Pengaruh Medication Therapy Management (MTM) terhadap Outcome Klinik dan Kualitas Hidup Pasien Hipertensi di Puskesmas Kota Yogyakarta

Medication therapy management (MTM), is a service model aimed at helping general health problems by preventing morbidity and mortality. Hypertension is a non-communicable disease which is a serious health problem which requires long-term therapy. This study aims to see the effect of MTM on clinical Outcomes and quality of life of patients in hypertensive patients. This type of research is a quasi experimental one group with a pretest-posttest design. Analysis using paired sample t-test and Wilcoxon test with a significance used P <0,05. Respondents were 70 people, 67,1% were women. The characteristics of the majority age are 55-64 years with a percentage of 51,4%, the majority of education level is high school with 42,8%, non-civil servant jobs with a percentage of 45,7%, the length of diagnosis is dominated by 1-10 years (77,1%) and comorbidities diabetes mellitus occurred the most (10,0%). The results showed that the quality of life increased from before getting MTM 54,4 ± 8,9 and after MTM intervention 60,4 ± 6,6 (P value <0,001). Clinical outcome from systolic 159,2 ± 8,9 mmHg and diastolic 103,8 ± 8,0 mmHg before MTM to 144,1 ± 14,4 mmHg for systolic and 89,7 ± 8,8 mmHg for diastolic with p value <0,001 (p <0,05) for systolic blood pressure and p value: 0,016 (p <0,05) after receiving MTM intervention. Medication Therapy Management (MTM) has a significant influence on improving the quality of life and clinical Outcomes of hypertensive patients. The higher the quality of life of patients, blood pressure becomes more controlled.

Educational Video to Improve Glycemic Control of Type 2 Diabetes Mellitus Patients

Glycemic control is a critical point in the management of type 2 diabetes mellitus (T2DM). The limited number of pharmacists in primary health care in Indonesia is one of the reasons that a simple alternative method is needed for managing T2DM patients. Objective: This study aimed to measure the effectiveness of an education diabetes video as a simple method of improving glycemic control of T2DM patients. Methods: This was a quasi-experimental pre-test/post-test study involving T2DM patients from one randomly selected public healthcare centre in East Jakarta. Glycated haemoglobin (A1C) levels were examined before and 12 weeks after the video intervention. Results: Thirty of T2DM patients enrolled in this study. The educational video was found to decrease the A1C level significantly (p = 0.001) from an average±SD of 7.930±1.262 to 5.517±0.614. Conclusions: This study found the educational was effective at improving the glycemic control of patients with T2DM. However, further investigation with control group still needed to confirm that the video that did it.

Persepsi Masyarakat terhadap Kandungan Alkohol Pada Kosmetik

Perception is an individual response about something that can be influenced by knowledge. Good individual knowledge of alcohol will affect their perception of alcohol-containing product. The MUI fatwa permits the use of alcohol in cosmetics. The purpose of this study was to observe the perception of alcohol content in cosmetics. The observation was carried out using a questionnaire technique with a nonprobability sampling technique with accidental sampling. The questionnaire was conducted by Pearson correlation test, validity test, reliability test, normality test, chi-square test, and description. In this study, using 98 respondents and get an average value of knowledge about cosmetics 6,73 with SD value of 0,49; knowledge of alcohol 4,54 with SD 1,17 and behavior with SD 1,46. There is a relationship between age with the level of cosmetic knowledge with p-value <0.05. As many as 46.94% stated, the halal label's urgency on cosmetics is very important and 39.80% is important, where the religion of the individual influences the urgency level of cosmetics halal. The urgency of halal labels on cosmetics is high in line with the behavior when buying cosmetics. The 81.63% of respondents stated that halal labels on cosmetic products affect the interest in buying cosmetics. As many as 61.24% of respondents have the perception that halal cosmetics do not contain alcohol. The Pearson halal label correlation test confirms this obtained a p-value value of 0.024 that the halal label influences respondents' perceptions. Individuals were having a perception that cosmetics with halal labels do not contain alcohol, which is influenced by halal labels' knowledge.

Kajian Adverse Drug Reactions Terkait Interaksi Obat di Bangsal Rawat Inap Rumah Sakit Akademik UGM

Adverse Drug Reactions (ADRs) is one of the causes of patient’s prolonged length of stay in the hospital and drug interactions can be included as one of the causes of the cause of ADRs. ADR related to drug interactions is a clinical problem that requires proper prevention. This study aimed to identify potential drug interactions also identify adverse drug reactions (ADRs) related to drug interactions in hospitalized patients at Universitas Gadjah Mada Teaching Hospital. This cross-sectional study used retrospective data collection through patient’s medical records from January to June 2018. Patients included in this study were all patients who received therapy more than two kind of drugs simultaneously treated in hospital wards of Universitas Gadjah Mada Teaching Hospital, Yogyakarta, Indonesia. The data collected were then analyzed descriptively. Drug interactions were analyzed using Drug Interaction Facts 2012 and Stockley. ADRs were analyzed by monitoring documented effects of patients with potential drug interaction. There were 115 of 362 patients (31.8%) with potential drug interactions. The total numbers of potential interactions that occur were 182 interactions. The most potential type of interaction was the interaction with moderate severity, with 115 interactions (63.2%). The majority of drug interactions occur through unknown mechanisms (54.4%). Actual ADR occurs in 3.3% patients who were 2 pediatric patients and 4 geriatric patients. This study can be a reference for drug interactions and ADRs as well as guide for pharmacist and healthcare in providing the right medication.

Adverse Drug Reactions Study of Antihypertensive Drugs in Primary Care Settings

Hypertension is one of the high-prevalence diseases in primary care. Failure to achieve the target of blood pressure is affected by non-compliance due to the antihypertensive adverse reactions. This study aims to determine adverse drug reaction (ADR) of antihypertensive drugs in primary care settings. A cross sectional study was conducted in “Sibela” Primary Care in Surakarta on March 2019. Investigators interviewed patients directly and observed supporting data from medical records. Hypertension patients with antihypertensive drugs at least for a month were eligible in this study. Then, the data were analyzed by the Liverpool algorithm that interpreted in 4 scales: unlikely, possible, probable, and definite. A total 70 subject were dominated by female (80%). Monotherapy of antihypertensive drugs prescribed to patient in primary care were amlodipine (80%) and captopril (10%). Nine events of ADR were found in hypertension patient. None ADR were doubtful. Possible ADR of amlodipine was drowsiness (5.4%), whereas probable ADR were nausea (3.4%), diuresis (1.8%), and abdominal pain (1.8 %). Definite ADR of captopril was dry mouth (14.3%) and probable ADR was abdominal pain (14.3%). Further investigation regarding the drowsiness, ADR of amlodipine, was needed.

Uji Perbandingan Antibiotik Profilaksis Ceftriaxone versus Cefazolin pada Bedah Obstetri dan Ginekologi

Surgical site infection (SSI) is the most common complication in postoperative surgical patients which is associated with high morbidity, mortality, and cost burden. These complications can be prevented by giving proper prophylactic antibiotics. Cefazolin is a recommended prophylactic antibiotic, but in the practice in Indonesia hospital, there are still many uses of ceftriaxone. This study aimed to compare the clinical outcome and safety of cefazolin and ceftriaxone as prophylactic antibiotics in preventing SSI in obstetric and gynecological surgical patients. The study design was double-blind randomized controlled trial. The data collection was conducted from January to June 2020 at dr. Dradjat Prawiranegara Regional Hospital Serang. A total of 82 subjects who met the inclusion criteria were divided into two groups by block randomization, 41 subjects were given cefazolin and 41 subjects were given ceftriaxone. The clinical outcome was measured by preventing SSI for the effectiveness and side effects for safety outcomes in both groups. The comparison of effectiveness and side effects were analyzed using the bivariate test (chi-square or fisher’s exact test) and relative risk (RR). The study showed that the effectiveness of cefazolin was the same as ceftriaxone in preventing SSI for 30 days (RR= 0.89; p= 0.724; 95%CI: 0,193-3,133) with the number of SSI 12.2% vs 9.8%. Side effects included nausea, vomiting, and phlebitis was observed in the administration of antibiotic by intravenous push (IVP) pre-operating. Cefazolin have safetier than ceftriaxone with the incidence of side effects were 9.8% vs 29.3% ((RR = 0,33; p= 0.003; 95% CI: 0.076-0.895). Cefazolin is an antibiotic recommended by Indonesian Ministry of Health and the Association of Obstetrics and Gynecology. This study encourages the use of cefazolin to prevent resistance due to ceftriaxone to overuse.

Hubungan Drug Related Problems (DRPs) Obat Antidiabetika terhadap Ketercapaian Kendali Glikemik pada Pasien Rawat Inap Diabetes Melitus Tipe 2 dengan Komplikasi Nyeri Neuropati

Drug Related Problems (DRPs) associated with Type-2 Diabetes Melitus is commonly caused by multi drug prescription since Type-2 Diabetes Mellitus has comorbid dan complication diseases. Neuropathic pain has 50% prevalence of Type-2 diabetes Mellitus Complication. DRPs can cause can cause inadequate therapy that might be the risk factor leads to neuropathic pain. This study was aimed to investigate the association between drug related problems of antidiabetic medication with glicemic control of hospitalized type 2 diabetes melitus with neuropathic pain patients. Cohort-study is used in this study. 50 patients were conducted in this study that underwent Hospital treatment at Rumah Sakit Akademik Universitas Gadjah Mada during the periods of 2018-2019. This study involved 50 patients who were divided into groups that experienced DRPs by 36 patients and non DRPs by 14 patients. All of the 50 has meet the inclusions criterias. Statistical analysis was using Chi-square test 95% confidence interval (p < 0.05). A number of 38 DRPs have found consists of 26,3% need more therapy, 55,2% with wrong drug therapy, 18,4% inadequate dosing. There was an association between DRPs of antidiabetics regiments and glycemic target on Type-2 Diabetes Mellitus patients with neuropathic pain complication (p=0,005). Identification of DRPs is needed to prevent the negative effect of patient therapy outcomes.

The Effect of Based Services Medication Therapy Management on Treatment Adherence and Quality of Life of Diabetes Mellitus Patients

Diabetes mellitus is a chronic metabolic disorder that is characterized by hyperglycemia. Diabetes mellitus need appropriate therapeutic management, because it can cause complications. On of the services that can do to improve diabetes control is Medication Therapy Management (MTM). MTM is a new service that will help pharmacist to improve patient adherence and quality of life. This study aims to determine the effect of based services MTM on treatment adherence and quality of life in patients with diabetes mellitus. This study was an experimental study using a quasi-experimental with one group pretest and posttest design which was conducted in Tegalrejo, Jetis and Gedontengen Health Center Yogyakarta City. Variables measured were medication adherence using the Morisky-Green Levine Medication Adherence Scale (MGLS) questionnaire and quality of life using Diabetes Quality of Life Clinical Trial Questionnaire (DQLCTQ) before and after MTM services. The effect of MTM on medication adherence was analyzed using Wilcoxon test and the effect of MTM on quality of life using Paired T-Test. The patients participate in this study were 20 people, with average score of adherences before application of MTM was 2.20±0.410 to 1.80±0.616 after the application of MTM (P=0.005) and the average of the patient's quality of life was 73.82±7.918, increased to 76.42±5,623 after MTM service (P=0.033). Statistically mean, there is a difference in adherence and quality of life before and after MTM services. Therefore, it can be concluded that MTM-based services performed by pharmacists have a significant effect on improving medication adherence and quality of life for DM patients. Moreover, it can facilitate monitoring patient therapy, and identification of problems related to the treatment.

Evaluasi Perencanaan Persediaan Antibiotik Secara Kuantitatif Di Instalasi Farmasi Rumah Sakit Tipe A

Planning an inventory of antibiotics that are not good will cause problems in planning, which are over-supply of antibiotics (stagnant) and lack of antibiotic stock (stockout). In this study an quantitative evaluation of antibiotic inventory planning was carried out using the Economic Order Quantity (EOQ) and Maximum-Minimum Stock Level (MMSL) control methods in 2017 at Type A Hospital’s Pharmacy Department. The EOQ method aims to minimize the number of orders while the MMSL method is used to determine the minimum and maximum stock of antibiotics that must be ordered. The results were compared with the need for 2018 then calculations are carried out to determine the amount of stagnant and stockout antibiotics. The number of antibiotics that were stagnant by EOQ method simulation was 44.73% and by MMSL method was 48.02%, while the number of antibiotics stocked by EOQ method was 38.15% and by MMSL method was 42.76%. The category of antibiotic supplies in 2018 in real terms which was included in a stagnant state was 23.68%, stockout ie 55.26% of 152 antibiotics. Evaluation of antibiotic inventory planning using the EOQ method results in the calculation of lower order quantities while the number of orders with MMSL is higher. To find out more broadly about the evaluation of inventory planning in the hospital needed further research by taking into account all drugs not just antibiotics.

The Effectiveness of Zoledronic Acid and Ibandronic Acid in Delaying Skeletal-Related Events in Multiple Myeloma in Indonesia

Zoledronic acid and ibandronic acid are listed in the Indonesian national formulary to prevent skeletal-related events (SRE) in patients diagnosed with bone metastasis in multiple myeloma (MM), with limited evidence to compare their effectiveness. This study aimed to investigate the effectiveness and safety of zoledronic acid and ibandronic acid in delaying SRE. The method was the retrospective, with data obtained from the multicenter study for MM patients with bone metastasis (aged over 18 years), based on medical records between January 2016 and December 2018. Patients were assigned to zoledronic acid and ibandronic acid groups. The clinical outcome was the next SRE which consists of vertebral/bone fracture, spinal cord compression leading to the need for surgery or radiation, and adverse event (AE) due to 2 years of drugs usage. Result of this research was made up of a total of seventy (70) patients with 40 in the zoledronic acid group, and 30 in ibandronic acid. At median treatment duration of 8 months (range: 2 – 24 month), SRE incident in zoledronic acid and ibandronic acid were 20.0 % and 23.3 % respectively. Furthermore, their mean SRE free survival times were 21 months [95% confidence interval (CI) 19 - 23 months], and 19 months [95% CI, 16 – 22 months], respectively. Also, their time intervals were not significantly different (p>0.05). The osteonecrosis of the jaw (ONJ) was AE which occurred more in zoledronic acid than ibandronic acid. The conclusion was zoledronic acid tends to delay SRE time compared to ibandronic acid, although more ONJ occur.