The impact of mobile health applications on the outcomes of patients with chronic kidney disease: a systematic review and meta-analysis.

Chronic kidney disease is one of the main causes of mortality worldwide. It affects more than 800 million patients globally, accounting for approximately 10% of the general population. The significant burden of the disease prompts healthcare systems to implement adequate preventive and therapeutic measures. This systematic review and meta-analysis aimed to provide a concise summary of the findings published in the existing body of research about the influence that mobile health technology has on the outcomes of patients with the disease. A comprehensive systematic literature review was conducted from inception until March 1st, 2023. This systematic review and meta-analysis included all clinical trials that compared the efficacy of mobile app-based educational programs to that of more conventional educational treatment for the patients. Eleven papers were included in the current analysis, representing 759 CKD patients. 381 patients were randomly assigned to use the mobile apps, while 378 individuals were assigned to the control group. The mean systolic blood pressure was considerably lower in the mobile app group (MD -4.86; 95%-9.60, -0.13; p=0.04). Meanwhile, the mean level of satisfaction among patients who used the mobile app was considerably greater (MD 0.75; 95% CI 0.03, 1.46; p=0.04). Additionally, the mean self-management scores in the mobile app groups were significantly higher (SMD 0.534; 95% CI 0.201, 0.867; p=0.002). Mobile health applications are potentially valuable interventions for patients. This technology improved the self-management of the disease, reducing the mean levels of systolic blood pressure with a high degree of patient satisfaction.

Impaired health-related quality of life due to elevated risk of developing diabetes: A cross-sectional study in Indonesia.

BACKGROUND: This study investigated the association between elevated risk of developing diabetes and impaired health-related quality of life (HRQoL) in the Indonesian population. METHODS: A cross-sectional study was conducted on 1,336 Indonesians from the general population who had no previous diagnosis of diabetes. Utility score to represent HRQoL was measured using the EuroQol 5-dimension, while the risk for developing diabetes was determined using the Finnish Diabetes Risk Score (FINDRISC) instrument. All participants underwent a blood glucose test after fasting for 8 hours. The association between FINDRISC score and HRQoL adjusted for covariates was analysed using multivariate Tobit regression models. Minimal clinically important differences were used to facilitate interpretation of minimal changes in utility score that could be observed. RESULTS: The median (interquartile range) of the overall FINDRISC score was 6 (7), while the mean (95% confidence intervals) of the EQ-5D utility score was 0.93 (0.93-0.94). Once adjusted for clinical parameters and socio-demographic characteristics, participants with a higher FINDRISC score showed a significantly lower HRQoL. No significant association was detected between fasting blood glucose level categories and HRQoL. A difference of 4-5 points in the FINDRISC score was considered to reflect meaningful change in HRQoL in clinical practice. CONCLUSION: An elevated risk of developing diabetes is associated with a lower HRQoL. Therefore, attention should be paid not only to patients who have already been diagnosed with diabetes, but also to members of the general population who demonstrate an elevated risk of developing diabetes. This approach will assist in preventing the onset of diabetes and any further deterioration of HRQoL in this segment of the Indonesian population.

Role and challenges of community pharmacists in managing mental health care in Indonesia: A mix-method study.

This research aims to explore roles and challenges faced by Indonesian community pharmacists in mental healthcare management. A sequential mixed method study was conducted. This study found that drug counselling as a pharmaceutical care service that is often given to patients with mental disorder. Nonetheless, inadequate training and concern of psychotropic drug abused were identified as a major barrier hindering effective service delivery. These finding suggests that there is a need for pharmacists to gain additional education and training in mental health, as well as implement a system that integrates patient medical records across all healthcare settings.

Factors Associated with Willingness to Pay for Cost-Sharing under Universal Health Coverage Scheme in Yogyakarta, Indonesia: A Cross-Sectional Survey.

BACKGROUND: National Health Insurance (NHI) in Indonesia requires an appropriate cost-sharing policy, particularly for diseases that require the largest financing. This study examined factors that influence willingness to pay (WTP) for cost-sharing under the universal health coverage scheme among patients with catastrophic illnesses in Yogyakarta, Indonesia. METHODS: This was a cross-sectional study using structured questionnaires through direct interviews. The factors related to the WTP for cost-sharing under the NHI scheme in Indonesia were identified by a bivariable logistic regression analysis. RESULTS: Two out of every five (41.2%) participants had willingness to pay for cost-sharing. Sex [AOR = 0.69 (0.51, 0.92)], education [AOR = 1.54 (0.67, 3.55)], family size [AOR = 1.71 (1.07, 2.73)], occupation [AOR = 1.35 (0.88, 2.07)], individual income [AOR = 1.50 (0.87, 2.61)], household income [AOR = 1.47 (0.90, 2.39)], place of treatment [AOR = 2.54 (1.44, 4.45)], a health insurance plan [AOR = 1.22 (0.87, 1.71)], and whether someone receives an inpatient or outpatient service [AOR = 0.23 (0.10, 0.51)] were found to affect the WTP for a cost-sharing scheme with p < 0.05. CONCLUSION: Healthcare (place of treatment, health insurance plan, and whether someone receives an inpatient or outpatient service) and individual socioeconomic (sex, educational, family size, occupational, income) factors were significantly related to the WTP for cost-sharing.

The efficient use of smartphone apps to improve the level of asthma knowledge.

Patient education is one of the important aspects of improving knowledge and quality of asthma control. In this digital era, it can be made with the support of an app - or known as mHealth. Unfortunately, implementing applications for patient education is relatively new among asthmatic patients in Indonesia. This study aimed to determine the efficacy of the educational content of the AsmaDroid® app on the levels of asthma knowledge among asthmatic patients. This study was a randomized controlled trial carried out from December 2019 to March 2020 in the Special Region of Yogyakarta, Indonesia. A quota sampling was employed, resulting in 140 study participants being categorized into control and treatment groups. Before and after the 4-week treatment period, all participants were asked to complete a pre-test and post-test of the Asthma General Knowledge Questionnaire for Adults (AGKQA) questionnaire. All the scores were then compared to determine the efficacy of educational content on the levels of asthma knowledge. The results of descriptive statistics reported that the pretest scores of AGKQA from the control group (minimum, maximum, and mean) were 9, 25, and 19.04±2.56, respectively, and post-test scores were 10, 27, and 18.79±3.59 (p=0.47). Meanwhile, in the treatment group, these were 13, 25, and 19.11±2.87, while post-test scores were 16, 31, 23.6±3.95 (p=0.01). Additionally, there was a difference between the post-test scores of the control and treatment groups, namely 4.81 (p=0.01). The educational content of the app significantly improved the levels of asthma knowledge.

Translation and performance of the Finnish Diabetes Risk Score for detecting undiagnosed diabetes and dysglycaemia in the Indonesian population.

A diabetes risk score cannot directly be translated and applied in different populations, and its performance should be evaluated in the target population. This study aimed to translate the Finnish Diabetes Risk Score (FINDRISC) instrument and compare its performance with the modified version for detecting undiagnosed type 2 diabetes mellitus (T2DM) and dysglycaemia among the Indonesian adult population. Forward and backward translations were performed and followed by cultural adaptation. In total, 1,403 participants were recruited. The FINDRISC-Bahasa Indonesia (FINDRISC-BI) was scored according to the original FINDRISC instrument, while a Modified FINDRISC-BI was analyzed using a specific body mass index and waist circumference classification for Indonesians. The area under the receiver operating characteristic curve, sensitivity, specificity, and the optimal cut-offs of both instruments were estimated. The area under the receiver operating characteristic curve for detecting undiagnosed T2DM was 0.73 (0.67-0.78) for the FINDRISC-BI with an optimal cut-off score of ≥9 (sensitivity = 63.0%; specificity = 67.3%) and 0.72 (0.67-0.78) for the Modified FINDRISC-BI with an optimal cut-off score of ≥11 (sensitivity = 59.8%; specificity = 74.9%). The area under the receiver operating characteristic curve for detecting dysglycaemia was 0.72 (0.69-0.75) for the FINDRISC-BI instrument with an optimal cut-off score of ≥8 (sensitivity = 66.4%; specificity = 67.0%), and 0.72 (0.69-0.75) for the Modified FINDRISC-BI instrument with an optimal cut-off score ≥9 (sensitivity = 63.8%; specificity = 67.6%). The Indonesian version of the FINDRISC instrument has acceptable diagnostic accuracy for screening people with undiagnosed T2DM or dysglycaemia in Indonesia. Modifying the body mass index and waist circumference classifications in the Modified FINDRISC-BI results in a similar diagnostic accuracy; however, the Modified FINDRISC-BI has a higher optimal cut-off point than the FINDRISC-BI. People with an above optimal cut-off score are suggested to take a further blood glucose test.

Asthma self-management app for Indonesian asthmatics: A patient-centered design.

BACKGROUND: A proper education on asthma self-management helps asthmatics to improve health outcomes, such as better asthma knowledge and self-efficacy, increased frequency of symptom-free days, reduced unscheduled healthcare visits and absence from school or work days. In this modern digital era, the use of smartphone apps is increasing rapidly and reaching almost all aspects of our life, including health promotion and patient education on asthma self-management. Studies found that the apps make it easier for asthmatics to receive the education. OBJECTIVE: The aim of this study was to describe the systematic design, development, and implementation process of a Google Android OS asthma self-management smartphone app according to the Patient-Centered Design approach. METHODS: The design, development, and implementation process of the app adopted the Patient-Centered Design approach, including: (1) user needs assessment, (2) design of the app prototype, (3) development of the app prototype, (4) usability test, and (5) product launch. For better results, the study involved end-users (asthmatics and health professionals) during the development of the app. RESULTS: The study resulted in a Google Android OS asthma self-management app, namely AsmaDroid. The app was developed to feature 8 contents and functions, namely: asthma education, a list of asthma medications, asthma diary or journal, peak flow record, asthma control test, asthma action plan, a chat box, and a map of nearest local hospitals or health centers. It was also found that the average success rate of the app was as follow: "completed with ease" was 88.15%, "completed with difficulty" was 7.78%, and "failed to complete" was 4.07%. It means that the success rate of app was "very high". CONCLUSION: The implementation of Patient-Centered Design approach has been successfully completed for the development of AsmaDroid. However, additional research into the use of the app in the actual clinical world is highly required to demonstrate its effectiveness in improving the level of asthma knowledge, the quality of asthma control, and other health outcomes.

Developing Consensus Indicators to Assess Pharmacy Service Quality at Primary Health Centres in Yogyakarta, Indonesia.

BACKGROUND: There have been no existing performance indicators to measure the overall quality of pharmacy services, including the aspects of drug management and clinical pharmacy services, at primary health centres in Indonesia. This study aimed to obtain these indicators based on a consensus of experts. METHODS: The modified Delphi method was used to obtain the consensus. The initial indicators, based on a literature review, were evaluated and assessed by members of the expert panel through three rounds of repetition until the consensus was reached. The expert panel members were selected based on their knowledge of or expertise in pharmacy service performance and geographical considerations. Analysis of the expert panel consensus level was determined by calculating the mean and interquartile range. RESULTS: Fifteen expert panel members started the first round (93.7% of the 16 targets) with 12 of them (75%) completing the third round of the modified Delphi method. Three expert panel members were representatives of the Regency Health Office, and the others were pharmacist practitioners at primary health centres from three different regencies. The consensus results were 26 indicators of drug management, 19 indicators of clinical pharmacy services, and two indicators of overall pharmacy performance. CONCLUSION: The consensus indicators for measuring drug management, clinical pharmacy services, and overall pharmacy performance can be used as a reference and standard to measure the quality of pharmacy services at primary health centres. Therefore, the measurement results are more relevant if compared between one and other studies.

Comparison of Real Cost Versus the Indonesian Case Base Groups (INA-CBGs) Tariff Rates Among Patients of High- Incidence Cancers Under the National Health Insurance Scheme

Background: The national health insurance of Indonesia has implemented the Indonesian Case Base Groups (INA-CBGs) tariff rates for healthcare payment. However, there is still problem of difference between the real cost of healthcare and the INA-CBGs tariff rates. This study aimed to evaluate the real cost of healthcare in comparison with the INA-CBG's tariff rates and to analyze factors associating with the real cost. The study focus on healthcare cost of non-chemotherapy expenditure among patients of high-incidence cancers having chemotherapy covered by the national health insurance. Methods: The study was conducted from the perspective of healthcare provider. Costs data was obtained from hospital billing of Sanglah hospital, a referral hospital in Bali Provincein the period of January ­ July 2014. The data involved 383, 161, and 152 of in-patient breast cancer cases, cervical cancer cases, and nasopharyngeal cancer cases, respectively. Descriptive statistic was used to analyze patients characteristics, one sample t-test was used to analyze the mean difference of healthcare cost based on real cost and INA-CBG's tariff rates, and finally, bivariate analysis was used to examine relationship between patients' characteristics and the real cost. Results: The study shows there were significant differences of non-chemotherapy expenditures based on the real cost and INA-CBG's tariff rates, in which the costs were lower for the real cost. Factors which significantly associated with the real cost were number of procedure, type of hospitalized room, and length of stay. Conclusions: The study supports the necessary of evaluation of the INA-CBG's tariff rates to adjust to the real healthcare expenditure. On the other hand, the hospital needs to evaluate the service quality of patient treatment by optimizing budget allocated by the health insurance.

National Burden of Cancers Attributable to Secondhand Smoking in Indonesia

Background: The high prevalence of smokers in Indonesia is also increase the number of people as secondhand smokers. Secondhand smoke causes many health problems, including cancer. Thus, Indonesia will bear large number cancer burden of disease, but research on cancer related to secondhand smoking in Indonesia still does not exist. Therefore, this study aimed to determine the number of secondhand smoke attributable fractions (SAFs) of six cancers (lung, bladder, colorectal, stomach, pancreas and larynx) and burden of cancer caused by secondhand smoking in Indonesia using Disability Adjusted Life Years (DALYs) indicator. Material and Methods: This research was using descriptive epidemiological prevalence-based research design, with cancers prevalence data gained from Indonesian health assurance system database in 2016. The SAFs is calculated by combining both data of secondhand smoking prevalence and relative risk and the DALY indicator is calculated as the sum of years of life lost due to premature mortality (YLL) and the equivalent healthy years lost due to disability (YLD). Results: Based on SAFs proportion, the highest SAFs among men were in pancreas cancer (80.20%), stomach cancer (79.54%) and laryngeal cancer (69.61%), whereas in women, pancreas cancer (78.95%), stomach cancer (78.26%) and bladder cancer (63.30%). Meanwhile, burden priorities for Indonesian men and woman were lung cancer (110,491), colorectal (68,131), and bladder cancer (39,140). Conclusions: In total, DALYs 6 cancer diseases due to secondhand smoke analyzed in this study were 283,360 DALYs. Thus, the results of the research can be used as a basis for further policies making on national cigarette prevention and control in Indonesia.

Knowledge, Perception, and Acceptance of HPV Vaccination and Screening for Cervical Cancer among Women in Yogyakarta Province, Indonesia

Objective: To determine knowledge, perception, and acceptance related to cervical cancer, HPV vaccination and screening for cervical cancer among Indonesian women, particularly in Yogyakarta province. Methods: A convenience sample of 392 women consists of 192 young women, 100 mothers of girls aged 12 ­ 15 years, and 100 adult women in Yogyakarta province, Indonesia was participated in this study. A self-administered paper-based questionnaire was used to determine demographics characteristics of respondents, as well as their knowledge ­ perception ­ acceptance related to cervical cancer, HPV vaccination, and screening for cervical cancer. Data collection were conducted during December 2013 to March 2014. Descriptive statistics was used to analyze description of demographics characteristics, knowledge, perception, and acceptance; while crosstab analysis using Chi-Square was used to analyze the relationship between demographics characteristics versus knowledge, perception, and acceptance. Results: This study found that knowledge and perception regarding cervical cancer, HPV vaccination, and screening for cervical cancer among women in Indonesia, particularly in Yogyakarta Province were still insufficient, however the acceptance was good. Among female young women, 64% had good knowledge, 62% had positive perception of cervical cancer and HPV vaccination, and 92% tended to accept HPV vaccination. Among mothers of girls aged 12 ­ 15 years, 44% had good knowledge, 46% had positive perception of cervical cancer and HPV vaccination, and 91% tended to accept HPV vaccination for their daughters. Among adult women, 68% had good knowledge, 57% had positive perception of cervical cancer and screening for cervical cancer, and 90% tended to accept cervical cancer screening. In general, demographics characteristics of having experience and exposure to information had significant relationship with knowledge, perception, and acceptance of HPV vaccination and screening for cervical cancer. Conclusions: Either knowledge or perception of cervical cancer and strategies toward it among Indonesian women particularly in Yogyakarta province were still unsatisfied. Efforts should be improved for supporting cervical cancer prevention and control in Indonesia through such as education on cervical cancer disease and strategies toward it.