Among 31,819 hypertensive patients, those with comorbidities had 2.45-fold higher visit rates; chronic disease program enrolment increased visits by 54% in Indonesian Puskesmas.
Chronic cardiovascular disease care utilization in Indonesian primary care is significantly driven by patient comorbidities, chronic disease program enrollment, and facility characteristics.
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Abstract Background Cardiovascular diseases (CVDs) remain a major global health challenge, especially in low- and middle-income countries such as Indonesia. Primary health centres (Puskesmas) in Indonesia serve as the frontline providers to deliver preventive and curative services for CVDs, particularly hypertension. However, there is limited evidence on the extent of chronic CVDs care service utilisation in Puskesmas. Purpose To investigate factors associated with chronic CVDs care service utilisation in Puskesmas by examining the visit frequency among hypertensive patients. Methods Data was collected from the national health insurance electronic medical records (P-Care) from 43 Puskesmas in Indonesia between January and December 2023. Poisson regression was utilised to identify factors associated with visit frequency, including patient characteristics (gender, chronic disease program enrollment, comorbidities, complications) and Puskesmas characteristics (facility type, accreditation, region). Results Among 321,217 patients in Puskesmas, 31,819 were identified with a hypertension diagnosis. However, only 26,992 of them had multiple visits to Puskesmas with a median annual visit length of 35.6 days. Patients with multiple comorbidities (diabetes mellitus and hypercholesterolemia) and complications (heart failure, stroke, coronary artery disease, hypertensive heart disease) had higher visit frequencies compared to those without (IRR: 2.45, 95% CI: 2.36–2.55, p0.001) and (IRR: 1.28, 95% CI: 1.27–1.29, p0.001), respectively. Enrolment in a chronic disease program (PRB/PROLANIS) had increased visit rates significantly (IRR: 1.54, 95% CI: 1.53-1.55, p0.001). Additionally, facility-related factors such as Puskesmas type, accreditation level, and geographical location were found to influence visit frequency. Puskesmas with greater financial and operational flexibility (BLUD), higher accreditation levels, and those located in Java Island were associated with higher incidence rates of multiple visits. Conclusion Chronic CVDs care service utilisation in Puskesmas was influenced by both patient-related and healthcare facility-related factors. Addressing these factors, such as expanding chronic disease program enrolment, improve Puskesmas’ accreditation, and reduce regional disparities are crucial to improve and strengthen Puskesmas capacity in delivering CVDs-related healthcare services.Figure 1 Figure 2
Qorina et al. (Sat,) reported a other. Among 31,819 hypertensive patients, those with comorbidities had 2.45-fold higher visit rates; chronic disease program enrolment increased visits by 54% in Indonesian Puskesmas.