Manajemen pengobatan penderita tuberkulosis paru dengan sistem dots (decectly observed treatment short-course) di Puskesmas dan BP4 Kota Yogyakarta
WOERJANDARI, Andajani, dr. Kristiani, SU
2001 | Tesis | S2 Kesehatan MasyarakatLatar belakang : Penelitian ini bertujuan untuk mengetahui pelaksanaan pengobatan dengan strategi DOTS (DirectlyObserved Treatment Short-Course) pada penderita Tuberkulosis Pam, serta hubungan antara sistem DOTS dengan proses penyelesaian pengobatan Tuberkulosis Pam di Puskesmas dan BP4 Kota Yogyakarta. Metode : Penelitian ini merupakan studi kasus yang bersifat evaluatif dengan metode kualitatif. Subyek penelitian adalah 86 penderita. TB pare yang sedang menjalani pengobatan di Puskesmas dan BP4 Kota Yogyakarta. Dilakukan observasi terhadap dokumen pengobatan, dan wawancara mendalam pada penderita tidak patuh, serta dilakukan Focus Group Diskusi terhadap 18 petugas pengelola TB Pam Puskesmas dan wawancara terstruktur terhadap Kepala Puskesmas dan Kepala BP4 Kota Yogyakarta. Data dianalisis secara diskriptif. Hasil dan Pembahasannya : Penderita TB Pam yang sedang berobat di Puskesmas dan BP4 81 penderita. Dan data tersebut yang mempunyai PMO 69 penderita (85.18%). Penderita yang diobati dengan Katagori I 49 (60.49%), Katagori II 5(6.17%) dan Katagori III 27 (33.34%). Penderita yang tidak patuh brobat pada fase awal 7 (8.64%) sedangkan tidak patuh pada fase akhir 10 (12.34%). Angka konversi sputum penderita TB Puskesmas 87.5 dan BP-4 67.1%. Angka kesembuhan Puskesmas 92.3% dan BP-4 87.1%. Puskesmas dan BP4 merupakan sarana terdepan yang langsung melayani penderita. TB Pam . Ketidak patuhan penderita disebabkan karena PMO tidak mampu berperanan untuk memotivasi dan mengatasi masalah penderita yang berkaitan dengan efek samping dan merasa sembuh. Petugas pengelola sudah dilatih, tetapi di Puskesmas masih melaksanakan tugas rangkap, sehingga mempengaruhi ketaatan pelaksanaan pemantauan keteraturan berobat Manajemen dokumen (TB-01) apabila sepenuhnya dimanfaatkan dalam rangka pemantauan penderita, kontrol terhadap petugas dan bimbingan teknis akan dapat meningkatkan kinerja petugas dalam rangka menjamin kepatuhan dan keteraturan berobat. Kesimpulan : Puskesmas dan BP4 Kota Yogyakarta telah menerapkan strategi DOTS dalam pengobatan TB Pam. Keberhasilan strategi DOTS dalam pengobatan dipengaruhi oleh ketaatan petugas pada pedoman kontrol kontrol pimpinan dan bimbingan teknis diperlukan untuk meningkatkan keterampilan petugas.
Background : This study was aimed at abserving the implementation of medication by means of the DOTS (Direcly Obeserved Treatment Short-course) strategy for the pulmonary tuberculosis patiens and the relationship between DOTS system and medication implementation process (medication compliance and regularity) of Pulmonary Tuberculosis patiens fo Community Health Centre and BP-4 of Yogyakarta. Methods : This was an evaluative case study using a qualitative methods. The subyects of study were 81 new Pulmonary Tuberculosis patient of January- April 2000 period who had medication at the Community Health Centers and BP-4 of Yogyakarta. Medications document were observed. Noncompliant patient were indepth interviewed. Focus Group discussions were conducted of 18 managerial staff of Pulmonary Tuberculosis of Community Health Centre. Structured interviews were conducted over the Community Health Centre Head, BP-4 manager of Yogyakarta. Data were analyzed discriptively. Result and Discussion : There were 81 patient Pulmonary Tuberculosis having medication treatment at the Community Health Centre and BP-4. The patient with BTA(+) were 47 (58.02%), BTA (-) Ro (+) were 28 (34.56%) and BTA (-) clinic (+) were 6 (07.42%). The patient with PMO were 69 (85.18%). The patien with medication of Category-I were 49 (60.49%), Category-II were 5 (6.17%) and Category-III were 33.34%). The noncompliant patient since the initial phase were 7 (8.64%) and those noncompliant during final phase were 10 (12.34%). After the initial phase sputum from the BTA (+) were conversed as 87.5% from Community Health Centre and 87.1% from BP-4). The cured rate were 92.3% from Community Health Centre and 87.1% from BP-4. The Community Health Centre and BP-4 were the front-line facilities that direcly served the Pulmonary Tuberculosis patiens. The managerial staff have been trained, but The Community Health Centres had the dual function and this influenced the compliance ti strategy, especially in document Tuberculusis management and regularity, controlover staff and technical guidance. Conclusion : The application of DOTS strategy to medication was influenced by staff compliance to guidance, leader control and technical guidance.
Kata Kunci : Pengobatan penderita TB Paru, Strategi DOTS, Pulmonary Tuberculosis patient medication, DOTS strategy
