Drug Utilization Evaluation Anti Edema Otak pada Pasien Stroke Hemoragik di Rumah Sakit Bethesda Yogyakarta
Abstract
Strok hemoragik adalah subtipe stroke yang menyebabkan tingginya mortalitas dan morbiditas. Edema otak adalah salah satu kontributor yang menjadi penyebab kematian. Penelitian ini bertujuan untuk mengevaluasi rasionalitas penggunaan anti edema otak pada pasien strok hemoragik di Rumah Sakit Bethesda Yogyakarta serta mengetahui faktor yang berpengaruh terhadap luaran klinis pasien. Penelitian ini merupakan penelitian non-eksperimental analitik dengan rancangan cohort retrospective dan dilaksanakan pada bulan April–Mei 2018 di Rumah Sakit Bethesda Yogyakarta. Subjek penelitian adalah pasien strok hemoragik intraserebral yang memenuhi kriteria inklusi dan diambil menggunakan teknik consecutive sampling. Rasionalitas penggunaan obat dievaluasi berdasarkan Panduan Praktik Klinis Neurologis (Perdossi) 2016, Drug Information Handbook 20th Edition, dan luaran klinis berdasarkan Skala Rankin. Data diolah secara statistik menggunakan uji Chi-Square dan regresi logistik. Hasil penelitian menunjukkan bahwa dari 52 subjek penelitian, subjek laki-laki berjumlah 26 (50,0%) dan subjek perempuan berjumlah 26 (50,0%). Penggunaan anti edema otak rasional pada 43 subjek (82,7%) dan tidak rasional pada 9 subjek (17,3%). Penggunaan obat yang tidak rasional meliputi tidak tepat dosis (11,5%) dan tidak tepat obat (5,8%). Sebanyak 17 subjek (32,7%) yang mendapat terapi rasional luaran klinisnya membaik, sedangkan 26 subjek (50,0%) luaran klinisnya memburuk. Pada subjek yang mendapat terapi tidak rasional, sebanyak 1 subjek (1,9%) luaran klinisnya membaik, sedangkan 8 subjek (5,4%) luaran klinisnya memburuk. Hasil analisis bivariat antara rasionalitas penggunaan anti edema otak dengan luaran klinis menunjukkan tidak terdapat hubungan yang bermakna (p=0,139) dan hasil analisis multivariat menunjukkan multivitamin adalah faktor yang paling mempengaruhi luaran klinis (RR 13,968; IK95% 1,459–133,711; p=0,022).
Kata kunci: Anti edema otak, drug utilization evaluation, strok hemoragik
Drug Utilization Evaluation of Anti Brain Oedema for Hemorrhagic Stroke Patients in Bethesda Hospital Yogyakarta
Abstract
Hemorrhagic stroke is a subtype of stroke that causes high mortality and morbidity. However, brain oedema is one of the contributors that cause mortality. The purpose of this study was to evaluate the rationality of anti-brain oedema use in hemorrhagic stroke patients at Bethesda Hospital Yogyakarta and to determine factors that influence a patient’s clinical outcome. The study was a non-experimental method conducted using a cohort retrospective design from April to May 2018 at Bethesda Hospital Yogyakarta. According to the inclusion criteria, subjects were intracerebral hemorrhagic stroke patients and were obtained using a consecutive sampling technique. Furthermore, evaluation of the rational use of anti-brain oedema was based on Panduan Praktik Klinis Neurology (Perdossi) 2016, Drug Information Handbook 20th Edition and ranking scale to assess outcome. Data were statistically processed using the Chi-Square test and logistic regression. The results showed that of the 52 subjects, 26 were males (50.0%) and 26 females (50.0%); rational use of anti-brain oedema was in 43 subjects (82.7%) while 9 subjects (17.3%) was irrational; irrationality consisted of a wrong dose (11.5%) and wrong medicine (5.8%); about 17 subjects (32.7%) obtaining rational therapy had better outcome while 26 subjects (50.0%) had worse outcome; also 1 subject (1.9%) obtaining irrational therapy had better outcome meanwhile 8 subjects (5.4%) had a worse outcome. However, the result of bivariate analysis showed no significant relationship between rationalities of the use of anti-brain oedema and clinical outcome (p=0.139), and multivariate analysis indicated multivitamin as the most influencing factor to the clinical outcome (RR 13.968; 95%CI 1.459–133.711; p=0.022).
Keywords: Anti brain oedema, drug utilization evaluation, hemorrhagic stroke
Keywords
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DOI: https://doi.org/10.15416/ijcp.2021.10.1.37
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