Buku Panduan Praktik Klinis Di Faskes Edit 2017
- Panduan Praktik Klinis Rumah Sakit
- Panduan Praktik Klinis 2017 Idi
- Buku Panduan Praktik Klinis Di Faskes Edit 2017 Free
02 ↘ panduan praktis PROLANIS panduan praktis. Buku Panduan Praktis yang diharapkan dapat membantu pemahaman tentang hak dan. BPJS Kesehatan, Fasilitas Kesehatan yang bekerjasama dengan BPJS. Dan Hipertensi sesuai Panduan Klinis terkait sehingga. Peserta tidak hadir terapi di Dokter Praktek. Staf Klinis Pemberi Asuhan Lainnya dan Staf Klinis Lainnya. BUKU PANDUAN KREDENSIAL. Setiap tenaga kesehatan yang menjalankan praktik di bidang pelayanan kesehatan wajib memiliki izin dalam bentuk SIP. Ayat 3: SIP diberikan oleh Pemda Kabupaten/Kota.
MethodsIn this exploratory, cross-sectional study, we recruited 276 PCPs from the selected area. The data were all collected in 2016 using self-report questionnaires and interviews.
PCPs’ satisfaction was measured using a modified version of the Warr-Cook-Wall Job Satisfaction Scale which contains 19 items and uses a Likert-type response scale. Analysis of variance, the Kruskal-Wallis H test, both with Bonferroni corrections for post hoc testing, and Cochran–Mantel–Haenszel tests were used to compare overall job satisfaction between participant groups. We used simple and multiple linear regression analyses to identify the predictors of PCP satisfaction. Furthermore, a logistic regression analysis for binary outcome was applied to model the PCPs intention to leave practice. ResultsPCPs’ mean overall satisfaction level was 3.19 out of 5. They tended to be very satisfied with their relationship with colleagues, working hours, and physical working conditions. However, the PCPs were dissatisfied with the new referral system, the JKN health services standards, and JKN policy.
The factors significantly associated with job satisfaction ( p. ConclusionsThe PCPs investigated in these two cities in Central Java had moderate satisfaction after the Indonesian health care reform. PCPs who worked in solo practices, performed managerial tasks, and had good experiences with patients tended to have higher satisfaction scores, which in turn prevented them from developing an intention to leave their practice. The three aspects that PCPs with which most dissatisfied were related with the JKN reform. Because of that, the government and BPJS for Health should aim to improve the JKN system in order to increase PCPs’ satisfaction.
BackgroundRecently, several Asian countries, such as Taiwan, China, and Thailand –, have implemented health system reforms for achieving universal coverage. Similarly, on 1 January 2014, Indonesia implemented mandatory national health insurance for all citizens, called Jaminan Kesehatan Nasional (JKN). This was an effort to improve insurance coverage in the country—in 2012, only 62.1% of the Indonesian population had health insurance under a variety of different schemes; the remainder of the population was not covered by any form of health insurance.The new system introduced a variety of new conditions for primary care physicians (PCPs). Before the health system reform, majority of the primary health care (PHC) payment system relied on a retrospective fee-for-service (FFS) system, and most services were paid out-of-pocket.
The payment system also did not force patients and PCPs to follow the regulations of the tiered referral system. Only a small portion of PCPs (5.1%) practiced as family physicians for PT.
Randolph gives you a series of five quests to slay powerful monsters, a new late-game weapon the reward for each. Ffxv a better engine blade 3. This shield is the reward for the third quest.
Askes (health insurer for civil servants) in 2012 and were paid by capitation. Furthermore, under the system, the majority of private PHC facilities did not provide preventive or promotive health services.The JKN reformed the payment system into a retrospective capitation system.
Nowadays, PHC facilities must manage their income based on capitation not only for curative and rehabilitative services but also for preventive and promotive services. The reform also introduced, among other procedures, a more strictly tiered referral system and defined the standard non-specialist diseases that had to be treated in PHC facilities. Several new health programmes were launched, such as home visits, medical history screening, disease management programs, and counter-referral programs.
Askes was renamed Badan Penyelenggara Jaminan Sosial (BPJS) for Health, and became the sole payer under the JKN. The BPJS for Health evaluates PHC facilities’ performance and, at the beginning of 2016, implemented a pay-for-performance (P4P) system for public PHC facilities in provincial capitals , –.Although the Indonesian government has stated that the PCP ratio per 1000 population was sufficient to serve the entire population of Indonesia , the ratio falls below that recommended by the World Health Organization, 1 physician per 1000 population. Specifically, the PCP ratio per 1000 population was 0.16 in 2015. Thus, although the number of physicians in Indonesia has been increasing, it still falls well short of the population growth. This condition need to be considered, because job satisfaction predicted the physician intention to leave practice.The change in the work conditions that follows health system reform can influence physicians’ satisfaction ,.
A Chinese study investigating satisfaction following implementation of universal health coverage confirmed this. However, there has been previous research on PCPs’ satisfaction in Indonesia before the reform. Most of these studies have focused only on the measurement of physician incomes under the capitation payment system created by PT. Askes before the JKN implementation.
These studies tended to show that PCPs were rather dissatisfied with this capitation system –. Because PCPs’ satisfaction is associated with healthcare quality , there is a need to analyse it within the reform framework.To investigate PCP satisfaction in Indonesia, we chose the Semarang Municipality and Demak Regency of Central Java Province as study areas. In Semarang municipality, the capital city of Central Java, has the highest number of physicians (i.e., general pratitioners) and public health officers in this province. However, the ratio of physicians to the population in the province was not high, at only 0.14 per 1000 population ,. The health status of the populations of these regions were regarded as poor based on select indicators. Specifically, in 2014, the incidence rates (IRs) of Dengue haemorrhagic fever (DHF) per 100,000 population were 98.57 (Semarang Municipality) and 36.26 (Demak Regency), both of which were higher than the provincial average (32.95).
Semarang Municipality was also included in 2013 as one of the five cities with the highest maternal mortality rate (29 cases). It also had the fourth highest mortality rate for children under the age of 5 (305 cases in 2014) and the highest number of new human immunodeficiency virus (HIV) cases (108 of 1399 cases) in the province.In light of the health system reform, it is necessary to consider the needs of health workers—especially PCPs, who work to serve patients as well as boost the overall health conditions of the surrounding areas. It is especially necessary to examine their job satisfaction and intention to leave. Therefore, this study assessed PCPs’ overall level of job satisfaction and its various aspects, as well as identified the predictors of satisfaction and PCPs’ intention to leave their practice in two cities in Central Java, Indonesia, after the healthcare reform of 2014.
Obtaining this information can help us in forming recommendations for the government on how to improve conditions for PCPs following the reform. ParticipantsThe participants were PCPs who worked in PHC facilities, namely, public health centres with or without inpatient care, private PHC clinics (usually served by 2 or more physicians), and solo practices. The study area contained 381 PCPs in total. We used purposive sampling, a nonprobability sampling technique wherein we select participants based on their specific characteristics. The characteristics were the length of work in the PHC facilities and the length of the contract between BPJS for Health and the PHC facilities. The participants were PHC physicians who had worked for more than three months.
We recruited participants from PHC facilities that had a contract with BPJS for Health for at least three months. Physicians who had worked for less than three months or who had worked only as physician substitutes were excluded from the study.The research team collected the data by visiting all PHC facilities. The addresses of these facilities were obtained from the Semarang Main Branch Office of BPJS for Health. The research team comprised students pursuing a bachelor’s or master’s degree in public health, as well as graduate students. The main researcher trained the research team before conducting the survey.
We used two methods for collecting the data: self-report questionnaires and interviews. The majority of PCPs completed the questionnaire by themselves, while also being given an opportunity to ask questions of the research team. Several PCPs, however, asked to be interviewed. In these cases, a member of the research team filled in PCPs’ answers. The use of multiple data collection methods can increase the response rate and reduce the amount of missing responses to questions.
The data collection was conducted from April to June 2016. In all cases, non-participation was the result of refusal, being on leave (maternity or sick leave), and further specialization. Three hundred eight questionnaires were submitted, but only 276 questionnaires had complete data for satisfaction. The incomplete questionnaires were excluded. InstrumentsThe questionnaire was initially developed in English and translated into Indonesian.
The questionnaire comprised 4 sections: determining the main place of practice, respondents’ characteristics, PCP satisfaction, PCPs’ intention to leave their practice. The first, second, and third sections consisted of closed-ended questions, while the fourth contained a mixture of closed- and opened-ended questions. We trialled the questionnaire in Semarang Regency with 42 PCPs, who were not included in the final sample. Following the trial, the questionnaire was discussed and revised by experts, including a health officer from the Central Java Provincial Health Office and a language expert. Determining the main place of practiceIn Indonesia, physicians can practise in up to three different places. Only PCPs working in more than one place were asked to complete this section. The section consisted of three questions evaluating their length of work, working hours, and presence of managerial tasks in each place of practice (Additional file ).
Panduan Praktik Klinis Rumah Sakit
Having a longer length of work and working hours and having managerial task to perform, resulted in a higher score. The place with the highest scores on these questions was defined as their main place of practice. If they had the same scores for two places, we chose one of them randomly for inclusion in the analysis. Respondents’ characteristicsThis section contained three sub-sections pertaining to PCPs’ personal characteristics, job and practice characteristics, and the PCPs’ perception and experiences with their patients (Additional file ). The first sub-section contained questions on age, gender, and duration of work in the main place of practice. As for job and practice characteristics, we focused on practice type, average monthly income for the last three months, average number of JKN patients examined per day, average number of private insured and FFS (non-JKN) insured patients examined per day, and management responsibilities. The average monthly total income was in the currency of Indonesia, the rupiah (1 US$ = Rp.
14,285.72 in January 2019). Finally, for the PCPs’ perception and experiences with their patients, we used questions adapted from other studies on patients’ unrealistic expectations and perceptions of patient aggressiveness. The Cronbach’s alpha for these questions was 0.626. Three invalid questions were revised by rewording the questions. PCP satisfactionWe modified a validated questionnaire called the Job Satisfaction Scale by Warr, Cook, and Wall. Our modifications focused on adapting the scale to Indonesian conditions, which differ from those of the developed countries in which this questionnaire has been used previously ,. In this study, we used a scoping analysis of published literature to determine suitable aspects of job satisfaction in the context of the Indonesia health system reform (not reported in this article).
The questionnaire consisted of 19 aspects (or items) and utilized a Likert-type rating scale (1 = very dissatisfied to 5 = very satisfied). The Cronbach’s alpha for reliability was 0.902, and the respective questions were modified. Please see the Additional file.
Data analysisWe obtained descriptive statistics for categorical variables (absolute and relative frequencies) and continuous variables (mean and standard deviation). To analyse overall PCP satisfaction (Tables, and ), we used 5-point Likert scale and treated these as continuous variable. To measure overall job satisfaction, we obtained the mean score of the 19 aspects.
When analysing PCP satisfaction levels according to specific aspects (Fig. And Table ), we used the Likert-type data treated as (ordinal) categorical variables.
In these cases, we converted the 5-point Likert-type data from the Job Satisfaction Scale to a 3-point scale (1 = very dissatisfied and dissatisfied, 2 = neutral, 3 = satisfied and very satisfied) because some of the categories in the 5-point scale had low counts and did not meet the requirements of a chi-square test. 1ANOVA2Mann-Whitney U test3Kruskal-Wallis H test4t-testaStatistical significance: p 45 to ≤60 versus 15 versus 15 versus 5 to ≤15cStatistical significance: p Rp 50.000.000. NoAspects of job satisfaction bp value1Physical working condition. VariableSimple linear regression (unadjusted)Multiple linear regressioncoefSigcoefSESigPCPs’ characteristicsAge (per 5-year increase)0.0440.005 #Gender (ref: Male)0.260 #Female−0.0813 Length of work in main practice (per 5-year increase)0.0420.122 #Job and practice characteristicType of practice (ref: Solo practice)0.000 #Health centre−0.544− 0.3100.0920.001.Health centre with inpatient care−0.564−0.3130.1080.004.Clinic−0.244−0.7800.0760.311Average total income per month for last 3 months d (ref: ≤Rp.
BACKGROUND:In 2014, Indonesia launched a mandatory national health insurance system called Jaminan Kesehatan Nasional (JKN). The reform introduced new conditions for primary care physicians (PCPs) that could influence their job satisfaction. This study assessed PCPs' satisfaction and its predictors in two cities in Central Java, Indonesia, following the reform. METHODS:In this exploratory, cross-sectional study, we recruited 276 PCPs from the selected area. The data were all collected in 2016 using self-report questionnaires and interviews. PCPs' satisfaction was measured using a modified version of the Warr-Cook-Wall Job Satisfaction Scale which contains 19 items and uses a Likert-type response scale.
Analysis of variance, the Kruskal-Wallis H test, both with Bonferroni corrections for post hoc testing, and Cochran-Mantel-Haenszel tests were used to compare overall job satisfaction between participant groups. We used simple and multiple linear regression analyses to identify the predictors of PCP satisfaction.
Furthermore, a logistic regression analysis for binary outcome was applied to model the PCPs intention to leave practice. RESULTS:PCPs' mean overall satisfaction level was 3.19 out of 5. They tended to be very satisfied with their relationship with colleagues, working hours, and physical working conditions. However, the PCPs were dissatisfied with the new referral system, the JKN health services standards, and JKN policy. The factors significantly associated with job satisfaction (p. MethodsIn this exploratory, cross-sectional study, we recruited 276 PCPs from the selected area.
The data were all collected in 2016 using self-report questionnaires and interviews. PCPs’ satisfaction was measured using a modified version of the Warr-Cook-Wall Job Satisfaction Scale which contains 19 items and uses a Likert-type response scale. Analysis of variance, the Kruskal-Wallis H test, both with Bonferroni corrections for post hoc testing, and Cochran–Mantel–Haenszel tests were used to compare overall job satisfaction between participant groups. We used simple and multiple linear regression analyses to identify the predictors of PCP satisfaction. Furthermore, a logistic regression analysis for binary outcome was applied to model the PCPs intention to leave practice. ResultsPCPs’ mean overall satisfaction level was 3.19 out of 5. They tended to be very satisfied with their relationship with colleagues, working hours, and physical working conditions.
However, the PCPs were dissatisfied with the new referral system, the JKN health services standards, and JKN policy. The factors significantly associated with job satisfaction ( p. ConclusionsThe PCPs investigated in these two cities in Central Java had moderate satisfaction after the Indonesian health care reform.
PCPs who worked in solo practices, performed managerial tasks, and had good experiences with patients tended to have higher satisfaction scores, which in turn prevented them from developing an intention to leave their practice. The three aspects that PCPs with which most dissatisfied were related with the JKN reform. Because of that, the government and BPJS for Health should aim to improve the JKN system in order to increase PCPs’ satisfaction. BackgroundRecently, several Asian countries, such as Taiwan, China, and Thailand –, have implemented health system reforms for achieving universal coverage. Similarly, on 1 January 2014, Indonesia implemented mandatory national health insurance for all citizens, called Jaminan Kesehatan Nasional (JKN). This was an effort to improve insurance coverage in the country—in 2012, only 62.1% of the Indonesian population had health insurance under a variety of different schemes; the remainder of the population was not covered by any form of health insurance.The new system introduced a variety of new conditions for primary care physicians (PCPs). Before the health system reform, majority of the primary health care (PHC) payment system relied on a retrospective fee-for-service (FFS) system, and most services were paid out-of-pocket.
The payment system also did not force patients and PCPs to follow the regulations of the tiered referral system. Only a small portion of PCPs (5.1%) practiced as family physicians for PT. Askes (health insurer for civil servants) in 2012 and were paid by capitation.
Furthermore, under the system, the majority of private PHC facilities did not provide preventive or promotive health services.The JKN reformed the payment system into a retrospective capitation system. Nowadays, PHC facilities must manage their income based on capitation not only for curative and rehabilitative services but also for preventive and promotive services. The reform also introduced, among other procedures, a more strictly tiered referral system and defined the standard non-specialist diseases that had to be treated in PHC facilities.
Several new health programmes were launched, such as home visits, medical history screening, disease management programs, and counter-referral programs. Askes was renamed Badan Penyelenggara Jaminan Sosial (BPJS) for Health, and became the sole payer under the JKN. The BPJS for Health evaluates PHC facilities’ performance and, at the beginning of 2016, implemented a pay-for-performance (P4P) system for public PHC facilities in provincial capitals , –.Although the Indonesian government has stated that the PCP ratio per 1000 population was sufficient to serve the entire population of Indonesia , the ratio falls below that recommended by the World Health Organization, 1 physician per 1000 population. Specifically, the PCP ratio per 1000 population was 0.16 in 2015. Thus, although the number of physicians in Indonesia has been increasing, it still falls well short of the population growth. This condition need to be considered, because job satisfaction predicted the physician intention to leave practice.The change in the work conditions that follows health system reform can influence physicians’ satisfaction ,.
A Chinese study investigating satisfaction following implementation of universal health coverage confirmed this. However, there has been previous research on PCPs’ satisfaction in Indonesia before the reform.
Most of these studies have focused only on the measurement of physician incomes under the capitation payment system created by PT. Askes before the JKN implementation. These studies tended to show that PCPs were rather dissatisfied with this capitation system –.
Because PCPs’ satisfaction is associated with healthcare quality , there is a need to analyse it within the reform framework.To investigate PCP satisfaction in Indonesia, we chose the Semarang Municipality and Demak Regency of Central Java Province as study areas. In Semarang municipality, the capital city of Central Java, has the highest number of physicians (i.e., general pratitioners) and public health officers in this province. However, the ratio of physicians to the population in the province was not high, at only 0.14 per 1000 population ,. The health status of the populations of these regions were regarded as poor based on select indicators. Specifically, in 2014, the incidence rates (IRs) of Dengue haemorrhagic fever (DHF) per 100,000 population were 98.57 (Semarang Municipality) and 36.26 (Demak Regency), both of which were higher than the provincial average (32.95). Semarang Municipality was also included in 2013 as one of the five cities with the highest maternal mortality rate (29 cases). It also had the fourth highest mortality rate for children under the age of 5 (305 cases in 2014) and the highest number of new human immunodeficiency virus (HIV) cases (108 of 1399 cases) in the province.In light of the health system reform, it is necessary to consider the needs of health workers—especially PCPs, who work to serve patients as well as boost the overall health conditions of the surrounding areas.
It is especially necessary to examine their job satisfaction and intention to leave. Therefore, this study assessed PCPs’ overall level of job satisfaction and its various aspects, as well as identified the predictors of satisfaction and PCPs’ intention to leave their practice in two cities in Central Java, Indonesia, after the healthcare reform of 2014. Obtaining this information can help us in forming recommendations for the government on how to improve conditions for PCPs following the reform.
ParticipantsThe participants were PCPs who worked in PHC facilities, namely, public health centres with or without inpatient care, private PHC clinics (usually served by 2 or more physicians), and solo practices. The study area contained 381 PCPs in total. We used purposive sampling, a nonprobability sampling technique wherein we select participants based on their specific characteristics. The characteristics were the length of work in the PHC facilities and the length of the contract between BPJS for Health and the PHC facilities.
The participants were PHC physicians who had worked for more than three months. We recruited participants from PHC facilities that had a contract with BPJS for Health for at least three months. Physicians who had worked for less than three months or who had worked only as physician substitutes were excluded from the study.The research team collected the data by visiting all PHC facilities.
Panduan Praktik Klinis 2017 Idi
The addresses of these facilities were obtained from the Semarang Main Branch Office of BPJS for Health. The research team comprised students pursuing a bachelor’s or master’s degree in public health, as well as graduate students. The main researcher trained the research team before conducting the survey. We used two methods for collecting the data: self-report questionnaires and interviews.
The majority of PCPs completed the questionnaire by themselves, while also being given an opportunity to ask questions of the research team. Several PCPs, however, asked to be interviewed. In these cases, a member of the research team filled in PCPs’ answers. The use of multiple data collection methods can increase the response rate and reduce the amount of missing responses to questions. The data collection was conducted from April to June 2016. In all cases, non-participation was the result of refusal, being on leave (maternity or sick leave), and further specialization.
Three hundred eight questionnaires were submitted, but only 276 questionnaires had complete data for satisfaction. The incomplete questionnaires were excluded. InstrumentsThe questionnaire was initially developed in English and translated into Indonesian. The questionnaire comprised 4 sections: determining the main place of practice, respondents’ characteristics, PCP satisfaction, PCPs’ intention to leave their practice. The first, second, and third sections consisted of closed-ended questions, while the fourth contained a mixture of closed- and opened-ended questions. We trialled the questionnaire in Semarang Regency with 42 PCPs, who were not included in the final sample.
Following the trial, the questionnaire was discussed and revised by experts, including a health officer from the Central Java Provincial Health Office and a language expert. Determining the main place of practiceIn Indonesia, physicians can practise in up to three different places. Only PCPs working in more than one place were asked to complete this section. The section consisted of three questions evaluating their length of work, working hours, and presence of managerial tasks in each place of practice (Additional file ).
Having a longer length of work and working hours and having managerial task to perform, resulted in a higher score. The place with the highest scores on these questions was defined as their main place of practice. If they had the same scores for two places, we chose one of them randomly for inclusion in the analysis.
Respondents’ characteristicsThis section contained three sub-sections pertaining to PCPs’ personal characteristics, job and practice characteristics, and the PCPs’ perception and experiences with their patients (Additional file ). The first sub-section contained questions on age, gender, and duration of work in the main place of practice. As for job and practice characteristics, we focused on practice type, average monthly income for the last three months, average number of JKN patients examined per day, average number of private insured and FFS (non-JKN) insured patients examined per day, and management responsibilities. The average monthly total income was in the currency of Indonesia, the rupiah (1 US$ = Rp. 14,285.72 in January 2019).
Finally, for the PCPs’ perception and experiences with their patients, we used questions adapted from other studies on patients’ unrealistic expectations and perceptions of patient aggressiveness. The Cronbach’s alpha for these questions was 0.626. Three invalid questions were revised by rewording the questions. PCP satisfactionWe modified a validated questionnaire called the Job Satisfaction Scale by Warr, Cook, and Wall.
Buku Panduan Praktik Klinis Di Faskes Edit 2017 Free
Our modifications focused on adapting the scale to Indonesian conditions, which differ from those of the developed countries in which this questionnaire has been used previously ,. In this study, we used a scoping analysis of published literature to determine suitable aspects of job satisfaction in the context of the Indonesia health system reform (not reported in this article). The questionnaire consisted of 19 aspects (or items) and utilized a Likert-type rating scale (1 = very dissatisfied to 5 = very satisfied). The Cronbach’s alpha for reliability was 0.902, and the respective questions were modified. Please see the Additional file. Data analysisWe obtained descriptive statistics for categorical variables (absolute and relative frequencies) and continuous variables (mean and standard deviation). To analyse overall PCP satisfaction (Tables, and ), we used 5-point Likert scale and treated these as continuous variable.
To measure overall job satisfaction, we obtained the mean score of the 19 aspects. When analysing PCP satisfaction levels according to specific aspects (Fig. And Table ), we used the Likert-type data treated as (ordinal) categorical variables. In these cases, we converted the 5-point Likert-type data from the Job Satisfaction Scale to a 3-point scale (1 = very dissatisfied and dissatisfied, 2 = neutral, 3 = satisfied and very satisfied) because some of the categories in the 5-point scale had low counts and did not meet the requirements of a chi-square test. 1ANOVA2Mann-Whitney U test3Kruskal-Wallis H test4t-testaStatistical significance: p 45 to ≤60 versus 15 versus 15 versus 5 to ≤15cStatistical significance: p Rp 50.000.000.
NoAspects of job satisfaction bp value1Physical working condition.