Eksplorasi Mutu Pelayanan Lanjut Usia Di Puskesmas Pada Era Integrasi Layanan Primer

Nana Caterina Sandi, Ariani Arista Putri Pertiwi, S.Kep., Ns., MAN, DNP ; Widyawati, S.Kp., M.Kes., Ph.D

2026 | Tesis | S2 Magister Keperawatan

Latar Belakang: Puskesmas memegang peran krusial dalam memberikan layanan berkualitas bagi lansia. Namun, status akreditasi tidak selalu mencerminkan mutu pelayanan yang dirasakan saat ini. Penerapan Integrasi Layanan Primer (ILP) yang mentransformasi alur dan integrasi UKP–UKM menuntut evaluasi mutu berbasis persepsi langsung pasien dan tenaga kesehatan. Tujuan Penelitian: Mengeksplorasi mutu pelayanan lanjut usia di Puskesmas pada era integrasi layanan primer berdasarkan persepsi pasien lanjut usia dan perawat. Metode: Penelitian ini menggunakan desain kualitatif dengan pendekatan studi kasus eksploratif dan deskriptif. Partisipan penelitian adalah 8 pasien lanjut usia dan 6 perawa. Pengumpulan data dilakukan melalui wawancara mendalam terhadap perawat dan diskusi kelompok terfokus terhadap pasien lanjut usia di Puskesmas Air Rami, Kabupaten Mukomuko. Pemilihan partisipan dilakukan secara purposive sampling. Analisis data dilakukan menggunakan metode analisis konten dengan kerangka mutu pelayanan SERVQUAL yang mencakup dimensi keandalan, daya tanggap, jaminan, empati, dan bukti fisik. Hasil: Implementasi ILP berdampak positif terhadap mutu pelayanan lansia, terutama dalam penataan alur layanan berbasis klaster dan peningkatan koordinasi. Pada aspek UKP, mutu pelayanan tercermin dari struktur klinis yang lebih teratur, peningkatan responsivitas petugas, serta dukungan manajemen dalam penyediaan sarana penunjang. Pada aspek UKM, layanan Posyandu lansia dan kunjungan rumah dinilai bermanfaat bagi kontinuitas asuhan, meskipun masih menghadapi kendala cakupan dan pemeliharaan fasilitas. Persepsi pasien dan perawat secara umum selaras dalam menilai peningkatan mutu, meskipun terdapat perbedaan pandangan pada aspek non-klinis seperti kebersihan dan ketersediaan sarana. Kesimpulan: Mutu pelayanan lansia di Puskesmas pada era ILP secara umum dipersepsikan cukup baik oleh pasien dan perawat, khususnya dalam dimensi keandalan, daya tanggap, dan empati. Namun, upaya berkelanjutan diperlukan untuk menguatkan pengelolaan SDM, pemeliharaan fasilitas fisik, dan optimalisasi program UKM sebagai bagian dari pendekatan promotif-preventif. Penilaian mutu berbasis persepsi langsung menjadi penting untuk memperoleh gambaran aktual dan relevan dengan konteks implementasi kebijakan ILP.

Background: The quality of elderly care at community health centers in the ILP era is generally perceived as quite good by patients and nurses, particularly in terms of reliability, responsiveness, and empathy. However, continuous efforts are needed to strengthen human resource management, physical facility maintenance, and optimization of UKM programs as part of a promotive-preventive approach. Perception-based quality assessment is important to obtain an actual and relevant picture of the ILP policy implementation context. Objective: Explore the quality of nursing care services for older adults in a Primary Health Centers during the implementation of integrative primary care, based on the perspectives of older adult patients and nurses. Methods: This study employed a qualitative design with an exploratory and descriptive case study approach. The participants consisted of 8 older adult patients and 6 nurses. Data were collected through in-depth interviews with nurses and focus group discussions with older adult patients at Air Rami Primary Health Center, Mukomuko Regency. Participants were selected using purposive sampling. Data analysis was conducted using content analysis based on the SERVQUAL service quality framework, which includes the dimensions of reliability, responsiveness, assurance, empathy, and tangibles. Results: The implementation of ILP has had a positive impact on the quality of elderly care, particularly in terms of organizing cluster-based service flows and improving coordination. In terms of UKP, the quality of service is reflected in a more organized clinical structure, increased responsiveness of staff, and management support in providing supporting facilities. In terms of UKM, elderly Posyandu services and home visits are considered beneficial for continuity of care, although there are still obstacles in terms of coverage and facility maintenance. The perceptions of patients and nurses are generally consistent in assessing quality improvement, although there are differences in views on non-clinical aspects such as cleanliness and availability of facilities Conclusion: The quality of elderly care at community health centers in the ILP era is generally perceived as quite good by patients and nurses, particularly in terms of reliability, responsiveness, and empathy. However, continuous efforts are needed to strengthen human resource management, physical facility maintenance, and optimization of UKM programs as part of a promotive-preventive approach. Perception-based quality assessment is important to obtain an actual and relevant picture of the ILP policy implementation context.

Kata Kunci : mutu pelayanan, lanjut usia, puskesmas, integrasil layanan primer, SERVQUAL