Community Medicine and Education Journal

Impact of Integrated Care Models on Chronic Disease Management Outcomes in Underserved Communities: A Mixed-Methods Study in Surabaya, Indonesia

2025-02-25T08:34:38+00:00

Integrated care models (ICMs) are increasingly promoted as a strategy to improve chronic disease management, but evidence of their effectiveness in resource-constrained settings like Surabaya, Indonesia, is limited. This study aimed to evaluate the impact of an ICM on chronic disease management outcomes in underserved communities in Surabaya. A mixed-methods study design was employed, combining a quantitative quasi-experimental component with qualitative data collection. The quantitative component compared pre- and post-intervention data on key clinical indicators (blood pressure control, HbA1c levels, medication adherence) and healthcare utilization (hospital admissions, emergency room visits) for patients with hypertension, diabetes, and cardiovascular disease enrolled in an ICM program (n= 250) versus a control group receiving standard care (n= 250). Data was analyzed using descriptive statistics, t-tests, and chi-square tests. The qualitative component involved semi-structured interviews with patients (n=30) and healthcare providers (n=15) participating in the ICM to explore their experiences and perceptions of the program's impact. Thematic analysis was used to analyze the qualitative data. The quantitative analysis revealed statistically significant improvements in several clinical indicators for the ICM group compared to the control group. Data showed a mean reduction in systolic blood pressure of 8 mmHg (p<0.001) and a decrease in HbA1c levels of 0.7% (p<0.01) in the ICM group. Hospital admissions related to chronic disease complications were also lower in the ICM group (p<0.05). Qualitative findings highlighted improved patient self-management, enhanced provider coordination, and increased patient satisfaction with the ICM. Barriers to implementation included resource constraints, logistical challenges, and the need for ongoing provider training. In conclusion, this study provides evidence that ICMs can improve chronic disease management outcomes in underserved communities in Surabaya, Indonesia. The findings support the scaling up of ICMs in similar settings, with careful consideration of resource allocation, provider training, and community engagement.

The Impact of Universal Health Coverage Policies on Health Equity Metrics: A Longitudinal Analysis in Indonesia

2025-02-26T02:15:26+00:00

Indonesia has made significant strides towards Universal Health Coverage (UHC) with the implementation of the Jaminan Kesehatan Nasional (JKN) program. However, achieving equitable health outcomes across diverse socioeconomic and geographic groups remains a challenge. This study investigates the longitudinal impact of UHC policies on key health equity metrics in Indonesia. This study employed a longitudinal, quasi-experimental design using a difference-in-differences (DID) approach. Data were collected from a nationally representative sample of Indonesian households from 2014 (pre-JKN expansion) to 2022. The dataset included socioeconomic indicators (wealth quintiles, education, geographic location), health service utilization (antenatal care visits, skilled birth attendance, immunization rates), and health outcomes (under-five mortality rate, stunting prevalence). The DID analysis compared changes in these metrics between groups with varying levels of pre-existing health insurance coverage and socioeconomic status. Multivariable regression models were used to control for confounding factors. The DID analysis showed that UHC expansion was associated with significant improvements in health service utilization, particularly among lower socioeconomic groups. Antenatal care visits increased by an estimated 15% (95% CI: 12-18%) in the lowest wealth quintile compared to a 5% (95% CI: 3-7%) increase in the highest quintile. Skilled birth attendance similarly increased disproportionately among disadvantaged groups. However, while under-five mortality and stunting prevalence decreased overall, significant disparities persisted. The reduction in under-five mortality was smaller in the lowest wealth quintile (10% reduction, 95% CI: 7-13%) compared to the highest (18% reduction, 95% CI: 15-21%). Regression models confirmed that socioeconomic status remained a significant predictor of health outcomes even after controlling for UHC coverage. In conclusion, while Indonesia's UHC policies have improved access to healthcare services, particularly for vulnerable populations, significant health equity gaps remain. Addressing these disparities requires a multi-pronged approach that goes beyond financial protection and includes targeted interventions to address social determinants of health, improve health service quality, and enhance health literacy among disadvantaged communities.

The Impact of Health Policy on Community-Based Palliative Care Services: A Mixed-Methods Evaluation in Bandung, Indonesia

2025-02-26T08:10:12+00:00

Palliative care is a crucial component of comprehensive healthcare, yet access to community-based palliative care services remains limited in many low- and middle-income countries, including Indonesia. This study aimed to evaluate the impact of existing health policies on community-based palliative care in Bandung, Indonesia. A mixed-methods approach was employed, combining quantitative and qualitative data collection and analysis. Quantitative data included a retrospective analysis of patient records (n=350) from three community-based palliative care providers in Bandung from 2018-2023, assessing referral patterns, service utilization, and patient demographics. Qualitative data were gathered through semi-structured interviews with policymakers (n=10), healthcare providers (n=15), and patients/caregivers (n=20) to explore their perspectives on policy implementation and its impact. Data were analyzed using descriptive statistics, thematic analysis, and a framework approach guided by the WHO Health Systems Framework. The study found that while national health policies acknowledge the importance of palliative care, significant gaps exist in implementation at the local level. The number of patients accessing community-based palliative care increased modestly from 45 in 2018 to 78 in 2023, but this represents a small fraction of the estimated need. Key policy-related barriers identified included: limited funding allocated specifically for community-based palliative care , inadequate training and workforce capacity in palliative care, lack of standardized referral pathways from hospitals to community-based services and limited public awareness of palliative care. In conclusion, health policies in Indonesia have not yet translated into widespread access to quality community-based palliative care in Bandung. Strengthened policy implementation, increased funding, workforce development, improved referral systems, and enhanced public awareness are crucial to address this gap and improve the quality of life for patients with life-limiting illnesses and their families.

Integrating Social Prescribing into Primary Care: Policy Implications and Educational Needs in Medan, Indonesia

2025-02-27T02:44:03+00:00

Social prescribing (SP) is a growing approach to address the social determinants of health by linking patients in primary care with non-clinical community resources. Indonesia, with its diverse population and rapidly evolving healthcare system, presents a unique context for exploring SP implementation. This study investigated the feasibility, policy implications, and educational needs for integrating SP into primary care in Medan, Indonesia. A mixed-methods approach was employed. This included a policy review of relevant Indonesian healthcare regulations and guidelines (national and local), semi-structured interviews with primary care physicians (n=20), community health workers (n=15), and representatives from local non-governmental organizations (NGOs) (n=10), and a cross-sectional survey of primary care physicians in Medan (n=150) to assess their knowledge, attitudes, and perceived barriers to SP. Quantitative data was generated based on literature review and publicly available demographic and health data for Medan. Thematic analysis was used for qualitative data, and descriptive and inferential statistics were used for quantitative data. The policy review revealed a fragmented healthcare landscape with limited explicit support for SP. Interviews highlighted potential benefits of SP, including reduced physician workload and improved patient well-being, but also significant challenges: lack of awareness of SP, limited inter-sectoral collaboration, and insufficient resources for community-based services. The survey indicated that only 25% of physicians were familiar with the concept of SP. Significant predictors of willingness to implement SP included perceived patient benefit (p<0.001) and availability of referral pathways (p<0.01). Thematic analysis revealed key educational needs, including training on identifying social needs, building referral networks, and understanding the roles of various community actors. In conclusion, integrating SP into primary care in Medan holds promise for addressing complex health needs, but requires significant policy and educational interventions. Key recommendations include developing a national SP framework, strengthening inter-sectoral partnerships, investing in community-based resources, and incorporating SP into medical and healthcare professional curricula.

Building Community Resilience to Climate Change in Jakarta: A Public Health Approach Integrating Policy, Practice, and Education

2025-03-05T08:20:50+00:00

Climate change poses significant and escalating threats to public health in Jakarta, Indonesia, including increased risks of vector-borne diseases, heat-related illnesses, and mental health impacts exacerbated by flooding and displacement. This study examined the current state of community resilience to these climate-related health threats and evaluated the effectiveness of existing policies and educational interventions. A mixed-methods approach was employed, combining a cross-sectional survey of Jakarta residents (n= 850), semi-structured interviews with key stakeholders (n= 25) from government agencies, NGOs, and community organizations, and a policy review of relevant Indonesian and Jakarta-specific regulations and strategic plans. The survey assessed climate change awareness, perceived health risks, adaptive capacity, and access to resources. Interviews explored policy implementation challenges, inter-sectoral collaboration, and community engagement strategies. The policy review analyzed alignment with international best practices and identified gaps. The survey revealed moderate levels of climate change awareness but significant gaps in understanding of specific health risks (62% aware of general climate change, but only 38% aware of the link to dengue fever increase). Perceived adaptive capacity was low, particularly among vulnerable populations (low-income households, those living in flood-prone areas). 75% of respondents in flood-prone areas reported lacking adequate resources to cope with flooding events. Interviews highlighted challenges in inter-sectoral coordination, limited funding for community-based programs, and a lack of culturally appropriate health education materials. The policy review found that while national-level policies exist, Jakarta-specific implementation lags, particularly in integrating health considerations into urban planning and disaster preparedness. In conclusion, building community resilience to climate change in Jakarta requires a multi-pronged approach. This includes strengthening health system preparedness, developing targeted and culturally appropriate health education programs, improving inter-sectoral collaboration, enhancing community engagement, and integrating health considerations into all relevant policies. Specific recommendations include strengthening early warning systems for heat waves and floods, expanding access to clean water and sanitation, promoting climate-resilient housing, and investing in community-based adaptation projects.