Analisis faktor risiko terjadinya pulang atas permintaan sendiri di bangsal rawat inap RSUD H. Abdul Aziz Marabahan

ABRIANSYAH, dr. Sugianto A., Sp.S., M.Kes., Ph.D

2008 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang : Data luaran pulang atas permintaan sendiri di ruang perawatan RSUD H. Abdul Aziz Marabahan menunjukan adanya peningkatan setiap tahun sebesar 3,3 %. Pasien PAPS tahun 2005-2007 sebesar 109 (7,0 %), 177 (9,3 %) dan 156 (11,6 %). Proporsi kunjungan PAPS yang paling banyak tahun 2005-2007 adalah pasien umum (68,8 %, 52,0 % dan 47,4 %). Proporsi yang paling banyak terjadinya PAPS adalah di Ruang Kenanga (56,0 %, 61 ,0% dan 59,0 %). Tujuan_: Mengidentifikasi faktor risiko terjadinya pulang atas permintaan sendiri di bangsal rawat inap RSUD H. Abdul Aziz Marabahan. Metode : Desain penelitian observasional dengan rancangan kasus kontrol (case contra~ . Subjek penelitian kasus adalah seluruh populasi pasien rawat inap yang PAPS. Kontrol seluruh pasien boleh pulang oleh dokter pada periode waktu yang sama. Perbandingan kasus dan kontrol 1 : 1, kelompok kasus 78 sampel dan kontrol 78 sampel. Jumlah subjek penelitian adalah 156 sampel. Data primer yang langsung diperoleh dari respond en dan kelompok stakeholder internal rumahsakit 10 orang dengan wawancara mendalam dan FGD. Data sekunder dari rekam medis rumahsakit. Data dianalisa dengan analisis bivariat ( uji chi-square dan OR) dan multivariat (uji regresi berganda). Variabel perancu dikendalikan dengan cara stratifikasi ( perhitungan Mantel- Haensze~ . Hasil dan pembahasan : Analisis bivariat didapat faktor-faktor risiko te~adinya PAPS adalah pasien dengan diagnosis medis > 1 diagnosis 2,02 kali (95% Cl1,16-2,87), alasan pulang PAPS karena biaya 1,73 kal i (95 % Cl 0,90-2,55) dan riwayat pernah PAPS 1,79 kali (95 % Cl 0,74-2,40). Analisis multivariat didapat faktor riwayat pernah pulang PAPS yang paling berisiko 6,73 kali (95 % Cl 2,47-18,36) terjadinya pasien PAPS. Wawancara mendalam dan FGD didapat faktor ekonomi yang paling besar risiko terjadinya PAPS. Riwayat PAPS biasanya mencakup aspek karakteristik pasien dan aspek karakteristik pelayanan rumahsakit, pengalaman yang kurang baik selama dirawat biasanya yang menjadi alasan untuk cenderung PAPS atau kembali PAPS. Kesimpulan dan saran : Faktor diagnosis medis > 1 berisiko terjadinya PAPS di bangsal rawat inap RSUD H. Abdul Aziz Marabahan. Disarankan bagi rumahsakit untuk mengidentifikasi faktor risiko PAPS lebih dini dan melengkapi pelayanan dokter spesialis dasar. Disarankan untuk meneliti kelompok diagnosis medis sepert.i penyakit kronis/akut dan penyakit dengan komplikasi dan informasi digali dari berbagai sumber. Kata kunci : Karakteristik pasien, karakteristik pelayanan dan pasien pulang atas permintaan sendiri (PAPS).

Background: Data of discharge against medical advice at inpatient room of H. Abdul Aziz Marabahan Hospital shows 3.3% increase every year. Patients of discharge against medical advice (DAMA) in 2005-2007 were 109 (7.0%), 177 (9.3%) and 156 (11 .6%). The greatest proportion of discharge against medical advice in 2005-2007 were general patients (68.8%, 52.0% and 47.4%) in Kenanga room (56.0%, 61.0% and 59.0%). Objective: To identify the risk factors of the prevalence of discharge against medical advice at inpatient ward of H. Abdul Aziz Marabahan Hospital. Method: The study was observational with case control design. Cases were all inpatient population with discharge against medical advice. Control were all patients that were allowed to leave by doctors at the same period. There were 78 samples of cases and 78 samples of control; so the total subject of the study were 156 samples. Primary data were obtained directly from respondents and 10 hospital internal stakeholders through indepth interview and focus group discussion. Secondary data were obtained from hospital medical records. Data analysis used bivariable (chi square and OR) multivariable (double regression test). Confounding variable was controlled using stratification method (Mantei-Haenszel calculation). Result and Discussion: The result of bivariable analysis showed that risk factor for the prevalence of discharge against medical advice were patients with medical diagnosis > 1 · diagnosis 2.02 times (95% Cl 1.16-2.87); cost as reason for discharge 1. 73 times (95% Cl 0.90-2.55) and had ever had discharge 1. 79 times (95% Cl 0. 7 4-2.40). The result of multivariable analysis showed that factor of history of discharge against medical advice was the most dominant risk at 6.73 times (95% Cl 2.47-18.36) for the prevalence of discharge against medical advice. The result of indepth interview and focus group discussion showed that economic factor was the greatest risk factor for the prevalence of discharge against medical advice. The history of discharge against medical advice generally included aspect of patient characteristics and hospital service characteristics. Uncomfortable experience during hospitalization generally became the reason for discharge against medical advice or recurrent discharge against medical advice. Conclusion and Suggestion: Factor of medical diagnosis > 1 brought risk for the prevalence of discharge against medical advice at inpatient ward of H. Abdul Aziz Marabahan Hospital. It was suggested that the hospital identified risk factor for discharge against medical advice early; provided basic specialist doctor service, and observed medical diagnosis on chronic/acute diseases and other diseases with complications using numerous relevant information sources. Keywords: characteristics of patients, characteristics of service, discharge against medical advice (DAMA).

Kata Kunci : Karakteristik pasien,Karakteristik pelayanan,Pasien pulang,Permintaan sendiri