IMPLEMENTASI STRATEGI DOTS (DIRECTLY OBSERVED TREATMENT SHORTCOURSE) DI RSD DR. SOEBANDI KABUPATEN JEMBER PROVINSI JAWA TIMUR TAHUN 2010
Hajar Sugihantoro, dr. Rustamaji, M. Kes
2012 | Tesis | S2 Ilmu Kesehatan MasyarakatLatar Belakang : WHO (2009), menempatkan Indonesia sebagai penyumbang TB terbesar nomor 5 di dunia setelah India, Cina, Afika Selatan, dan Nigeria. Setiap 100.000 penduduk Indonesia terdapat 130 penderita baru TB paru BTA positif. Cara yang paling efektif memberantas penyakit TB paru adalah dengan menggunakan obat kombinasi OAT. Salah satu metode pengobatan TB yakni dengan DOTS (Directly Observed Treatment ShortCourse), yang merupakan strategi pengobatan dari WHO. Dalam penerapan DOTS terdiri dari 5 strategi yakni, komitmen pemerintah dan semua pihak, diagnosis mikroskopis, ketersediaan OAT berkelanjutan, pengobatan jangka panjang dengan PMO dan pencatatan serta pelaporan. Pola pencarian pengobatan pasien tuberkulosis sekitar 60% untuk pertama kali melakukan pengobatan ke rumah sakit. Untuk mengetahui pelaksanaan program DOTS di daerah, maka perlu dilakukan penelitian untuk mengevaluasi keberhasilan pengobatan TB di RS daerah yakni di RSD dr. Soebandi Jember sebagai rumah sakit rujukan daerah Jawa Timur bagian timur. Tujuan : Menggambarkan pelaksanaan program DOTS TB di RSD dr.Soebandi Jember yang meliputi strategi, ketepatan serta kekuatan dan kelemahan pelaksanaan DOTS TB di RSD dr.Soebandi Jember. Metode : Penelitian ini merupakan penelitian deskriptif menggunakan metode kualitatif dan kuantitatif dengan rancangan studi kasus. Data didapatkan dengan cara melakukan wawancara, observasi dan telaah dokumen data pasien TB dari kartu TB. Hasil Penelitian : Berdasarkan hasil penelitian didapatkan bahwa pasien tuberkulosis 70% terdapat pada usia produktif 13-50 tahun. 5 strategi DOTS telah dijalankan dengan hasil sebagai berikut, komitmen politik pemerintah dan RS telah tertuang dalam SK Dinkes dan RS. Diagnostik secara mikroskopis telah dilakukan sebagai dasar diagnosa pasien TB. Ketersediaan obat dijamin oleh obat program dari DinKes dan pihak RS menyediakan cadangan apabila terjadi kekosongan. Pencatatan dan pelaporan telah dilakukan di kartu TB berdasarkan panduan pencatatan dari DepKes. Pengobatan jangka panjang dengan PMO di RS sudah dilakukan tetapi belum optimal karena keterbatasan SDM dari dalam Tim DOTS RS. Hasil pengobatan pasien TB di RSD dr Soebandi Jember tahun 2010 yakni angka kesembuhan 62% masih kurang dari standar 85%, dan angka default 33% melebihi dari standar maksimal 10%, sedangkan angka gagal 2% masih dibawah standar maksimal 4%. Kesimpulan : Pelaksanaan DOTS TB di RSD dr. Soebandi Jember sudah berjalan tapi belum optimal karena hasil yang didapat belum memenuhi standar dari Depkes dalam Pedoman Nasional Penanggulangan tuberkulosis.
Background: Indonesia has big problem in lung tuberculosis . According to WHO (2009), still puts Indonesia as the fifth largest contributor to TB in the world after India, China, South African and Nigeria. Every 100,000 population in Indonesia there were 130 new cases of smear positive TB. The most effective way of combating TB disease is to use a combination of drugs OAT. One method that TB treatment with DOTS (Directly Observed Treatment ShortCourse), which is a treatment strategy of WHO. In applying the DOTS consists of 5 strategy ie, the commitment of government and all parties, microscopic diagnosis, the availability of ATD, long-term treatment with the supervisors to swallow and the recording and reporting. Search patterns of treatment of tuberculosis patients about 60% for the first time patient make a treatment to the hospital. To know the implementation of the DOTS program, then needs a research to evaluate the success of TB treatment in hospitals in the dr. Soebandi Jember hospital as a referral hospital at eastern region of East Java. Objective: To describe the implementation of TB DOTS program in dr.Soebandi Jember hospital which includes implementation strategy, accuracy and strength and weaknesses of the implementation of the DOTS TB in dr.Soebandi Jember hospital. Methods: This study is a descriptive study using qualitative and quantitative methods. Qualitative data will be obtained by conducting interviews, observations and document TB review. Result : Based on the results of research obtained the data that 70% of tuberculosis patients are at age 13-50 years. 5 of the DOTS strategy has been implemented with the following results, political commitment and government hospitals have been set out in the MoU Health Office and hospital. Microscopically diagnostic has been done as a basis for diagnosis of TB patients. Availability of drugs is guaranteed by the drug program of the Health Office and the Hospital provide a backup in case of vacancy. Recording and reporting has been done on the card based on TB recording guidance from the MOH. Long-term treatment with supervisors to swallow in RS has been done but has not been optimal due to limited human resources of the DOTS Team RS.The results of the treatment cure rate of 62% is still less than the standard 85%, and the default rate exceeds 33% of the standard maximum of 10%, while the failure rate of 2% is has below the standard maximum of 4%. Conclusion: Implementation of the DOTS TB in dr. Soebandi Jember hospital is already running, but is still not optimal because the results are not meet the standards of the Ministry of Health in the National Guidelines for Prevention of tuberculosis.
Kata Kunci : tuberkulosis, DOTS, rumah sakit, strategi.
