Utilization of repeat services in the outpatient department of Dewi Sartika general hospital, Kendari City, 2023

The reutilization of services in outpatient clinics of hospitals plays a crucial role in enhancing the quality and effectiveness of healthcare services. This study aims to analyze the factors associated with service reutilization in hospital outpatient clinics using a cross-sectional design and quantitative approach. Data were collected through questionnaires from 100 respondents at Dewi Sartika General Hospital in Kendari, Southeast Sulawesi, during October-November 2023, using accidental sampling techniques. The analysis results indicate that factors such as service quality, family encouragement, facilities, location, and patient attitudes are significantly associated with service reutilization in outpatient clinics. Univariate analysis was used to describe sample and variable characteristics, while bivariate analysis involved correlation testing to evaluate the relationships among variables. The conclusion of this study highlights the importance of enhancing communication, education, and family support in influencing patient decisions to reuse the same services at the hospital. The development of family support programs, patient empowerment, family-friendly policies, and periodic program evaluations are crucial steps in improving patient experiences and healthcare outcomes. Recommendations include critical steps such as enhancing communication, education, and family support, as well as developing structured family support programs, empowering patients, implementing family-friendly policies, and conducting regular program evaluations. It is expected that the implementation of these recommendations will improve patient experience, enhance adherence to treatment, and overall improve healthcare outcomes.


Introduction
According to the World Health Organization (WHO), hospitals are an integral part of a social and health organization.Their function is to provide comprehensive, curative, and preventive healthcare services to the community.Hospitals also offer outpatient care to reach families at home.Furthermore, hospitals serve as centers for education and training of healthcare professionals as well as biomedical research hubs (1).
According to Law number 44 of 2009, hospitals are healthcare institutions that provide comprehensive individual healthcare services, including inpatient, outpatient, and emergency care.Hospitals not only serve curative purposes but also contribute to enhancing the health status of individuals, thereby improving the quality of health and life for the people of Indonesia (2).
The reuse of services at the Outpatient Department of Dewi Sartika General Hospital in Kendari City in 2023 becomes a significant focus of research in efforts to enhance healthcare services in Southeast Sulawesi.Despite its rich natural beauty, the region often faces challenges in accessing adequate healthcare services.In this context, the Outpatient Department serves as one of the primary places where the community seeks medical care without the need for hospitalization, making understanding the factors influencing the reuse of services crucial.
As time progresses and the demand for better healthcare services increases, the Outpatient Department of Dewi Sartika Hospital in Kendari City faces pressure to ensure that the services provided not only meet the medical needs of patients but also provide satisfaction and encourage reuse.Therefore, research on the factors influencing patients' decisions to reuse outpatient services becomes important to identify areas for improvement and development in the healthcare system.
In the context of previous research, several factors such as service quality, accessibility, and patient satisfaction have been identified as significant influences on the reuse of healthcare services.However, this study will highlight unique aspects relevant to the local conditions at the Dewi Sartika Outpatient Department, including patient preferences, demographic characteristics, and the dynamics of interaction between patients and healthcare providers.
A better understanding of the reuse of services at the Outpatient Department can assist the hospital in developing more effective strategies to improve service quality, expand service coverage, and ensure the availability of optimal resources.Thus, this research is expected to provide valuable insights for hospital management, healthcare providers, and policymakers in efforts to improve public health in Kendari City and its surroundings.
The reuse of services allows patients to receive continuous and integrated care.By returning to use services at the Outpatient Department, patients can access medical care regularly to monitor their health conditions, manage chronic diseases, and avoid potential complications.This can improve patients' quality of life and extend life expectancy.Additionally, the reuse of services also benefits healthcare providers.By monitoring patients regularly, doctors and medical staff can identify changes in patients' conditions early, provide timely interventions, and reduce the risk of unwanted medical events.This helps improve the efficiency and effectiveness of healthcare services provided by the hospital (4).From a healthcare system perspective, the reuse of services in the Outpatient Department can help reduce the burden on inpatient facilities.By providing appropriate care in the Outpatient Department, patients with conditions that do not require hospitalization can still receive the medical attention they need without burdening the limited bed capacity and resources of the hospital.Another impact of the reuse of services is the creation of a stronger relationship between patients and healthcare providers.Through repeated interactions in the Outpatient Department, patients can feel more connected to their medical team, feel heard, and be more willing to share information about their health conditions.This strengthens the patient-doctor relationship and enables healthcare providers to deliver more personalized and focused care (5).
On a global scale, issues regarding the reuse of services in Outpatient Departments encompass several aspects.Firstly, there are challenges related to accessibility and the quality of healthcare services, which can influence patients' decisions to reuse services in the Outpatient Department.Economic factors, inadequate healthcare infrastructure, and a lack of awareness about the importance of preventive care are also issues affecting the reuse of services in many countries (6).
In Asia, issues related to the reuse of services in Outpatient Departments often revolve around disparities in access to and distribution of healthcare services.Some countries in Asia still face challenges in providing evenly distributed and affordable healthcare services for all segments of society.Additionally, local cultures and beliefs can also influence patients' decisions to reuse services in the Outpatient Department (7.8).
In Indonesia, the reuse of services in Outpatient Departments in hospitals is also a significant concern in efforts to improve the quality of healthcare services.Although there have been improvements in the accessibility and quality of healthcare services in some areas, challenges remain regarding the disparity between urban and rural areas, as well as between healthcare facilities in various regions.Awareness of the importance of preventive care and the management of chronic diseases also needs to be addressed in the context of the reuse of services in Outpatient Departments in Indonesia.Wider health education and efforts to improve health literacy in the community can help increase awareness of the importance of quality and integrated care in the Outpatient Departments of hospitals (9).RSU Dewi Sartika is a type C private hospital in the Southeast Sulawesi Province located at Jl. Kapten Piere Tendean No.118 Baruga, Kendari City, Southeast Sulawesi.With the emergence of new hospitals and various services available, the hospital management strives every day to provide the best services possible to influence patients' decision-making.The same applies to RSU Dewi Sartika, which has provided various services, including outpatient care, where patients generally require repeated treatments.

Figure 1 Outpatient Visits at Dewi Sartika General Hospital
The data provided highlights the trend in the number of new and existing patients visiting the hospital over the years 2020, 2021, and 2022, along with the total number of visits.In 2020, there were 1,686 new patients and 5,639 existing patients, totaling 7,325 visits.The year 2021 witnessed a significant increase in new patients, reaching 3,911, while the number of existing patients remained relatively stable at 5,411, resulting in a total of 9,322 visits.However, in 2022, the number of new patients decreased to 1,572, while the number of existing patients increased to 6,643, totaling 8,215 visits.Analyzing the trend in visits by new and existing patients provides insight into the changing demands for healthcare services from year to year.
The prolonged visits reflect a high interest from patients in utilizing the return services for their previous care paths, indicating strong loyalty to the care services provided, demonstrating trust and satisfaction with their previous healthcare experiences (10).Conversely, satisfaction is key to maintaining loyalty and enhancing the positive reputation of the hospital, while dissatisfaction can negatively impact the perception and image of the hospital in the public eye (11) Understanding the importance of patient experiences and their impact on repeat service utilization in the outpatient department, the hospital can focus on improving service quality and ensuring patient satisfaction as a primary priority.Monitoring patient return rates, enhancing communication, and adapting to patient needs can help the hospital maintain and improve patient interest in utilizing return services.Thus, maintaining and improving patient satisfaction levels becomes a strategic step in building sustainable relationships between the hospital and patients, as well as creating a strong reputation in the healthcare industry services (12) Given the trends and importance of patient satisfaction and repeat service utilization, the researcher is interested in conducting a study titled "Utilization of Return Services in the Outpatient Department at Dewi Sartika RSU in 2023."

Material and Method
This research adopts a cross-sectional design with a quantitative and observational approach to investigate the relationship between predetermined independent and dependent variables.Through the use of a questionnaire as the primary instrument, the study aims to evaluate the influence of factors such as service quality, family support, facilities, location, and patient attitudes on the utilization of return services.Conducted from October to November 2023, the research involves a sample of 100 respondents.The sampling technique employs accidental sampling method, where respondents are selected randomly based on predefined criteria (13) Data analysis involves two main approaches.Firstly, univariate analysis is utilized to describe the characteristics of the sample and variables in the study.Secondly, bivariate analysis involves correlation testing to evaluate the relationship between service quality, family support, facilities, location, attitudes, and the dependent variable, which is the utilization of return services.Through this approach, the research aims to provide a comprehensive understanding of the factors influencing patients' decisions to reuse healthcare services, as well as insights for service providers to enhance the quality and accessibility of the services they offer.

Characteristics Employee House Sick
In this study, out of the total 100 respondents, the majority were male (53.0%) compared to females (47.0%).Most respondents were aged above 36 years, contributing 41.0% of the sample, while the 31-35 age group was the second largest at 24.0%.Regarding education, the majority of respondents had completed secondary school (47.0%), followed by those with no formal education (16.0%).A total of 58.0% of respondents rated the services at RSU Dewi Sartika as good, however, 42.0% considered them less satisfactory.Good family support was perceived by 55.0% of respondents, while 45.0% felt it was inadequate.Overall, the facilities and location of RSU Dewi Sartika were rated good by the majority of respondents, at 57.0% and 62.0%, respectively.However, perceptions of attitudes at RSU Dewi Sartika were fairly evenly divided between good (51.0%) and not good (49.0%).A total of 64.0% of respondents expressed an intention to reuse RSU Dewi Sartika services, while 36.0%indicated otherwise.This data provides important insights into patient perceptions and evaluations of various aspects of services at RSU Dewi Sartika.

Connection _ between Variables X and Y
The statistical test results from Table 4 indicate several significant findings regarding the relationship between Variable X and Y. Firstly, the constant term reflects the value of Service Reutilization in the Outpatient Installation when all independent variables are zero.However, this result is not statistically significant as the p-value (Sig) is greater than 0.05.Moving on to individual variables, a significant positive relationship is observed between the Location variable and the Reutilization of Services in the Outpatient Installation, supported by a low p-value (Sig) of 0.002.Similarly, the Facilities variable shows a significant positive correlation with Service Reutilization, as evidenced by the low p-value (Sig) of 0.005.
Furthermore, the Family Encouragement variable demonstrates a highly significant positive correlation with Service Reutilization, with a very low p-value (Sig) of 0.000, indicating its substantial influence.Attitude also exhibits a significant positive relationship with Service Reutilization, supported by a low p-value (Sig) of 0.010.In contrast, the Service variable indicates a significant negative relationship with Service Reutilization, as indicated by the low p-value (Sig) of 0.039.These findings suggest that Service has a negative impact on the Reutilization of Services in the Outpatient Installation.

The influence of attitudes on the reuse of outpatient services
Patients' attitudes towards healthcare services can directly influence their decisions to reuse outpatient services at the same hospital.Positive attitudes towards healthcare services, such as perceptions of service quality, trust in doctors and medical staff, and satisfaction with previous experiences, tend to motivate patients to choose the same hospital again for their healthcare needs.Research indicates that patients with positive attitudes towards outpatient services are more likely to reuse the same services, contributing to higher reuse rates in outpatient care contexts.
Patients' attitudes can also affect their perceptions of medical procedures and interactions with medical staff.Patients with positive attitudes are generally more receptive to recommended treatment procedures and feel more comfortable communicating with doctors and medical staff.Positive attitudes can also foster better relationships between patients and healthcare providers, which in turn can increase patients' trust and satisfaction with the services provided.Conversely, negative attitudes or dissatisfaction with healthcare services can reduce the likelihood of patients reusing outpatient services at the same hospital (14).
It is important to note that patients' attitudes are influenced not only by their personal experiences with healthcare services but also by external factors such as information from friends, family, or social media, as well as general perceptions of healthcare service quality in a region or country.Therefore, efforts to increase the reuse of outpatient services must include strategies to foster positive attitudes among patients.This may involve efforts to improve communication between doctors and patients, ensuring the availability of accurate and clear information about treatment procedures, and addressing other aspects of the patient experience in hospitals.
Attitudes can also be influenced by factors such as trust in the healthcare system, cultural beliefs, and individual expectations of healthcare.Therefore, a holistic and sustainable approach is needed to understand and manage patients' attitudes towards outpatient services.This includes approaches focused on patient education, emotional support, and empowering patients in decision-making regarding their healthcare.By understanding the influence of attitudes on the reuse of outpatient services, hospitals can develop more effective strategies to increase patient satisfaction and improve healthcare outcomes (15).
Improving attitudes towards the reuse of outpatient services requires planned and targeted strategic steps.First, comprehensive educational approaches need to be implemented to raise public awareness of the importance of followup in their healthcare.Broad information campaigns can help change perceptions and attitudes towards the reuse of services, educating about the benefits of disease prevention and early management.
It is important to strengthen communication and patient involvement in decision-making regarding their care.Healthcare providers need to open up empathetic communication channels, ensuring that patients feel heard and understood at every step of their care.By building strong relationships between patients and healthcare providers, it is expected that positive attitudes towards the reuse of outpatient services can be enhanced, supporting efforts towards better health for the community at large (16).
In facing the challenges of reusing outpatient services, strategic steps demonstrate hospitals' commitment to improving staff attitudes towards patient care.Training programs and awareness initiatives lay the foundation for improving communication and empathy, while measurements and feedback from patients provide valuable insights for continuous improvement.Furthermore, inclusive approaches and recognition of staff demonstrate the importance of building a patient-oriented organizational culture and supporting outstanding performance.Regular evaluations, which are integral to performance management, help ensure that improvement efforts continue to meet patient expectations and needs.
By consistently implemen.tingthese steps, hospitals can transform the dynamics of their healthcare services to focus more on patients and quality-oriented care.Thus, increasing the reuse of outpatient services is not just about improving staff attitudes but also about building a strong foundation for better patient experiences.In this regard, hospitals not only become places of care but also partners in patients' healthcare journeys, promoting trust, satisfaction, and sustainable quality services.

Location influence towards reuse of outpatient services at home Sick
The influence of location on the reuse of outpatient services at hospitals is a crucial aspect of healthcare service management analysis.The hospital's location can affect patients' decisions to reuse the same services.Factors such as accessibility, distance from home or workplace, and the surrounding environment can play a key role in patients' decisions.
Research has shown that easily accessible locations tend to increase the reuse of outpatient services.Hospitals located in strategic and easily accessible areas have a competitive advantage in attracting patients for further care.Patients are more likely to choose hospitals that are not too far or difficult to access, as this can reduce travel complexity and costs (17).
Location can also affect patients' perceptions of service quality.Hospitals located in more remote or less accessible areas may be perceived to have lower service quality by some patients.This can influence their decision to reuse the same services, especially if there are other hospital options that are more accessible and perceived to be of higher quality.
The surrounding environment of the hospital can also play a crucial role in the influence of location on the reuse of services.A safe, comfortable, and clean environment can create a positive experience for patients, which can then increase their willingness to reuse services at the same hospital.Conversely, an uncomfortable or unsafe environment may deter patients from returning.
It is also important to note that demographic and social factors, such as the characteristics of the population around the hospital, can also influence the impact of location on the reuse of outpatient services.For example, an older population or those with limited mobility may be more sensitive to location accessibility factors.Therefore, hospital management strategies should consider the demographic and social characteristics of the target population in designing services and selecting optimal locations (18).
The influence of location on the reuse of outpatient services at hospitals is a complex and diverse factor.In managing healthcare services, it is important for hospitals to understand patients' preferences and needs regarding location and to continuously improve accessibility, quality, and the hospital's surrounding environment to enhance patient satisfaction and optimal reuse of services (19).
Investing in healthcare infrastructure in areas with limited access to healthcare services can be an effective strategic step.This could involve building community health centers, outpatient clinics, or emergency units that are more accessible to the local community.By expanding the reach of healthcare services to remote or marginalized areas, hospitals can enhance the connection between location and the reuse of outpatient services, ensuring that patients have equal and adequate access to the healthcare they need.
In efforts to increase the reuse of outpatient services, location-focused strategies are key to ensuring optimal accessibility for patients.Firstly, careful geographic analysis should be conducted to determine the most strategic locations and consider patient needs and preferences.This step will help hospitals position themselves better in environments that are accessible to most patients.
Providing reliable transportation is a critical strategic step.Free or affordable transportation services will help overcome geographic and economic barriers that some patients may face.Additionally, optimizing parking facilities around the hospital will provide additional convenience for patients and their families in accessing outpatient services.
The use of technology, partnerships with public transportation services, and community education programs will also support the improvement of healthcare service accessibility.Through these measures, hospitals can ensure that location is no longer a barrier for patients to reuse outpatient services.Thus, these efforts will not only improve the overall quality of healthcare services but also create a more inclusive and friendly environment for all patients.

The influence of facilities on the reuse of outpatient services
The influence of facilities on the reuse of outpatient services at hospitals is a crucial factor in understanding patients' preferences and decisions regarding their healthcare.Comprehensive and quality facilities at hospitals can be a primary driver for patients to reuse the same services.Facilities including comfortable waiting areas, state-of-the-art medical equipment, and easy access to various medical services can enhance patient satisfaction and strengthen their bond with the hospital.
Research has shown that patients tend to choose hospitals that provide comprehensive and adequate facilities for their medical needs.Easy access to facilities such as laboratories, radiology rooms, pediatric health centers, and specialized clinics can increase patients' trust in the hospital's ability to provide holistic and comprehensive care.
Clean, well-maintained, and modern facilities can also create a positive perception of service quality at the hospital.Patients tend to feel more confident and comfortable when using well-maintained facilities, which in turn can increase their satisfaction with the care experience (20).
The availability of supporting facilities such as ample parking, accessibility for people with disabilities, and other convenience facilities can also influence patients' decisions to reuse outpatient services at the same hospital.Patients are more likely to return to hospitals that provide user-friendly environments and address their practical needs (21).
In managing healthcare services, it is important for hospitals to continually improve and expand their facilities to meet the evolving needs of patients.Efforts to increase the reuse of outpatient services may involve investing in facility maintenance, infrastructure development, and overall service quality improvement.By considering the influence of facilities on patient preferences, hospitals can enhance their service quality and strengthen relationships with patients to achieve better healthcare outcomes.
The influence of facilities on the reuse of outpatient services at hospitals plays a crucial role in determining patient preferences and decisions regarding their healthcare.Good facilities not only include comfortable physical environments but also provide efficient and quality services.Firstly, the presence of modern and comprehensive facilities, such as state-of-the-art medical equipment and other support facilities, can increase patients' trust in the quality of care they receive.Patients are more motivated to reuse services if they feel that the facilities they visit have the ability to provide comprehensive and effective care.
The availability of child-friendly and disability-friendly facilities can also influence the reuse of outpatient services.Patients with young children or family members with special needs are more likely to choose hospitals that provide facilities tailored to their needs.Family-friendly and inclusive facilities can create a more pleasant environment for patients and their families, which in turn can encourage service reuse.
It is important to pay attention to the cleanliness and sanitation of healthcare facilities.Clean and well-maintained facilities convey professionalism and concern for patient well-being.Patients will be more motivated to reuse services if they feel comfortable and safe in such an environment.Therefore, investing in the maintenance and improvement of healthcare facilities is a strategic step to enhance the influence of facilities on the reuse of outpatient services at hospitals.By providing a comfortable, family-friendly, and clean environment, hospitals can strengthen relationships with patients and ensure their satisfaction and trust in utilizing healthcare services.
In improving the reuse of outpatient services at hospitals, strategic measures focusing on facilities play a crucial role in creating a supportive environment for patients.The importance of physical maintenance and infrastructure improvement cannot be underestimated, as comfortable waiting areas, clean outpatient rooms, and other support facilities are determining factors in the patient experience.By implementing routine maintenance and repairs of these facilities, hospitals can provide a more positive experience for patients, strengthen trust, and encourage service reuse (22).
Technology integration is important in improving service efficiency and quality.Electronic medical record management systems, online queue systems, and telemedicine services are examples of technologies that can optimize service processes, reduce waiting times, and provide easier access for patients.By combining physical maintenance with technological innovation, hospitals can strengthen the influence of their facilities on the reuse of outpatient services, making the patient experience better and solidifying the hospital's position as a leading healthcare provider (23) (24).

The influence of service on reuse of outpatient services
The influence of services on the reuse of outpatient services at hospitals is a crucial factor in patient satisfaction and loyalty.High-quality services encompass not only the technical aspects of medical care but also the overall patient experience.Friendly, empathetic, and responsive services tailored to patient needs can enhance their trust and satisfaction with the hospital.
Research indicates that patients tend to return to hospitals that provide good service.Factors such as ease of registration, short waiting times, clear communication between patients and service providers, and attention to patient needs are essential elements in creating a positive experience for patients.
Good service also involves efforts to involve patients in decision-making regarding their treatment and providing comprehensive information about diagnoses, medical procedures, and treatment plans.Patients who feel heard and understood by doctors and medical staff are likely to be more satisfied and have greater trust in the treatment recommendations provided.The quality of service also includes efforts to provide holistic and comprehensive care to patients.This involves comfortable management and adequate support during treatment processes, as well as efficient handling of patient needs and complaints.
In the context of competition in the healthcare industry, high-quality services can be a determining factor in winning patient trust and loyalty.Hospitals that can provide superior service will not only increase patient satisfaction and reuse of outpatient services but also strengthen their image and reputation in the community.Therefore, investing in service quality development is a strategic step for hospitals to achieve competitive excellence and maintain patient loyalty.
The services provided at hospitals have a significant influence on patients' decisions to reuse outpatient services.Firstly, the quality of services directly affects patients' experiences during their visits.Friendly, responsive, and patientoriented services can enhance patient satisfaction and trust in healthcare providers.Patients who feel heard, understood, and valued are more motivated to reuse services because they feel that their needs and interests are well taken care of (25).
The availability of comprehensive and integrated services also plays a crucial role in influencing patients' decisions to reuse outpatient services.Patients seek hospitals capable of providing complete and thorough care, from diagnosis to follow-up and rehabilitation.Hospitals that can provide sustainable and coordinated services are more likely to be chosen by patients for service reuse because this creates comfort and trust in their treatment process (26).
It is important to pay attention to affordability and accessibility aspects in healthcare services.Patients will be more motivated to reuse services if they feel that the services are easily accessible and financially affordable.Factors such as short waiting times, ease of registration, and schedule flexibility can also increase the likelihood of reusing outpatient services.By prioritizing quality, integrated, and accessible services, hospitals can strengthen the influence of services on patients' decisions to reuse the healthcare services they need.
Strategic steps such as improving coordination between departments, reducing waiting times, and increasing service availability during flexible hours will help create a supportive environment for patients in maintaining their health and optimally reusing healthcare services (27).
Strategic steps to enhance the influence of services on the reuse of outpatient services at hospitals require a comprehensive approach focused on patient satisfaction and needs.Firstly, the importance of training and developing staff in interpersonal and communication skills cannot be underestimated.Well-trained staff can build strong relationships with patients, increase trust, and provide better overall service.Furthermore, improving service quality through reducing waiting times, increasing accessibility, and effectively meeting patient needs is crucial.With efficient queue management systems and friendly service, hospitals can create a positive experience for patients, encouraging them to reuse outpatient services.
Strengthening communication between patients and hospitals and effectively leveraging technology are also integral parts of this strategy.By providing clear information to patients about medical procedures and treatment plans and facilitating access to healthcare services through technology, hospitals can ensure active patient participation in their treatment process.By implementing these measures in a coordinated and consistent manner, hospitals can strengthen their position as leading healthcare providers, increase patient satisfaction, and build sustainable relationships with the communities they serve.

The influence of family encouragement on reuse of outpatient services
The influence of family support on the reuse of outpatient services at hospitals plays a significant role in patients' decision-making regarding their healthcare.Family encouragement and support can have a profound impact on patients' decisions to reuse healthcare services at the same hospital.Family members often serve as sources of information, support, and motivation for patients in managing their health, including decisions related to medical care.
Research indicates that positive encouragement from family members can increase patients' tendency to reuse outpatient services at hospitals.Emotional support, accurate information, and encouragement to undergo appropriate and consistent treatment can motivate patients to continue accessing the necessary healthcare services.In situations where patients require ongoing care, family encouragement and support can be key factors influencing patients' choices to continue using the same services.
Family encouragement can also help patients overcome barriers or fears related to medical treatment.For example, moral and physical support from family members can provide security and confidence to patients who may feel anxious or uncomfortable facing certain medical procedures.This can help reduce stress and boost patients' confidence in facing healthcare experiences.
The role of family encouragement can vary depending on family dynamics and interpersonal relationships within them.Some patients may be more influenced by advice and encouragement from family members, while others may prefer to make treatment decisions independently.Therefore, it is important to understand individual patient preferences and needs as well as family dynamics in understanding how family encouragement influences the reuse of outpatient services at hospitals.
To increase the reuse of outpatient services, hospitals may consider involving families as part of the patient care team and providing the necessary resources and information to support their role in the care process.By strengthening the relationship between patients, families, and healthcare providers, hospitals can ensure that patients receive holistic and comprehensive support in their journey toward recovery and optimal well-being (28).
Family encouragement plays a crucial role in influencing patients' decisions to reuse outpatient services at hospitals.Firstly, support and encouragement from family members can be a powerful motivational factor for patients to continue their treatment.When patients feel supported by their families, they are more likely to feel motivated and encouraged to continue maintaining their health by reusing services (29).
Family encouragement can also influence patients' perceptions of the importance of regular care and follow-up in their health conditions.Discussions and education within the family environment can help patients understand the risks and benefits of reusing outpatient services.When patients feel encouraged and supported by their families, they are more likely to prioritize their health and continue necessary treatment (30).
The emotional and practical support provided by families can also help overcome barriers that patients may face in reusing services.For example, families can assist in administrative processes, remind appointment schedules, or provide financial support if needed.All of these can strengthen patients' commitment to their treatment and increase the likelihood of reusing outpatient services.Therefore, it is important for hospitals to recognize the significant role played by families in supporting patients in their care and to strive to involve families as partners in efforts to improve patient health and well-being.
Strategic steps that can be taken to leverage family encouragement in increasing the reuse of outpatient services at hospitals involve three main approaches.Firstly, through family education programs, hospitals can provide comprehensive information about the of regular care and the benefits of reusing outpatient services.Thus, families can become more effective supporters for patients in maintaining their health.Secondly, by developing family support systems, hospitals can form teams or groups aimed at providing emotional support, information, and practical assistance to family members of patients.These teams can help overcome barriers that patients and families may face in the care process, as well as provide moral support and motivation to maintain health.Finally, collaboration with social workers and counselors allows hospitals to provide psychosocial support services to patient families.With family counseling, they can understand their roles and responsibilities in patient care, manage stress, and strengthen healthy family relationships.Through these steps, hospitals can create an environment that supports and motivates patients to consistently maintain their health and reuse necessary healthcare services.

Conclusion
In the context of healthcare, the conclusion of this research emphasizes the need for improvement in communication, education, and family support as crucial factors influencing patients' decisions to reuse the same services at hospitals.The development of structured family support programs, empowering patients in treatment decision-making, developing family-friendly hospital policies, as well as continuous evaluation and monitoring of program effectiveness, are crucial steps in ensuring that patients and their families receive the support they need.It is hoped that through the implementation of these recommendations, hospitals can enhance patient experience, improve adherence to treatment, and overall enhance healthcare outcomes.

Recommendations
Critical steps to be taken in the context of healthcare include enhancing communication, education, and family support, as well as developing structured family support programs, empowering patients, family-friendly policies, and regular program evaluation.The implementation of these recommendations is expected to improve patient experience, enhance adherence to treatment, and overall improve healthcare outcomes.

Table 1
Characteristics of Respondent Distribution at Dewi Sartika RSU in 2023

Table 2
. The analysis using the F-test (ANOVA) indicates a significant relationship between the factors studied and the reuse of services at the Outpatient Installation of Dewi Sartika General Hospital in Kendari City in 2023 (F(5, 94) = 12.136, p < .001).The regression results show that the variables tested together in the regression model can explain the variation in the reuse of services with a squared axis of 108.193.Thus, it can be concluded that the factors included in the regression model significantly contribute to understanding the patterns of reuse of services at the Outpatient Installation of Dewi Sartika General Hospital in Kendari City.

Table 2
F Test Results (ANOVA) Factors Associated with Reuse of Services in Outpatient Installations at the Dewi Sartika General Hospital, Kendari City in 2023 Model Sum Of Squares df Mean Square F Sig

Table 3
presents the coefficient of determination results indicating the relationship between factors that potentially influence the reuse of services at the Outpatient Installation of Dewi Sartika General Hospital in Kendari City in 2023.The analysis results show that the model used in this study has a moderate level of accuracy, as indicated by the R Square value of 0.392.This means that approximately 39.2% of the variation in the reuse of services can be explained by the variables included in the model.The lower Adjusted R Square value (0.360) suggests that adding variables to the model does not significantly increase the explanatory power of the reuse of services.The relatively low standard error of estimation(1.335)indicatesthat this model can provide reasonably accurate estimates of the reuse of services at the Outpatient Installation of Dewi Sartika General Hospital in Kendari City.

Table 3
Results of the Coefficient of Determination of Factors Associated with Reuse of Services in Outpatient Installations at the Dewi Sartika General Hospital, Kendari City in 2023

Table 4
Factors Associated with the Reuse of Services in Outpatient Installations at the Dewi Sartika General Hospital, Kendari City in 2023 a. Dependent Variable: Rema