FAKTOR RISIKO DAN DAMPAK BIAYA DARI PERSPEKTIF RUMAH TANGGA PADA PASIEN HEMODIALISIS RAWAT JALAN DI RSUD KARAWANG

Abstract

ABSTRAK

Insidensi dan prevalensi gagal ginjal kronis (GGK) yang memerlukan terapi hemodialisis (HD) dua kali perminggu atau lebih semakin meningkat di Indonesia, menyebabkan beban biaya yang tinggi, termasuk bagi pasien dan keluarganya. Guna mengendalikan biaya, perlu dilakukan upaya promosi dan pencegahan melalui pengendalian faktor risiko. Penelitian ini bertujuan untuk mengetahui faktor risiko terjadinya GGK di RSUD Karawang dan dampak biaya dari perspektif rumah tangga, yang meliputi biaya transportasi dan akomodasi, obat dan suplemen yang tidak ditanggung BPJS Kesehatan, perawatan di rumah, hilangnya produktivitas dan biaya-biaya lain yang harus ditanggung oleh pasien. Pada penelitian observasional dengan metode case-control ini, data primer diambil melalui wawancara menggunakan kuesioner terstruktur terhadap 100 pasien yang menjalani terapi HD (case) dan 100 pasien dari poli lain (control), secara potong-lintang. Data sekunder diambil dari rekam medik 100 pasien GGK yang sama. Penelitian dilakukan selama enam bulan, Februari-Agustus 2018, di RSUD Karawang. Analisis faktor risiko dilakukan dengan metode regresi logistik (p <0,05) dan analisis biaya dengan metode akuntansi. Hasil penelitian menunjukkan bahwa perempuan berisiko 10,1 kali lipat dibanding laki-laki dan kelompok masyarakat dengan penghasilan tidak tahu berisiko 17,3 kali lipat dibanding kalangan berpenghasilan >Rp6 juta/bulan untuk terkena GGK. Para penderita hipertensi, diabetes mellitus, anemia, dan batu ginjal masing-masing memiliki risiko masing-masing 75.0, 5.4, 40.9, dan 26.0 kali lipat untuk terkena GGK dibanding non-penderita penyakit-penyakit tersebut. Kebiasaan mengkonsumsi jamu yang diduga mengandung bahan kimia obat (BKO) meningkatkan risiko terkena GGK sampai 9.8 kali lipat. Biaya dari perspektif rumah tangga yang dikeluarkan berupa biaya transportasi Rp.400.000, biaya makan Rp. 400.000, penginapan (bagi yang rumahnya jauh) Rp500.000, serta obat dan suplemen (multivitamin) Rp500.000 per pasien per bulan. Potensi hilangnya produktivitas mencapai Rp. 1.241.904 per pasien per bulan. Dari 16 faktor risiko, ada 7 faktor risiko yang signifikan bermakna secara statistik ( p Value < 0,05) yaitu hipertensi, anemia, batu ginjal, pendapatan kategori tidak tahu, jenis kelamin perempuan, perilaku konsumsi jamu diduga mengandung bahan kimia obat dan diabetes mellitus. Besar rata-rata biaya dari perspektif rumah tangga tertinggi yaitu biaya obat dan multivitamin yang tidak dicover BPJS dan biaya penginapan, diikuti biaya makan dan transportasi.

Kata kunci : : Gagal ginjal kronis (GGK), hemodialisis (HD), faktor risiko, regresi logistik, biaya dari perspektif rumah tangga

ABSTRACT

Incidence and Prevalence of Chronic Kidney Disease (CKD) is getting increased in Indonesia, it causes high living cost, especially for the patient and its family. Unlike most of chronic disease, CKD at end stage will be needing hemodialysis therapic (HD) at least twice a week, or even more. To control the cost, prevention efforts has to be done through controlling the risk factors. The purpose of this research is to understand the risk factors that causes CKD at RSUD Karawang and the living cost impact from household perspective of each patient, which including transportation and acomodation cost (accompany included), medicinal and each suplements which uncovered by Badan Penyelenggara Jaminan Sosial insurance (BPJS), home care cost, loss of productivity and other costs that must be done by the patient (and its family) related of the disease. On observational research with case-control method, the primer data is collected by interviewing 100 patients whose doing HD Therapy and 100 outpatient through questioners that the researcher made, on cross sectional way. Meanwhile, secondary data is collected from medical record of the same 100 CKD patients. This research was done for 6 (six) months, from February until August 2018 at RSUD Karawang. Risk factor analysis done with (p <0,05)  logistic regression method and cost analysis with accountancy method. The result showed that women 10,1 fold way more risky than men, then, community with unpredictable income is 17, 3 fold way more risky than the community with > 6 million rupiahs/month to get CKD disease. Hypertension sufferes, diabetes mellitus, Anemia, kidney stones, each disease have 75.0, 5.4, 40.9, and 26.0 fold risk to get CKD disease compered with those whose does not have diseases written above. Then, having habit to consuming herbal medicine which contain drugs chemical increase the risk up to 9,8 to get CKD disease. Household perspective cost which has to be spend are including transportation (Rp. 400.000), accomodation cost (Rp. 400.000), room (depends on family sccess distance to the hospital) Rp. 500.000, also the medicinal & suplements costs Rp. 500.000/month. Zero income might potentional as the patient will loss of productivities during the HD Therapy which cost Rp. 1.241.904/month. From 16 risk factors, there are 7 which statistically significant, that is hypertension, anemia, kidney stones, unspecified income category, women, consumption of herbal medicine contain medical chemicals and diabetes mellitus. Highest household perspective cost is down on medicine and multivitamins that have not been covered by BPJS and lodging cost, along with the meal and transportation costs.

Keywords : Prevalence of Chronic Kidney Disease (CKD); Hemodialysis (HD); Risk Factor; logistic regression; household perspective cost.