Adherence to Medical Treatment in Elderly Patients with Coronary Artery Disease in the Settings of Primary Outpatient Care

Aim. To study medication adherence in elderly patients with coronary artery disease (CAD) in primary care practice.Material and methods. The study conducted in out-patient clinic of Moscow city. 293 elderly (≥65 years) patients with established CAD included. The following patient data obtained via electronic medical record system: demography, medical history, modifiable risk factors and prescribed pharmacotherapy. Level of medication adherence measured by Morisky scale (MMAS-8) via telephone survey.Results. According to Morisky scale high adherence was identified in 146 (49.8%) elderly patients, moderate adherence – in 99 (33.8%) patients, low adherence – in 48 (16.4%) patients. Analysis of specific questions of the scale done in non-adherent patients revealed signs of unintentional non-adherence due to forgetfulness (45.9%) and signs of intentional non-adherence due to patients feeling worse (35.8%) or better (28.4%). By means of dichotomic interpretation of Morisky scale results the population under research was divided into two groups: 147 (50.2%) non-adherent patients and 146 (49.8%) – totally adherent patients. These groups were comparable in terms of sex (female 71.2 vs 68.0%; p>0.05) and age (median 73.5 vs 73.0 years; p>0.05) distribution, and medical history: myocardial infarction (39.0% vs 38.8%), atrial fibrillation (37.0 and 41.5%), chronic heart failure (90.4% vs 91.2%), diabetes (26.7% vs 24.5%). There were fewer smokers in adherent group (0.7% vs 6.5%; p<0.05). As primary antianginal pharmacotherapy adherent and non-adherent patients were equally prescribed beta-blockers (75.3% vs 75.5%; p>0.05). Drugs that improve prognosis were also prescribed comparably: antiplatelets (66.4% vs 61.9%; p>0.05), anticoagulants (36.3% vs 44.9%; p>0.05), statins (82.2% vs 79.6%; p>0.05), renin-angiotensin system inhibitors (89.0 and 87.8%; p>0.05). Adherent patients had lower mean values of lipids: total cholesterol (4.7±1.2 vs 5.2±1.4 mmol/l; p<0.05) and low density cholesterol (2.4±0.9 vs 2.8±1.2 mmol/l; p<0.05). Non-adherent elderly patients made more visits to general practitioner (median 5 vs 3 visits; p<0.05). Share of patients receiving drugs within supplementary pharmaceutical provision program was comparable in both groups (53.7% vs 50.7%; p>0.05).Conclusion. Half of elderly patients with CAD are non-adherent to treatment in primary care setting. Medical history and structure of pharmacotherapy do not influence level of adherence in this population. Among adherent patients fewer individuals smoke and mean values of lipids are lower. Non-adherent elderly patients cause higher load on general practitioner, supplementary pharmaceutical provision program provided no better adherence in the population under research.

the Strategi Identifikasi Masyarakat Penerima Rumah Subsidi Kota Makassar

The subsidized housing provision program according to the government's target in providing livable houses for Low-Income Communities (MBR) needs to be implemented to solve the problem of housing needs in Makassar City. Implementation of housing provision based on target as recipients of subsidized assistance according to the MBR criteria and the problem of the Backlog. In addition, the low-income community will face strict banking regulations regarding the credit ratio limit of their incomes which have an inappropriate impact as a subsidized KPR recipients. The purpose of this study is to identify the criteria for low-income communities as recipients of subsidized housing and the terms of the credit ratio in terms of their income. The method used was to collect data at the research location using a sample based on several categories as recipients of subsidized houses, namely 1) unlivable housing condition, 2) backlog categories, home ownership and home occupancy, and 3) economic conditions. The results of this study will identify 3 (three) criteria for low-income communities as beneficiaries of subsidized housing, so that the program can be implemented according to the right target in reducing the problems of housing shortages and the economy of the low-income community.

Penilaian Manfaat Nilai Ekonomi Program Penyediaan Air Minum dan Sanitasi Berbasis Masyarakat

The Community-Based Drinking Water Provision Program (Pamsimas) is a government program that collaborates with regions and is supported by the World Bank in terms of increasing access to drinking water, sanitation, and improving health, especially in solving diarrhea and water-borne and environmental diseases. This program requires a large budget so it is a shame if it does not have a positive impact on society. So it isnecessary to study the impact of different programs for the community and information on the effectiveness of the program so that apart from being useful, the community can jointly contribute to the sustainability of the program. The method used is the binomial test related to differences in the level of clean water availability before and after the Pamsimas program. The ratio of effectiveness to see the relationship between output and the expected end result. The greater the output contribution to the achievement of the final result, it can be said that the organization, program or activity is effective. The results showed that there were differences in the availability of clean water facilities in Sudimara Village, Cilongok District, Banyumas Regency, Central Java before and after the Pamsimas program. Meanwhile, based on 6 indicators of success, it shows the level of effectiveness, only the fifth criterion is in the effective criteria and the other 5 indicators are in the very effective criteria. The conclusion of the Pamsimas program has been optimal and successful in providing clean water and this program is also said to be very effective in its implementation in Sudimara Village, Cilongok District, Banyumas Regency, Central Java. Abstrak Program Penyediaan Air Minum Berbasis Masyarakat (Pamsimas) adalah program pemerintah yang bekerjasama dengan daerah didukung Bank Dunia untuk peningkatan akses layanan air minum, sanitasi, dan peningkatan kesehatan terutama dalam penyelesaian penyakit diare dan penyakit yang ditularkan melalui air dan lingkungan. Program ini membutuhkan anggaran yang besar sehingga disayangkan jika tidak membawa dampak yang positif pada masyarakat. Sehingga perlu adanya kajian mengenai dampak perbedaan program bagi masyarakat dan informasi mengenai efektifitas keberadaan program agar selain bermanfaat, masyarakat diminta bersama-sama berkontribusi demi keberlanjutan program.. Metode yang digunakan yakni uji Beda terkait perbedaan tingkat ketersediaan air bersih sebelum dan sesudah adanya program pamsima. Rasio Efektivitas untuk melihat hubungan diantara output dan hasil akhir yang diharapkan. Semakin besar kontribusi output pada pencapaian hasil akhir, dapat dikatakan bahwa organisasi, program, atau kegiatan tersebut efektif. Hasil penelitian memperlihatkan terdapat perbedaan ketersediaan sarana air bersih di Desa Sudimara sebelum dan setelah adanya program Pamsimas. Sedangkan berdasarkan 6 indikator keberhasilan memperlihatkan tingkat efektivitasnya sangat efektif dan efektif. Simpulan program pamsimas sudah optimal dan berhasil dalam penyediaan air bersih di Desa Sudimara. Program ini juga sudah dapat dikatakan efektif dalam pelaksanaan. Kata Kunci : Uji Binomial, Rasio Efektivitas, Pamsimas

Healthy Diet Assistance for the Most Deprived in Post-Crisis Greece: An Evaluation of the State Food Provision Program

In 2016, the European Union set up the Fund for European Aid to the Most Deprived (FEAD) as its first structured food provision program to combat food insecurity. Computational analysis and a cross-sectional survey took place from January 2016 to June 2018 to calculate FEAD’s contribution to its beneficiaries’ diets and to collect beneficiary satisfaction data. Dairy, fresh meat, legumes, sugar, olive oil, and tomato concentrate were the most commonly procured items. The program’s contribution to vegetable, dairy, and grains intake was 3.4%, 6.1%, and 6.0%, respectively, as opposed to discretionary calories (12.2%) and fats/oils (24.5%). The program’s algorithm greatly favors (almost 3-fold) single-person applications, compared with applications with four or more people. Beneficiaries valued each food provision at 21.23 ± 23.4 euros, which, for 64.4% of them, translated to a high positive impact on the household budget. FEAD had a highly positive impact on feelings of anxiety and security, for 50.7% and 41.6% of its beneficiaries. Satisfaction with the foods provided was also high for ~70% of the beneficiaries. The program is met with high beneficiary satisfaction and is perceived as a substantial assistance. Increases in the amounts and variety of foods delivered, with a focus on fruit, vegetables, and fish, should be considered to further improve the program’s dietary impact.

Assisting Towards a Healthy Diet for the Most Deprived in Post-Crisis Greece: An Evaluation of the State Food Provision Program

Introduction In 2016 the European Union setup its first structured food provision program to combat food insecurity. We aimed to measure the program&rsquo;s capacity in assisting its beneficiaries to achieve a healthy diet and measure their satisfaction. Methods A computational study was carried out to calculate daily food provision per person under the program for January 2016-December 2017. A cross sectional survey in 3942 beneficiaries took place in December 2017-June 2018 collecting anthropometric, sociodemographic and program satisfaction data. Descriptive statistics were performed and reported as relatively frequencies, mean &plusmn; standard deviation. Results Dairy, fresh meat, legumes, sugar, olive oil and tomato concentrate were the most commonly procured items. The program&rsquo;s contribution to vegetable, dairy and cereal intake was the lowest (3.4%, 6.1%, 6.0% respectively) as opposed to free sugars (12.2%) and oils (24.5%). The program&rsquo;s algorithm favors greatly (almost 3-fold) single person applications compared to 4+ persons applications. The monetary value was estimated at 21.23&plusmn;23.4 euros/food provision, however 64.4% of beneficiaries reported a high positive impact on the household budget. 50.7% and 41.6% reported high positive impact on feelings of anxiety and security, respectively. ~70% of the beneficiaries were highly satisfied with the foods provided, with lower scores for quality and shelf-life (50.7% and 58.8% high respectively). Conclusions The program is met by high beneficiary satisfaction and is perceived as a substantial assistance. Increases in the amounts and variety of foods delivered, with a focus on fruit, vegetables and fish should be considered, to further improve the program&rsquo;s dietary impact.

EVALUASI LAPORAN AKUNTABILITAS KINERJA INSTANSI PEMERINTAH PADA SATUAN KERJA NON VERTIKAL TERTENTU PENYEDIAAN PERUMAHAN PROVINSI SULAWESI UTARA

LAKIP is the government’s accountability for activities carried out within one budget year and as one of the realization of good governance. The community questioned whether the budget used was appropriate or not with what they received.In addition, accountability reports on public sector organizations are only oriented to "output" rather than "outcome". This resulted public sector organizations to pay more attention to value for money that is able to consider inputs, outputs, especially outcomes that underlie the three main elements namely economy, efficiency and effectiveness.This study aims to find out how the SNVT Provision program in North Sulawesi Province is measured using the concept of value for money.The research method used is descriptive qualitative with the results of interviews and data collected, analyzed and conclusions drawn.The results showed that the evaluation of the SNVT program for the Provision of Housing in the Province of North Sulawesi was measured by the concept of value for money for economic measurements achieving good results. However, the measurement for efficiency and effectiveness are not yet optimum as the budget is not fully realized.