KESESUAIAN PENERAPAN CLINICAL PATHWAY DAN EFEKTIVITAS PELAYANAN SKIZOFRENIA RAWAT INAP DI RSUP DR. SARDJITO YOGYAKARTA

Ika Nurfarida, dr. Mahar Agusno, SpKJ(K).

2014 | Tesis | S2 Psikiatri

Clinical pathway adalah syarat utama kendali mutu dan biaya terutama pada kasus yang berpotensi menghabiskan sumber daya yang besar. Skizofrenia merupakan salah satu ggn jiwa yang menghabiskan sumber daya besar sehingga perlu dievaluasi efektivitas pelayanannya. Penelitian yang mempergunakan rancangan penelitian kuasi eksperimental dengan pendekatan kualitatif ini bertujuan untuk mengetahui efektivitas intervensi proses penerapan clinical pathway dan efektivitas proses pelayanan pasien selama tiga bulan penerapan clinical pathway skizofrenia rawat inap di RSUP Dr. Sardjito, Yogyakarta. Sumber data diperoleh dari sumber data primer dan sekunder. Tahap persiapan penerapan clinical pathway sudah sesuai dengan pedoman pengembangan clinical pathway RSUP Dr Sardjito, Yogyakarta, namun tahap penerapannya belum efektif. Hal ini dapat diketahui dari kelengkapan pengisian form clinical pathway hanya 33,11%, frekuensi dan prosedur konsultasi antar tim multidisiplin belum disepakati, belum semua informasi tentang clinical pathway sampai, peran case manager dan tanggung jawab tim belum optimal, disain form terlalu kecil dan belum resmi dari rumah sakit, sistem dokumentasi dan monitoring layanan belum konsisten. Proses pelayanan pasien skizofrenia rawat inap di RSUP Dr. Sardjito, Yogyakarta selama penerapan clinical pathway belum efektif, yang dapat diketahui dari masih terdapat layanan skizofrenia yang belum sesuai dengan konsep perencanaan dalam clinical pathway, verifikasi dan validasi psikiater terhadap layanan yang dilakukan PPDS belum konsisten dan terdokumentasi, ketersediaan obat-obatan belum mengacu kepada standar cost effectiveness, dan outcome belum tercapai sesuai standar pelayanan minimal.

Clinical pathway is a requirement for quality and cost control, especially on cases potentially exhausting on available resources. Schizophrenia is a mental disorder with a potency to exhaust available resources, therefore requires evaluation for its service effectiveness. This study was a quasi experimental study with qualitative approach. The aims of this study were to assess the effectiveness of clinical pathway application and patient service during three months application of clinical pathway for schizophrenia in the inward service in Sardjito Hospital, Yogyakarta. The data for this study was obtained from both primary and secondary sources. Our results showed that the preparation phase for the clinical pathway was appropriate with guideline provide for clinical pathway development in Sardjito Hospital. Nevertheless the application was still ineffective. The completeness of the clinical pathway forms was only 33.11%. The frequency and consultation procedure of multidisciplinary management was yet to be approved. We also found that the information about the clinical pathway was not properly disseminated to subjects, the role of the case manager and team responsibility was not optimal. The design of the forms was too small and not yet to be officially approved by the hospital, so that the documentation system and service monitoring were not consistent yet. The inward service for schizophrenic patients during the application of the clinical pathway for schizophrenia was yet to be efficient. We found that there were still services not in conformity with the concept provided in the clinical pathway. Home psychiatrists’ verification and validation towards services provided by the resident in training were not consistent and were not well documented. The availability of the drugs was not yet referred to cost effectiveness standard and the outcome has not reached the minimum service requirements.

Kata Kunci : efektivitas – clinical pathway – skizofrenia