Characteristic of Midwives who Refer Complex Obstetrics Cases

Abstract

Characteristic of Midwives who Refer Complex Obstetrics Cases Karakteristik Bidan yang merujuk Kasus Obstetri Komplek Arietta R.D. Pusponegoro, Astrid M.P. Iskandar Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia Dr. Cipto Mangunkusumo General Hospital Jakarta Objective: To identify reasons for referring and characteristics of midwives who have an independent practice and its relation with the complication that manifested from the cases. Methods: Descriptive analytic case-control. Medical records of patients referred directly to RSCM in January 2016-July 2017 were obtained, then information about midwives and obstetric cases, along with its complications, were collected. Interview and analysis of six characteristics of midwives were conducted. Characteristics analyzed were age, education, training, duration of work experience, number of patients ever treated, also distance and travel time of the referral process. Results: All midwives refer due to inadequate facilities. There is a statistically signifi cant correlation between duration of work experience and number of patients that has been managed, with the complication that manifested from referred cases, with OR 7.036 and 6.032, respectively. Conclusions: Midwives refer due to inadequate facilities, and so patients can be treated immediately. Characteristics that affect midwives in referring are: duration of work experience and number of patients that has been managed. It is necessary to re-evaluate the position of midwives who practiced independently in BPJS, refresher programs, and monitoring by relevant agencies. A larger number of samples and data combination of midwives' and patients' characteristics in referral cases are needed for further research. Confounding and external factors are identifi ed fi rst in order to do a thorough analysis. Keywords: characteristics, complicated cases, midwives, emidwives who practiced independently, referral, referral system. Abstrak Tujuan: Mengetahui alasan rujuk dan karakteristik bidan yang berpraktik mandiri serta hubungannya dengan kasus komplikatif yang dirujuk ke RSCM. Metode: Deskriptif analitik kasus kontrol. Data diambil dari rekam medis pasien yang dirujuk langsung ke RSCM di bulan Januari 2016 hingga Juli 2017, kemudian informasi mengenai data bidan dan kasus obstetri beserta komplikasinya dikumpulkan. Dilakukan wawancara dan analisis enam karakteristik bidan. Karakteristik yang dianalisis yaitu usia, pendidikan, pelatihan, lama waktu berpraktik, jumlah pasien yang pernah ditangani, serta jarak dan waktu tempuh proses merujuk. Hasil: Keseluruhan bidan merujuk karena fasilitas yang tidak memadai. Terdapat hubungan yang bermakna antara waktu praktik dan jumlah pasien yang pernah ditangani, dengan kasus komplikatif yang dirujuk langsung ke RSCM, dengan nilai OR 7,036 dan 6,032. Kesimpulan: Bidan merujuk karena fasilitas tidak memadai dan agar pasien langsung ditangani. Karakteristik bidan yang mempengaruhi dalam merujuk yaitu lama waktu praktik dan jumlah pasien yang ditangani. Perlu dilakukan evaluasi ulang mengenai kedudukan bidan yang berpraktik mandiri di BPJS, program penyegaran bidan, serta monitoring oleh instansi terkait. Perlu penelitian lanjut dengan sampel lebih banyak serta menggabungkan karakteristik bidan dan pasien pada kasus-kasus rujukan. Faktor perancu dan eksternal diidentifi kasi terlebih dahulu agar analisis dilakukan menyeluruh. Kata kunci: bidan yang berpraktik mandiri, karakteristik bidan, kasus komplikatif rujukan, sistem rujukan.