Nindya Rahmanida, Adang Bachtiar | http://devotion.greenvest.co.id
707
INTERPROFESSIONAL COLLABORATION ON NON-
COMMUNICABLE DISEASE PROGRAMS (NDP) IN
PRIMARY HEALTH SERVICES
Nindya Rahmanida
1
, Adang Bachtiar
2
Public Health Science Study Program, Faculty of Public Health,
University of Indonesia, Indonesia
12
1
[email protected]m,
2
[email protected]
KEYWORDS
Interprofessional
Collaboration, Non-
Communicable Diseases
Program, Primary Health
Care
ARTICLE INFO
Accepted:
May 26
th
2022
Revised:
June 8
th
2022
Approved:
June 14
th
2022
ABSTRACT
This study aims to discuss interprofessional collaboration in the Non-
Communicable Disease program and the factors that influence interprofessional
collaboration in the program. The research method used in this study is a
qualitative descriptive method. The type of data used in this research is qualitative
data, which is divided into primary data and secondary data. The results showed
that interprofessional collaboration is a strategy to achieve the desired quality of
results effectively and efficiently in health services. Communication in
collaboration is an important element to improve service quality and patient
safety. A non-communicable disease (NCD) is a disease or medical condition that
cannot be passed from one individual to another. Most NCDs occur in low- and
middle-income countries. Based on WHO data, NDP was the cause of 68% of
deaths in the world in 2012. Interprofessional collaboration at Posbindu NDP
Puskesmas is carried out by the PNDP Program Holder. Other Puskesmas officers
are only involved in determining the schedule for implementing activities so that
they do not conflict with the schedule of other Puskesmas activities. Planning is
done in writing with a planning format from the Treasurer of the Health Center.
However, this plan is only related to the development and service activities of the
NDP Posbindu. The factors that influence interprofessional cooperation in the
NDP program are cooperation, communication, ethics, and the role of the
profession.
INTRODUCTION
Currently, one of the health problems is the shift from infectious diseases to non-
communicable diseases (NDP). This is supported by reports from the NCD as many as 60
non-communicable diseases are the cause of death for all ages, 4% and 29% died before the
age of 70% in developing countries as well as developed countries. Based on the Ministry of
Health in 2013 Indonesia was at 71% for non-communicable diseases such as stroke as much
as 12.1 per 1000, injury 8.2%, diabetes mellitus 6.9%, obstructive lung 3.7%, coronary heart
1.5% , cancer 1.4% per 1000, heart failure 0.3%, and kidney failure 0.2% cause an increase in
death due to NDP (Adih, Selik, Hall, Babu, & Song, 2016).
The morbidity, mortality and NDP aspects are the background for the Indonesian
Government in establishing the Integrated Non-Communicable Disease Development Post
(Posbindu NDP) in accordance with WHO directives in 2010, Minister of Health Regulation
No. 71 of 2015 and Law of the Republic of Indonesia No. 36 of 2009 concerning Health
Article 158 paragraph 1 in tackling non-communicable diseases (Surya, Abdi, Unipdu,
STIKES, & Dharma, n.d.).
Based on the theory of Lawrence Green and Andersen, the low rate of utilization of
Posbindu by the community is due to the influence of three behavioral factors, namely
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predisposing factors such as education and work (Sukismanto, Hartono, Sumardiyono, &
Andayani, 2021). According to Fuadah and Rahayu in their research on the Utilization of
NDP Posbindu in patients with hypertension, it was stated that the factor causing the absence
of hypertension sufferers to the NDP Posbindu was work, besides the low level of education
made the sufferer not understand about NDP Posbindu (HIJAH, Fuadah, & Safitri, 2020).
The reinforcing factor is influenced by family support, health worker support, posbindu
cadre support, peer support. According to Nasution, et al, the support of health workers,
namely providing information needed by the community also motivates NDP targets to lead a
healthy life (Pardoel et al., 2021). Meanwhile, according to Wahyuni, peer support can be
seen from the invitation of neighbors or fellow elderly who invite respondents to visit
Posbindu (Zulkarnain, 2019).
Health is one of the human rights embodied in primary health care, one of which is the
puskesmas. The Puskesmas is a form of multidisciplinary service which is carried out by
various fields of health professionals which can potentially lead to interprofessional conflict
and slower service. To realize good quality and optimal health services, it is necessary to
implement interprofessional collaboration practices among health workers (Wibawa &
Sutrimo, 2021). According to the World Heath Organization, the practice of interprofessional
collaboration occurs when health workers from various professional backgrounds work
together with patients, patients' families, nurses and the community in providing the best
quality health services across the entire range of care.
The practice of collaboration has not been optimally carried out due to various obstacles
in its implementation, these obstacles are influenced by an imbalance of authority, limited
understanding of the role of each profession in a team, responsibilities and friction between
professions when providing care to patients. In addition, there is an assumption that doctors
are leaders as well as decision makers, while other medical personnel are only implementers,
making the implementation of interprofessional collaboration practices still limited. Nguyen
mentioned that doctors have doubts about the competence of other health workers in
providing patient care, which raises a doctor's concern regarding the issue of patient
confidentiality when sharing information together (Nguyen, 2008).
This perception indirectly limits communication between professions and hinders the
practice of collaboration. Differences in perceptions related to perceived barriers when
practicing interprofessional collaboration, it is known that nurses feel these obstacles more
because of hierarchical and socio-cultural constraints from the dominance of the authority of
one of the professions in the health team (Yusra, Findyartini, & Soemantri, 2019). Research
on non-communicable disease programs has also been carried out by (Puoane, Tsolekile,
Sanders, & Parker, 2008), (Islam et al., 2014), (Pekka, Pirjo, & Ulla, 2002), (Nethan, Sinha,
& Mehrotra, 2017), (Habib & Saha, 2010).
These obstacles are also supported by the lack of good communication between health
workers. Communication is one of the competencies in carrying out interprofessional
collaboration practices, where health workers are required to be able to communicate with
patients, patient families, communities and other health professionals in a responsive and
responsible manner. Effective communication is very influential in the practice of
interprofessional collaboration to provide a positive side and benefits in patient care,
including increasing patient satisfaction in treatment outcomes, minimizing the occurrence of
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medication errors, reducing mortality and complications, so as to reduce the cost of care
issued by patients (Gucciardi, Espin, Morganti, & Dorado, 2016). In addition, the use of staff
becomes more efficient and makes the work environment more comfortable uh comfortable.
This is interpreted as an effort that can improve the quality of services provided and become
one of the effective strategies in health services. Based on the facts described above, this
study aims to determine interprofessional collaboration in primary health care.
METHOD RESEARCH
The research method used in this study is a qualitative descriptive method. The type of
data used in this study is qualitative data, which is categorized into two types, namely
primary data and secondary data. Sources of data obtained through library research
techniques (library study) which refers to sources available both online and offline such as:
scientific journals, books and news sourced from trusted sources. These sources are collected
based on discussion and linked from one information to another. Data collection techniques
used in this study were observation, interviews and research. This data is analyzed and then
conclusions are drawn.
RESULT AND DISCUSSION
1. Interprofessional Collaboration
The ability to work with professionals from other disciplines to provide collaborative,
patient-centred care is considered an essential element of professional practice that requires a
specific set of competencies. The American Nurses Association describes effective
communication as a standard of professional nursing practice. Professional competence in
nursing practice is not only psychomotor and clinical diagnostic skills, but also abilities in
interpersonal and communication skills. Registered nurses are expected to communicate in a
variety of formats and in all areas of practice (Asyifa Permana Sari Tarigan, n.d.).
Collaboration between healthcare providers is necessary in any healthcare setting, as no
single profession can meet the needs of all patients. As a result, good service quality depends
on professionals working together in interprofessional teams. Effective communication
between health professionals is also important to provide efficient and patient-oriented
comprehensive treatment. In addition, there is increasing evidence showing that poor
communication between health professionals is detrimental to patients (Meijboom,
Schmidt‐Bakx, & Westert, 2011). Another important communication skill mentioned is the
ability to adapt the language to the target client. While the role of understanding and effective
communication clearly emerges as a dominant competency for effective collaborative
practice that will improve quality (Suter et al., 2009).
Effective communication, responsibility and mutual respect for nurses and doctors are
able to give the best contribution in cooperative relationships. Effective communication
between nurses and doctors is able to foster trust between the professions (Adih et al., 2016).
For this reason, it is necessary to have effective communication in interprofessional
collaboration practices to improve the quality of service and patient safety.
2. NDP (Non-Communicable Diseases) Program
Non-Communicable Diseases (NCDs) are diseases or medical conditions that cannot be
passed from one individual to another. The majority of NCDs occur in low and middle
income countries. Based on WHO data, NDP is the cause of 68% of deaths in the world in
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2012. It is predicted that NDP will continue to increase. NDP is a challenge in the world of
health (Limato et al., 2022).
The NDP control program globally refers to the Global Action Plan for the Prevention
and Control of Noncommunicable Disease from the WHO. Meanwhile, for reference in the
implementation process, WHO has designed the Package of Essential Noncommunicable
(PEN) Disease Interventions for Primary Health Care in Low-Resource Settings, where PEN
relies on first-level health services and takes into account the fact that the majority of NCDs
occur in low-income countries and who have their respective limitations (WHO, 2012)
In Indonesia itself, the Ministry of Health of the Republic of Indonesia has designed a
"Technical Guide to the Implementation of Non-Communicable Disease Control in Health
Centers", which is designed to follow the directions of the WHO guidelines. Primary health
services play an important role in strengthening efforts to control NCDs comprehensively,
covering preventive, promotive, curative and rehabilitative aspects. Government health
programs such as the Chronic Disease Management Program (Prolanis) organized by the
Health Insurance Administration Agency (BPJS). Prolanis is intended for BPJS participants,
aiming to treat chronic diseases and improve the quality of life of chronic disease patients. In
addition, the puskesmas is also assisted by other health facilities such as the NDP Integrated
Development Post (Posbindu), which plays a role in early detection and monitoring of NDP,
along with its risk factors.
3. Interprofessional Collaboration on NDP (Non-Communicable Diseases) Programs in
Primary Health Services
Primary health care is a very important first step in improving public health. By providing
basic health services quickly and accurately, it is hoped that the community can avoid non-
communicable diseases through NDP which is held at the puskesmas. Puskesmas is a
community health center that has a function as a center for driving health-oriented
development, a community empowerment center and a strata health service center which
includes individual and community health services.
Interprofessional Collaboration at Posbindu NDP Puskesmas is carried out by the PNDP
Program Holder. Other Puskesmas officers are only involved in determining the schedule for
implementing activities so that they do not conflict with the schedule of other Puskesmas
activities. Planning is done in writing with a planning format from the Treasurer of the Health
Center. However, this plan is only related to the development activities and services of NDP
Posbindu. Meanwhile, the overall NDP Posbindu program planning has not been done in
writing. There are no special documents for k Posbindu NDP program planning but made into
one file in the Community Health Center Activity Implementation Plan (RPK). The RPK is
made at the end of every year around October to November and then submitted to the Pati
District Health Office to be checked and approved. The purpose of holding NDP Posbindu is
to increase community participation in preventing and early detection of NDP risk factors.
4. Factors Affecting Interprofessional Collaboration in the NDP (Non-Communicable
Diseases) program
The factors that influence interprofessional collaboration in the NDP program are;
a. Cooperation
Basically, interprofessional cooperation is an activity based on a number of
main dimensions so that it can run well. Cooperation (teamwork) involving two or
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more professions has a great complexity in its application. The key dimensions of
inter-professional collaboration include:
1) Set clear team goals. This is highly expected because it aims to prevent the
occurrence of multi-perceptions, overlapping understandings, and achievement
goals.
2) Have a common team characteristic or identity. This context is one of the key
dimensions that shows that the team shows an identity from the amalgamation of
various professions. Team activities and demonstrated team performance are a
hallmark of the team and not a characteristic of a profession.
3) Have a shared team commitment. Commitment is a realization of the team's plan
to achieve group goals. In inter-professional collaboration, the commitment that is
built is the result of a group agreement aimed at achieving group goals by taking
into account the roles and responsibilities of the profession.
4) Clear roles in each profession. It cannot be denied or avoided that uniting various
professions, each of which has different duties and responsibilities, will result in
overlapping roles and duties of each profession. By means of an agreement within
the group, it is necessary to define the roles and duties of each profession which
are clear in this interprofessional collaboration.
5) The concept of interdependence (interdependence). Interdependence in the context
of interprofessional cooperation is a strategy to reduce or eliminate dominance
between professions. This concept was developed to show that in solving a health
problem or handling a patient, an attitude of interdependence is needed between
each other so that the medical decisions taken are an agreement aimed at
producing maximum patient outcomes or healing.
b. Communication
The effectiveness of interprofessional communication is influenced by:
1) Perception is a personal view of things that have happened. Perception is formed
on what is expected and experience. Differences in perceptions between
interacting professions will cause problems in communication.
2) A comfortable environment makes a person tend to be able to communicate well.
Noise and a person's lack of freedom can create confusion, tension or discomfort.
3) Knowledge is an insight into something. Interprofessional communication can be
difficult when the interlocutors have different levels of knowledge. This situation
will lead to negative feedback, namely the message becomes unclear if the words
used are not known by the listener.
4) Efforts to improve interprofessional communication skills. IPE is an important
step to take because through IPE, students can practice interprofessional
communication skills in situations that do not endanger the patient but still reflect
situations that are close to real situations. The need for learning strategies to
improve interprofessional communication is growing. Therefore, educators are
expected to be able to develop learning methods and strategies that combine
communication skills and patient culture as well as technical skills from the
academic stage (Parrish & Linder-VanBerschot, 2010). One of the IPE models
that can be applied is IPE simulation. Through the IPE simulation, students can
develop knowledge and skills in communicating with other professions.
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c. Ethics
The Basic Principles of Professional Ethics are the ones that underlie the
implementation of Professional Ethics, namely:
1) Responsibility Principle
Each professional must be responsible for the implementation of the work and
also for the results. In addition, professionals are also responsible for the impact
that may occur from their profession on the lives of other people or the general
public.
2) The Principle of Justice
Each professional is required to prioritize fairness in carrying out his work. In this
case, justice must be given to anyone who has the right.
3) Each professional has the authority and freedom in carrying out work in
accordance with his profession. This means that a professional has the right to be
able to do or not do according to the code of ethics.
4) Principle of Moral Integrity
This moral integrity is a quality of honesty and moral principles in a person who is
carried out consistently in carrying out his profession. This means that a
professional must have a personal commitment to be able to maintain the interests
of the profession, himself, and also the community.
Three principles that must be adhered to in professional ethics, including:
1) Responsibility, The meaning of responsibility here is responsibility for
implementation (by function) as well as responsibility for impact (by profession).
2) Freedom, The purpose of freedom here is to be able to develop the profession
within the limits of the rules that apply within a profession.
3) Justice, The principle of justice wants to build an impartial condition that allows
all interested parties to ride.
d. Professional role
1) Communicate clearly professional roles and responsibilities to patients, families
and other professionals
2) Recognize the limitations of the profession in skills, knowledge and abilities
3) Involve diverse healthcare professions in complementing professional expertise,
as well as related resources, to develop strategies to meet patient needs
4) Explain the roles and responsibilities of other service providers and how teams
work together to deliver services.
5) Using the scope of knowledge, skills and abilities available from the health
profession to provide services that are safe, timely, efficient, effective and fair.
6) Communicate with team members to clarify the responsibilities of each member
in implementing components of the service plan or health intervention
7) Establish dependency relationships with other professions to improve patient care
and further learning
8) Engage in continuous professional and interprofessional development to improve
team performance
9) Use the unique and complementary abilities of all team members to optimize
patient care
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CONCLUSION
Interprofessional collaboration is a strategy to achieve the desired quality of results
effectively and efficiently in health services. Communication in collaboration is an important
element to improve the quality of care and patient safety. A non-communicable disease
(NCD) is a disease or medical condition that cannot be passed from one individual to another.
The majority of NCDs occur in low and middle income countries. Based on WHO data, NDP
is the cause of 68% of deaths in the world in 2012.
Interprofessional Collaboration at Posbindu NDP Puskesmas itself is carried out by the
PNDP Program Holder. Other Puskesmas officers are only involved in determining the
schedule for implementing activities so that they do not conflict with the schedule of other
Puskesmas activities. Planning is done in writing with a planning format from the Treasurer
of the Health Center. However, this plan is only related to the development activities and
services of NDP Posbindu. The factors that influence interprofessional collaboration in the
NDP program are cooperation, communication, ethics, and the role of the profession.
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