Factors Associated with the Participation of Hypertensive Patients on

Chronic Disease Management Program (Prolanis) in Puskesmas

North Larangan Year 2019

Awani Ceria Luksita and Gisely Vionalita

Public Health Department, Esa Unggul University, Health Sciences Faculty,

H. Holil Street, Kreo, South Tangerang, Indonesia

Keywords: Prolanis Participation, Distance, Family Support, Gender, Health Worker.

Abstract: Prolanis is a health service system and discusses proactivity by participants supported by health facilities

and BPJS. Prolanis will encourage participants to get disease protection to achieve optimal quality of life

with an indicator of 75% having good results on specific examinations. Prolanis activities include

medical/educational consultations, reminders, home visits, club activities, and health status monitoring.

Based on data obtained from the Puskesmas North Larangan, there were 230 hypertension sufferers in

February 2019. In February 2019 the number of participants participating in the prolanis club was only 24

people with hypertension. This research to know factors related to the participation of hypertensive patients

in Program Pengelolaan Penyakit Kronis (Prolanis) in Puskesmas North Larangan 2019. The type of this

study is quantitative with Case-Control design, to obtain data on the data carried out by observation and

interviews with 72 respondents with total sampling technique for case respondents and purposive sampling

technique for control respondents. The results of the Chi-Square test showed a relationship between distance

(ρ = 0.005), family support (ρ = 0,000), health workers (ρ = 0,000) with participation in Prolanis.

1 INTRODUCTION

Based on WHO reports in 2015, showing about 1.13

billion people in the world suffer from hypertension.

That is, 1 in 3 people in the world diagnosed with

hypertension, only 36.8% of them take medication.

The number of patients with hypertension in the

world continues to increase annually, estimated in

2025 there will be 1.5 billion people affected by

hypertension (WHO,2015).

Indonesia is a country that is included in shifting

health trends is from infectious diseases to

untransmitted diseases. Data on the disease is not

contagious, from the results of Riskesdas year 2018

the prevalence of hypertension based on the

diagnosis of doctors or taking antihypertensive drugs

on the population of > 18 Tahum by 8.8%.

(Kemenkes, 2018).

Data from the Tangerang City Health Office

(2015) hypertension in the Regency and city of

Tangerang ranked first in the category of major

diseases suffered by the population of Tangerang

Regency/city. The problem of hypertension disease

every year has an increased number of sufferers. So,

there is an effort done to lower the hypertension

number. The number of patients with hypertension

in Karo district in 2015 is 53,708 people.

In order to improve public health status and

make a successful social Security program in

accordance with presidential Regulation number 19-

year 2016 about health Insurance article 21

paragraph 1, one of the benefits obtained by the

participants BPJS Healthcare is a promotive and

preventive health service, one of which is Prolanis.

The main purpose of the Prolanical program in

Puskesmas is to encourage participants with chronic

illnesses to achieve optimum quality of life with an

indicator 75% of registered participants and visit to

the first Level healthcare facility (FKTP) with good

results on Specific examination of the disease type

DM II and hypertension to prevent complications of

disease.

Puskesmas North Larangan has a Prolanis health

program that has been running since October 2017

and has a regular schedule of the second week in

each month with the number of participants 21

Luksita, A. and Vionalita, G.

Factors Associated with the Participation of Hyper tensive Patients on Chronic Disease Management Program (Prolanis) in Puskesmas North Larangan Year 2019.

DOI: 10.5220/0009589202150219

In Proceedings of the 1st International Conference on Health (ICOH 2019), pages 215-219

ISBN: 978-989-758-454-1

215

hypertension patients, Along with the time the

number of participants experienced fluctuation

where it can happen because of the provisions of the

puskesmas on hypertension patients who must

follow the club Prolanis and supplemented by the

number of patients with hypertension in Handled by

the Puskesmas. Currently recorded in February year

2019 number of participants who attended club

Prolanis as many as 24 people with patients with

hypertension. Activity that is always done club

Prolanis Prohibition of Northern Prohibitions are the

following first participants are given education

through counseling and health materials that is an

activity to improve health knowledge in the effort

Restoring illness and preventing disease and

improving health status for participants thereafter

continued with gymnastics activities in an effort to

improve physical condition through sports

activities/healthy gymnastics and activities that The

last medical examination has been monitored since

the participants attended the club Prolanis.

According to researchers, the utilization of prolanis

activities is not carried out well, because the number

of participants is very slightly compared with the

numbers of people visiting the hypertension each

month in Puskesmas more than 100 people and the

presence of permanent participants who make

increasingly narrow opportunities for other

hypertensive patients by having other diagnoses

such as uric acid, cholesterol, and high blood sugar

to follow Prolanis so that it can make the patient

experience other complications of diseases, as well

as the lack of health promotion conducted by

officers such as absence of banners and leaflets.

2 RESEARCH METHODS

This type of quantitative research aims to obtain an

overview by studying the correlation or the

relationship between independent variables and

dependent variables. This research uses case-control

by identifying case groups and control groups and

then researched retrospective. The research uses the

quantitative approach, where the study uses

statistical analyses that emphasize hypothesis

testing. The design of the research used is Case-

Control where independent variables and dependent

variables are measured or collected simultaneously

or at the same time. The samples needed for this

study amounted to 72 respondents, with comparisons

to the cases and controls in this study being 1:2,

which meant it required 24 cases and 48 controls.

3 RESULT AND DISCUSSION

3.1 Univariate Analysis

Table 1: Overview of each variable on hypertension

patient participation in Prolanis year 2019.

Variable Frequency Percentage

(%)

Participation hypertensive

patient

Not Participant 48 66,7

Participant

24 33,3

Distance

Much

45 62,5

Near 27 37,5

Family Support

Bad

38 52,8

Good 34 47,2

Gender

Woman 47 65,3

Man

25 34,7

Health Officers

Bad

40 55,6

Good 32 44,4

Based on the results of the study of 72 respondents

known that the participation of hypertensive patients

in Prolanis there are as many as 48 hypertension

patients (66.7%) Not a participant who never

participated in Prolanis and 24 hypertension patients

(33.3%) Who are currently a participant of Prolanis.

When viewed based on the distance of the house of

Hypertension patients with the North Prohibition

Puskesmas has a remote home as much as 45

patient’s hypertension (62.5%) and has a close-

quarter of 27 hypertension patients (37.5%). In

addition, from a total of 72 respondents, the number

of hypertensive patients 38 hypertension patients

(52.8%) Received poor support from his family and

the number of hypertensive patients as much as 34

ICOH 2019 - 1st International Conference on Health

216

hypertension patients (47.2%) Received poor

support from her family. According to the gender of

25 patients (34.7%) with man and female gender as

much as 47 patients (65.3%) woman gender. Out of

a total of 72 hypertensive patients were known that

the number of hypertensive patients who had bad

treatment from health officers of 40 patients (55.6%)

and the number of hypertension patients who

received good treatment from health personnel as

much as 32 patients (44.4%).

3.2 Bivariate Analysis

According to table 2, in the variable distance

proportion in the control group is from 72

respondents, obtained in the participation of

hypertensive patients on Prolanis the highest

proportion of the highest hypertensive patients with

a distance from the Puskesmas, namely As many as

36 patients (75%) and obtained in the participation

of hypertensive patients on Prolanis the highest

proportion in the case of the group is hypertensive

patients with a close home distance from health

centers, namely as many as 15 patients (62.5%). In

the family support variables of 72 respondents on

The participation of hypertensive patients on

Prolanis the highest proportion in the control group

is a hypertensive patient who does not have a family

support well that is as much as 38 patients (79.2%)

And in the participation of hypertensive patients on

Prolanis the highest proportion in the case of the

group is a hypertensive patient who had good family

support as much as 24 patients (100%). In the

gender variable of the 72 respondents, obtained on

the participation of hypertensive patients on Prolanis

the highest proportion in the case of the group is

hypertensive patients with female gender as much as

19 patients (79.2%) And in the participation of

hypertensive patients.

In Prolanis the highest proportion in the control

group is patient hypertension with female gender as

much as 28 patients (58.3%). In a health personnel

variable from 72 respondents, obtained in the entry

of hypertensive patients on Prolanis The highest

proportion of the case is hypertension patients who

have good category for health personnel as much as

24 patients (100%) and obtained in the participation

of hypertensive patients on Prolanis the highest

proportion in the control group is a hypertensive

patient who has bad category for health personnel as

much as 40 patients (83.3%).

3.3 Discussion

3.3.1 Distance

Utilization of healthcare services according to

Kemenkes (2010) can be influenced by several

factors such as the affordability of the location of

services, types, and quality of services available, as

well as the affordability of information. Access to

the health services referred to in this case is the

distance that is far away from the house or place of

residence into the center where the activities of

health services for the community in the region.

According to the (Ministry of National Education

(2005), the distance is the space of the gap (long or

distant) between two objects or places that is the

distance between the house and Puskesmas. The

Table 2: Proportion of hypertension patient participation in Prolanis year 2019.

Variabel Participation Hypertension Patient

Participant Not a participant P-Value OR

N % N % (95% CI)

Distance

Much 9 37,5 36 75 0,005 5,000

Near 15 62,5 12 25 (1,744-

14,338)

Family Support

Good 0 0 38 79,2 0,000 0

Bad 24 100 10 20,8

Gender

Woman 19 79,2 28 58,3 0,137 2,714

Man 5 20,8 20 41,7 (0,868-

8,847)

Health officers

Good

83,3

0,000

Bad 24 100 8 16,7

Factors Associated with the Participation of Hypertensive Patients on Chronic Disease Management Program (Prolanis) in Puskesmas North

Larangan Year 2019

217

results showed patients who visited Puskesmas

where Prolanis activities carried out more that had a

home distance of > 1 km, where the respondents

visited the Puskesmas only to take medication when

they were sick so they To visit when important

circumstances. Access to transportation to reach the

health center of respondents can only use Ojek

transportation because there is no public

transportation from the city through the front or

around the north ban Puskesmas when reached on

foot can take 18-30 minutes. Based on the results of

observation conducted by the researcher's

geographic location of North ban Puskesmas more

leads near the border with district Ciledug. The

location of a beautiful prohibition Kelurahan

different from the 3 other Kelurahan that is built by

the Puskesmas ban North is further away and

integral areas with large highways that make the

public access the city general vehicles 2 times the

vehicle is the first by public transportation in the

second city by using Ojek. This becomes most of the

respondents easy to feel tired, nobody drove and

need to charge a community barrier to come to visit

the Puskesmas North ban.

3.3.2 Family Support

A family is a group that has a very important role in

developing, preventing, adapting and or correcting

health problems found in families. To achieve the

healthy behavior of the community, it must begin in

each family order. A family is a conducive place for

the growth of healthy behavior for children as a

candidate for the community, the promotion is a role

(Notoatmodjo, 2010). Nearly 85% of elderly

activities were conducted at home, in the family. It is

not easy for the elderly to change the way life adapts

to the state of record. They need time to understand,

understand and accept different conditions than ever

before. Positive support from the family is

encouraged by the elderly (Permenkes, 2015).

Family support is essential to the Manifesting the

prosperous and inner elderly. Birth support can be

met or played by anyone but the emotional and inner

needs of the elderly require intensive involvement of

their families and even strengthening

intergenerational relationships (Suardiman, 2011).

Based on the results of interviews conducted with

the charge of Prolanis at Puskesmas Ban North, the

Puskesmas has been doing good cooperation with

the family of participants where the family

participants participated in motivating participants to

follow Prolanis activities such as reminding

schedules, giving direction and understanding and

driving elderly to Puskesmas. However, according to

family respondents do not support to follow Prolanis

by reason only knowing that Prolanis form activities

for the elderly with hypertension and do not know

all information about Prolanis in terms of benefits,

types of activities and free fees in the responsibility

of BPJS. According to respondents who have

entered the age of seniors, their families have their

own busyness such as working, caring for infants,

and having other affairs that make respondents

almost never accompanied by families during

Prolanis activities Last.

3.3.3 Gender

Gender is one of the predisposing factors of the

exact sociodemography factor. According to the

Green theory (2005), It is mentioned that

sociodemographic factors such as social status

(based on income, education, occupation, living

area, and others), age, gender, ethnic groups, family,

and history affect the behavior related to Health.

Gender variables can be used in grouping goals or

individuals for planning purposes. According to

Tawakal and Nadjib (2015), Female-type

respondents have a greater chance of utilizing

chronic disease management programs because

women have higher levels of awareness of their

illness so that Women are more utilizing chronic

disease management programs to prevent the

severity of the disease suffered. Based on the results

of the study, female-type respondents had a greater

chance than men. It is also supported by the age

number of female life expectancy according to the

year 2018 BPS which is 73.19 years different from

the age number of life expectancy of 69.3 years.

Other factors besides genetics and male work and

behavior are more prone to cause death because

women have higher levels of awareness of the

illness so that women will go straight to the ministry

Health programs in Puskesmas to prevent the

severity of the illness.

3.3.4 Health Officer

According to Prolanis Handbook, Home Visit is a

health service activity by visiting the House of

participants to give information/health education and

environment for the participants of Prolanis and his

family (BPJS, 2015). According to LAW RI No. 36

the Year 2014 health workers, health workers should

give motivation in the form of providing important

information about chronic diseases as well as how

complications will occur if not performed

prevention. Prolanis activity itself has been active

ICOH 2019 - 1st International Conference on Health

218

but there are still many patients with hypertension

who do not utilize the program, this is because the

sufferers who are not interested in the activities or

officers who are less socialize activities Prolanis.

Based on interviews with health workers themselves,

they claim that Prolanis is a new program and does

not have a specific SPO regarding the

implementation of the program. This makes the

health worker does not make Prolanis as a priority

program so that there is no special activity to

socialize the benefits of this program to the

community. Officers stated that they will give the

activity if the patient has repeated treatment.

4 CONCLUSION AND ADVICE

4.1 Conclusion

Hypertension patient participation in Prolanis

obtained the proportion of hypertension patients not

participants as much as (66.7%). Distance to the

participation of hypertensive patients on Prolanis

obtained the proportion of hypertensive patients with

a remote home distance of (62.5%). Family support

for the participation of hypertensive patients on

Prolanis obtained the proportion of hypertension

patients who received poor support as much as

(52.8%). Gender to the participation of hypertensive

patients on Prolanis obtained the proportion of

hypertension patients with the gender of women that

is as much (65.3%). Health officers on the

participation of hypertensive patients on Prolanis

obtained the proportion of hypertension patients did

not get the good treatment from the health officers as

much as (55.6%). Based on the results of the study

stated that there is a relationship between distance,

family support and the role of health officers with

the participation of hypertensive patients on

Prolanis.

4.2 Advice

PHC can cooperate with the village for the

implementation of this Prolanis can run in the office

of the village that is built by Puskesmas ban North in

order to be closer to the participant's house and also

can attract more participants. The PHC can also

include families in a program so that families can

better understand health and care about the health of

their family members. Health officers are expected

to expand information about the activities and

benefits of Prolanis activities can be a pamphlet or

animated advertisement that can be displayed on the

TV waiting room Puskesmas so that it can spur

patients motivated to Follow the activities of

Prolanis.

REFERENCES

Bpjs. (2015). The practical Guide to Prolanis (chronic

disease management Program).

Department of National Education. (2005). Great

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Tangerang City Health Office. (2015). Health profile of

Tangerang City. Tangerang.

Green, L. W. (2005). Health Program Planning an

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McGraw-Hill Companies.

Kemenkes. (2010). Optimization of public health services

in the development of health degrees.

Notoatmodjo, S. (2010). Health Behavioral Sciences.

Jakarta: Rhineka Cipta.

Permenkes. (2015). Maintenance of the elderly health

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Suardiman, S. (2011). Elderly psychology. Yogyakarta:

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Factors Associated with the Participation of Hypertensive Patients on Chronic Disease Management Program (Prolanis) in Puskesmas North

Larangan Year 2019

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