Pengelolaan penanganan pengobatan Tuberkulosis di RS Dr M. Djamil Padang :: Suatu studi kasus

SYAFRIZAL, dr. Tridjoko Hadianto, DTMH.,M.Kes

2007 | Tesis | S2 Ilmu Kesehatan Masyarakat (Kebij. dan Manaj. Pe

Latar Belakang, Usaha peningkatan mutu secara berkelanjutan (CQI) terjadi pada seluruh proses, produk dan pelayanan. Salah satunya memahami variasi, menghilangkan atau meminimalisasikan penyebab terjadinya variasi dalam proses pelayanan. RS Dr M Djamil Padang sebagai pilot project dalam uji coba penerapan sistem Indonesian Diagnostic Related Group (INA-DRG) Case Mix, diharuskan selalu melakukan evaluasi proses pelayanan. Tujuan, Untuk mengetahui bagaimana pengelolaan penanganan pengobatan tuberkulosis di RS Dr M Djamil Padang Metode, Suatu studi kasus dengan analisa diskriptif kualitatif. Subjek penelitian 37 kasus TB yang ditangani dari 1 Mei s/d 31 Juli 2007, dengan melibatkan 27 informan (3 dokter spesialis paru, 2 dokter spesialis penyakit dalam, 10 dokter residen, 2 dokter umum dan 10 orang pasien TB). Intrumen yang digunakan berupa format telaah dokumen rekam medik dan wawancara. Hasil, Sebagian besar pasien ditherapi dengan OAT. Pemeriksaan penunjang tidak semua kasus diberlakukan sama. Sebagian besar diberi rekomendasi pulang, namun tidak ada penjelasan mengenai kelanjutan pemberian OAT dan ditindak lanjuti pengobatan ke poli RS. Dukungan pemeriksaan kultur 58% kasus (hasil tidak diterima dokter dari laboratorium sampai pasien pulang, 57%nya), pemeriksaan sputum 68% kasus (hasil tidak diterima dokter 20%nya) dan rongent thorax 65% kasus ((hasil tidak diterima dokter 24%nya). Pola penanganan pengobatan TB tidak konsisten yang bisa berakibat kuman TB kebal obat (resisten), sehingga pengobatan lanjutan dapat menjadi lebih mahal, masa lebih lama dan lebih membahayakan penderita. Kesimpulan, RS Dr M Djamil Padang bisa melaksanakan sistem Indonesia diagnostic related group (INA-DRG) case mix secara baik, namun masih diperlukan pengkajian kembali mengenai prosedur penanganan maupun kualitas pelayanan.

Background: Efforts to continuous quality improvement take place at all processes, products and services. One effort is trying to understand variation, omitting or minimalizing causes of the prevalence in service processes. Dr. M. Djamil Hospital of Padang as a pilot project of a trial in the implementation of Indonesian Diagnostic Related Group Case Mix is obliged to carry out continuous service process evaluation. Objective: To identify the management of tuberculosis medication operating procedure at Dr.M Djamil Hospital of Padang. Method: This was a case study with descriptive qualitative analysis. Subject of the study were 37 tuberculosis cases treated from 1st May - 31st July 2007 involving 27 informen (3 lung specia list doctors, 2 internists, 10 residents, 2 general physicians and 10 tuberculosis patients). Instruments of the study were medical record observation sheets and interview. Result: The majority of patients were given antituberculosis drugs. Supporting examination was not carried out to all cases. Most of patients were recommended hospital discharge but there was no information about the continuation of antituberculosis drug supply and no follow up medication at hospital outpatient. Supporting culture examination was carried out to 58% of cases (57% of result was not accepted by the doctor – from laboratory until patients were asked to discharge), sputum examination was carried out to 68% of cases (20% of the result was not accepted by the doctor) and thorax xray examination was carried out to 65% of cases (24% of the result was not accepted by the doctor). The pattern of tuberculosis medication operating procedure was inconsistent leading to resistance of tuberculosis germs to drugs so that subsequent medic ation could become more expensive, longer and more harmful to the patients. Conclusion: Dr. M. Djamil Hospital of Padang could implement indonesian diagnostic related group (INA-DRG) case mix properly by re-evaluating operating procedure as well as quality of service.

Kata Kunci : Layanan Kesehatan,Pengobatan Tuberkulosis,tuberculosis, operating procedure, medication variation