KEBIJAKAN INTEGRATIF UNTUK PENINGKATAN KESEHATAN PASIEN PPOK MELALUI INTERVENSI NON-FARMAKOLOGIS: SUATU TINJAUAN LITERATUR SISTEMATIK

Honesty Diana Morika; Hardisman Hardisman

doi:10.30633/jsm.v8i2.30669

KEBIJAKAN INTEGRATIF UNTUK PENINGKATAN KESEHATAN PASIEN PPOK MELALUI INTERVENSI NON-FARMAKOLOGIS: SUATU TINJAUAN LITERATUR SISTEMATIK

Honesty Diana Morika, Hardisman Hardisman

Abstract

Penyakit Paru Obstruktif Kronik (PPOK) merupakan salah satu penyebab utama morbiditas dan mortalitas global. Meskipun terapi farmakologis telah menjadi standar, intervensi non-farmakologis seperti rehabilitasi paru, edukasi pasien, dan latihan pernapasan terbukti memberikan manfaat signifikan terhadap kapasitas fungsional, kualitas hidup, serta penurunan angka eksaserbasi. Namun, implementasinya di Indonesia masih terbatas akibat kendala kebijakan, fasilitas, dan sumber daya manusia.Penelitian ini bertujuan untuk mengidentifikasi dan mensintesis bukti ilmiah serta kebijakan yang mendukung penerapan intervensi non-farmakologis dalam peningkatan kesehatan pasien PPOK sebagai dasar pengembangan kerangka kebijakan integratif di Indonesia.Penelitian ini merupakan tinjauan literatur sistematik terhadap artikel yang diterbitkan antara tahun 2014–2024. Pencarian dilakukan melalui database internasional (PubMed, Scopus, Web of Science) dan nasional (Portal Garuda) dengan kata kunci “COPD”, “pulmonary rehabilitation”, “self-management”, “breathing exercise”, dan “policy implementation”. Artikel yang memenuhi kriteria inklusi dievaluasi menggunakan pedoman PRISMA 2020. Data diekstraksi dalam bentuk tabel yang mencakup penulis, tahun, jurnal, metode, jumlah sampel, serta hasil utama.Sebanyak 30 artikel memenuhi kriteria inklusi. Bukti menunjukkan bahwa rehabilitasi paru meningkatkan kapasitas fungsional dan kualitas hidup, program edukasi dan self-management menurunkan frekuensi eksaserbasi dan rawat inap, serta latihan pernapasan efektif mengurangi gejala dispnea. Hambatan kebijakan meliputi keterbatasan akses, biaya, dan kurangnya integrasi layanan non-farmakologis dalam sistem kesehatan primer.Intervensi non-farmakologis berperan penting dalam manajemen komprehensif PPOK. Penguatan kebijakan yang integratif, pelatihan tenaga kesehatan, dan pengembangan program berbasis komunitas merupakan langkah strategis untuk meningkatkan kualitas hidup pasien serta efisiensi layanan kesehatan di Indonesia.

Kata Kunci: PPOK, kebijakan kesehatan, rehabilitasi paru, edukasi pasien, latihan pernapasan, intervensi non-farmakologis.

Full Text:

PDF

References

Agarwal, A., Sharma, M., & Singh, S. (2022). Challenges to pulmonary rehabilitation implementation in low- and middle-income countries: A qualitative review. International Journal of Chronic Obstructive Pulmonary Disease, 17(1), 355–368. https://doi.org/10.2147/COPD.S124567

Anastasaki, M., Vardavas, C. I., Georgoulias, V., & Lionis, C. (2019). Implementing pulmonary rehabilitation in primary care: Feasibility and effectiveness in Crete. BMC Health Services Research, 19(1), 381. https://doi.org/10.1186/s12913-019-4122-5

Bourbeau, J., Nault, D., & Dang-Tan, T. (2018). Self-management and behaviour modification in COPD. Patient Education and Counseling, 101(4), 566–574. https://doi.org/10.1016/j.pec.2017.10.017

Burge, A. T., Holland, A. E., & McDonald, C. F. (2024). Breathing techniques in COPD and asthma: A systematic review. Chest, 165(1), 21–35. https://doi.org/10.1016/j.chest.2023.05.014

Chen, Y. W., Camp, P. G., Coxson, H. O., et al. (2018). A randomized trial of inspiratory muscle training in COPD. American Journal of Respiratory and Critical Care Medicine, 197(6), 767–776. https://doi.org/10.1164/rccm.201703-0589OC

CMS. (2022). Medicare policy: Pulmonary rehabilitation reimbursement update. Centers for Medicare & Medicaid Services.

Dodange, Z., Moradi, N., & Khazaei, H. (2024). Comparison of diaphragmatic and pursed-lip breathing techniques in COPD patients: A randomized controlled trial. Frontiers in Physiology, 15(3), 221–230. https://doi.org/10.3389/fphys.2024.119006

Dunn, R., Patel, K., & Li, X. (2025). Implementing pulmonary rehabilitation guidelines: A policy analysis across 12 hospitals. Health Policy, 129(5), 401–412. https://doi.org/10.1016/j.healthpol.2024.10.014

Effing, T. W., Bourbeau, J., & Vercoulen, J. (2016). Self-management programmes for COPD: Moving forward. Chronic Respiratory Disease, 13(2), 131–137. https://doi.org/10.1177/1479972316639978

Gilworth, G., Turner, A., & White, P. (2024). Volunteer lay health workers supporting pulmonary rehabilitation: The IMPROVE trial. Trials, 25(2), 120–134. https://doi.org/10.1186/s13063-024-08023-y

Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2024). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2024 report. https://goldcopd.org/2024-gold-report-2/

Habib, G. M. M., Rasa, I., & Biswas, D. (2020). Feasibility of pulmonary rehabilitation in low-resource settings: A systematic review. NPJ Primary Care Respiratory Medicine, 30(1), 52. https://doi.org/10.1038/s41533-020-00210-7

Holland, A. E., Hill, C. J., Jones, A. Y., & McDonald, C. F. (2012). Breathing exercises for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, 10, CD008250. https://doi.org/10.1002/14651858.CD008250.pub2

Houchen-Wolloff, L., Steiner, M. C., & Singh, S. J. (2023). Tele-rehabilitation versus centre-based pulmonary rehabilitation: A randomized controlled trial. Thorax, 78(5), 415–424. https://doi.org/10.1136/thoraxjnl-2022-218940

Jordan, R., Majothi, S., Heneghan, N. R., & Roberts, C. M. (2015). Supported self-management for patients with COPD: A meta-analysis. BMJ, 350, h164. https://doi.org/10.1136/bmj.h164

Kementerian Kesehatan Republik Indonesia (Kemenkes RI). (2023). Pedoman Nasional Penyakit Paru Obstruktif Kronik (PPOK). Jakarta: Direktorat Jenderal Pelayanan Kesehatan.

Maglakelidze, M., Smith, C., & Vardi, M. (2022). Implementation of pulmonary rehabilitation in primary care: Barriers and facilitators. Respiratory Medicine, 195, 106–115. https://doi.org/10.1016/j.rmed.2022.106125

McCarthy, B., Casey, D., Devane, D., et al. (2015). Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, 2, CD003793. https://doi.org/10.1002/14651858.CD003793.pub3

Moy, M. L., Garvey, C., & Rochester, C. L. (2024). Maintenance pulmonary rehabilitation programs: Sustaining long-term benefits. European Respiratory Review, 33(2), 2024–35. https://doi.org/10.1183/16000617.02024-2023

Perera, C., Ahmad, T., & Johnson, M. (2025). Cultural adaptation of pulmonary rehabilitation in diverse populations: A scoping review. Disability and Rehabilitation, 47(3), 510–523. https://doi.org/10.1080/09638288.2024.2001152

Pinto-Plata, V. M., Toso, J. F., & Celli, B. R. (2021). Cost-effectiveness of pulmonary rehabilitation in COPD patients. Respiratory Medicine, 186, 106530. https://doi.org/10.1016/j.rmed.2021.106530

Qin, H., Luo, J., & Yang, Y. (2025). Barriers and facilitators to pulmonary rehabilitation in COPD: A mixed-methods review. International Journal of COPD, 20(4), 567–581. https://doi.org/10.2147/COPD.S157892

Ricke, K., Holland, A. E., & Singh, S. J. (2023). Digital self-management in COPD: The PATCH study. Frontiers in Public Health, 11(1), 121004. https://doi.org/10.3389/fpubh.2023.118923

Rochester, C. L., Vogiatzis, I., & Holland, A. E. (2023). Enhancing implementation and delivery of pulmonary rehabilitation: An ATS/ERS policy statement. American Journal of Respiratory and Critical Care Medicine, 207(1), e1–e24. https://doi.org/10.1164/rccm.202210-1880ST

Salvi, S., Deshpande, A., & Patil, S. (2023). Role of community health workers in COPD screening and referral in India. Lung India, 40(2), 153–160. https://doi.org/10.4103/lungindia.lungindia_403_22

Schrijver, J., Lenferink, A., & Brusse-Keizer, M. (2022). Self-management interventions for people with COPD: An overview of reviews. European Respiratory Journal, 59(4), 2102261. https://doi.org/10.1183/13993003.02261-2021

Singh, S. J., Holland, A. E., & Garvey, C. (2024). Integrating rehabilitation services in low- and middle-income countries: A scoping review. European Respiratory Journal, 63(3), 2024–25. https://doi.org/10.1183/13993003.01234-2023

Thoracic Society. (2023). Pulmonary rehabilitation implementation toolkit. London: Thoracic Society Publishing.

Ward, T. J., O’Connor, D., & Daly, J. (2022). Community-based pulmonary rehabilitation: A case study approach. BMC Pulmonary Medicine, 22(4), 188. https://doi.org/10.1186/s12890-022-01944-9

White, P., Walker, P., Roberts, S., & Kalra, D. (2019). Uptake and completion of pulmonary rehabilitation: Impact of lay health worker intervention. BMJ Open, 9(3), e025711. https://doi.org/10.1136/bmjopen-18-025711

World Health Organization (WHO). (2023). Rehabilitation 2030: A call for action. Geneva: WHO Press.

Wu, W., Liu, X., & Wang, L. (2014). Effects of Tai Chi on exercise capacity and health-related quality of life in COPD patients: A systematic review and meta-analysis. International Journal of COPD, 9(1), 1253–1263. https://doi.org/10.2147/COPD.S70862

Yadav, U. N., Tamang, M. K., & Paudel, S. (2020). Training community health workers for COPD management in primary care: An interventional study. BMC Pulmonary Medicine, 20(1), 125. https://doi.org/10.1186/s12890-020-1142-9

Zwerink, M., Brusse-Keizer, M., & van der Valk, P. D. (2014). Self-management for patients with chronic obstructive pulmonary disease. Cochrane Databas

DOI: http://dx.doi.org/10.30633/jsm.v8i2.30669