Faktor-Faktor yang Mempengaruhi Rawat Inap Ulang Pasien Skizofrenia pada Era Jaminan Kesehatan Nasional di Rumah Sakit Jiwa Grhasia Pemda DIY

ABSTRACT Background : The implementation of National Health Insurance (JKN) applies a quality and cost control system services aimed at improving the efficacy and effectivity of health insurance with managed care principle. Readmission is used as an indicator for effectivity and technical competence of a hospital. The increasing cases of readmission, specifically in schizophrenia patients, leads to an increase in health care costs in the hospital. The aim of this study is to know the determinant factors of readmission of schizophrenia patients. Methods : This study was a non-experimental research using a case control study plan. The study was conducted in Grhasia Mental Hospital. The samples were 53 groups of readmission and 53 group of non-readmission. The respondents were the schizophrenia patients and their caregivers. The data collecting used questionnaire and in-depth interview. Result : Bivariate analysis showed the incidence of readmission of schizophrenia patients to some risk factors as follows: (1) Marriage OR 2.822; CI95% 1.082 – 7.630; p-value 0.018; (2) Work OR 2.709; CI95% 1.063 – 7.106; p-value 0.021; (3) Medication Adherence OR 14.692; CI95% 5.245 – 42.221; p-value <0.001; (4) Caregiver Level of Knowledge OR 8.571; CI95% 2.213 – 47.927; p-value 0.0003. Multivariate analysis showed that risk factors affecting incidence of readmission of schizophrenic patients are medication adherence (OR13.556, CI95% 5.037 - 36.480; p-value <0.001) and caregiver level of knowledge (OR 7.175; CI95% 1.628 – 31.605; p-value 0.009). Conclusion : Determinant factors of the readmission of schizophrenia patients are the lack of medication adherence of the patients and caregiver’s lack of knowledge. Demographic factors (age, gender, marital status, education, and job) and ownership of health insurance are not statistically significant to the readmission of schizophrenia patients. Keywords : schizophrenia, readmission, medication adherence, caregiver level of knowledge, national health insurance ABSTRAK Latar Belakang : Implementasi Jaminan Kesehatan Nasional (JKN) menerapkan sistem kendali mutu dan biaya pelayanan bertujuan untuk meningkatkan efisiensi dan efektifitas jaminan kesehatan dengan prinsip managed care. R eadmission sebagai dimensi mutu efektivitas dan kompetensi teknis rumah sakit. Meningkatnya kasus readmission pasien skizofrenia di rumah sakit meningkatkan biaya pelayanan kesehatan. Tujuan penelitian ini adalah mengetahui faktor-faktor yang mempengaruhi rawat inap ulang ( readmission ) pada pasien skizofrenia. Metode : Penelitian ini merupkan studi non eksperimental menggunakan rancangan case control study. Penelitian dilakukan di RSj Grhasia. Jumlah sampel 53 pasien kelompok readmission dan 53 pasien pada kelompok non readmission . Responden penelitian ini adalah pasien skizofrenia dan caregiver . Pengumpulan data dengan kuesioner dan wawancara mendalam. Hasil : Analisis bivariat menunjukkan kejadian readmission terhadap faktor resiko perkawinan diperoleh nilai OR 2,822, CI 95% 1,082-7,630, p-value 0,018; pekerjaan diperoleh nilai OR 2,709, CI 95% 1,063-7,106, p-value 0,021; kepatuhan minim obat diperoleh nilai OR 14,692, CI 95% 5,247-42,221, p-value <0,001; tingkat pengetahuan caregiver diperoleh nilai OR 8,571, CI 95% 2,213-47,927, p-value 0,0003. Hasil analisis multivariat menunjukkan bahwa faktor resiko yang berpengaruh terhadap kejadian readmission pasien skizofrenia adalah kepatuhan minum obat (OR 13,556, CI 95% 5,037-36,480, p-value <0,001) dan tingkat pengetahuan caregiver (OR 7,175, CI 95% 1,628- 31,605, p-value 0,009). Kesimpulan : Faktor-faktor yang mempengaruhi readmission pasien skizofrenia adalah kepatuhan minum obat dan tingkat pengetahuan caregiver . Faktor demografi (usia, jenis kelamin, status perkawinan, pendidikan dan pekerjaan) tidak bermakna secara statistik terhadap readmission pasien skizofrenia. Kata Kunci : skizofrenia, readmission , kepatuhan minum obat, pengetahuan caregiver , jaminan kesehatan.