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"Peningkatan Prevalensi Penderita Diabetes Mellitus di era JaminanKesehatan Nasional, akan meningkatkan beban pembiayaan kesehatan.Implementasi Program Rujuk Balik yang melibatkan banyak instansi menjadisangat penting dalam memberikan efisiensi bagi pembiayaan maupun pasien.Penelitian ini untuk mengetahui faktor-faktor yang mempengaruhi implementasikebijakan program rujuk balik pasien diabetes mellitus stabil di Rumah SakitUmum Daerah Johar Baru Tahun 2017 melalui teori Van Meter dan Van Horn. Penelitian ini menggunakan pendekatan kualitatif dengan disain studimelalui content analisis dan metode triangulasi dan pendekatan kuantitatif dengandisain studi kasus. Data primer didapat melalui wawancara mendalam, kuesioner,observasi, dan telaah dokumen. Untuk data sekunder dari dokumen dan literatur. Dari hasil penelitian menunjukan bahwa implementasi Program RujukBalik di Rumah Sakit Umum Daerah Johar Baru belum berjalan efektif. Peranankolaborasi antara pembuat dengan pelaksana kebijakan harus semakin baiksehingga implementasi Program Rujuk Balik akan berjalan dengan optimal.

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The effect of increasing prevalence of Diabetes Mellitus in UniversalHealth Coverage era will increase the cost of finance. Implementation of RereferenceProgram involve many institution that make important for giving financeand patient rsquo s service more efficient. Objective of this reseach is to find theeffectiveness of Re reference policy of Stabil Diabetes Mellitus at Johar BaruHospital in 2017 according to Van Meter and Van Horn theory.

This reseach is using quantitative and qualitative approach with studydesign by analysis content and triangulation method. Primary data is procured fromdeepening inteview, quesioner, observation and documents. Secondary dataprocured from documents and literatures.

From result of this reseach showed that Re reference Program is lessoptimum at Johar Baru Hospital. Collaboration between the policy maker and theimplemeters of Re reference Program need to be better, so there implementation ofRe reference Program will be optimum."

"Atas rekomendasi dokter spesialis pelayanan Rujuk Balik ke puskesmas dianjurkan bagi pasien di RS yang menderita penyakit kronis termasuk diabetes melitius. Penelitian ini bertujuan untuk melihat faktor-faktor yang berhubungan dengan kesediaan pasien diabetes mellitus tipe 2 peserta JKN di RSU Jagakarsa untuk dirujuk balik ke FKTP.Desain potong lintang dan pendekatan kualitatif melalui wawancara mendalam digunakan dalam studi ini. Hasil penelitian menunjukkan bahwa kepercayaan pasien terhadap dokter layanan primer, persepsi pasien mengenai ketersediaan obat di fasilitas kesehatan primer, jarak tempuh terhadap fasilitas kesehatan primer dan dukungan keluarga dan teman berhubungan dengan kesediaan pasien untuk dirujuk balik. Disarankan untuk mengembangkan SOP rujuk balik di RS dan mengembangkan pojokrujuk balik.

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Back referral service to primary care is provided for JKN patients including diabetes mellitus type 2 patients as recommended by the internal medicine specialist. This studyaim is to analyse the factors that related to willingness of the patients to be referred to primary care after receiving care at the hospital in Jagakarsa Hospital. This study is using quantitative method with cross sectional design, followed by qualitative method with in depth interview.

The study revealed that trust to the primary health care physician, perception on medicine availability in primary health care facility, accessiibility and support from family and friend affect patient willingness to agree with back referral service. The study suggested to develop standard procedure for back referral and initiate back referral corner in hospital."

"Inisiasi insulin merupakan langkah awal yang diperlukan pasien diabetes mellitus (DM) tipe 2 dalam menerlma insulin untuk mengendalikan glukosa darah. Penelitian bertujuan untuk mengidentifikasi faktor -faktor yang mempengaruhi iniasiai insulin dengan menggunakan metode descriptive correlational dan desain cross sectional, melibatkan sampel 110 pasien. Analisis menggunakan chi-square dan regresi logistik ganda.Hasil penelitian didapatkan bahwa karakteristik responden (usia, jenis kelamin, pendidikan, pendapatan, lama mengalami DM), keyakinan terhadap insulin tidak: berhubungan dengan inisiasi insulin. Pengetahuan merupakan faktor yang paling berpengaruh dalam inisiasi insulin (p : 0.00, a : 0.05, OR : 9.63). Variabel lain yang memiliki hubungan signifikan dengan inisiasi insulin adalah sikap (p : 0.015,a : 0.05), efikasi diri (p : 0.00, a : 0.05), interaksi dengan petugas kesehatan (p : 0.00, a : 0.05). Perawat seharusnya meningkatkan pengetahuan dan efikasi diri melalui interaksi yang baik dengan pasien guna mengubah sikap pasien dalam inisiasi insulin.

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Insulin initiation is a first stage of insulin acceptance for patients with Type 2 diabetes mellitus to maintain blood glucose. The purpose of this study is to identifIed factors that influence insulin initiation. Using cross sectional design and descriptive correlational method, a total of 110 respondents participated in this study. Statistical analysis used chi-square and multiple logistic regression.

The result shows that characteristic of respondents such as age, sex, education, income, duration of DM and insulin's belief were not associated with insulin initiation. Knowledge was the most predominant factor related to insulin initiation (p : O.OO,OR: 9.63). Other variables that has significantly relationship to insulin initiation were attitude (p : 0.015), self efficacy (p : 0.00), interaction between health care providers (p : 0.00). Nurses should increase patient's knowledge, self efficacy by improving interaction in order to change patient's attitude toward insulin initiation."

"ABSTRAK Latar belakang : Prevalens diabetes melitus (DM) terus meningkat di negaraberkembang yang merupakan negara endemis tuberkulosis (TB). Diabetes melitusmeningkatkan risiko infeksi, hambatan konversi sputum dan kegagalanpengobatan TB. Penelitian ini bertujuan menganalisis faktor-faktor yangmempengaruhi konversi sputum Basil Tahan Asam (BTA) mikroskopik padaakhir bulan kedua pengobatan TB pada pasien TB paru kasus baru dengan DM.Metode : Penelitian kohort retrospektif ini dilaksanakan di RSUP Perahabatanterhadap pasien-pasien TB paru BTA positif kasus baru dengan DM yang berobatpada periode Juli 2012 sampai Juni 2015. Hubungan faktor risiko dengan konversisputum BTA mikroskopik dianalisis dengan analisis bivariat dan multivariat.Hasil penelitian: Proporsi kegagalan konversi sputum BTA mikroskopik padapasien TB paru kasus baru dengan DM adalah 43,04%, sedangkan pada pasientanpa DM 22,75% (p<0,001, KI95% 0,11-0,30) dan risiko relatif (RR) kegagalankonversi 1,89 kali lebih tinggi pada kelompok DM. Faktor risiko yang meningkatbermakna pada pasien gagal konversi adalah kadar kepositifan sputum BTAsebelum terapi (p=0,021), HbA1c (p=0,014), GDP (p=0,047), GD 2jam PP(p=0,030) dan kavitas pada foto toraks (p=0,033) sedangkan albumin serum lebihrendah bermakna (p=0,013). Analisis multivariat mendapatkan faktor risikoterkuat untuk kegagalan konversi sputum adalah kadar albumin serum yangrendah (p=0,046, aOR 0,464, KI95% 0,218-0,986), tingkat kepositifan sputumBTA mikroskopik sebelum terapi yang tinggi (p=0,009, aOR 2,313, KI95%1,230-4,349) dan kadar HbA1c yang tinggi (p=0,018, aOR 1,298, KI 95% 1,047-1,610).Kesimpulan: Tingkat kepositifan sputum BTA sebelum terapi yang tinggi, statuskontrol DM yang tidak baik, kavitas pada foto toraks dan kadar albumin serumyang rendah meningkatkan risiko kegagalan konversi sputum BTA pada pasienTB dengan DM.ABSTRACT Background: The link of DM and TB is more prominent in developing countrieswhere TB is endemic and the burden of DM is increasing. Diabetes mellitusincreases the risk of TB infection, delayed sputum smear conversion and TBtreatment failure. This study would like to evaluate factors associated withdelayed sputum smear conversion in the end of two months of TB treatment innew cases TB with DM patients in Persahabatan Hospital.Methods: This retrospective cohort study was conducted in PersahabatanHospital, included all new cases TB with DM patients in the period from July2012 - June 2015. All the risk factors performed bivariate and multivariateanalysis in association with sputum smear conversion in the end of two months ofTB treatment.Results: The proportion of sputum smear conversion failure is higher in TB-DMthan non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with therelative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.Bivariate analysis resulted in significant higher of initial sputum smear level(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serumalbumin (p=0,013) in non-conversion patients. Multivariate analysis resulted inrisk factors strongly associated with sputum conversion failure are low albuminlevel (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,cavity at chest x-ray and lower albumin level associated with sputum smearconversion failure in TB-DM patients.;Background: The link of DM and TB is more prominent in developing countrieswhere TB is endemic and the burden of DM is increasing. Diabetes mellitusincreases the risk of TB infection, delayed sputum smear conversion and TBtreatment failure. This study would like to evaluate factors associated withdelayed sputum smear conversion in the end of two months of TB treatment innew cases TB with DM patients in Persahabatan Hospital.Methods: This retrospective cohort study was conducted in PersahabatanHospital, included all new cases TB with DM patients in the period from July2012 - June 2015. All the risk factors performed bivariate and multivariateanalysis in association with sputum smear conversion in the end of two months ofTB treatment.Results: The proportion of sputum smear conversion failure is higher in TB-DMthan non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with therelative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.Bivariate analysis resulted in significant higher of initial sputum smear level(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serumalbumin (p=0,013) in non-conversion patients. Multivariate analysis resulted inrisk factors strongly associated with sputum conversion failure are low albuminlevel (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,cavity at chest x-ray and lower albumin level associated with sputum smearconversion failure in TB-DM patients.;Background: The link of DM and TB is more prominent in developing countrieswhere TB is endemic and the burden of DM is increasing. Diabetes mellitusincreases the risk of TB infection, delayed sputum smear conversion and TBtreatment failure. This study would like to evaluate factors associated withdelayed sputum smear conversion in the end of two months of TB treatment innew cases TB with DM patients in Persahabatan Hospital.Methods: This retrospective cohort study was conducted in PersahabatanHospital, included all new cases TB with DM patients in the period from July2012 - June 2015. All the risk factors performed bivariate and multivariateanalysis in association with sputum smear conversion in the end of two months ofTB treatment.Results: The proportion of sputum smear conversion failure is higher in TB-DMthan non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with therelative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.Bivariate analysis resulted in significant higher of initial sputum smear level(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serumalbumin (p=0,013) in non-conversion patients. Multivariate analysis resulted inrisk factors strongly associated with sputum conversion failure are low albuminlevel (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,cavity at chest x-ray and lower albumin level associated with sputum smearconversion failure in TB-DM patients.;Background: The link of DM and TB is more prominent in developing countrieswhere TB is endemic and the burden of DM is increasing. Diabetes mellitusincreases the risk of TB infection, delayed sputum smear conversion and TBtreatment failure. This study would like to evaluate factors associated withdelayed sputum smear conversion in the end of two months of TB treatment innew cases TB with DM patients in Persahabatan Hospital.Methods: This retrospective cohort study was conducted in PersahabatanHospital, included all new cases TB with DM patients in the period from July2012 - June 2015. All the risk factors performed bivariate and multivariateanalysis in association with sputum smear conversion in the end of two months ofTB treatment.Results: The proportion of sputum smear conversion failure is higher in TB-DMthan non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with therelative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.Bivariate analysis resulted in significant higher of initial sputum smear level(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serumalbumin (p=0,013) in non-conversion patients. Multivariate analysis resulted inrisk factors strongly associated with sputum conversion failure are low albuminlevel (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,cavity at chest x-ray and lower albumin level associated with sputum smearconversion failure in TB-DM patients."

"Pasien diabetes melitus tipe 2 berisiko tinggi mengalami penurunan fungsi kognitif yang dapat berkembang menjadi penyakit Alzheimer dan memperburuk manajemen mandiri pasien, termasuk manajemen pengobatan mandiri. Akan tetapi, tenaga kesehatan di pelayanan kesehatan primer tidak rutin melakukan pemeriksaan fungsi kognitif. Selain itu, belum diketahui faktor lain yang memengaruhi penurunan fungsi kognitif. Maka dari itu, diperlukan analisis faktor-faktor yang memengaruhi fungsi kognitif pasien diabetes melitus tipe 2 agar menjadi dasar dalam pengambilan langkah tindak lanjut yang tepat. Penelitian potong lintang ini dilakukan untuk menilai prevalensi penurunan fungsi kognitif pada pasien diabetes melitus tipe 2 dan menganalisis faktor-faktor yang memengaruhi fungsi kognitif pasien diabetes melitus tipe 2 di Puskesmas Kecamatan Pasar Minggu Jakarta Selatan. Sebanyak 101 subjek penelitian diperoleh menggunakan metode consecutive sampling. Data diperoleh melalui observasi rekam medis, wawancara, dan pengukuran langsung. Instrumen asesmen fungsi kognitif yang digunakan adalah The Montreal Cognitive Assessment (MoCA) yang telah diterjemahkan ke dalam Bahasa Indonesia atau MoCA-INA. Subjek penelitian dengan skor MoCA-INA di bawah 26 dinyatakan mengalami penurunan fungsi kognitif. Prevalensi tinggi (81,2%) penurunan fungsi kognitif ditemukan pada pasien diabetes melitus tipe 2 di Puskesmas Kecamatan Pasar Minggu Jakarta Selatan. Pasien diabetes melitus tipe 2 memiliki penurunan subdomain fungsi eksekutif atau visuospasial, bahasa, dan memori tunda. Faktor-faktor yang memengaruhi fungsi kognitif pasien diabetes melitus tipe 2 di Puskesmas Pasar Minggu Jakarta Selatan adalah usia (r=-0,351, p=0,001), waktu tempuh pendidikan (r=0,320, p=0,001), durasi menderita diabetes melitus (r=-0,374, p<0,001), durasi konsumsi metformin (r=-0,405, p<0,001), aktivitas fisik (p=0,005), dan diet (p=0,039).

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Diabetes mellitus type 2 patients are at high risks of developing cognitive function impairment that can progress to Alzheimer’s disease and impair patients’ self-management, including self-medication management. However, primary care physicians do not routinely assess cognitive function. On the other hand, the other factors affecting cognitive function impairment have not been known. Therefore, analysis of factors affecting cognitive function is needed to take appropriate follow-up steps. This cross-sectional study aimed to assess prevalence of cognitive function impairment among diabetes mellitus type 2 patients at Pasar Minggu Community Health Center, South Jakarta and analyze the affecting factors. A total of 101 study subjects were selected by the consecutive sampling method. Data were obtained by medical record observation, interview, and direct assessment. The instrument used to assess cognitive function was The Montreal Cognitive Assessment (MoCA) which was translated to Bahasa Indonesia or MoCA-INA. Study subjects with MoCA-INA score below 26 were stated as having cognitive function impairment. A high prevalence (81,2%) of cognitive function impairment was found in diabetes mellitus type 2 patients at Pasar Minggu Community Health Center, South Jakarta. Diabetes mellitus type 2 patients was found to have impairments in executive or visuospatial function, language, and delayed recall subdomains. Factors affecting cognitive function of diabetes mellitus type 2 patients at Pasar Minggu Community Health Center, South Jakarta were age (r=-0,351, p=0,001), years of education (r=0,320, p=0,001) duration of diabetes mellitus (r=-0,374, p<0,001), duration of metformin consumption (p<0,001), physical activity (r=-0,405, p=0,005), and diet (p=0,039)."

"Diabetes mellitus (DM) merupakan sekelompok kelainan heterogen yang ditandai dengan peningkatan kadar glukosa darah (hiperglikemia). Kejadian diabetes mellitus di perkotaan terus meningkat akibat perubahan pola perilaku masyarakat yang kurang sehat seperti pola makan tinggi lemak, kurang aktifitas, dan stres. Penulisan ini bertujuan menganalisis asuhan keperawatan Ny. S dengan DM dan edukasi kesehatan terkait nutrisi. Hasil asuhan keperawatan menunjukkan perbaikan nutrisi dengan gula darah terkontrol serta nafsu makan meningkat, dan pengetahuan pasien dan keluarga meningkat terkait nutrisi serta mampu mengikuti anjuran diit. Pengembangan program edukasi diabetes perlu dilakukan secara berkelanjutan melalui diskusi dan demonstrasi yang diadakan rutin di ruang rawat RSUP Persahabatan.

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Diabetes mellitus (DM) is heterogeneous group of disorders characterized by elevated blood glucose level (hyperglycemia). Incidence of diabetes mellitus is increasing due to changes in community behavior patterns such as high-fat diet, lack of activity, and stress. This research aims to analyze nursing care of diabetes mellitus and health education about nutrition. The results shows improved nutrition with blood glucose control and good appetite, improved family knowledge and patient dietary compliance. Development of diabetes education program has to be sustainable with discussion and demonstration methods in every ward of RSUP Persahabatan."

"Indonesia merupakan negara terbanyak keempat kematian akibat diabetes Mellitus dan penyakit jantung diantara negara-negara Asia Tenggara. Penelitian dengan desain studi cross sectional ini bertujuan untuk mengetahui gambaran biaya akibat sakit serta kualitas hidup pasien diabetes mellitus tipe 2 dengan penyakit jantung dengan sampel 110 orang di RSUD Dr.M.Yunus Bengkulu. Rata-rata biaya pasien akibat sakit diabetes mellitus tipe 2 dengan penyakit jantung selama setahun adalah Rp. 6.081.572 dimana komposisi biaya langsung adalah (81,54%) dan biaya tidak langsung (18,46%). Proporsi terbesar adalah biaya obat (37,05%). Faktor-faktor yang mempengaruhi biaya akibat penyakit tersebut adalah Lama Hari Rawat (LHR) dan jenis pekerjaan sedangkan faktor yang mempengaruhi kualitas hidup pasien adalah Lama/durasi sakit. Disarankan agar RSUD.dr.M.Yunus Bengkulu menyusun clinical pathway dan formularium rumah sakit. Pemerintah perlu merevisi formularium nasional dengan memperhatikan kondisi lokal dan mengembangkan program peningkatan kualitas hidup pasien.

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Indonesia is the fourth most deaths due diabetes mellitus and heart disease among south Asia countries. This study with cross-sectional design is aiming to describing the cost of illness and quality of life of patients with type 2 diabetes mellitus with heart disease in dr.M.Yunus public hospital. Number of samples was110 patients. The annual cost of illness due to type 2 diabetes mellitus with heart disease perpatient was Rp. 6,081,572, with direct cost is reached (81.54%) and indirect cost (18.46%). The largest proportion of the cost was drug (37.05%). Factors that affect COI were Length of Stay (LOS) and the type of work, and factor affect quality of life was duration of illness. It is recommended that dr.M.Yunus Public Hospital Bengkulu should prepare clinical pathways and hospital formulary. The central government needs to revise national formulary with considering variability of country situation and develop program to improve quality of DM patient."

"Kehidupan perkotaan menimbulkan banyak sekali masalah kesehatan baik fisik maupun psikososial. Perubahan gaya hidup masyarakat perkotaan meningkatkan masalah kesehatan seperti diabetes mellitus. Diabetes merupakan penyakit kronik yang menyebabkan stress seperti perasaan takut, khawatir, burn out, depresi, tidak berdaya, putus asa. Salah satu masalah keperawatan psikososial pada pasien adalah ansietas. Hasil evaluasi keperawatan menunjukkan bahwa teknik relaksasi nafas dalam dan hipnosis lima jari dapat mengurangi ansietas ringan?sedang.

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Urban lifestyles had many health problems both physical and psychosocial. Changes in urban lifestyles lead to increased health problems such as diabetes mellitus. Diabetes is a chronic disease that causes stress for patients such as worry, fear, burn out, depression, helplessness, and hopelessness. One of nursing problems in patients with diabetes is anxiety. Nursing evaluation results show that the deep breathing relaxation techniques and five fingers hypnosis can reduce anxiety mild-moderate in patients."

"ABSTRAK Rujuk Balik merupakan program BPJS yang bertujuan untuk mengendalikan serta mengelola penyakit-penyakit kronis termasuk Diabetes Melitus dan Hipertensi. pengobatan terhadap pasien penyakit kronis tersebut diberikan seumur hidup sehingga hal ini tentu saja dapat mengakibatkan adanya peningkatan biaya pelayanan kesehatan.Sesuai dengan Permenkes No. 28 tahun 2014 BPJS menerapkan prinsip kendali mutu dan kendali biaya dengan cara memberikan pelayanan secara berjenjang, efektif dan efisien. Salah satu program yang mewakili konsep tersebut adalah Program Rujuk Balik (PRB). Dengan adanya Program Rujuk Bali diharapkan dapat meningkatkan aksesibilitas, kualitas pelayanan kesehatan dan efisiensi biaya. Program rujuk balikseharusnya memudahkan pelayanan promotif preventif terhadap penyakit Diabetes Mellitus dan Hipertensi. Namun, pada pelaksanaannya, program Rujuk Balik di Rumah Sakit IMC Bintaro masih jauh dibawah target capaian Nasional. Hal ini akan berdampak kepada penumpukan pasien poli internist dan juga menjadi resiko atas kekosongan persediaan obat di rumah sakit. Dalam menganalisis implementasi pelaksanaan program rujuk balik diabetes mellitus dan hipertensi dilakukan dengan menggunakan teori kebijakan Van Horn Van Meter serta Edward III dengan variable : Standard dan Tujuan Kebijakan; Sumber Daya; Komunikasi antar Organisasi; Karateristik Agen Pelaksana; DisposisiImplementor ; Lingkungan Social Ekonomi dan Politik.Hasil penelitian menunjukan adanya kekosongan obat di FKTP, tidak adanya link pendataan secara system diantara Rumah Sakit dan FKTP, sosialisasi serta koordinasi yang kurang diantara BPJS, Rumah Sakit dan FKTP menjadi hambatan dalam pelaksanaan program rujuk balik diabetes mellitus dan hipertensi di Rumah Sakit IMC, Bintaro

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ABSTRACT

Back-Refferal is a BPJS program that aims to control and manage chronic diseases including Diabetes Mellitus and Hypertension. The treatment of patients with chronic diseases is given for long term periods and lead to an increase the cost of health

services. In accordance with Permenkes No. 28 of 2014 BPJS applies the principles of quality control and cost control by providing services in stages, effective and efficient. One program that represents the concept is Back Referral Program (BRP). With the

existence of the Back-Referral Progra is expected to improve accessibility, quality of health services and cost efficiency. The referral program should facilitate preventive promotive services for Diabetes Mellitus and Hypertension. However, the implementation of Back-Referral Program in IMC Bintaro Hospital was still far below

the National achievement target. This will have an impact on the accumulation of patients in internist station and also be a risk for drugs availabilities supplies in hospitals.

In analyzing the implementation of the program of back-refferal program diabetes mellitus and hypertension was carried out using the policy theory of Van Horn Van Meter and Edward III with variables: standard and policy objectives; resource; Communication between organizations; Characteristics of implementing agents;

Implementor Disposition; Socio-economic and political environment.

The results showed that there was a drug shortage in the FKTP, there was no system data link between the Hospital and FKTP, lack of socialization and coordination among BPJS, hospitals and FKTP as obstacles in implementing back-refferal program diabetes

mellitus and hypertension in IMC Hospital, Bintaro"

"Efikasi diri dan kepatuhan merupakan faktor yang penting dalam meningkatkan kualitas hidup pasien DM tipe 2. Penelitian ini bertujuan untuk mengetahui hubungan antara tingkat efikasi diri dan kepatuhan dengan kualitas hidup pasien DM tipe 2 yang menjalani rawat jalan di Rumah Sakit di Jakarta.Desain dalam penelitian ini adalah cross sectional, dengan jumlah sampel 125 pasien DM tipe 2. Alat ukur yang digunakan adalah Diabetes Management Self-Efficacy (DMSES), the Diabetes Activities Questionare (TDAQ), dan Diabetes Quality Of Life (DQOL).Hasil penelitian menunjukkan bahwa efikasi diri (0,0005), dan kepatuhan (0,0005) berhubungan secara signifikan dengan kualitas hidup dengan variabel yang paling dominan adalah kepatuhan.Hasil uji multivariat menunjukkan bahwa variabel efikasi diri, kepatuhan, tingkat pendidikan, dan depresi menentukan kualitas hidup pasien DM. Perlunya dikembangkan pengkajian dan intervensi keperawatan yang berfokus pada efikasi diri dan kepatuhan pasien DM tipe 2.

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Self-efficacy and adherence are important factor in improving the quality of life of patients with type 2 diabetes. This study aimed to determine the relationship between self-efficacy and adherence to the quality of life of patients with type 2 diabetes mellitus in an outpatient unit of a Hospital in Jakarta.

This study was a cross-sectional, with sample of 125 patients with type 2 diabetes mellitus. The Diabetes Management Self- Efficacy (DMSES), the Diabetes Activities Questionare (TDAQ), and the Diabetes Quality of Life (DQOL) were employed as instruments.

The results showed that selfefficacy (0.0005), and adherence (0.0005) were significantly associated with quality of life and the most dominant variable is adherence.

Multivariate test results indicate that the variable self-efficacy, adherence, education level, and depression determines quality of life of diabetic patients. This study suggestsis the need fornursing assessment and interventions that focus on the self-efficacy and adherence diabetes mellitus patient."