Papers by Dwiana Ocviyanti
Indonesian Journal of Obstetrics and Gynecology, Apr 30, 2023
Objective: To determine the effect of clinical governance in PHCs on maternal and perinatal healt... more Objective: To determine the effect of clinical governance in PHCs on maternal and perinatal health in Banten Province, Indonesia. Methods: This was an observational analytic study with cross sectional method performed on the PHCs on Banten Province, Indonesia. All PHCs in Banten Province having maternal and perinatal health services were included in the study. Clinical governance and services were measured using a self-made questionnaire fi lled by the representative of the PHC. Characteristics analyzed in this study were age, education level, completed training, and occupation. Clinical governance aspects analyzed in this study were leadership, culture, competence, governance, and readiness. The services analyzed in this study were antenatal, pathology, and emergency service. Results: There were 117 PHC representatives who were recruited to the study. The PHC which were categorized as "outstanding" for leadership, culture, competence, governance, and readiness were 23.1%, 41%, 98%, 81.2%, and 83.8%, respectively. The PHC which were categorized as having "good" antenatal, pathology, and emergency services were 92.3%, 51.3%, and 90.6%, respectively. The PHCs with better clinical governance aspects delivered better antenatal, pathology, and emergency services for maternal and perinatal care. Conclusions: Primary health cares with better clinical governance aspects delivered better antenatal, pathology, and emergency services for maternal and perinatal care. Therefore, improving clinical governance is essential to improve maternal and perinatal health services quality in Banten Province, Indonesia
PubMed, Jul 27, 2017
Objective: National cervical cancer prevention program has been initiated in Indonesia since Apri... more Objective: National cervical cancer prevention program has been initiated in Indonesia since April 2015 and the ministry of health has started efforts to integrate the HPV Vaccine in the national immunization program since Q4 2015. Thus, it becomes important to analyze the cost-effectiveness of HPV vaccine. The objective of this model is to examine the potential long-term epidemiologic and economic impact of quadrivalent HPV(qHPV;6/11/16/18) vaccination program in Indonesia. Methods: A previously validated transmission dynamic model was used to estimate the long-term epidemiologic and economic consequences of quadrivalent HPV vaccination by comparing cost-effectiveness of 2 dose qHPV vaccination strategy for girls 11-12 years old (with or without catch up; catch up dose for 12–26 years) versus Screening Only (Pap Smear) for reducing cost related to HPV type 6,11,16,18 (cervical cancer, CIN 1, CIN 2/3, and genital warts). Costs of an HPV disease episode-of-care (diagnosis and treatment) were calculated for base case analysis using local Indonesian cost. Result: 2-dose qHPV vaccination strategies without catch up reduce the overall incidence of HPV 16/18–related cervical cancer relative to screening by 54.4% over the 100 year following vaccine introduction. Likewise, vaccination strategies reduce the incidence of HPV type 16/18 CIN 2/3, CIN 1 by 69.1% and 71.8% respectively, also reducing HPV type 6/11 CIN 1, genital warts in female, genital warts in male by 82.9%,84.2%,82.1% respectively, at this time point. From total reduction of health care cost, 67.1% attributable for diseases caused by HPV type 16/18 and 32.9% attributable for diseases caused by HPV type 6/11. Without catch up, cost/QALY would be $450/year. However catch-up strategy is more cost effective versus vaccinates 12-year-old girls only; with cost/QALYs would be $390/year. Conclusion: HPV 6/11/16/18 vaccination of females in Indonesia are 1) substantially reduce genital warts, CIN, and cervical cancer; 2) improve quality of life, and 3) with the Indonesia GDP of USD 3,531.80 in 2014 , Cost/QALYs result with or without catch up is considered very cost-effective when implemented; however with catch up, the cost/QALY can be better.
Advanced Science Letters, Sep 1, 2018
Indonesian Journal of Obstetrics and Gynecology, 2009
Tujuan: Mendapatkan gambaran mengenai pelaksanaan manajemen risiko dalam pelayanan pasien PEB/ekl... more Tujuan: Mendapatkan gambaran mengenai pelaksanaan manajemen risiko dalam pelayanan pasien PEB/eklampsia di IGD lantai 3 RSCM. Bahan dan cara kerja: Penelitian ini dilakukan di IGD lantai 3 RSCM menggunakan pendekatan kualitatif dengan melakukan wawancara terhadap 15 orang pasien yang datang dan dirawat karena PEB/Eklampsia dan pihak manajemen yang terdiri dari Direktur Pelayanan Medis RSCM, Dokter konsultan IGD lantai 3 RSCM, dan Kepala Ruangan IGD RSCM. Hasil: Sebagai tolok ukur keluaran, angka kematian ibu menurun sebesar 0,14%; lama rawat menjadi 1 hari di IGD; dan kepuasan pasien sebesar 53,3%. Dalam hal identifikasi risiko diketahui bahwa belum ada SOP yang khusus dibuat RSCM untuk penanganan PEB/Eklampsia dan walaupun sudah ada prosedur pelaporan dan pencatatan insiden klinis, namun belum ada formulir pelaporan selain rekam medis dan belum terstruktur dengan baik. Kinerja perawat masih dianggap kurang dan belum ada sistem manajemen risiko formal yang diterapkan. Analisa risiko sudah berjalan dengan baik. Terdapat upaya penurunan risiko seperti pelatihan tenaga medis, pemenuhan fasilitas, supervisi dan forum komunikasi. Namun sistem prioritas masih perlu dikembangkan. Pendanaan risiko dialokasikan untuk perlindungan terhadap tenaga medis jika terjadi tuntutan di mana kasus diproses sesuai dengan prosedur hukum yang berlaku dan untuk pemenuhan fasilitas terutama bagi pasien tidak mampu. Sudah terdapat upaya peninjauan sebagai evaluasi risiko. Kesimpulan: Langkah-langkah manajemen risiko dalam penanganan pasien PEB/Eklampsia di IGD lantai 3 RSUPNCM sudah membaik walaupun belum dilaksanakan secara optimal, terlihat dari pencapaian tolok ukur keluaran dari angka kematian ibu, lama rawat, dan kepuasan pasien sampai bulan Agustus 2008 memberikan hasil yang baik dan menurunkan terjadinya risiko yang tidak diinginkan. Faktor-faktor yang mendukung baiknya keluaran adalah tenaga kerja yang terlatih terutama dokter, fasilitas pelayanan yang lengkap, serta pengawasan yang baik dan terstruktur. [Maj Obstet Ginekol Indones 2009; 33-3: 135-42] Kata kunci: PEB, eklampsia, manajemen risiko, IGD, RSCM
Advanced Science Letters, 2018
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Papers by Dwiana Ocviyanti