Determinan Ketidakpatuhan Kunjungan Kontrol Rutin Pasien Hipertensi di Kabupaten Kulon Progo Tahun 2025

LISANDY YUNITA NABABAN, Dr. dr. Metalia Puspitasari, Sp. PD-KGH; Dr. dr. Citra Indriani, MPH

2026 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Penelitian ini bertujuan untuk mengevaluasi program monitoring kontrol rutin pasien hipertensi di Kabupaten Kulon Progo Tahun 2025, melalui evaluasi program berdasarkan logic model CDC, evaluasi sistem surveilans hipertensi berdasarkan pedoman CDC (2001), serta studi analitik determinan ketidakpatuhan kunjungan kontrol rutin pasien hipertensi

Metode: Penelitian ini menggunakan desain gabungan tiga substudi. Substudi evaluasi program menggunakan pendekatan kuantitatif deskriptif dengan 65 responden pengelola program di Dinas Kesehatan dan 21 Puskesmas. Substudi evaluasi sistem surveilans menggunakan pendekatan kuantitatif deskriptif dengan 22 responden. Substudi analitik menggunakan desain case-control dengan 330 responden (165 kasus dan 165 kontrol) yang dipilih dari data kohort hipertensi Puskesmas. Analisis data meliputi analisis univariat, bivariat, dan multivariat menggunakan software STATA versi 17.

Hasil: Capaian Standar Pelayanan Minimal (SPM) hipertensi di Kabupaten Kulon Progo tahun 2025 sebesar 19,30%. Implementasi program telah berjalan pada seluruh tahapan namun belum optimal, terkendala rangkap tugas SDM, keterbatasan anggaran, edukasi nonfarmakologi yang belum optimal, tidak adanya mekanisme reminder pasien, serta jejaring fasilitas kesehatan yang belum optimal. Kualitas sistem surveilans menunjukkan atribut penerimaan (95,3%) dan stabilitas (81,8%) berkategori baik; kesederhanaan (63,6%) dan kualitas data (61,9%) cukup baik; sedangkan fleksibilitas (50%), keterwakilan (46,9%), dan ketepatan waktu (14,3%) berkategori kurang baik, terutama akibat entri data manual berulang dan beban kerja rangkap petugas. Pengetahuan kurang (aOR 2,09; 95%CI) dan persepsi kurang (aOR 2,77; 95%CI) terbukti sebagai faktor yang meningkatkan risiko ketidakpatuhan kontrol rutin pasien hipertensi, sementara dukungan keluarga, dukungan petugas kesehatan, akses pelayanan kesehatan, dan riwayat DM tidak terbukti berhubungan signifikan.

Kesimpulan: Implementasi program monitoring kontrol rutin hipertensi dan sistem surveilans di Kabupaten Kulon Progo masih belum optimal, dengan kendala utama pada sumber daya manusia, koordinasi jejaring, dan kualitas pelaporan data. Ketidakpatuhan pasien banyak dipengaruhi oleh pengetahuan dan persepsi yang kurang. Perbaikan program memerlukan penguatan edukasi pasien, mekanisme reminder kontrol, koordinasi jejaring fasilitas kesehatan, serta digitalisasi pencatatan dan pelaporan surveilans.

Background: This study aimed to evaluate the routine control monitoring program for hypertension patients in Kulon Progo District in 2025, through a program evaluation based on the CDC logic model, an evaluation of the hypertension surveillance system based on CDC (2001) guidelines, and an analytic study of determinants of non-adherence to routine control visits among hypertension patients.

Methods: This study employed a combined three-substudy design. The program evaluation substudy used a descriptive quantitative approach involving 65 program officer respondents from the District Health Office and 21 Public Health Centers (Puskesmas). The surveillance system evaluation substudy used a descriptive quantitative approach with 22 respondents. The analytic substudy used a case-control design with 330 respondents (165 cases and 165 controls) selected from the Puskesmas hypertension cohort data. Data analysis included univariate, bivariate, and multivariate analysis using STATA version 17 software.

Results: The achievement of the Minimum Service Standard (SPM) for hypertension in Kulon Progo District in 2025 was 19.30%. Program implementation had been carried out across all stages but was not yet optimal, constrained by dual workload among human resources, limited budget, suboptimal nonpharmacological education, the absence of a patient reminder mechanism, and underdeveloped health facility networks. The quality of the surveillance system showed acceptability (95.3%) and stability (81.8%) in the good category; simplicity (63.6%) and data quality (61.9%) in the fairly good category; while flexibility (50%), representativeness (46.9%), and particularly timeliness (14.3%) were in the poor category, largely due to repetitive manual data entry and dual workload among officers. Poor knowledge (aOR 2.09; 95%CI) and poor perception (aOR 2.77; 95%CI) were shown to be factors increasing the risk of non-adherence to routine control visits, whereas family support, health worker support, access to health services, and history of diabetes mellitus were not significantly associated.

Conclusion: Implementation of the hypertension routine control monitoring program and its surveillance system in Kulon Progo District remains suboptimal, with the main constraints lying in human resources, network coordination, and data reporting quality. Patient non-adherence is largely influenced by poor knowledge and perception. Program improvement requires strengthening patient education, establishing a control reminder mechanism, improving coordination among health facility networks, and digitalizing surveillance recording and reporting.

Kata Kunci : hipertensi, kontrol rutin, evaluasi program, surveilans, kepatuhan