Korelasi Tingkat Kepatuhan Konsumsi Obat Antiepilepsi Menggunakan Kuesioner MGLS (Morisky, Green, Levine Adherence Scale) dengan Frekwensi Kejang Pasien Epilepsi

Epilepsy is a chronic non-communicable brain disorder that can affect people of all ages. AED (antiepileptic drug) is the main therapy for most epilepsy patients with the overall goal being to prevent seizures without causing side effects. One measure of management of drug therapy in epilepsy is the decrease / loss of seizures, so that the frequency of seizures is one of the measures to achieve end-outcome. This study was an observational cross sectional study conducted on outpatients in Airlangga University Hospital, which aims to look at the relationship between the level of adherence using antiepileptic drugs with the incidence of seizures in epilepsy patients. The level of adherence with AED consumption in this study used the MGLS questionnaire (Morisky, Green, Levine Adherence Scale). The level of adherence based on the MGLS questionnaire was divided into 3 levels including low, medium or medium obedient and high compliant. The seizure events in epilepsy patients observed were the presence or absence of seizures during the past month, the data of which were obtained from patient or family interviews and from diary seizures. The results of the study of 40 respondents found that there was a moderate positive correlation between the level of adherence measured using the MGLS questionnaire whose majority level of adherence was moderate with the occurrence of seizures in epilepsy patients (r = 0.423 with p = 0.006 <0.05.

Hubungan Tingkat Penerimaan diri dengan Tingkat Kepatuhan Minum Obat Pasien Lupus di Yayasan Kupu Parahita Indonesia

Lupus is a chronic autoimmune disease that can become a bio-psycho-socio-economic-culture-spiritual burden for individuals because its complex treatment and management. Self-acceptance and adherence to medication are the keys in lupus management. Purpose of this study was to determine the relationship between self-acceptance level of lupus patients and their medication adherence level. The study was designed using a correlational study with a cross sectional approach. About 92 lupus patient respondents at Kupu Parahita Indonesia Foundation who went to the Saiful Anwar Hospital Malang were selected using purposive sampling according to inclusion and exclusion criteria. Respondents were asked to fill out a modified Acceptance of Illness questionnaire to measure patient self-acceptance level and the Morisky Medication Adherence Scale 8 (MMAS-8) to assess drug adherence level. From the 92 respondents, it was found that 37% had a high level of self-acceptance, 52.2% were moderate, and 10.8% were low. Adherence medication level in 92 respondents showed 51.1% high, 38.1% moderate, and 10.8% low. Spearman test results showed a significant relationship between self-acceptance level and medication adherence level (p=0.001, r=0.355). This value indicates the strength of the weak relationship and the direction of the positive correlation between self-acceptance and medication adherence. Conclusion, the higher of self-acceptance level of lupus patients, the higher medication adherence level.

HUBUNGAN PENGETAHUAN DAN KEPATUHAN IBU HAMIL ANEMIA DALAM MENGKONSUMSI TABLET TAMBAH DARAH DI WILAYAH KERJA PUSKESMAS LEMPAKE KOTA SAMARINDA

Anemia pada ibu hamil merupakan masalah utama kesehatan ibu dan menjadi program prioritas di Indonesia. Suplementasi Tablet Tambah Darah (TTD) adalah intervensi cost effective yang secara signifikan menurunkan prevalensi anemia pada ibu hamil. Ketidakpatuhan dan kurangnya pengetahuan mengenai pentingnya mengkonsumsi TTD secara teratur menjadi hambatan dalam program ibu hamil bebas anemia. Penelitian bertujuan untuk melihat hubungan pengetahuan ibu hamil anemia mengenai informasi penting suplemen Fe dan kepatuhan ibu hamil dalam mengkonsumsi TTD sesuai dosis. Penelitian ini merupakan penelitian observasional analitik cross sectional. Sebanyak 48 ibu hamil anemia yang melakukan antenatal care yang teregister pada kohor ibu dari bulan Januari–Mei 2019 dijadikan sebagai sampel. Variabel penelitian adalah pengetahuan tentang pesan penting TTD dan kepatuhan menelan TTD yang diukur dengan Morisky Medication Adherence Scale (MMAS-8). Sebagian besar ibu hamil anemia berusia 20-30 tahun, pendidikan SMA dan PT, bekerja, berpenghasilan baik. Pengetahuan tentang pesan pesan penting cukup baik dan lebih dari separuh ibu hamil anemia mengkonsumsi TTD secara rutin setiap hari selama tiga bulan. Pengetahuan ibu hamil anemia tentang informasi penting tentang TTD meningkatkan kepatuhan mengkonsumsi TTD. Monitoring kepatuhan dan penggunaan TTD sesuai dosis sangat diperlukan agar ibu hamil dan bayinya bebas dari dampak buruk anemia.

Factores asociados a la no-adherencia al tratamiento farmacológico antihipertensivo en pacientes de un hospital del seguro social

Introducción: La falta de adherencia a la terapia antihipertensiva contribuye directamente a que los pacientes coexistan con hipertensión, desencadenando mayor riesgo de morbilidad y mortalidad. Así, la falta de adherencia al tratamiento se convierte en una de las principales causas de hipertensión no controlada en la población. Evaluamos los factores asociados a la no-adherencia al tratamiento antihipertensivo en pacientes de cardiología de un hospital de EsSalud en San Juan de Lurigancho-Lima, durante el 2017. Material y Métodos: Estudio analítico-transversal, se incluyeron pacientes que acudieron a consultorio externo de cardiología con historia previa de hipertensión esencial y se excluyeron hipertensión secundaria por otras causas biológicas. Se utilizó el Test de Morisky-Green Morisky Medication Adherence Scale (MMAS-4) para evaluar la no-adherencia al tratamiento antihipertensivo. Resultados: De los 270 participantes de estudio, el 69% (n=185) eran adultos mayores de 65 años, 46% (n=124) varones y el 76% (n=118) tenían pareja estable. Entre los antecedentes clínicos, el 60% (n=122) reportó diagnóstico clínico de hipertensión arterial, el 30% (n=80) de diabetes mellitus tipo II y el 27% (n=73) no-adherencia al tratamiento. Los factores asociados a la no-adherencia de tratamiento fueron sexo masculino (ORa: 0,45, IC95% 0,20-1,04), trabajador independiente (ORa:3,88, IC95% 1,51-9,97), IMC mayor de 30 (ORa:0,23, IC95% 0,07-0,70). Conclusiones: en los pacientes con diagnóstico de hipertensión esencial existen factores de riesgo modificables y no modificables asociados a la no-adherencia al tratamiento. Se deben considerar estos factores para implementar estrategias de tamizaje y focalizar las intervenciones para adherir a los pacientes renuentes a su tratamiento.

Organizational aspects of neurorehabilitation at the outpatient stage

The study was aimed to evaluate the effectiveness of IRP implementation in patients of a specialized clinic providing long-term care to neurological and neurosurgical patients. Material and methods. The study was conducted in 2020-2021. on the basis of the MC "Expert Health" (Odessa, Ukraine). 83 patients undergoing neurorehabilitation program were examined. The correspondence of the fulfillment of key rehabilitation tasks in terms of time and quality was assessed. Additionally, the level of motivation and compliance of the patient was assessed using the MOT-Q questionnaires (for patients with previous TBI (n = 13), SRMS (for patients with stroke (n = 54) and with SRQ-E (for patients with other types of neurological pathology (n = 16). The overall level of compliance was assessed using the General Rehabilitation Adherence Scale (GRAS). The level of safety was assessed according to the following criteria: the presence of FAST certificates for personnel, a system for monitoring vital functions, equipment and consumables for the provision of emergency care. Statistical processing was carried out by methods of variance and correlation analysis, using the MedCalc 1.3 software. Results. There were not recorded any significant violations of safety principles in the provision of rehabilitation assistance in the certification of personnel according to FAST. The frequency of detecting cases of improper implementation of IRP did not exceed 6.0% (5 cases out of 83 analyzed). When assessing the relationship between the effectiveness of IRP and the level of compliance, a strong positive correlation was found - r = 0.78 Conclusion. 1. Provision of rehab services for neurological patients in the long term requires coordination of the actions of specialists at the intra-, inter-, and transdisciplinary levels. 2. A necessary condition for the functioning of a multidisciplinary team in the provision of rehabilitation care is certification of staff in the BLS systems - for allied health specialists and ACLS for physicians. 3. The effectiveness of IRP depends on the patient's compliance level (r = 0.78). 4. For the continuity of the rehabilitation process, it is necessary to involve relatives and facilitate their training in the basics of "home" rehabilitation.

The Effect of Medication Remainder Application (MRA) on The Level of Knowledge and Compliance of Type 2 Diabetes Mellitus patients in Universitas Sumatera Utara Hospital, Indonesia

Effect of MRA on the level of knowledge and compliance of patients with Type 2 Diabetes Mellitus in hospital of Universitas Sumatera Utara. This Cohort Study was conducted in August - November 2018 at the hospital of Universitas Sumatera Utara with a total of 30 respondents. The research subjects were one group pretest-posttest given intervention in the form of a digital MRA application on a patient's smartphone. to measure the level of patients knowledge by using the Diabetes Knowledge Questionnaire-24 (DKQ-24) questionnaire while the Morisky Medication Adherence Scale-8 (MMAS-8) questionnaire was used to measure compliance. The data obtained were collected and then analyzed by using Microsoft Excel and Spearman test statistics. Based on the Spearman Test the Sig (2-tailed) value was 0.301 (p≤0.05), the knowledge is positively correlated with the compliance rate of 0.195 which has a low correlate level. Based on the results of the study it can be concluded that the MRA influences to increase the knowledge and compliance of patients with type 2 DM.

Evaluation of Adherence to the Oral Antibiotic Treatment in Patients With Diabetic Foot Infection

Introduction: The knowledge about level of adherence to oral antibiotic treatment in diabetic patients with ulcer infection could be essential as a method of evaluation/monitoring of conservative treatment. Aim: To assess the adherence to oral antibiotic treatment in outpatients with diabetic foot infection (soft tissue vs. osteomyelitis) by 8-item structured, self-reported medication adherence scale. Methods: cross-sectional study was carried out with 46 consecutive patients who had diabetic foot infection (soft tissue or bone infection) and required antibiotic oral treatment at outpatient clinical setting. Medication adherence was tested using the Spanish version of the validated eight-item self-report MMAS-8. Results: patients with diabetic ulcer infection, had well level of adherence to antibiotic medication (7 ± 1.2 vs. 7.4 ± 1.5). Patients with lower level of adherence had lower level of satisfaction with the antibiotic medication. The profile of the patients with lower level of adherence were patients with primary level of education and patient who required more help to take the medication. Conclusion: Patients with diabetic foot infection demonstrated well level of adherence to antibiotic medication, independently of type of infection (soft tissue vs. osteomyelitis) by 8-item structured, self-reported medication adherence scale.

Primary Non-adherence to Treatment with New Oral Anticoagulants: The Results of a Prospective Observational Study «ANTEY»

Aim: To assess the main characteristics of patients with non-valvular Atrial Fibrillation (AF) who are initially non-adherent to New Oral Anticoagulants (NOAC), and to identify factors associated with this version of non-adherence. Materials and Methods: The ANTEY study included 201 patients with non-valvular AF, who had indications and without contraindications for NOAC treatment. The patients had previously been advised to take oral anticoagulants but they did not comply with all medical recommendations. The observation period was 1 year, during which 2 in-person visits were performed: an inclusion visit (V0) and a visit (V1), as well as 1 telephone contact/follow up (FU); the interval between contacts was 6 months. All patients were recommended to take the NOAC by decision of the physician. During the V0, V1 and FU visits, the “National Society for Evidence-Based Pharmacotherapy (NSEPh) Adherence Scale” questionnaire was used to assess overall adherence and associated factors. 15 (7.5%) patients had not started NOAC therapy by the end of the study (primary non-adherent patients). Their characteristics are analysed in this work. Results: The main reasons for primary non-adherence to NOAC were high cost (33.3%), fears of adverse effects (AE) (33.3%), doubts about the need for treatment (13.3%) and the complex therapy regimen (13.3%). In the group of primary non-adherent patients in comparison with the rest of the patients there were significantly more patients with 1 point according to CHADS2VASc (20% and 2.2%, respectively, p = 0.029) and patients with 3 points according to HAS-BLED (33.3% and 9.1%, respectively, p = 0.006); they took antiplatelet drugs more often 73.3% versus 21.5%, respectively (p = 0.001). Full employment at work (OR = 5.2; CI95% [1.5; 18.1], p = 0.009), history of quitting smoking (OR = 5.1; CI95% [1.5; 17.0], p = 0,008), the presence of any pharmacotherapy AE (OR = 4.0; CI95% [1.01; 16.0], p = 0.048) increased the chance of primary non-adherence to NOAC by 4-5 times. Conclusion: The most vulnerable in relation to initiation of NOAC therapy for the prevention of thromboembolic complications in AF are those patients who continue to work or have any pharmacotherapy AE. The leading factors preventing the initiation of NOAC administration are their high cost, fear of the development of AE from the therapy, and patients’ doubts about the need for treatment with these drugs. The clinical trial registration number is NCT 03790917.