ANALISIS SISTEM RUJUKAN BALIK PASIEN JIWA: STUDI KASUS DI RSJ GRHASIA DIY

GRACE FEBRINA SIMANJUNTAK, Intansari Nurjannah BSN., MNSc., Ph.D.; Joep Ahmed Djojodibroto MD., MA (HMPP)

2017 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Prevalensi gangguan jiwa berat di Indonesia sebesar 1,7 per mil terdapat di Yogyakarta salah satunya terkhusus pada penduduk pedesaan. Salah satu fasilitas pelayanan di bidang kesehatan jiwa yang berada di D.I. Yogyakarta yaitu RSJ Grhasia DIY yang banyak melayani pasien rujukan dari Puskesmas. Insiden kekambuhan pasien gangguan jiwa tergolong tinggi dikarenakan ketidakteraturan minum obat selama proses rawat jalan. Untuk itu, pelayanan yang diberikan di rumah sakit haruslah sejalan dengan pelayanan di puskesmas dengan adanya sistem rujukan balik yang disusun oleh pihak manajemen RS sebagai informasi lanjutan perawatan. Tujuan: (1) Teridentifikasinya persepsi dokter spesialis jiwa, perawat ruangan di RSJ Grhasia DIY serta tenaga kesehatan yang bertanggung jawab terhadap program jiwa di Puskesmas (2) Teridentifikasinya pelaksanaan sistem rujukan balik pasien jiwa di RSJ Grhasia DIY (3) Teridentifikasinya faktor penghambat pelaksanaan sistem rujukan balik (4) Teridentifikasinya dampak pelaksanaan sistem rujukan balik di Puskesmas Metode: Penelitian ini menggunakan pendekatan studi kasus deskriptif dengan desain kasus holistik tunggal menggunakan teknik pengumpulan data yaitu wawancara mendalam, observasi dan telaah dokumen. Pengambilan sampel secara purposive sampling dengan kriteria inklusi dan eksklusi yang telah ditetapkan sebelumnya Hasil: Sebagian besar tenaga kesehatan memiliki pengertian yang sama tentang rujukan balik pasien jiwa yaitu transfer informasi kondisi pasien pasca rawat inap di RSJ Grhasia DIY, pelaksanaan sistem rujukan balik pasien jiwa belum berjalan dengan baik, faktor penghambat pelaksanaan sistem yaitu belum adanya pengawasan dan evaluasi dari manajemen RS dan belum adanya umpan balik dari puskesmas. Dampak pelaksanaan sistem rujukan balik di Puskesmas sangat baik. Kesimpulan: Pelaksanaan sistem rujukan balik pasien jiwa di RSJ Grhasia belum berjalan dengan baik untuk itu diperlukan adanya pengawasan dan evaluasi secara berkala oleh manajemen RSJ Grhasia DIY serta diperlukan umpan balik dari Puskesmas sehingga tercipta komunikasi terapeutik yang berkelanjutan untuk menjamin perawatan pasien jiwa yang utuh di masyarakat.

Background: The prevalence of severe mental disorders in Indonesia of 1.7 per mil one of them contained in Yogyakarta especially in the rural population. One service facilities in the field of mental health in D.I.Yogyakarta namely RSJ Grhasia DIY, that many patient from rural area came to hospital to get medication. The incidence of relapse of patients with mental disorders is high due to the irregularity of taking medication for an outpatient process. To that end, the services provided in the hospital must be in line with the ministry in the clinic with a referral system through which prepared by hospital management as further information maintenance to be carried out in health centers as primary care. Objective: (1) Identification of the perception of psychiatric specialist, nurse rooms at RSJ Grhasia DIY and health staff which responsible for programme mental health at primary health services (2) Identification of the implementation of a back referral system in RSJ Grhasia DIY (3) Identification of the barrier factors of the implementation of the back referral system (4) Identification of the impact of back referral system at the primary health services. Methods: This study used a descriptive case study approach to the design of holistic case of single-use data collection techniques are in-depth interviews, observations, review of documents. Sampling is purposive sampling with inclusion and exclusion criteria predetermined. Results: Most of the health workers have the same understanding about the back referral psychiatric patients, namely the transfer of information on the conditions of patients after hospitalization at RSJ Grhasia DIY, the implementation of a referral system through the patient's life is not going well, factors inhibiting the implementation of the system is the lack of supervision and evaluation of hospital management, the lack of feedback from the primary health service and the impact behind the referral system in very good health center. Conclusions: The implementation of a back referral system through psychiatric patients have not been going well for the necessary supervision and periodic evaluation by hospital management of RSJ Grhasia DIY and required feedback from the health center so as to create a sustainable therapeutic communication to ensure the care of psychiatric patients in the community intact.

Kata Kunci : Pelaksanaan Rujukan Balik, Pasien Jiwa, RSJ Grhasia DIY, behind the reference implementation, psychiatric patients, RSJ Grhasia DIY