印度尼西亚马卡萨市公立初级卫生保健（PUSKESMAS）中心心血管服务的准备情况。

The readiness of public primary health care (PUSKESMAS) for cardiovascular services in Makasar city, Indonesia.

机构信息

Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, 3584, CT, Utrecht, The Netherlands.

Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia.

出版信息

BMC Health Serv Res. 2022 Sep 1;22(1):1112. doi: 10.1186/s12913-022-08499-w.

DOI:10.1186/s12913-022-08499-w

PMID:36050732

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9436735/

Abstract

BACKGROUNDS

The increasing burden of cardiovascular disease (CVD) has become a major challenge globally, including in Indonesia. Understanding the readiness of primary health care facilities is necessary to confront the challenge of providing access to quality CVD health care services. Our study aimed to provide information regarding readiness to deliver CVD health services in public primary health care namely Puskesmas.

METHODS

The study questionnaire was adapted from the World Health Organization (WHO) Service Availability and Readiness Assessment (SARA), modified based on the package of essentials for non-communicable disease (PEN) and the Indonesian Ministry of health regulation. Data were collected from all Puskesmas facilities (N = 47) located in Makassar city. We analysed relevant data following the WHO-SARA manual to assess the readiness of Puskesmas to deliver CVD services. Human resources, diagnostic capacity, supporting equipment, essential medication, infrastructure and guidelines, and ambulatory services domain were assessed based on the availability of each tracer item in a particular domain. The mean domain score was calculated based on the availability of tracer items within each domain. Furthermore, the means of all domains' scores are expressed as an overall readiness index. Higher scores indicate greater readiness of Puskesmas to deliver CVD-related health care.

RESULTS

Puskesmas delivers health promotion, disease prevention, and prompt diagnosis for cardiovascular-related diseases, including hypertension, diabetes, coronary heart disease (CHD), and stroke. Meanwhile, basic treatments were observed in the majority of the Puskesmas. Long-term care for hypertension and diabetes patients and rehabilitation for CHD and stroke were only observed in a few Puskesmas. The readiness score of Puskesmas to deliver CVD health care ranged from 60 to 86 for. Furthermore, there were 11 Puskesmas (23.4%) with a score below 75, indicating a sub-optimal readiness for delivering CVD health services. A shortage of essential medicines and a low capacity for diagnostic testing were the most noticeable shortcomings leading to suboptimal readiness for high-quality CVD health services.

CONCLUSION

Close cooperation with the government and other related stakeholders is required to tackle the identified shortcomings, especially the continuous monitoring of adequate supplies of medicines and diagnostic tools to achieve better CVD care for patients in Indonesia.

摘要

背景

心血管疾病（CVD）负担不断增加，已成为全球范围内的重大挑战，包括印度尼西亚。了解基层医疗保健设施的准备情况对于提供高质量 CVD 医疗服务至关重要。我们的研究旨在提供有关在公共基层医疗保健设施（即 Puskesmas）提供 CVD 健康服务的准备情况的信息。

方法

研究问卷改编自世界卫生组织（WHO）的服务可用性和准备情况评估（SARA），并根据非传染性疾病基本包（PEN）和印度尼西亚卫生部的规定进行了修改。数据来自位于马卡萨尔市的所有 Puskesmas 设施（N=47）。我们根据 WHO-SARA 手册分析了相关数据，以评估 Puskesmas 提供 CVD 服务的准备情况。人力资源、诊断能力、辅助设备、基本药物、基础设施和指南以及门诊服务领域根据特定领域中每个示踪剂项目的可用性进行评估。根据每个领域内示踪剂项目的可用性计算出领域平均得分。此外，所有领域得分的平均值表示总体准备指数。较高的分数表示 Puskesmas 提供与 CVD 相关的医疗保健的准备程度越高。

结果

Puskesmas 提供与心血管疾病相关的疾病预防、促进健康和及时诊断服务，包括高血压、糖尿病、冠心病（CHD）和中风。同时，大多数 Puskesmas 都提供了基本治疗。高血压和糖尿病患者的长期护理以及 CHD 和中风的康复仅在少数 Puskesmas 中观察到。Puskesmas 提供 CVD 保健服务的准备程度范围为 60 至 86。此外，有 11 家 Puskesmas（23.4%）得分低于 75，表明提供 CVD 保健服务的准备程度不理想。基本药物短缺和诊断测试能力低是导致高质量 CVD 保健服务准备不足的最明显缺陷。