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"Penelitian ini bertujuan untuk melakukan evaluasi program latihan Klub Jantung Sehat Pondalisa sekaligus mengetahui hubungan frekuensi dan keteraturan senam terhadap penurunan tekanan darah. Dengan demikian diharapkan akan didapatkan tekanan darah yang terkendali pada anggota KJS Pondalisa khususnya dan masyarakat usia dewasa tua umumnya.Studi kohort retrospektif dilakukan dengan menggunakan data yang terdapat pada buku anggota KJS Pondalisa. Digunakan pendekatan analisis Cox Regression untuk melihat efek frekuensi dan keteraturan senam yang telah dilakukan oleh para anggota KJS Pondalisa selama 1 tahun pertama keanggotaan terhadap penurunan tekanan darah. HR (hazard ratio) digunakan sebagai estimasi RR (risiko relatif) efek frekuensi dan keteraturan senam terhadap penurunan tekanan darah. Anatisis multivariat digunakan untuk mengendalikan variabel-variabel perancu.Sebanyak 132 data anggota K7S Pondalisa dianalisis dalam penelitian ini. Dalam 1 tahun pertama keanggotaan terdapat 11,36% anggota yang melakukan senam 2x1minggu, 39,39 % anggota yang melakukan senam > 8 minggu (9-15 minggu) berturut-turut, dan 11,36% anggota yang melakukan senam 2xlminggu selama > 8 minggu (9-15 minggu) berturut-turut. Tidak ada anggota yang melakukan senam 3xlminggu sesuai program dan tidak ada anggota yang melakukan senam 2x1minggu selama < 8 minggu berturut-turut_ Keteraturan senam anggota maksimum selama 15 minggu. Didapatkan penurunan tekanan darah pada 32,58 % anggota dengan rata-rata penurunan tekanan darah sistolikldiastolik sebesar 6 mmHg/4 mmHg yang dapat dipertahankan minimal selama 1 bulan. Besarnya penurunan TD ini diharapkan dapat bermanfaat dalam menurunkan angka kesakitan dan kematian akibat hipertensi; sedikitnya dapat memperlambat perjalanan penyakit hipertensi serta bermanfaat dalam pencegahan primer.Efek frekuensi senam 2xlminggu terhadap penurunan tekanan darah meningkat sebesar 1 Va dibandingkan dengan frekuensi senam < 2xlminggu [RR 1,01;95%CI [0,43-2,38]. Efek senam teratur 9-15 minggu berturut-turut terhadap penurunan tekanan darah meningkat sebesar 36 % dibandingkan dengan senam teratur < 8 minggu berturut-turut [RR 1,36;95%CI [0,63-2,93]. Senam yang dilakukan 2xlminggu selama 9-15 minggu berturut-tunrt memberikan manfaat penurunan tekanan darah sebesar 34 % dibandingkan dengan senam <2xlminggu selama 8 minggu berturut-turut [RR 1,34;95% CI [0,50-3,60]. Tidak ada perbedaan manfaat penurunan tekanan darah antara senarn < 2xlminggu selama 9-15 minggu berturut-turut dengan senam < 2xlminggu selama < 8 minggu berturut-turut [RR 0,99;95% CI [0,42-2,32].Dan basil penelitian ini disimpulkan bahwa efek frekuensi senam 2xlminggu terhadap penurunan tekanan darah tidak berbeda dengan efek frekuensi senam < 2xlminggu. Efek keteraturan senam 9-15 minggu berturut-turut terhadap penurunan tekanan darah lebih besar dibandingkan efek frekuensi senam 2xlminggu. Hal ini menunjukkan pentingnya mempertahankan keteraturan senam untuk mendapatkan basil penurunan tekanan darah yang lebih baik. Manfaat penurunan tekanan darah pada frekuensi senam 2xlminggu didapatkan bila dilakukan selama 9-15 minggu berturut-turut. Walaupun senam sudah dilakukan secara teratur sarnpai dengan 15 minggu berturut-turut, bila dilakukan dengan frekuensi < 2x1minggu tidak didapatkan manfaat penurunan tekanan darah.Masih adanya faktor-faktor yang belum diperhitungkan seperti durasi dan intensitas latihan, peran obat anti hipertensi, dan adaltidaknya penyakit lain, serta masih lebar dan tidak konsistennya rentang interval kepercayaan yang dihasilkan, menyebabkan basil penelitian ini belum sepenuhnya menunjukkan efek frekuensi dan keteraturan senam terhadap penurunan tekanan darah yang sebenarnya pada populasi. Oleh karena itu, masih diperlukan penelitian lanjutan menggunakan berbagai nilai frekuensi dan keteraturan senam, dengan memperhitungkan berbagai faktor di atas dan jumlah sampel yang lebih besar, untuk memperoleh manfaat penurunan tekanan darah yang sebenarnya dan presisi yang lebih akurat.

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The aim of this research is to evaluate the performance of `Klub Jantung Sehat Pondalisa' as well as the association of frequency and regularity of exercise with blood pressure reduction. The long-term benefit achieved will be adequate control of blood pressure among members of the club and adults as a whole.

Retrospective cohort study was conducted, using data found on the member's logbook. Cox Regression analysis approach was used to find the benefit of blood pressure reduction through exercise's frequency and regularity which have been done by all member of KJS Pondalisa during the first year of membership. HR (hazard ratio) was used to estimate the RR (relative risk) of both exercise's frequency and regularity to reduce blood pressure. Confounders were adjusted by multivariate analysis.

There were 132 members analyzed in this research. In the first year of membership, there were 11.36% members doing exercise twice weekly, 39.39 % members doing exercise > 8 weeks (9-15 weeks) regularly, and 11.36% members doing exercise twice weekly in > 8 weeks (9-15 weeks) regularly. There were no member doing exercise thrice weekly as programmed. There were no member doing exercise twice weekly in < 8 weeks regularly. The maximum exercise's regularity was 15 weeks. There were 32.58 % blood pressure reduction among members. The mean systolic/diastolic reduction which can be maintained for at least I month were 6 mmHg/4 mmHg, This amount of BP reduction might reduce morbidity and mortality among hypertensives; at least might retard the natural history of hypertension and give benefit to primary prevention.

The effect of twice weekly's exercise on blood pressure reduction increase 1 % as compared to less than twice weekly's exercise [RR 1,01;95%CI [0,43-2,38]. Effect of doing 9-15 weeks regular exercise on blood pressure reduction increase 36 % as compared to members doing 8 weeks regular exercise [RR 1,36;95%CI [ 0,63-2,93]. Members doing exercise twice weekly in 9-15 weeks regularly get benefit on blood pressure reduction 34 % more as compared to members doing exercise less than twice weekly in < 8 weeks regularly [RR 1,34;95% CI [0,50-3,60]. There were no difference in blood pressure reduction between members doing exercise less than twice weekly in 9-15 weeks regularly and members doing exercise less than twice weekly in < 8 weeks [RR 0,99;95% CI [ 0,42-2,32].

From this research, we conclude that there was no different effect of blood pressure reduction between twice weekly's exercise and less than twice weekly's exercise. The effect of exercise in 9-15 weeks regularly toward blood pressure reduction is bigger compared with effect of twice weekly's exercise. This fording shows the importance of maintaining exercise's regularity to get benefit of reducing blood pressure. The benefit of twice weekly's exercise for blood pressure reduction will be achieved when it is conducted in 9-15 weeks regularly. Although exercise has been conducted regularly up to 15 weeks, if done less than twice weekly, it will not yield the benefit of blood pressure reduction.

There are still many factors which have not been considered such as the duration and intensity of exercise, the role of anti hypertensive drugs, and the presence of other diseases. All of those factors together with the wide range and inconsistent of confidence interval, make the results of this study fail to show the maximal effect of exercise's frequency and regularity to reduce blood pressure in population. Therefore, further research is needed using several degrees of exercise's frequency and regularity, considering also the above mentioned related factors and bigger number of sample size, to obtain the true benefit of blood pressure reduction and more accurate precision."

"Pengelolaan hipertensi dan diabetes melitus yang memerlukan pengelolaan terkoordinasi, menjadi perhatian karena prevalensinya semakin meningkat. Kemampuan dokter sebagai care coordinator tidak terlepas dari kemampuan kepemimpinan, dan belum ada penilaiannya di Indonesia. Penelitian ini bertujuan mengembangkan intrumen penilaian kinerja dokter di layanan primer sebagai care coordinator dan kaitannya dengan kepemimpinan.Pendapat pakar dan metode Delphi digunakan untuk mengembangkan dimensi dan butir penilaian. Validasi instrumen dilakukan dengan analisis faktor eksplorasi. Kurva ROC digunakan untuk mencari titik potong skor care coordinator pada pasien hipertensi atau DM terkontrol dibandingkan tidak terkontrol. Korelasi Pearson dilakukan untuk melihat korelasi antara skor care coordinator dengan skor kepemimpinan klinis, kepemimpinan transformasional, komitmen, kepuasan kerja, dan budaya organisasi, serta faktor-faktor sosiodemografis dokter dan praktik keprofesian.Pengumpulan data dilakukan selama periode April−November 2015. Melalui penggalian pendapat 19 orang pakar (akademisi, praktisi, pengandil), 2 kali putaran Metode Delphi (110 sampel dan 81 sampel), dan 249 sampel analisis faktor, didapatkan instrumen penilaian kinerja dokter pengelola kasus PTM di puskesmas sebagai care coordinator yang terdiri dari 11 dimensi dan 33 butir penilaian dengan koefisien alpha sebesar 0,94 dan korelasi butir penilaian dengan dimensinya lebih dari 0,4. Terdapat perbedaan skor care coordinator antara pasien hipertensi atau diabetes terkontrol dan tidak terkontrol (p = 0,02) dengan titik potong sebesar 7,7. (skor maksimal 9). Terdapat korelasi positif antara skor kepemimpinan klinis, skor kepemimpinan transformasional, skor kepuasan kerja, usia dokter, lama lulus dokter, lama bekerja di puskesmas, pelatihan dokter keluarga, dan status kepegawaian terhadap skor care coordinator. Faktor yang paling berperan terhadap peningkatan skor care coordinator adalah skor kepemimpinan klinis dan skor kepemimpinan transformasional (R square 0,47).Telah dikembangkan instrumen penilaian kinerja dokter sebagai care coordinator di layanan primer yang valid dan handal. Walaupun dokter pengelola kasus dalam kesehariannya berinteraksi dengan pasien dan tidak menduduki jabatan struktural sebagai pimpinan, namun mereka harus tetap memiliki kemampuan kepemimpinan klinis serta kepemimpinan transformasional untuk menunjang kinerja sebagai care coordinator dalam pengelolaan masalah kesehatan pasien.

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Hypertension and Diabetes Mellitus management that need coordination of care is vital because of their increasing prevalence. To become care coordinator, primary care physician should have leadership capabilities. However, there is no instrument available to measure care coordination and leadership for primary care physician in Indonesia. This research aims to develop instruments for primary care physician's performance as care coordinator in primary care facilities and its correlation with leadership.Data collection was conducted from April to November 2015. Expert opinion and Delphi method were conducted to develop dimensions and item indicators. Exploratory Factor Analysis was performed for instrument validation. ROC curves were used to gain cut-off point of care coordinator's score from controlled and uncontrolled hypertension or diabetes mellitus patient. Pearson correlation was conducted to determine correlation between care coordinator score and clinical leadership, transformational leadership, commitment, job satisfaction, and organizational culture, as well as doctor's sociodemographic factors and professional practice.Nineteen experts panel (academics, practitioners, health policy makers), 110 participants of 1st round Delphi Method, 81 participant of 2nd round of Delphi Method, and 249 samples for factor analysis were gathered to create 11 dimensions and 33 items with loading factors at least 0.4 and alpha cronbach as high as 0,94. There was care coordinator score difference between controlled and uncontrolled hypertension or diabetes mellitus patients (p = 0.02) with cut-off point 7,7 (maximum score 9). There was positive correlation between care coordinator score and clinical leadership score, transformasional leadership score, satisfaction score, age, graduation period, working period, family medicine training, and employment status. Dominant factors correlate to care coordinator score were clinical leadership score and transformational leadership score (R square 0.47).A valid and reliable instrument of care coordinator performance for Indonesian primary care physician has been developed. Although the main activity of practitioner is very much relate to patient interaction, they should also have leadership capacities to support their role as care coordinator for patient?s health management."