GERIATRIC SERVICES
GENERAL HOSPITAL AREA OF CIBINONG

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
With the rising quality of life has been an increase in the population of seniors in Indonesia which could pose problems related aspects of medical, psychological, economic, and social improvement is required so that the health care of the elderly. For instance, a person aged 70 years of age who are healthy and have no previous disease compared with someone who was 40 years old which is also healthy and did not have previous illnesses, are equally exposed to illness of pneumonia with the same amount of germs. Then the patients age 70 will suffer from the disease with the degree of illness more severe and longer healing process compared to patients aged 40 years. Various conditions of the Elderly is also followed with the problems that arise in everyday life, including problems of wear, bathing, using the toilet, limitation of motion, Bowel issues (CHAPTERS) and Urinating (BAK), eating problems, and problems maintaining neatness. Geriatric medicine medical science is a discipline that provides health care to the elderly (elderly) and focuses on the promotion, prevention, diagnosis, treatment and rehabilitation. Geriatric patients are elderly patients with multi disease and/or experienced a drop in 2 (two) or more organ function and/or psychic problems, social, and economic need of health services is carried out through a multidisciplinary approach and working in an interdisciplinary. Geriatric patients generally have the following characteristics: 1. Chronic degenerative diseases has a range (multipatologi), 2. Experience a decline in organ function, 3. Often consume a variety of drugs purchased either own or that prescribed thereby cause side effects due to interactions of medications (polypharmacy). 4. Generally also experience impaired nutritional status (malnutrition), psychosocial problems, psychiatric disorders, and disorders of good basic daily living activities (ADL) and instrumental. Based on the above characteristics, it can be concluded that handling very complex so that geriatric patients needed Comprehensive Geriatric health services (preventive, curative, rehabilitative, promotif and palliative) and an integrated team approach, and organised hierarchical society, ranging from Clinics and hospitals. The following description of occurred before the implementation of this initiative, among others: 1. Elderly and Geriatric Patients follow service as befits patient public, so that with the number of patients who are pretty much in each polyclinic is causing the patient into a long service time. 2. Filtering is not done at the stage of examination to distinguish groups of Elderly and geriatric medicine, Geriatric Group services so that it does not comprehensively implemented and integrated. 3. Elderly and Geriatric Patients follow public services in supporting units (pharmacies, laboratory, Radiology), there is no specificity. 4. Not done promotif and preventive efforts (such as outreach gymnastics and Elderly) against Elderly patients, so it's not an increase in knowledge about the efforts that should be made to improve the quality of life in the old days. 5. Special nutrition education are not given against the Elderly and Geriatric patients, so patients don't get enough knowledge about eating patterns that are already different from other adult patient.

B. Strategic Approach

 2. What was the solution?
Based on the results of the analysis of the problem then the PROVINCIAL HOSPITAL Cibinong initiative to form the Ministry of geriatric medicine. Geriatric medicine is the medical discipline that provides health care to the elderly (elderly) and focuses on the promotion, prevention, diagnosis, treatment and rehabilitation. Geriatric patients are elderly patients with multi disease and/or experienced a drop in 2 (two) or more organ function and/or psychic problems, social, and economic need of health services is carried out through a multidisciplinary approach and working in an interdisciplinary. Geriatric patients generally have the following characteristics: 1. Chronic degenerative diseases has a range (multipatologi); 2. Experience a decline in organ function; 3. Often consume a variety of drugs purchased either own or that prescribed thereby cause side effects due to interactions of medications (polypharmacy); and 4. Generally also experience impaired nutritional status (malnutrition), psychosocial problems, psychiatric disorders, and disorders of good basic daily living activities (ADL) and instrumental. Based on the above characteristics, it can be concluded that halding very complex so that geriatric patients needed Comprehensive Geriatric health services (preventive, curative, rehabilitative, promotif and palliative) and an integrated team approach, and organised hierarchical society, ranging from Clinics and hospitals. Geriatric services carried out by an integrated Team that works in interdisciplinary Geriatric, minimally consists of: 1. A specialist in the disease; 2. Other specialists in accordance with the type of illness the patient geriatric medicine; 3. General practitioners who have followed training in geriatric medicine and psikogeriatri; 4. The nurse who had attended nursing training gerontik; 5. Power pharmacy; 6. Power nutrition; and 7. Implementing a simple rehabilitation services (social workers, physiotherapists).

 3. How did the initiative solve the problem and improve people’s lives?
With the multi condition of disease, various decreased organ function, psychological disorders, and social economy and environment of the elderly citizens, at the service of the citizens of the elderly in a hospital geriatric service is done through integrated multidisciplinary approach with a plenary that works in an interdisciplinary. For it certainly requires a different treatment of the service with other public patients, with the aim of improving the quality of life, quality of service, and the Geriatric patient safety at the hospital. Non medical services provided with the aim to resolve the problems of everyday life that are normative occur in the elderly, especially the problem of motion, difficulty walking, the risk of experiencing a fall, in addition to the problem of not able to take care of yourself and decrease in memory. or nuisance behaviour early. For every elderly will get ease of access in a short time, so it needs to be prepared a special facilities, such as its own queue counter, waiting room and special drug-taking counters, as well as a bathroom with a grip safety, prior geriatric service is medically stages. While the medical services provided are comprehensive, given the Elderly patients generally have more than one type of illness that require integrated handling to get optimal results. In order for the service of Geriatric patients more focus, then the necessary stages of service as follows: • All elderly patients who come to the clinic/IGD early screening will be done to determine whether it belongs to in the geriatric patient. • For ordinary elderly patients will be forwarded to the appropriate specialist with the ailment. If the patient belongs to the geriatric assessment will be done by Integrated Teams comprehensive geriatric medicine geriatric medicine. In addition to medical services that are curative, rehabilitative and palliative, groups of Elderly and geriatric medicine is also in need of services which are preventative and promotif, in order to increase their level of knowledge so that preventative steps against a condition that more weight can be done.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
Innovative and creative innovation is implemented in terms of service to Elderly patients (Elderly) and geriatric medicine, including the Ministry of promotif, preventive, curative, rehabilitative, and palliative. Promotif and preventive services in the form of education and outreach to Elderly patients on diseases and responses, including diet and exercise. Its activities in the form of gymnastics and nutritional education Elderly poly, as well as health education in outpatient waiting room. Service of curative, rehabilitative, and palliative services implemented through integrated, which carried out the examination on the basis of a disease afflicting the patient. Because most of the disease more than one type, then conducted a consultation between medical specialists, with the doctor in charge of the Patients is a specialist in the Disease. In addition, Elderly and Geriatric service flow is implemented differently with other general patients, where accessibility services easier, as well as a shorter service time.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
Starting in 2014, the PROVINCIAL HOSPITAL services have conducted Cibinong Elderly and geriatric medicine is simple with the purpose to glorify elderly. As for the circuit stages a Geriatric service has been implemented can be explained as follows: I. PREPARATION PHASE • Following the construction of staged by West Java Health Office to find out more detail about Geriatric service standard based on the regulation of the Minister of health no. 79 by 2014, about the Penyelenggraan service of geriatric medicine at the hospital. • Geriatric HOSPITALS Cibinong formed a team consisting of medical specialists internal medicine, general practitioners, nurses, and Dietitians • Schedule service of Special clinics are elderly. • Prepare easy access special service Elderly by providing Special Registration Counters, Special Lounges, and a special Drug-taking Counters, besides providing Elderly given special stamps starting from the registration number to the form support inspection, with the goal of keeping Elderly patients can be looked in the queue. • Perform socialization to health centers through the health service Districts of Bogor that HOSPITALS have conducted Cibinong special service to the elderly. II. STAGE OF IMPLEMENTATION OF THE Once the preparation phase is complete, on May 17, 2014 Cibinong HOSPITALS began providing services Elderly and Geriatric simple levels, by implementing the special Outpatient clinics are Elderly one time in a week that is on Thursday, with the following facilities: • Special registration counters Elderly • Stamp cards for Elderly patients and supporting reference format • Elderly, special lounges • Special Geriatric examination room • Special drug counters Elderly By 2014-2015, the integrated multidisciplinary Geriatric service is implemented through a consul between Clinics with doctors in charge of the patient (DPJP) is a specialist in the Disease. As for the flow of services implemented in HOSPITALS for Elderly patients Cibinong is as follows: • Patients enrolled in the special counter of elderly • After getting medical treatment card and queue number, patients get an Elderly stamp • Patients wait in the waiting room of special Elderly to get consultation and examination. • At the time of examination, Geriatric patient screening done. When a patient suffering from the disease more than two, then classified patients Geriatric, and consulted a specialist according to the complaint. If only 1-2 disease then classed as Elderly patients • When patients need support, then the examination form examination of supporting Elderly stamp given, so that the clerk can put patients in the queue at the unit of work. • After the inspection is completed, patients get a prescription drug that has also been given the stamp of the elderly, and brought the recipe to the Special Drug Counters elderly. As the implementation of promotif and preventive efforts, HOSPITALS providing services: Cibinong • Poly Nutritional Education on every Tuesday and Thursday • Gymnastics Elderly on Saturdays. • Guidance on Elderly Patient waiting room once a month.
 6. How was the strategy implemented and what resources were mobilized?
With the multi condition of disease, various decreased organ function, psychological disorders, and social economy and environment of the elderly citizens, at the service of the citizens of the elderly in a hospital geriatric service is done through integrated multidisciplinary approach with a plenary that works in an interdisciplinary. For it certainly requires a different treatment of the service with other public patients, with the aim of improving the quality of life, quality of service, and the Geriatric patient safety at the hospital. As promotif and preventive efforts, in addition to do outreach to health problems in the Elderly patient waiting room and geriatric medicine, also opened a Nutrition Education efforts as Poly Hospital in providing and enhancing knowledge to patients and their families in the awarding of quality menu against Elderly and Geriatric patient based on the patient's personal condition. To keep the Elderly and Geriatric patients fitness, also opened a gymnastics guidance Elderly every week. Approach in providing service to the Elderly and Geriatric patient refers to the standard stage of Geriatric service which carried out the screening to distinguish patients Elderly and geriatric medicine. Non medical services are also provided with the aim to overcome the problems of everyday life that are normative occur in the elderly, especially the problem of motion, difficulty walking, the risk of experiencing a fall, while not able to take care of yourself and decrease in memory or nuisance behaviour early. The resources used for these innovations include:  Human Resources (Hr), consists of: • A specialist in the disease; • Other specialists in accordance with the type of illness the patient geriatric medicine; • General practitioners who have followed training in geriatric medicine and psikogeriatri; • The nurse who had attended nursing training gerontik; • Power pharmacy; • Power nutrition; • Implementing a simple rehabilitation services (social workers, physiotherapists).  The cost of the The budget for the service of the Elderly and Geriatric patients by 2014 and 2015 are not listed in a special budget, but rather join the other account numbers. TOTAL COSTS for the 2014-2016 18,461,092,334

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
The stakeholders involved and contributing in the implementation of these innovations include cross-sector and cross-Program, namely: • West Java Health Office and the health service Districts of Bogor, in an effort to improve the quality of life of patients Aged and geriatric medicine in West Java in General and the Bogor district in General. • A whole range of structural Regional general hospitals (HOSPITALS), Cibinong, ranging from the Director up to staff, in an effort to improve health services to the community in accordance with the vision of Bogor District General Hospital area of Cibinong, i.e. into the Hospital relied on and trusted community. • The entire staff of functional HOSPITALS Cibinong, include a specialist In Disease, Nerve Specialist, medical rehabilitation Specialist, Nutritionist, along with a whole range of other functional, in an effort to improve medical services towards Elderly and Geriatric patients in HOSPITALS Cibinong. • Whole health partners at the level of District, sub-district and villages include cadre of Posyandu Cadre, the PKK, and Elderly Cadres, in an attempt to obtain ease of access services at advanced level healthcare facilities especially for patients Elderly.

 8. What were the most successful outputs and why was the initiative effective?
The output (output) is most successful is: 1. The average Elderly patient visits 70 (seventy) patients with Geriatric patients 10-20 per day of service, which reflects the growing understanding and utilization of clinics are Elderly and geriatric medicine at HOSPITALS and Community Facilities by the Cibinong basic medical services (Clinic). 2. Generally speaking, the waiting time a patient is Elderly or Geriatric Physician examination to undergo started getting the drug on average 1-2 hours, this is shorter than ever where the waiting time of patients can reach 3-4 hours. 3. The short time with more Elderly and Geriatric patient service in HOSPITALS Cibinong, can lower the risk of occurrence of normative barriers occur in the elderly, such as the risk of falling and decrease in patient body durability due to fatigue, which can memperberat the condition of Elderly disease itself. 4. The number of Elderly who follow gymnastics Elderly traveling average is 25 people, is a picture of increasing public knowledge about the importance of keeping the Elderly body fitness in a bid to improve the quality of life in old age. These activities also illustrate the increasing role of Elderly Cadres at the level of basic health facilities to move the elderly in seeking positive activities among the activities of everyday life. 5. There are Elderly patients who utilize the clinic nutrition education describes the increasing public knowledge of the importance of regulating the diet pattern to maintain the stability of body condition in old age.

 9. What were the main obstacles encountered and how were they overcome?
The main constraints encountered in implementing this strategy: 1. Less discipline her the officer giving the Elderly stamp on form examination of the support (such as X-ray and laboratory) so that the waiting time of elderly patients in the same units with public patient queues. 2. Still the presence of the patient who does not register itself, but through his family that is still young. This fishing misunderstanding among Elderly patients of other queued at the same counter. 3. Yet the extent of the dissemination of Nutrition Education for the Elderly the poly, so visits are still low. 4. Yet the availability of specialized Geriatric building here means infrastructure aspects for service by 2014 – 2015, so the convenience of the Elderly and Geriatric patients have not reached optimal. Efforts are being made to overcome this obstacle is to: 1. Perform continuous monitoring on Elderly Services is a Groove starting from the registration to the patients receiving the drug, including the compliance officer in providing Elderly stamp on form. 2. Provide Elderly patients sense if there is a misunderstanding at the time of waiting in line at the counter of the elderly. 3. Improve coordination and dissemination towards basic health Services Facilities (Clinics) and Elderly cadres through Bogor regency health services, so as to improve the utilization of the poly Elderly Education. 4. He built a special building of geriatric medicine at semester II in 2015 and planning the purchase of meubeuler in 2016 as an effort to improve the quality and convenience of service of Elderly and geriatric medicine.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
Pharmacy Outpatient Clinic Services Elderly and Geriatric HOSPITALS in Cibinong occurred positive change that provides major benefits in the Elderly and Geriatric services, namely as follows: 1. Elderly and Geriatric Patients not to wait long in the registration Counters like other common patients. 2. Elderly and Geriatric Patients more comfortable waiting queue, because a Doctor's examination to wait in the waiting room with a special queue that is not as long queues of patients. 3. Elderly and Geriatric Patients get priority in supporting the inspection unit, such as Radiology and laboratory 4. Elderly and Geriatric Patients getting drugs faster because of the Special Drug Counters served on the elderly. Generally speaking, the waiting time a patient is Elderly or Geriatric Physician examination to undergo started getting the drug on average 1-2 hours, this is shorter than ever where the waiting time of patients can reach 3-4 hours. The short time with more Elderly and Geriatric patient service in HOSPITALS Cibinong, can lower the risk of occurrence of normative barriers occur in the elderly, such as the risk of falling and decrease in patient body durability due to fatigue that can incriminating the condition of Elderly disease itself.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
With the rising quality of life has been an increase in the population of seniors in Indonesia which could pose problems related aspects of medical, psychological, economic, and social improvement is required so that the health care of the elderly. Elderly (elderly) is an advanced phase or the final phase of the journey of human life, from infants, children, adolescents, adults and elderly. According to WHO, old age is the age of more than 60 years. Over the implementation of the initiative at the PROVINCIAL HOSPITAL Geriatric Cibinong, then health care to elderly patients felt it was not very useful regardless of the results of community satisfaction survey that has been conducted against the services provided, it certainly helps to increase the level of trust the community to the PROVINCIAL HOSPITAL Cibinong who had done a breakthrough or innovation so as to realize a public service that is effective and efficient. Integrity in the public service with regard to commitment to honesty to carry out all duties and responsibilities in accordance with the applicable provisions. This commitment is an extra system in order to prevent the occurrence of mal-administration in the ranks of the bureaucracy, particularly with regard to the Administration, and the public service itself. The principles of efficiency, accountability and justice distributif in the public service is indispensable it is emphasised in order that the Government apparatus as a man of the community can give a sense of satisfaction in providing service to the community.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
Elderly (elderly) is an advanced phase or the final phase of the journey of human life, from infants, children, adolescents, adults and elderly. Aging is a natural process that is inevitable and must be faced. The process of aging is not a disease, but rather a process of change from an individual is healthy and fit to become less healthy and fit. These conditions will be experienced by all individuals and organs of the body, where the decline of the number of cells or tissues and physiological function, easy to contract the disease, reduced resistance to physical stress or psikologik, and are irreversible (cannot be reversed at a previous state). A group of Elderly (Elderly) are vulnerable groups that require special treatment, especially at a time when they need health services, so as not to incriminating the illness he suffered. PROVINCIAL HOSPITAL services through special Cibinong Elderly strives to provide a Ministry priority group of patients aged 60 years and above, so the service time can be further shortened, through a special registration counters, stamp a special waiting room, the elderly elderly, special drug counters and elderly. To this end, special on Tuesdays and Thursdays, Cibinong HOSPITALS provide service "One Stop Service" on Elderly patients, which started from the services specialist, laboratory examination, until the acceptance of the drug, conducted in a specialized Geriatric, equipped with comfortable lounges and representative.

Contact Information

Institution Name:   GENERAL HOSPITAL AREA OF CIBINONG
Institution Type:   Academia  
Contact Person:   FUSIA MEIDIAWATY
Title:   DOCTOR  
Telephone/ Fax:   +6218753487
Institution's / Project's Website:  
E-mail:   uchie.fm@gmail.com  
Address:   JL. Ksr Dadi Kusmayadi No 27 Cibinong
Postal Code:   16914
City:   Bogor Regency
State/Province:   West Java
Country:  

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