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Acute respiratory infection (ARI) is a common disease in the community. Riskesdas 2018 stated that ARI prevalence was 4.4% and the highest was in 1-4 years old children (8%). The capitation payment system in clinics collaborated with BPJS Kesehatan demands the physician to prescribe as effective and as efficient as possible. On the other hand, the capitation tariff obtained by clinics is considered as too low, thus constrains of the prescription leading to irrational prescribing is likely to occur. This study analyses further the prescribing pattern for ARI children in clinics and its rationality based on the difference in source of funding. A cross sectional research using retrospective method was conducted. Data were gathered from 409 medical records and or patients’ prescription of children between 1-12 years old and diagnosed as having non pneumonia ARI during 1st January to 30th November 2019. Result showed that non pneumonia ARI patients were mostly boys (54,3%) aged 1-5 years old (6.0%). The average number of items for BPJS patients was 3,45, the percentage of generic prescribing was twofold higher for BPJS group (63.94%), the percentage of essential medicine prescribing was 63.96% while the percentage of antibiotic use was lower (48.50%). Dosage propriety for BPJS patients was 70.80% which was slightly higher than non-BPJS group. Overall, the prescribing indicators and dosage properness for BPJS patients were better than non-BPJS patients.

Background: The World Health Organization reported Indonesia as one of the countries with the most prevalent cases of diphtheria worldwide. The microbiological aspects of diphtheria-inducing bacteria are of great significance in tracing disease transmission and case management. However, clinical aspects are critical for updating clinical features and case management in the field, which may sometimes differ from theoretical foundations. Objectives: This study aimed to identify the microbiological and clinical aspects, including molecular typing and case fatality rates, in diphtheria-confirmed cases from the capital city of Indonesia, Jakarta, and surrounding areas in 2017. Methods: The microbiological aspect of 40 diphtheria-confirmed cases were obtained by re-identify diphtheria-inducing bacteria isolated from the samples, while the clinical aspects of the cases were obtained from the medical records and epidemiological data. The chi-square test was used to examine the correlation between fatal cases and myocarditis and diphtheria antitoxin administration delay. In this study, P ≤ 0.05 was set as the significance level. Results: All 40 diphtheria confirmed cases were induced by toxigenic Corynebacterium diphtheriae with two biotypes, namely intermedius (60.0%) and mitis (40.0%). There are six sequence types of bacteria with two main sequence types, ie, ST534 (46.4%) and ST377 (35.7%). The proportions of cases that had a fever and sore throat were 72.5% and 77.5%, respectively; however, the prevalence rates of the cases with pseudomembrane and bull neck were 100% and 47%, respectively. Most cases were administered a combination of penicillin or erythromycin with other antibiotics (40%), and 22.5% of the cases only received penicillin. Myocarditis was noticed in three fatal cases, and their relationship was statistically significant (P = 0.000). All five fatal cases (12.5% of cases) received diphtheria antitoxin (DAT) lately or had not received it yet. Conclusions: Toxigenic C. diphtheriae with two biotypes (namely mitis and intermedius) and two main sequence types (ie, ST534 and ST377) was the causative agent of diphtheria-confirmed cases from Jakarta and surrounding areas in 2017. It was also concluded that those fatal cases were correlated with myocarditis complications.

Pharmaceutical services is a direct service and responsible to patients relating to pharmaceutical products aimed to improve the quality of life of patients. Quality of pharmaceutical services can be assessed based on outpatient satisfaction. The aim of the study was to compare the satisfaction of outpatients with pharmaceutical services in hospitals and primary health care. This study used a cross-sectional comparative study design and was conducted in February-November 2017 in 11 provinces, each province consisting of 2 districts/cities selected purposively. Samples were outpatients who got medicines in hospitals or primary health care at least 31 patients in each pharmacy. Satisfaction was assessed by the dimension of responsiveness, reliability, collateral, friendliness, and physical evidence. Data was collected by the questionnaires and analyzed using chi-square test. The results of the study show that outpatient satisfaction with pharmaceutical services in hospital and primary health care was 90,9% and 96.6%, respectively. The largest percentage of outpatients in hospitals and primary health care are in the age group of 40-59 years, female, has further education, and not working/housewives. There were significant differences in the age group, gender, and education of outpatients between hospitals and primary health care. There was no significant relationship between the characteristics (age, sex, education, occupation) of outpatients and satisfaction with pharmaceutical services in hospitals and primary health care

Latar belakang: Pengobatan pada anak yang terinfeksi HIV merupakan beban bagi para orang tua/pengasuh karena berbagai permasalahan menyangkut kesehatan mereka. Metode: Penelitian untuk mengeksplorasi pengalaman dan dukungan sosial pada pengobatan anak terinfeksi HIV dilakukan di 5 provinsi di Indonesia dengan prevalensi HIV tertinggi. Total sampel anak sebanyak 239 orang dari sejumlah 267 orang yang direncanakan. Data dikumpulkan dengan wawancara semi terstruktur dengan orang tua/pengasuhnya. Analisis dilakukan terhadap 16 anak berusia 2-14 tahun yang telah mendapatkan terapi obat antiretroviral. Hasil: Dari sejumlah 160 anak, sebanyak 62,5% anak mengkonsumsi 1-2 item obat dan 36,9% mengkonsumsi 3 5 item. Efek samping yang paling sering terjadi adalah kulit kemerahan, mual dan muntah. Kesulitan yang paling sering dihadapi adalah rasa bosan dan anak mempertanyakan minum obat. Orangtua/pengasuh berusaha melanjutkan pengobatan dengan mengingatkan jadwal minum obat, membujuk, memberikan penjelasan bahkan memaksa atau mengancam mereka untuk minum obat. Kesulitan tersebut makin bertambah seiring meningkatnya usia anak. Dukungan yang paling sering berasal dari orang tua dan keluarga besar seperti nenek atau paman, khususnya untuk anak yang sudah yatim. Kesimpulan: Pemahaman hambatan pengobatan pada anak terinfeksi HIV dapat membantu untuk menyediakan intervensi yang tepat untuk meningkatkan kepatuhan yang akan mendorong kesuksesan terapi mereka. Kata kunci: anak terinfeksi HIV, antiretroviral, dukungan social, pengobatan, kesulitan Abstract Background: The treatment of HIV infected children is a burden to their caregiver due to many existing problems related with their health. Methods: A research to explore the experience and social support on the treatment of HIV infected children was conducted in 5 provinces in Indonesia with highest prevalence of HIV. Total children sample was 239 out of previous 267 planned. Data was collected through semi structured interview with caregivers of the children. Analysis was conducted to 160 children aged 2-14 years old who were on antiretroviral therapy. Results: Among those 160 children, 62.5% took 1-2 items of medicines and 36.9% took 3-5 items. The most frequent adverse events were skin rash followed by nausea and vomiting. Boredom and questioning were the most frequent difficulties. The caregivers attempted to continue the treatment by reminding the children on schedule to take medicines, wheedling, explaining, forcing or even threatening them. The difficulties appeared more as the children grew older. The most frequent supports mainly came from parents, and extended family such as grandmother or uncle especially for orphaned children. Conclusion: Understanding obstacles in HIV infected children will help to do proper interventions to improve adherence that will lead to successful therapy. Keywords: HIV infected children, antiretroviral, social support, treatment, difficulties

Benefits of Fornas are guidance in determining drug use, increasing rational drug use, quality control and treatment costs and optimizing services. The use of antibiotics is regulated according to the category of health service facilities. Therefore it is necessary to evaluate the suitability between the availability of antibiotic drugs and national formulary. The study design was cross sectional. This type of research is quantitative followed by qualitative data collection. Quantitative data in the form of secondary data on the availability of antibiotics for the period 2014-2017 at the North Sulawesi Provincial Health Office, Manado City Health Office, and 2 Health Centers in Manado City. The average percentage of suitability of antibiotics with the national formulary from 2014 to 2017 at level 1 health facilities was 61.77% in the Provincial Health Office, 61.59% in the City Health Office, 50.14% in the Puskesmas Bahu, 56.85% in the Tikala Health Center. The low percentage of conformity with fornas in the Provincial Health Office, Manado City Health Office and 2 Health Centers was dominated by the large number of antibiotic use which can only be used for level 2 and 3 health facilities. There needs to be escorting the process of socialization, implementation and supervision. It is necessary to consider forming a particular system, for example reward and punishment for doctors who write prescriptions. Keywords: JKN, Antibiotics, National Formulary, FKTP Abstrak Manfaat Fornas yaitu acuan penetapan penggunaan obat dalam JKN, meningkatkan penggunaan obat rasional, kendali mutu dan biaya pengobatan dan mengoptimalkan pelayanan. Penggunaan antibiotik diatur berdasarkan kategori fasilitas pelayanan kesehatan. Oleh karena itu perlu dilakukan evaluasi kesesuaian antara ketersediaan obat antibiotik dan formularium nasional. Desain penelitian adalah cross sectional. Jenis penelitian ini adalah kuantitatif yang diikuti oleh pengumpulan data kualitatif. Data kuantitatif berupa data sekunder ketersediaan antibiotik selama periode 2014 – 2017 di Dinas Kesehatan Provinsi Sulut, Dinkes Kota Manado, dan 2 Puskesmas di Kota Manado. Rata-rata persentase kesesuaian antibiotik dengan formularium nasional dari tahun 2014 – 2017 pada faskes tingkat 1 adalah 61,77% di Dinkes Provinsi, 61,59% di Dinkes Kota, 50,14% di Puskesmas Bahu, 56,85% di Puskesmas Tikala. Rendahnya persentase kesesuaian dengan fornas di Dinkes Provinsi, Dinkes Kota Manado dan 2 Puskesmas lebih didominasi karena banyaknya penggunaan antibiotik yang hanya boleh digunakan untuk faskes tingkat 2 dan 3. Perlu ada pengawalan terhadap proses sosialisasi, implementasi dan pengawasan. Perlu dipertimbangkan untuk membentuk sistem tertentu, misalnya reward and punishment terhadap dokter yang menulis resep. Kata kunci: JKN, Antibiotik, Formularium Nasional, FKTP

Pharmacy is a place where a pharmacist provides pharmaceutical services. To improve services, it is necessary to carry out an evaluation of patients’s or consumers’ satisfaction on pharmaceutical services.This research aimed to assess the satisfaction of the patients covered by national health insurance programme (JKN) and to find out the relationship of patients’ characteristics and their satisfaction. This research used a cross sectional survey design, conducted for patients visiting pharmacy to redeem the prescribed drug in Tangerang Selatan city, Serang district, Bekasi city, Bogor district, Yogyakarta city, Bantul district, Solo city, and Sragen district. The sample was 152 adult JKN patients chosen by accidental sampling. Data were collected using self assessment questionnaire analyzed using chi square analysis. This study found that the highest level of dimension of pharmaceutical services satisfaction was empathy and the lowest one was assurance, in term of the availability of drugs and the number of drugs that was covered by JKN scheme. Among 5 characteristics (i.e: age, sex, marriage status, education, and occupation), only occupation variable that had significant correlation with satisfaction. The pharmacy management should communicate with the JKN provider regarding the kinds of drugs covered and concern with the drugs availability in the pharmacy

Home yard has been used to plant certain medicinal plants, also as known as TOGA program. This research was aimed to study the implementation of TOGA program and community tradition in planting and using medicinal plants. A qualitative research was conducted in West Java, Central Java, East Java and Bali which based on National Basic Health Research 2010 data had the highest percentage of jamu usage. Data was collected in 2011 through in depth interview and focus group discussion with related stakeholder and observation in research location. Result in Bogor district showed TOGA program has been included in Family Welfare Development Program and similar program was also developed in some villages. There was no certain TOGA program in Karanganyar, Sumenep and Gianyar districts. TOGA program in Karanganyar was inserted in other program due to economic needs while in Gianyar the program was originated from ornamental plants. The community usually used medicinal plants for the prime medication before going to health facility. Planting medicinal plants is an inherited tradition where parents become the main source of planting and usage information. The Agriculture Office and village officials had more significant roles to guide the community while the Health office only suggested or monitored them

Prescribing indicator is an easy core indicator to evaluate drug utilization as stated in WHO guideline. Rational prescribing pattern is important to improve rational use of drugs whereas irrational prescribing pattern can lead to irrational drug use. This study aimed to assess the prescribing pattern in public and private primary healthcare facilities which were included in the National Health Insurance Program in Indonesia. This study has been conducted using the cross sectional research design, quantitative and retrospective method in four provinces in Java island (West Java, Banten, DIY and Central Java provinces) from May to July 2014. The method of retrospective data collection were collected 757 prescriptions from 26 PHCs and 900 prescriptions from 30 clinics or General Practitioners (GPs). All data in the prescribing form were analyzed manually using Microsoft Excel 2007. The average number of item in public and private facilities was 3.31 and 3.06 respectively. The percentage of generic prescribing was 93.3% and 62.0%, the percentage of drugs in accordance with the 2013 national formulary was 89.0% and 64.5%, the percentage of antibiotic per total number of encounter was 42.8% and 39.4%, while the percentage of injection per total encounter was only 0.7% and 2.2%. Paracetamol and dexamethasone were the most frequently prescribed drugs while for antibiotic group were amoxicillin, ciprofloxacin, cotrimoxazole and cefadroxil.The average number of items per encounter and antibiotic were not met the WHO standard(≤3 for average number and less than 30% for antibiotic percentage). Suitable interventions are needed to improve the prescribing practices in Indonesia.

Hasil Riskesdas 2007 menunjukkan kasus Tuberkulosis (TB) Paru ditemukan merata di seluruh provinsi di Indonesia, sedangkan hasil Riskesdas 2010 menunjukkan prevalensi TB paru nasional adalah 725 per 100.000 penduduk. Salah satu penyebab putusnya terapi adalah efek samping obat. Hal ini menimbulkan resistensi kuman sehingga memperberat penyakit. Penelitian ini bertujuan untuk mendapatkan informasi efek samping akibat penggunaan obat antituberkulosis(OAT) dan kepatuhan pasien. Jenis penelitian adalah time series, dilakukan terhadap pasien baru penderita tuberkulosis di 10 puskesmas di Provinsi Banten dan Jawa Barat pada bulan Mei 2011. Pasien diikuti selama 6 bulan hingga periode penelitian berakhir. Pasien diwawancara mengenai efek samping obat yang dialaminya setiap bulan saat mengambil obat atau kunjungan ke rumah oleh petugas puskesmas. Pemantauan kepatuhan dilakukan dengan menghitung obatsisa yang disimpan oleh pasien. Jumlah sampel dalam penelitian ini adalah 92 pasien, semuanya masih patuh dalam menjalani terapi. Frekuensi kejadian efek samping yang paling sering timbul pada bulan pertama dan kelima yaitu mual; pada bulan kedua pusing; serta pada bulan ketiga, keempat dan keenam nyeri sendi. Efek samping lain yang sering timbul akibat penggunaan OAT yaitu mengantuk dan lemas pada bulan pertama, kedua dan ketiga. Berdasarkan hasil penelitian dapat disimpulkan bahwa dengan adanya pemantauan yang dilakukan petugas, efek samping yang terjadi dapat terdata dan tidak menyebabkan menurunnya kepatuhan pasien. Hal ini dapat terjadi karena adanya komunikasi yang baik antara pasien dengan petugas mengenai proses pengobatan TB. Disarankan agar pemantauan efek sampingdan kepatuhan dilakukan dengan menekankan pada komunikasi pasien dengan petugas. Selain itu perlu dilakukan pemantauan laboratorium secara rutin.Kata Kunci: Efek Samping, Obat Antituberkulosis (OAT), Tuberkulosis (TB) paruAbstractThe result of Basic Health Research in 2007 shown that lung tuberculosis cases spread out all over Indonesia. Meanwhile, the 2010 Basic Health Research shown the prevalence of lung TB was 725 per 100,000 populations. Side effects are among the causes of therapy drop out thus resulted in bacterial resistance which further caused the severityof TB. This research aimed to explore the information of side effects experiences caused by TB drugs therapy as well as to monitor adherence. The research was a time series research, conducted to new patients diagnosed as having lung TB in 10 public health centers (PHCs) in Banten and West Java provinces on May 2011. Those patients were followed up to6 months until the research was terminated. Patients’ experiences of side effects were collected by monthly interview, when they came to the PHCs to take drugs or during patient’s home visit by the PHC staff. Monitoring of adherence was conducted by counting the tablet at patients’ home. The sample was 92 patients, whom all were counted as adhering thetherapy. The most frequent side effect in the first and fifth months was nausea; in the second month was dizziness; and in the third, fourth and sixth month was neuromyalgia. Other side effects reported were drowsiness and weakness in the first three months. Based on the result, it is concluded that by health provider monitoring, the side effects can beidentified and had not caused low adherence. This can be the result of good communication between patients and health provider about TB therapy. It is recommended that side effects and adherence monitoring should be conducted by emphasizing on patients and provider communication. In addition, laboratory monitoring should be conductedperiodically.Keywords : side effects, antituberculosis drugs, lung tuberculosis

Indonesia is facing shortage of pharmacist in public health centers (PHCs), therefore the local government and PHCs have to cope with this problem. This paper aimed to describe the pharmaceutical manpower availability in PHCs, the problems occurred and potential applied solutions. Data was taken from National Health Facility Research 201. Quantitative data related to pharmaceutical manpower in PHCs was analyzed descriptively based on regions. Supporting qualitative data through in-depth interviews with the health office staffs in Bogor and Bekasi and pharmacists in four PHCs were conducted and being analyzed using thematic analysis. It was found that Sulawesi had the highest percentage of PHCs having pharmacist (29.1%) while Eastern Indonesia 51.5% of PHCs didn’t have any staff with pharmacy related educational background. The highest percentages of staff composition were pharmacy technician followed by nurse. The main problem was due to high workload with limited manpower available. The proposed solutions are recruitment of new pharmacists, but in case it is not possible then placing pharmacist in certain type of PHCs with urgent needs is a priority. Empowering pharmacy technician, all available trained staff and other resources such as on job students are other feasible choices.Indonesia masih menghadapi keterbatasan jumlah apoteker di puskesmas, sehingga pihak pemerintah daerah dan puskesmas harus berupaya mengatasi permasalahan tersebut. Penelitian ini bertujuan untuk menggambarkan ketersediaan dan distribusi tenaga pelayanan kefarmasian di puskesmas serta permasalahan dan alternatif pemecahannya. Data diambil dari hasil Riset Fasilitas Kesehatan (Rifaskes) tahun 2011I. Data kuantitatif tentang tenaga pelayanan kefarmasian di puskesmas dianalisis secara deskriptif berdasarkan regional. Data kualitatif sebagai pendukung diperoleh melalui wawancara mendalam dengan bagian kepegawaian dinas kesehatan dan apoteker empat puskesmas di Kota Bogor dan Bekasi, 3 kemudian dianalisis dengan metode analisis tema. Hasil analisis menunjukkan bahwa Sulawesi memiliki persentase puskesmas dengan tenaga apoteker tertinggi (29,1%) sedangkan Indonesia Timur memiliki persentase puskesmas tertinggi dengan tenaga pelayanan kefarmasian tanpa latar belakang pendidikan farmasi (51,5%). Persentase tenaga kefarmasian terbesar di puskesmas adalah tenaga teknis kefarmasian kemudian perawat. Permasalahan utama yang dihadapi puskesmas adalah beban kerja yang berat dengan kondisi tenaga yang terbatas. Alternatif pemecahan masalah yaitu pengangkatan apoteker baru, namun jika tidak memungkinkan maka penempatan apoteker pada puskesmas dengan kebutuhan mendesak merupakan prioritas utama. Pilihan lain yang memungkinkan adalah pemberdayaan tenaga teknis kefarmasian dan staf lain yang sudah dilatih atau memanfaatkan tenaga siswa magang.

Drug is one of the essential elements in healthcare that should be effectively and efficiently managed. Following the decentralization in 2001 in Indonesia, drug management has changed in district drug management units and also in District General Hospitals. Certainly this condition influences the sustainability of drug access in primary health care such as in Community Health Center and District General Hospital, especially in drug financing policy. A cross sectional descriptive study to obtain information on drug management in public healthcare in district had been carried out between July and December 2006 in 10 District Public Drug Management Units from 10 district health offices and 9 district general hospitals as samples. Data were collected by interviewing heads of Drug Section in District Health Offices and heads of Hospital Pharmacies using structured questionnaires and observing drug storage in District Drug Management Units, Community Health Centers, and Hospital Pharmacies. Results of the study show that drug planning in District Health Offices and General Hospitals did not meet the basic real need in some districts nor District Hospitals. The minimum health service standards had not been achieved yet. Furthermore, drug procurement, storage and recording as well as reporting was not good enough either, such as shown by the existence of expired drugs. Lead time for drug delivery to community health centers in some districts was longer than the average of lead time in the past 3 years.