. The data comes from referral health facilities throughout Indonesia in 2019 and 2020. Cardiovascular service claims data by sex and age group were analyzed descriptively and with different tests between years. There was a decrease in the number of patients accessing cardiovascular services at referral health facilities for all genders, age groups, and types of main diagnoses, by around 27.8%, from 933,017 (2019) to 673,801 (2020). There was a significant decrease in total claims for all types of cardiovascular disease during the COVID-19 pandemic compared to before, especially the reduction in aneurysms and aortic dissection (40.2%) and hypertensive heart disease (39.6%). The decline also occurred in all sexes and age groups, with an average percentage decline of 31.2%. Our findings show that the reduction in the cost of cardiovascular disease claims goes hand in hand with the decrease in the number of cardiovascular patient visits. To guarantee treatment for cardiovascular disease patients during the COVID-19 pandemic, BPJS can maximize the telemedicine services that have been built. The organizer of the National Health Insurance program in Indonesia has developed a JKN mobile application that has the potential for telemedicine services guaranteed by JKN. On the other hand, BPJS needs to limit promotive and preventive budgets related to CVD so that it does not become a potential catastrophic financing.

The Role of Government-run Insurance in Primary Health Care Utilization: A Cross-Sectional Study in Papua Region, Indonesia, in 2018

Health development in the Papua region often lags behind other areas of Indonesia. The study aims to analyze the role of government-run insurance in primary health care utilization in the Papua region, Indonesia. The study examined 17,879 Papuan. The study used primary health care utilization as an outcome variable and health insurance ownership as an exposure variable. The study also employed nine control variables: province, residence, age, gender, marital status, education, employment, wealth, and travel time to primary health care. The research employed data using binary logistic regression in the final analysis. The results show that Papuans with government-run insurance were three times more likely to utilize primary health care than uninsured Papuans (AOR 3.081; 95% CI 3.026-3.137). Meanwhile, Papuan with private-run insurance were 0.133 times less likely to utilize primary health care than uninsured Papuans (AOR 0.133; 95% CI 0.109-0.164). Moreover, Papuans who have two types of health insurances (government-run and private-run) were 1.5 times more likely to utilize the primary health care than uninsured Papuan (AOR 1.513; 95% CI 1.393-1.644). The study concluded that government-run insurance increases the chance of primary health care utilization in the Papua region, Indonesia. Government-run insurance has the most prominent role compared to other health insurance categories.

Health insurance ownership among female workers in Indonesia: does socioeconomic status matter?

BACKGROUND

Female workers are vulnerable groups in the Indonesian context, and female workers must be responsible for domestic problems and earn a living. The study aimed to analyze the role of socioeconomic on health insurance ownership among female workers in Indonesia.

METHODS

The study population was all female workers in Indonesia. This cross-sectional study involved 7,943 respondents. The study analyzed health insurance ownership as an outcome variable and socioeconomic status as an exposure variable. The study also involved five control variables: residence, age, marital, education, and occupation. The research used multinomial logistic regression in the final step.

RESULTS

The results show the poorest female workers have a possibility of 0.735 times more than the richest to have NHI (AOR 0.733; 95% CI 0.733-0.737). The poorer female workers have 0.939 times less likely than the richest to have NHI (AOR 0.939; 95% CI 0.937-0.942). Female workers with middle socioeconomic status are possibly 0.833 times less than the richest to have NHI (AOR 0.833; 95% 0.831-0.835). Moreover, the richer female workers have 1.028 times more likely than the richest to have NHI (AOR 1.028; 95% CI 1.025-1.030). Moreover, all socioeconomic statuses have a lower possibility than the richest of having other health insurance.

CONCLUSIONS

The study concluded that socioeconomic has a role in health insurance ownership among female workers in Indonesia.

Hubungan Status Gizi Dan Kejadian Tuberculosis Paru Pada Anak Usia 1-5 Tahun Di Indonesia

Tuberculosis is one of the causes of morbidity and mortality that often occurs in children. WHO 2018 data states that there are 1.1 million cases of TB in children each year. One of the causes of TB in children is nutritional status. Poor nutritional status led to weak immunity and thus easier to be infected by tuberculosis. This study aims to analyze the correlation of nutritional status and the occurrence of TB in children aged 1-5 years old in Indonesia. This research is a quantitative study with a cross-sectional design using Riskesdas 2018 data. The sample of the study was children aged 1-5 years old with a total sample of 27779. The confounding variables were sex, residence area, BCG immunization, parents’ education status, parents’ employment status, the existence of smokers, and the physical condition of the house. Bivariate analysis using Chi-Square test and regression logistic for multivariate analysis. The variable associated with TB in children was nutritional status (p-value 0.02) PR 1.78 (95% CI; 1.1-2.9). Other variables related were the area of residence (p <0.05) PR 2.336 (95% CI 1.449-3.768) and the employment status of the father (PR 3.943 95% CI 1.584-9.815). There was a correlation between nutritional status and pulmonary tuberculosis in children aged 1-5 years in Indonesia. Further research is needed by using different designs and other variables.   Abstrak TB paru merupakan salah satu penyebab kesakitan dan kematian yang sering terjadi pada anak. Data WHO 2018 menyebutkan terdapat 1,1 juta kasus TB anak terjadi setiap tahunnya. Salah satu penyebab TB anak adalah status gizi. Status gizi yang buruk membuat imunitas anak rentan sehingga dapat terserang TB paru. Penelitian ini bertujuan unuk melihat ada tidaknya hubungan status gizi terhadap kejadian TB paru anak usia 1-5 tahun di Indonesia. Penelitian kuantitatif studi crossectional dengan menggunakan data Riskesdas 2018. Sampel penelitian adalah anak usia 1-5 tahun dengan jumlah sampel 27779. Variabel perancu jenis kelamin, wilayah tempat tinggal, imunisasi BCG, status pendidikan orang tua, status pekerjaan orang tua, keberadaan perokok, dan kondisi fisik rumah. Analisis bivariat menggunakan uji Chi-Square dan multivariate menggunakan analisis regresi logistic ganda. Variabel yang berhubungan dengan TB paru anak adalah status gizi (p value 0,020) PR 1,78, (95% CI; 1,1-2,9). Variabel lainnya yang berhubungan adalah wilayah tempat tinggal (p value 0,00) PR 2,336 (95%CI 1,449-3,768) dan status pekerjaan ayah (PR 3,943 95%CI 1,584-9,815). Terdapat hubungan antara status gizi terhadap kejadian TB paru anak usia 1-5 tahun. Diperlukan penelitian lebih lanjut dengan desain yang berbeda dan variabel lainnya.

Hubungan Konsumsi Alkohol dengan Cedera Disebabkan Kecelakaan Lalu Lintas di Indonesia Tahun 2018

The incidence of injury increased from 7.5% to 9.2% (2007-2018). The proportion of injuries due to traffic accidents in Indonesia is 2.2% and the highest is at 15-24 years of age at 4.9%. Total per capita alcohol consumption is expected to increase in Indonesia by 2025. The behavior of consuming alcoholic beverages increases the risk of traffic accidents. This study aimed to determine the relationship and the magnitude of the risk of alcohol consumption behavior with the incidence of injuries caused by traffic accidents in people aged >10 years in Indonesia. This research was a quantitative study using univariate, bivariate, and multivariate analysis. The multivariate results of the study showed a significant relationship between alcohol consumption and injuries caused by traffic accidents with OR 2.436 (95% CI: 1.233 - 4.811) after being controlled by other variables, namely age, sex, education, occupation, area of residence and island of domicile. Male group had a significant relationship with OR 1.204 (95% CI: 1.131 - 1.282), higher education was significantly associated with OR 1.953 (95% CI: 1.783 - 2.138), work was significantly associated with OR 1.230 (95% CI: 1.138 - 1.329) ), living in urban areas was significantly associated with OR 1.176 (95% CI: 1.104 - 1.253) and domicile in Sulawesi Island was significantly associated with OR 1.811 (95% CI: 1.580 - 2.077). The age variable is not significant. Alcohol consumption is the variable that has the greatest influence on injuries caused by traffic accidents. Interventions need to be focused on population groups who are more at risk in formulating health policies and programs to reduce the incidence of injuries caused by traffic accidents. Abstrak Kejadian cedera meningkat dari 7,5% menjadi 9,2% (2007-2018). Proporsi cedera akibat kecelakaan lalu lintas di Indonesia sebesar 2,2% dan paling tinggi pada usia 15-24 tahun sebesar 4,9%. Total konsumsi alkohol per kapita diperkirakan meningkat di Indonesia tahun 2025. Perilaku mengonsumsi minuman beralkohol meningkatkan risiko kecelakaan lalu lintas. Penelitian ini bertujuan untuk mengetahui hubungan dan besaran risiko perilaku konsumsi minuman beralkohol dengan kejadian cedera disebabkan kecelakaan lalu lintas pada penduduk usia >10 tahun di Indonesia. Penelitian ini merupakan penelitian kuantitatif dengan menggunakan analisis univariat, bivariat, dan multivariat. Hasil multivariat penelitian menunjukkan hubungan yang signifikan antara konsumsi minuman beralkohol dengan cedera disebabkan kecelakaan lalu lintas dengan OR 2,436 (95% CI: 1,233 – 4,811) setelah dikontrol oleh variabel lain yaitu variabel umur, jenis kelamin, pendidikan, pekerjaan, wilayah tempat tinggal dan pulau domisili. Kelompok laki-laki berhubungan bermakna dengan OR 1,204 (95% CI:1,131 – 1,282), pendidikan tinggi berhubungan bermakna dengan OR 1,953 (95% CI: 1,783 – 2,138), bekerja berhubungan bermakna dengan OR 1,230 (95% CI: 1,138 – 1,329), tinggal di perkotaan berhubungan bermakna dengan OR 1,176 (95% CI: 1,104 – 1,253) dan domisili di Pulau Sulawesi berhubungan bermakna dengan OR 1,811 (95% CI: 1,580 – 2,077). Variabel umur tidak signifikan. Variabel konsumsi alkohol adalah variabel yang paling besar pengaruhnya terhadap cedera disebabkan kecelakaan lalu lintas. Perlu fokus intervensi terhadap kelompok penduduk yang lebih berisiko dalam merumuskan kebijakan dan program kesehatan untuk menurunkan kejadian cedera disebabkan kecelakaan lalu lintas.

The influence of Jaminan Kesehatan Nasional (JKN) on the cost of delivery services in Indonesia

The maternal mortality rate in Indonesia is still high, at 305 per 100,000 live births. Several studies indicated maternal financial burden as one of the dimensions of access that influence a pregnant woman’s ability to receive adequate, high-quality medical care. This study aims to identify the association between the use of Indonesia’s national health insurance (JKN) and out-of-pocket (OOP) expenditures in accessing delivery services, using data from the Indonesian Family Life Survey 5. In addition, this study also investigated the relationship of JKN and the potential reduction of catastrophic delivery expenditures (CDEs) for delivery services. The results show that JKN was associated with reduced OOP expenditures for delivery as well as reduced risk of incurring CDE. However, some OOP expenditure for cost of delivery services still exists among mothers who used JKN during delivery, potentially due to factors such as medicine stock availability and inpatient care shortages.

The Assessing Promotive and Preventive Programs Efficiency in Indonesia: A Data Envelopment Analysis and Qualitative Approach

Health Operational Aid for promotive and preventive programs increases year by year. Despite that, health outcomes remain low. The objective of our study was to measure the technical efficiency of public health programs. We conducted a quantitative approach using Health Production Model to measure the efficiency of 315 districts across 34 provinces in Indonesia. To measure the efficiency score, we run the Data Envelopment Analysis. We also conducted a qualitative one to explore the source of inefficiency by managing interviews and focus group discussion to informants from six districts. The results indicated a wide variation in efficiency among districts. The average efficiency score was 63% with minimal and maximal scores were 15% and 100%, respectively. The high performing districts were in affluent or accessible areas. The qualitative analysis resulted in districts with the mixed planning process and the exact basis for budget distribution, as well as various criteria for priority setting, have higher performance than those which have not. Moreover, there were specific cases played a role in the low performing districts, such as the high-risk population in remote areas and the vaccines issues on halal status. In conclusion, districts still can improve their efficiency in achieving health output using their health resources. Abstrak Bantuan Opersional Kesehatan (BOK) yang digunakan untuk membantu upaya program promotif dan preventif meningkat setiap tahunnya. Akan tetapi, keluaran kesehatan tetap rendah. Tujuan analisis ini adalah menilai efi siensi teknis pada program kesehatan masyarakat yang menggunakan BOK. Dengan menggunakan Model Produksi Kesehatan, kami melakukan pendekatan kuantitatif untuk mengukur skor efi siensi di 315 kabupaten/kota di Indonesia. Skor tersebut diukur dengan Data Envelopment Analysis. Kami juga melakukan pendekatan kualitatif untuk menggali lebih dalam tentang sumber inefi siensi dengan melakukan wawancara dan diskusi kelompok terarah kepada informan di enam kabupaten/ kota. Hasil analisis menunjukkan bahwa terdapat variasi skor efi siensi antar kabupaten/kota. Rata-rata efi siensi adalah 63% dengan skor minimal sebesar 15% dan maksimal sebesar 100%. Kabupaten/kota dengan skor efi siensi tinggi berada di area kaya atau mudah diakses. Hasil kualitatif menunjukkan bahwa kabupaten/kota dengan perencanaan bottom-up yang dikombinasikan dengan top-down, kepastian dasar pembagian distribusi, dan beberapa kriteria untuk setting prioritas memiliki skor efi siensi yang tinggi. Masalah khusus yang dihadapi kabupaten/kota juga berperan dalam inefi siensi, seperti populasi berisiko tinggi di daerah terpencil atau isu halal/haram vaksin. Secara garis besar, kabupaten/ kota masih berpotensi meningkatan efi siensi dalam mencapai output kesehatan dengan menggunakan sumber daya kesehatan yang dimilikinya.

Analisis Biaya Satuan Program Pendampingan Ibu Hamil

Currently, One of the Ministry of Health’s programs to improve maternity and child health is through the Assistance to Pregnant Women Program. Furthermore, as an evaluation material for the implementation of them conducted by students and health cadres, the unit cost information needed in the Assistance to Pregnant Women Program. This study aims to analyze the unit costs of the Assistance to Pregnant Women Program using the Activity-Based Costing (ABC) method. Qualitative research with a descriptive-analytic approach. This approach describes and interprets investment, operational, and maintenance costs that are directly related to the assistance to Pregnant Women Program. This research was performed in two districts, specifi cally Lebak District, which represented areas with diffi cult access and Surabaya City, which represented areas with easy access. The results showed that the unit cost of the assistance to pregnant women program in the City of Surabaya was IDR. 3,027,750.00, and the District of Lebak was IDR. 2,907,250.00. These unit costs can be used as a recommendation for the District Health Offi ces and other districts.  Abstrak Salah satu Program Kementerian Kesehatan untuk meningkatkan Kesehatan Ibu dan Anak adalah melalui Program Pendampingan Ibu Hamil. Sebagai bahan evaluasi pelaksanaan Program Pendampingan Ibu Hamil yang dilakukan oleh mahasiswa dan kader, maka diperlukan informasi biaya satuan yang dibutuhkan dalam Program Pendampingan Ibu Hamil. Penelitian ini bertujuan untuk menganalisis biaya satuan Program Pendampingan Ibu Hamil menggunakan metode Activity Based Costing (ABC). Merupakan penelitian kualitatif dengan pendekatan deskriptif analitik. Pendekatan ini menguraikan dan menginterpretasikan biaya investasi, operasional dan pemeliharaan yang terkait langsung dengan Program Pendampingan Ibu Hamil. Penelitian ini dilakukan di dua Kabupaten yaitu Kabupaten Lebak yang mewakili daerah dengan akses sulit dan Kota Surabaya yang mewakili daerah dengan akses mudah. Hasil penelitian menunjukkan bahwa biaya satuan program pendampingan ibu hamil di Kota Surabaya sebesar Rp 3.027.750,00 dan Kabupaten Lebak sebesar Rp2.907.250,00. Biaya satuan tersebut dapat menjadi bahan rujukan Dinas Kesehatan dan daerah lain dalam mengalokasikan pelaksanaan Program Pendampingan Ibu Hamil.

STRATEGI PENGUATAN PROGRAM POSBINDU PENYAKIT TIDAK MENULAR DI KOTA BOGOR

Latar Belakang: Kapasitas SDM kesehatan dan kemampuan pendanaan yang terbatas menjadi ancaman keberlanjutan program Posbindu Penyakit Tidak Menular (PTM). Penelitian ini bertujuan untuk menganalisis strategi penguatan program Posbindu PTM di Kota Bogor.Metode: Desain penelitian merupakan kualitatif dengan pendekatan studi kasus. Informan utama penelitian berasal dari Dinas Kesehatan, Puskesmas, kader, dan masyarakat.Hasil Penelitian: Posbindu PTM kota Bogor telah dikunjungi oleh masyarakat dari kalangan usia muda hingga tua, namun jumlah kader dan peralatan setiap Posbindu berbeda, kader kurang mendapatkan pelatihan dan pendanaan yang belum maksimal.Kesimpulan: Strategi berupa pelatihan yang lebih intensif terhadap kader mengenai PTM dari tenaga kesehatan, penambahan kegiatan kesehatan untuk meningkatkan intensitas kehadiran warga dan kerja sama lintas sektor menjadi alternatif yang dapat diterapkan untuk penguatan program Posbindu PTM. 

STRATEGI PENGUATAN PROGRAM POSBINDU PENYAKIT TIDAK MENULAR DI KOTA BOGOR

Latar Belakang: Kapasitas SDM kesehatan dan kemampuan pendanaan yang terbatas menjadi ancaman keberlanjutan program Posbindu Penyakit Tidak Menular (PTM). Penelitian ini bertujuan untuk menganalisis strategi penguatan program Posbindu PTM di Kota Bogor.Metode: Desain penelitian merupakan kualitatif dengan pendekatan studi kasus. Informan utama penelitian berasal dari Dinas Kesehatan, Puskesmas, kader, dan masyarakat.Hasil Penelitian: Posbindu PTM kota Bogor telah dikunjungi oleh masyarakat dari kalangan usia muda hingga tua, namun jumlah kader dan peralatan setiap Posbindu berbeda, kader kurang mendapatkan pelatihan dan pendanaan yang belum maksimal.Kesimpulan: Strategi berupa pelatihan yang lebih intensif terhadap kader mengenai PTM dari tenaga kesehatan, penambahan kegiatan kesehatan untuk meningkatkan intensitas kehadiran warga dan kerja sama lintas sektor menjadi alternatif yang dapat diterapkan untuk penguatan program Posbindu PTM.