Biopsychosocial model is a useful worldview for primary care or family doctors. However, it is often considered as impractical or too complicated. The objective of this study is to review the implementation of the biopsychosocial model in clinical practice, and its contributions to clinical outcomes. Hermeneutic circle literature review was conducted to provide experiential learning in an attempt to understand biopscyhosocial model, first developed by George Engel. Literature search started with review articles in Medline and Scopus as search engines. Citations from previous articles, editorials, and research articles were identified and interpreted in the context of the knowledge derived from all identified relevant articles. The progress of biopsychosocial model has been slow, and primary care doctors do not implement biopsychosocial medicine in their practice, while biomedical thinking and approach are still the dominant model. Biopsychosocial research addressed chronic illnesses and functional disorders as conditions in need for biopsychosocial model implementation. As payment scheme, clinical guidelines and clinical performance indicators are biomedically oriented, there is no incentive for primary care doctors to adopt biopsychosocial model in their practice. Workload and lack of competence in primary care may hinder the implementation of biopsychosocial model. Biopsychosocial model helps primary care doctors to understand interactions among biological and psychosocial components of illnesses to improve the dyadic relationship between clinicians and their patients and multidisciplinary approaches in patient care. Biopsychosocial model potentially improves clinical outcomes for chronic diseases and functional illnesses seen in primary care.

The World Health Organization recommends malaria be diagnosed by standard microscopy or rapid diagnostic test (RDT) before treatment. RDTs have been used with greater frequency in the absence of matching blood slide confirmation in the majority of RDT reported cases in Mimika Regency, Papua Province, Indonesia. Given the importance of RDT in current health system as point-of-care tool, careful validation of RDT product performance for providing accurate malaria diagnosis is critical. Plasmotec Malaria-3 (XW-P07) performance was evaluated by comparing it with paired blood film microscopy and quantitative real-time PCR (qPCR). Consecutive whole blood samples were derived from one clinic in Mimika as part of routine passive malaria case detection. RDT results were read by two trained technicians and interpreted by consensus. Expert microscopic examination of blood slides was cross-checked by observer-blinded second reader and a third examiner if discordant between examinations. qPCR was used as the ‘gold standard’, followed by microscopy for the outcome/disease variable. Comparison analysis included sensitivity (Sn), specificity (Sp), positive and negative predictive values (PPV & NPV), and other diagnostic screening performance measures for detecting Plasmodium falciparum and Plasmodium vivax infections. Overall malaria positive samples from qPCR was 42.2% (175/415 samples); and from matching blood slides 40.5% (168/415) of which those infections with relatively low parasite densities ≤100/μl blood was 5.7% of P. falciparum and 16.5% of P. vivax samples examined. Overall RDT performance when compared with microscopy for detecting P. falciparum was Sn:92%, Sp:96.6%, PPV:88%, NPV:97.8%, Kappa:0.87; and for P. vivax Sn:72.9%, Sp:99.1%, PPV:95.4%, NPV:93.4%, Kappa:0.79. Overall RDT performance when compared with qPCR for detecting P. falciparum was Sn:92%, Sp:96.6%, PPV:88%, NPV:97.8%, Kappa:0.87; and for P. vivax Sn:66%, Sp:99.1%, PPV:95.4%, NPV:90.9%, Kappa:0.73. Plasmotec Malaria-3 test showed good overall performance scores in precision for detecting P. falciparum, but lower values regarding sensitivity and negative likelihood ratio for detecting P. vivax, a finding partly associated with greater frequency of lower density P. vivax infections compared to P. falciparum in this study. In particular, the negative likelihood ratio (>0.1) for P. vivax detection indicates RDT lacked sufficient discriminating exclusion power falling below general acceptance criteria.

Indonesia has set 2030 as its deadline for elimination of malaria transmission in the archipelago, with regional deadlines established according to present levels of malaria endemicity and strength of health infrastructure. The Municipality of Sabang which historically had one of the highest levels of malaria in Aceh province aims to achieve elimination by the end of 2013. From 2008 to 2010, baseline surveys of malaria interventions, mapping of all confirmed malaria cases, categorization of residual foci of malaria transmission and vector surveys were conducted in Sabang, Aceh, a pilot district for malaria elimination in Indonesia. To inform future elimination efforts, mass screening from the focal areas to measure prevalence of malaria with both microscopy and PCR was conducted. G6PD deficiency prevalence was also measured. Despite its small size, a diverse mixture of potential malaria vectors were documented in Sabang, including Anopheles sundaicus, Anopheles minimus, Anopheles aconitus and Anopheles dirus. Over a two-year span, the number of sub-villages with ongoing malaria transmission reduced from 61 to 43. Coverage of malaria diagnosis and treatment, IRS, and LLINs was over 80%. Screening of 16,229 residents detected 19 positive people, for a point prevalence of 0.12%. Of the 19 positive cases, three symptomatic infections and five asymptomatic infections were detected with microscopy and 11 asymptomatic infections were detected with PCR. Of the 19 cases, seven were infected with Plasmodium falciparum, 11 were infected with Plasmodium vivax, and one subject was infected with both species. Analysis of the 937 blood samples for G6PD deficiency revealed two subjects (0.2%) with deficient G6PD. The interventions carried out by the government of Sabang have dramatically reduced the burden of malaria over the past seven years. The first phase, carried out between 2005 and 2007, included improved malaria diagnosis, introduction of ACT for treatment, and scale-up of coverage of IRS and LLINs. The second phase, from 2008 to 2010, initiated to eliminate the persistent residual transmission of malaria, consisted of development of a malaria database to ensure rapid case reporting and investigation, stratification of malaria foci to guide interventions, and active case detection to hunt symptomatic and asymptomatic malaria carriers.

General practitioners (GPs) in Indonesia are medical doctors without formal graduate professional training. Only recently, graduate general practice (GP) is being introduced to Indonesia. Therefore, it is important to provide a framework to prepare a residency training in general practice part of which is to equip GP graduate doctors to deliver person-centered, comprehensive care in general practice. Experiential learning theory is often used to design workplace-based learning in medical education. The aim of this study was to evaluate a graduate professional training program in general practice based on the ‘experiential learning’ framework. This was a pre-posttest study. The participants were 159 GPs who have been practicing for a minimum of 5 years, without formal graduate professional training, from two urban cities of Indonesia (Yogyakarta and Jakarta). A 40-week curriculum called the ‘weekly clinical updates on primary care medicine’ (WCU) was designed, where GPs met with clinical consultants weekly in a class. The participant’s knowledge was assessed with pre-posttests involving 100 written clinical cases in line with each topic in the curriculum. Learning continued with a series of group discussions to gain reflection to reinforce learning. Participants’ knowledge regarding clinical problems in general practice was moderately increased (p < 0.05) after the training from a mean score of 50.64–72.77 (Yogyakarta’s doctors) and 39.37–51.81 (Jakarta’s doctors). Participants were able to reflect on the principles of general practice patient-care. Participants reported satisfaction during the course, and expressed a desire for a formal residency training. A graduate educational framework for GP based on the ‘experiential learning’ framework in this study could be used to prepare a graduate GP training; it is effective at increasing the comprehension of general practitioners towards better primary care practice.

To be recognized as a primary care physician (PCP), an Indonesian general practitioner (GP) has to follow a formal postgraduate training in primary care. However, 4 years since the regulation was published, the progress of the training is slow. There is a need to deeply investigate the doctors’ perspectives, particularly to explore factors associated with their willingness to follow this training. This study aims to explore the GPs’ views and perspectives related to the formal postgraduate training in primary care that may influence their enrolment in PCP program. We conducted semi-structured interviews with a topic guide. The study took place in Yogyakarta from January to December 2016. The participants were GPs practicing in Yogyakarta primary care clinics who were recruited using purposive-maximum variation sample design. The interviews were audio-recorded and transcribed. The data were analysed using interpretative phenomenological analysis approach. Nineteen GPs participants were involved in this study. Three major themes were identified, namely unfamiliarity, resistance, and positivism. Almost all the GP participants were unfamiliar with the primary care training program. They were also pessimistic if the training could change the health service in the country while it lacked resources and infrastructures. However, exposure to the training brought positive insights that it could improve the doctors’ knowledge and skills in primary care practice. The government intention to establish PCP training is currently on the right tract. However, information dissemination and more supports in primary care are also essential.

Objective Indonesia is one of the top five countries with the highest prevalence of diabetes mellitus (DM). There were 18 million DM patients in 2020, and this number has doubled in has doubled in 2022. The main complication of DM in the oral cavity is periodontitis. Periodontitis and DM have a bidirectional relationship. Controlling the severity of both diseases can improve the quality of life of DM patients. The aim of this study is to determine the severity of periodontitis in older people with type 2 DM. Material and Methods This research is observational with a cross-sectional design. The research subjects were 263 patients aged ≥ 60 years, taken using a purposive sampling technique. The diagnosis and severity of periodontitis were based on the European Federation of Periodontology (EFP) and the American Academy of Periodontology (AAP) with the Centers for Disease Control and Prevention (CDC), using the clinical attachment loss (CAL) and probing depth (PD) clinical parameters. The diagnosis of DM was established by measuring HbA1c. Descriptive statistics was used to describe the distribution of severity of periodontitis. Results In total, 42 people (16%) in this study did not experience periodontitis, and 221 people (84%) experienced periodontitis with 4.5% of the study population suffering from mild periodontitis, 21.3% moderate periodontitis, and 74.2% severe periodontitis. The results of this study indicated that severe periodontitis was the most common category in patients with type 2 DM. Severe periodontitis is the most common type of periodontitis at all levels of age, occupation, and education. It was found most commonly among those aged 60 to 65 years, housewives, and those with elementary education level with moderate or poor oral hygiene. Conclusion Almost all respondents who suffered from type 2 DM experienced periodontitis, severe periodontitis being most common category at all age levels, occupations, education, and oral hygiene status. The severity of periodontitis in this study tended to be due to high HbA1c levels.