Peningkatan Peran Apoteker dan Outcome Pasien Tuberkulosis Melalui Uji Coba Model Training-Education-Monitoring-Adherence-Networking (TEMAN) Apoteker
Abstract
Model Training-Education-Monitoring-Adherence-Networking (TEMAN) Apoteker memberikan ruang bagi apoteker yang telah mendapatkan pelatihan untuk melakukan intervensi melalui edukasi pasien tuberkulosis (TB), monitoring terapi, asesmen kepatuhan pasien dan kerjasama dengan tenaga kesehatan lain. Penelitian ini bertujuan untuk mengetahui dampak uji coba model TEMAN Apoteker terhadap peran apoteker dan outcome pasien TB. Penelitian terdiri atas 2 tahap yaitu pelatihan dan intervensi apoteker dengan jenis penelitian quasi experimental study dengan rancangan one group pretest-posttest design. Setelah mendapatkan pelatihan, apoteker melakukan intervensi pada saat kunjungan rutin pasien TB di puskesmas dan Rumah Sakit Khusus Paru Respira di DIY. Subjek penelitian yang dilibatkan meliputi petugas TB (apoteker dan programmer TB) dan pasien dengan diagnosis baru TB yang memenuhi kriteria inklusi, yaitu usia lebih dari 15 tahun, mendapatkan terapi obat anti tuberkulosis (OAT), bersedia mengisi kuesioner dan menandatangani informed consent. Kriteria eksklusinya adalah pasien multi drug resistance (MDR) TB; memiliki penyakit hepatik, psikiatrik (mental) dan disfungsi kognitif. Instrumen yang dikembangkan peneliti adalah kuesioner untuk mengukur tingkat pengetahuan petugas TB dan kuesioner untuk mengukur tingkat pengetahuan dan kepatuhan pasien TB. Analisis data menggunakan analisis deskriptif dan uji Wilcoxon sign rank. Adanya pelatihan efektif meningkatkan pengetahuan 37 petugas TB secara bermakna p=0,000 dari rerata 11,3±3,00 (kategori menengah) menjadi 16,3±2,31 (kategori tinggi). Sebanyak 40 (81,6%) pasien meningkat pengetahuannya secara bermakna (p=0,000) dan sebanyak 5 (10,2%) pasien meningkat kepatuhannya secara bermakna (p=0,034) setelah intervensi apoteker. Di sisi lain, dari total 49 pasien TB, sebanyak 29 (59,2%) pasien bertambah berat badannya, 100% konversi sputum, 33 (67,3%) kejadian adverse drug reactions (ADR), dan 8 (16,3%) potensi interaksi obat menjadi terdokumentasi melalui monitoring apoteker. Intervensi model TEMAN Apoteker meningkatkan peran apoteker dan outcome pasien TB.
Kata kunci: Anti-tuberkulosis, apoteker, kepatuhan, edukasi, intervensi
Enhancing Pharmacist’s Role and Tuberculosis Patient Outcomes Through Training-Education-Monitoring-Adherence-Networking (TEMAN) Pharmacist Model Intervention
Training-Education-Monitoring-Adherence-Networking (TEMAN) Pharmacist model provides opportunities for trained pharmacist to intervene through education of tuberculosis (TB) patient, therapy monitoring, assessment of patient’s adherence, and collaboration with other health professionals. The study aimed to determine the impact of TEMAN Pharmacist model intervention against the role of pharmacist and TB patient outcomes. The study design was a quasi-experimental study with one group pretest-posttest consisted of two phases: training and pharmacist intervention. After training, pharmacists intervene during regular visits TB patients in primary health care and Special Hospital Lung Respira in Yogyakarta. The research subjects were TB officer (pharmacist and TB programmers) and patients with newly TB diagnostic who met the inclusion criteria, i.e. patients aged 15 years or older, receiving antituberculosis therapy, and willing to fill out given questionnaires and signing a letter of approval for the study (informed consent). Meanwhile, the exclusion criteria were patients with multi-drug resistance (MDR) TB; have hepatic disease, psychiatry (mental), and cognitive dysfunction. The instrument developed was a questionnaire to measure the level of knowledge of TB officers and questionnaires to measure the level of knowledge and adherence of TB patients. The data were analyzed descriptively and by using Wilcoxon test. The training effectively improved the knowledge of participants significantly (p=0,000) on average 11.3±3.00 (intermediate category) to 16.3±2.31 (high category). A total of 40 (81.6%) TB patients increased their knowledge significantly (p=0,000) and 5 (10.2%) increased their adherence significantly (p=0,034) after the pharmacist’s intervention. Additionally, out of 49 patients, 29 (59.2%) patients increased body weight, 100% sputum smear conversion, 33 (67.3%) incidence of ADR, and 8 (16.3%) potential drug interactions were documented by the pharmacist monitoring. Intervention of TEMAN Pharmacist model improves the role of the pharmacist and the outcome of TB patients.
Keywords: Adherence, antituberculosis, education, pharmacists, intervention
Keywords
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World Health Organization. Global tuberculosis report 2015. Geneva: World Health Organization; 2015.
Departemen Kesehatan Republik Indonesia. Keberhasilan upaya pengendalian TB ditentukan oleh dukungan semua pihak dan seluruh lapisan masyarakat. [diunduh 16 Maret 2015]. Tersedia dari: http://www.depkes.go.id/article/view/1873.
Yasin NM, Wahyono D, Riyanto BS, Sari IP. Tuberculosis-related to knowledge, adverse drug reactions, clinical outcome, adherence in tuberculosis patients and pharmacist role: A preliminary survey for pharmacist intervention model development. Int J Pharmaceutical Clinical Research. 2016; 8(5):517–22.
Chahine EB, Sourial M, Scales J. Role of the pharmacist in the management of adults with pulmonary tuberculosis. US Pharm. 2012;37(7):HS2–HS6.
Clark PM, Karagoz T, Apikoglu-Rabus S, Izzettin FV. Effect of pharmacist-led patient education on adherence to tuberculosis treatment. Am J Health Syst Pharm. 2007;64(5):497-505. doi: 10.2146/ajhp050543
Mitrzyk BM. Treatment of extensively drug-resistant tuberculosis and role of the pharmacist. Pharmacotherapy. 2008;28(10):1243–54. doi: 10.1592/phco.28.10.1243.
Mkele G. The role of the pharmacist in TB management. S Afr Pharm J. 2010;2010:18–20.
Nakatani H, Buchmann M. The role of the pharmacist in tuberculosis care and control. Signing Ceremony WHO FIP Joint Statement: World Health Organization; 2011.
Bam TS, Aditama TY, Chiang CY, Rubaeah R, Suhaemi A. Smoking cessation and smokefree environments for tuberculosis patients in Indonesia: A cohort study. BMC Public Health. 2015;15(604):1–8. doi: 10.1186/s12889-015-1972-2
Ng N, Padmawati RS, Prabandari YS, Nichter M. Smoking behavior among former tuberculosis patients in Indonesia: Intervention is needed. Int J Tuberc Lung Dis. 2008;12(5):567–72.
Westerlund EE, Tovar MA, Lönnermark E, Montoya R, Evans CA. Tuberculosis-related knowledge is associated with patient outcomes in shantytown residents; results from a cohort study, Peru. J Infect. 2015;71(3):347–57. doi: 10.1016/j.jinf.2015.05.010
Putera I, Pakasi AT, Karyadi E. Knowledge and perception of tuberculosis and the risk to become treatment default among newly diagnosed pulmonary tuberculosis patients treated in primary health care, East Nusa Tenggara: A retrospective study. BMC Res Notes. 2015;8:238. doi: 10.1186/s13104-015-1209-6
Kayigamba FR, Bakker MI, Mugisha V, De Naeyer L, Gasana M, Cobelens F, et al. Adherence to tuberculosis treatment, sputum smear conversion and mortality: A retrospective cohort study in 48 Rwandan clinics. PLoS ONE. 2013;8(9):e73501. doi: 10.1371/journal.pone.0073501
Bernabe-Ortiz A, Carcamo CP, Sanchez JF, Rios J. Weight variation over time and its association with tuberculosis treatment outcome: A longitudinal analysis. PLoS ONE. 2011;6(4):e18474. doi:10.1371/jou rnal.pone.0018474
Yasin NM, Wahyono D, Riyanto BS, Sari IP. Model TEMAN apoteker: Alternatif model intervensi apoteker bagi pasien tuberkulosis. J Manag Pharm Prac. 2016;6(3):229–42.
Santoso S. Metode penelitian kuantitatif plus aplikasi program SPSS. Ponorogo: Pusat Penelitian Fakultas Ekonomi Universitas Muhammadiyah Ponorogo; 2010.
Dahlan MS. Besar sampel dan cara pengambilan sampel dalam penelitian kedokteran dan kesehatan. Jakarta: Penerbit Salemba Medika; 2010.
Wu PS, Chou P, Chang NT, Sun WJ, Kuo HS. Assessment of changes in knowledge and stigmatization following tuberculosis training workshops in Taiwan. J Formos Med Assoc. 2009;108(5):377–85. doi: 10.1016/S0929-6646(09)60081-4.
Minnery M, Contreras C, Perez R, Solorzano N, Tintaya K, Jimenez J, et al. A cross sectional study of knowledge and attitutes towards tuberculosis amongst front-line tuberculosis personnel in high burden areas of Lima, Peru. PloS ONE. 2013;8(9):e75698. doi:10.1371/journal.pone.0075698.
Kanjee Z, Catterick K, Moll AP, Amico KR, Friedland GH. Tuberculosis infection control in rural South Africa: Survey of knowledge, attitude and practice in hospital staff. J Hosp Infect. 2011;79(4):333–8. doi: 10.1016/j.jhin.2011.06.017
Roy A, Abubakar I, Chapman A, Andrews N, Pattinson M, Lipman M, et al. A controlled trial of the knowledge impact of tuberculosis information leaflets among staff supporting substance misusers: Pilot study. PloS ONE. 2011;6(6):e20875. doi: 10.1371/journal.pone.0020875
Kiefer EM, Shao T, Carrasquillo O, Nabeta P, Seas C. Knowledge and attitudes of tuberculosis management in San Juan de Lurigancho district of Lima, Peru. J Infect Dev Ctries. 2009;3(10):783–8.
Schindel TJ, Kehrer JP, Yuksel N, Hughes CA. University-based continuing education for pharmacists. Am J Pharm Edu. 2012;76(2):20. doi:10.5688/ajpe76220.
Schindel TJ, Kehrer JP, Yuksel N, Hughes CA. University-based continuing education for pharmacists. Am J Pharm Educ. 2012;76(2):1–7. doi: 10.5688/ajpe76220
Clark PM, Karagoz T, Apikoglu-Rabus S, Izzettin FV. Effect of pharmacist-led patient education on adherence to tuberculosis treatment. Am J Health Syst Pharm. 2007;64(5):497–506. doi: 10.2146/ajhp050543
den Boon S, van Lill SWP, Borgdorff MW, Verver S, Bateman ED, Lombard CJ, et al. Association between smoking and tuberculosis infection: A population survey in a high tuberculosis incidence area. Thorax. 2005;60(7):555–7. doi: 10.1136/thx.2004.030924
Gnanasan S, Ting, KN, Wong KT, Mohd Ali S, Muttalif AR, Anderson C. Convergence of tuberculosis and diabetes mellitus: Time to individualise pharmaceutical care. Int J Clin Pharm. 2011;33(1):44–52. doi: 10.1007/s11096-010-9452-3.
McInerney PA, Nicholas PK, Wantland D, Corless IB, Ncama B, Bhengu B, et al. Characteristics of anti-tuberculosis medication adherence in South Africa. Appl Nurs Res. 2007;20(4):164–70. doi: 10.1016/j.apnr.2006.06.006
Francis MT, Chandrasekaran K. Effectiveness of knowledge based approach for the improvement of patient adherence and reducing the severity of adverse drug reaction in anti tubercular therapy. Int J Pharmacy Teaching Practices. 2012;3(3):313–7.
Bhardawaj A, Kumar R, Dabas V, Alam N. Assessment and enhancing adherence to treatment regimen in tuberculosis out patient. Int J Pharm Pharm Sci. 2012;4(3):517–22.
Esmael A, Ali I, Agonafir M, Desale A, Yaregal Z, Desta K. Assessment of patients’ knowledge, attitude, and practice regarding pulmonary tuberculosis in Eastern Amhara Regional State, Ethiopia: Cross-sectional study. Am J Trop Med Hyg. 2013;88(4):785–8. doi: 10.4269/ajtmh.12-0312
Gelaw SM. Socioeconomic factors associated with knowledge on tuberculosis among adults in Ethiopia. Tuberc Res Treat. 2016;ID6207457:1–11. doi: 10.1155/2016/6207457.
Behnaz F, Mohammadzade G, Mousavi-e-roknabadi RS, Mohammadzadeh M. Assessment of knowledge, attitudes and practices regarding tuberculosis among final year students in Yazd, central Iran. J Epidemiol Glob Health. 2014;4(2):81–5. doi: 10.1016/j.jegh.2013.09.003
Arbex MA, Varella MCL, Siqueira HR, Mello FAF. Antituberculosis drugs: Drug interactions, adverse effects, and use in special situations, Part 1: First-line drugs. J Bras Pneumo. 2010;36(5):626–40.
Arbex MA, Varella MCL, de Siqueira HR, de mello FAF. Antituberculosis drugs: drug interactions, adverse effects, and use in special situations- art 1: First-line drugs. J Bras Pneumol. 2010;36(5):626–40. doi: 10.1590/S1806-37132010000500016
Cuny P, Marfaing-Koka A, Lottmann M, Rieutord A, Barbault-Foucher S. Drug interaction between bortezomib and tuberculosis treatment: A case report Eu J Hosp Pharm Sci Pract. 2014;21(3):167-169. doi: 10.1136/ejhpharm-2013-000345
Castro AT, Mendes M, Freitasa S, Roxo PC. Incidence and risk factors of major toxicity associated to first-line antituberculosis drugs for latent and active tuberculosis during a period of 10 years. Rev Port Pneumol. 2015;21(3):144–50. doi: 10.1016/j.rppnen.2014.08.004
Marra F, Marra CA, Bruchet N, Richardson K, Moadebi S, Elwood RK, et al. Adverse drug reactions associated with first-line anti-tuberculosis drug regimens. Int J Tuberc Lung Dis. 2007;11(8):868–75.
Gulbay BE, Gurkan OU, Yıldız OA, Onen ZP, Erkekol FO, Baccıoglu A, et al. Side effects due to primary antituberculosis drugs during the initial phase of therapy in 1149 hospitalized patients for tuberculosis. Respir Med. 2006;100(10):1834–42. doi: 10.1016/jrmed.2006.01.014
Gülbay BE, Gürkan OU, Yıldız OA, Önen ZP, Erkekol FO, Baççıoğlu A, et al. Side effects due to primary antituberculosis drugs during the initial phase of therapy in 1149 hospitalized patients for tuberculosis. Respir Med. 2006;100(10):1834–42. doi: 10.1016/j.rmed.2006.01.014.
Nader LA, de Mattos AA, Picon PD, Bassanesi SL, De Mattos AZ, Pineiro Rodriguez M. Hepatotoxicity due to rifampicin, isoniazid and pyrazinamide in patients with tuberculosis: is anti-HCV a risk factor?. Ann Hepatol. 2010;9(1):70–4.
DOI: https://doi.org/10.15416/ijcp.2017.6.4.247
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