Evaluasi Pelaksanaan Program Rujuk Balik (PRB) dan Kaitannya Dengan Kepatuhan Pasien BPJS Kesehatan di Puskesmas Singgani Kota Palu: Studi Mixed Method

Abstract

The Patient Back-Referral Program (PRB) services at primary healthcare facilities are frequently constrained by network disruptions and pharmaceutical stockouts, compromising patient treatment retention. This study aimed to evaluate PRB implementation and its correlation with patient adherence at Singgani Public Health Center, Palu City, utilizing a Sequential Explanatory Mixed-Methods design, quantitative data were analyzed first in the primary phase, followed by a supporting qualitative phase to explain the findings. Quantitative data were gathered from 249 chronic disease respondents via the MMAS-8 questionnaire, followed by in-depth interviews with 6 informants to elucidate statistical outcomes. The Chi-Square test demonstrated that information system quality was significantly correlated with adherence (p-value < 0.001), whereas pharmaceutical availability lacked direct statistical significance (p-value = 0.064). The novelty of this study uncovers that the impact of internal supply chain stockouts was mitigated by a public-private partnership with a contracted network pharmacy acting as a logistical safety valve, alongside robust intrinsic patient motivation. Conversely, non-adherence was triggered by behavioral barriers, notably perceived recovery upon symptom abatement, clinical anxiety over generic brand substitution, and a deficit in manual contingency protocols during server downtimes. In conclusion, adherence outcomes depend not merely on technological infrastructure and physical inventory, but on operational manual readiness, optimized network integration, and patient healthcare-seeking intent. The practical contribution outlines strategic recommendations for healthcare management to formalize manual fallback SOPs during system failures, implement automated digital tracking reminders, and leverage institutionalized free psychological counseling services to mitigate therapeutic burnout