Update Artikelilmiah: 43697

RETNO SETYANINGSIH

NIM

Judul Artikel

Abstrak (Bhs. Indonesia)

Latar Belakang: Data yang diperoleh dari Puskesmas Kembaran II, pada Januari–September 2023,
ditemukan sebanyak 42 kasus tuberkulosis di Desa Ledug. Berdasarkan petunjuk teknis pelayanan
tuberkulosis bagi peserta JKN, tidak semua pasien tuberkulosis perlu dirujuk ke FKRTL. Namun,
yang terjadi di Puskesmas Kembaran II, masih dijumpai beberapa pasien tuberkulosis paru tanpa
penyulit yang seharusnya masih bisa dilakukan pengobatan di puskesmas tetapi dilakukan rujukan.
Penelitian ini bertujuan untuk mengevaluasi pelaksanaan rujukan berjenjang pasien tuberkulosis di
wilayah kerja Puskesmas Kembaran II Kabupaten Banyumas dari aspek context, input, process, dan
product.
Metodologi: Penelitian ini merupakan penelitian kualitatif dengan desain studi kasus. Subjek
penelitian ini terdiri dari 1 informan kunci, 3 informan utama, dan 3 informan pendukung dengan
teknik purposive sampling. Pengumpulan data dilakukan dengan wawancara mendalam kepada
informan dan telaah dokumen. Data dianalisis menggunakan analisis tematik.
Hasil Penelitian: Evaluasi context menunjukkan bahwa petugas kesehatan mengetahui dan
memahami peraturan dan puskesmas telah menerapkan kebijakan yang mengacu pada peraturan
yang berlaku. Evaluasi input mengenai keterlibatan SDM menunjukkan bahwa ketersediaan sumber
daya sesuai kebutuhan, kompetensi tenaga kesehatan sudah sesuai, dan petugas kesehatan sudah
memahami peran. Puskesmas memiliki sarana prasarana penunjang seperti komputer yang
dilengkapi dengan jaringan internet tetapi masih terdapat sarana prasarana yang belum tersedia
seperti mesin TCM, pemeriksaan foto toraks, dan pojok dahak. Alur rujukan pasien tuberkulosis
sudah sesuai dengan petunjuk klinis pelayanan tuberkulosis tetapi belum tersedia SOP pelaksanaan
rujukan berjenjang pasien tuberkulosis dan pelaksanaannya belum sesuai dengan prosedur rujukan.
Evaluasi process menujukkan bahwa alasan pasien dilakukan rujukan sesuai tetapi masih terdapat
kendala baik secara internal maupun eksternal. Evaluasi product menunjukkan bahwa hasil dan
capaian sudah baik dan terdapat rencana tindak lanjut yang dapat dilakukan agar pelaksanaan
rujukan berjenjang pasien tuberkulosis berjalan sesuai dengan aturan yang telah ditetapkan.
Kesimpulan: Implementasi legislasi sistem rujukan berjenjang pasien tuberkulosis berjalan dengan
baik. Keterlibatan SDM juga sudah sangat mendukung pelaksanaan rujukan berjenjang pasien
tuberkulosis. Namun, ketersediaan sarana prasarana dalam pelaksanaan rujukan berjenjang pasien
tuberkulosis masih belum mencukupi. Selain itu, pelaksanaannya juga belum memenuhi prosedur
rujukan yang terdapat pada Pedoman Sistem Rujukan Nasional. Selama ini alasan pasien dilakukan
rujukan tuberkulosis sudah sesuai meskipun masih terdapat hambatan dalam pelaksanaan rujukan
berjejang pasien tuberkulosis baik dari sisi internal maupun eksternal. Saat ini, ketercapaian rujukan
berjenjang pasien tuberkulosis tidak melebihi ketetapan standar maksimum.

Abtrak (Bhs. Inggris)

Background: Kembaran II Health Center's data proved that in January–September 2023, there were 42 tuberculosis cases in Ledug Village. According to the technical instructions for tuberculosis services for National Health Insurance participants, not all tuberculosis patients need to be referred to a follow-up Referral Health Facility. However, at the Kembaran II Community Health Center, some pulmonary Tuberculosis patients without complications were referred despite the patients should have been able to get treatment in the Kembaran II Health Center. This study intended to analyze the tiered referral system's evaluation for tuberculosis patients in the work area of Kembaran II Health Center, Banyumas Regency through its context, input, process and product.
Methods: This study made use of qualitative research utilizing a case study design. The subjects of this research involved seven informants through a purposive sampling technique. Data collection was further carried out by in-depth interviews with informants and reviewing document. Data were analyzed using thematic analysis.
Results: Context evaluation shows that health workers know and understand the regulations and the health center has implemented policies that refer to applicable regulations. Evaluation of input regarding HR involvement shows that the availability of resources is according to needs, the competence of health workers is appropriate, and health workers understand their roles. Health centers have supporting infrastructure but there are still infrastructure facilities that are not yet available. The referral flow for tuberculosis patients is in accordance with the clinical instructions for tuberculosis services, but there is no SOP for implementing tiered referrals for tuberculosis patients and the implementation is not in accordance with the referral procedure. Process evaluation shows that the patient's reasons for referral are appropriate but there are still obstacles both internally and externally. Product evaluation shows that the results and achievements are good and there are follow-up plans that can be carried out so that the implementation of tiered referrals for tuberculosis patients runs in accordance with the established rules.
Conclusion: Implementation of legislation on a tiered referral system for tuberculosis patients is going well. The involvement of human resources has also greatly supported the implementation of tiered referrals for tuberculosis patients. However, the availability of infrastructure for implementing tiered referral for tuberculosis patients is still insufficient. Apart from that, the implementation also does not comply with the referral procedures contained in the National Referral System Guidelines. So far, the reasons why patients are referred for tuberculosis are appropriate, although there are still obstacles in implementing tiered referrals for tuberculosis patients, both internally and externally. Currently, the achievement of tiered referral for tuberculosis patients does not exceed the maximum standard.
Keywords: Tiered referral, tuberculosis, CIPP

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