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Soebroto Hospital” telah dipamerkan pada Sesi Poster yang diselenggarakan pada 1st ISPOR

Indonesia Conference 2014, 24-27 Mei 2014 di Sanur Paradise Plaza Convention Center-Bali.

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Ahmad Fuad Afdhal Ph.D

(President ISPOR Indonesia Chapter)

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Tuberculosis Outpatient’s Knowledge, Adherence, And Therapeutic Outcomes At Rspad Gatot Soebroto

Hospital”, berdasarkan penilaian Tim Evaluasi Abstrak, maka abstrak saudara dinyatakan

diterima dan memenuhi syarat.

Untuk itu harap mencetak abstraknya dalam bahasa Inggris dengan ukuran kertas A2 dan dibawa

sendiri dan diserahkan ke panitia pada hari Jum’at 23 Mei 2014 di sekretariat panitia, Sanur Paradise

Plaza & Convention Center.

Atas perhatian dan kerjasamanya kami sampaikan terima kasih.

Jakarta, 8 Mei 2014

Tim Evaluasi Abstrak ISPOR Indonesia Conference 2014

dr. Deliana Permatasari

Evaluation of Pulmonary Tuberculosis Outpatient’s Knowledge,

Adherence, and Therapeutic Outcomes

at

RSPAD Gatot Soebroto Hospital

Dian Ratih Laksmitawati*), Sesilia Andriani K, Gladys

Faculty of Pharmacy, Pancasila University

Jalan Srengseng Sawah, Jagakarsa, South Jakarta 12640 *)corresponding author : [email protected]

BACKGROUND The prevalence of tuberculosis (TB) in Indonesia is still high. This proved that the therapeutic outcome of TB treatment is still low. Therapeutic outcome can be improved by increasing the adherence that is supported by the increase of the patient’s knowledge.

OBJECTIVES To evaluate the knowledge, adherence, and therapeutic outcome in patients with pulmonary tuberculosis at RSPAD Gatot Soebroto Hospital.

METHODS This is an observational analytic study with cross sectional design, conducted on 30 patients using total sampling technique. Data were taken prospectively towards newly diagnosed pulmonary tuberculosis patients and followed for 2 months. The tools used in this research is Modified Morisky Scale questionnaire to access

adherence and knowledge about diseases and drugs questionnaire. The therapeutic outcome were measured by counting the percentage of patients that entered the

extension phase after completing the intensive phase therapy.

Number of Patients Answered Correct from the Disease Knowledge Questionnaire

Number Of Patients Answered Correct From The TB Drug Knowledge

Questionnaire

Paired t test was performed to determine whether there is a mean difference between the knowledge of patients before and after starting treatment; and Wilcoxon test

was conducted to determine mean difference between the patient’s adherence at the beginning and end of the intensive phase of therapy. The results showed that 90% of

patients achieve improvement in the therapeutic outcome. In addition there is a significant increase in patient’s knowledge about the disease (14.41%) and drug (2.39%). As for adherence, there is a significant decrease as much as 9.44%.

CONCLUSION During 2 months of intensive phase TB therapy, the patients experienced an increase in their knowledge of TB disease and drugs compared to before therapy. Using Morisky Scale to measure adherence, there has been a decrease in the motivation through the observation of the significant reduction in the patient’s adherence in

drug consumption.

Ten percent of patients are categorized as experiencing therapy failure during intensive phase, therefore patients were given drug inserts for 1 month.

Research Scheme

newly diagnosed TB patients After 2 month intensive phase

excluded

Descriptive analysis T-paired and Pearson analysis

Pre-post datas

Therapy outcome

Questionnaires of :

Disease knowledge Drug knowledge Adherence

Meet the inclusion criterias Did not meet the in-clusion criterias

Pulmonary Tuberculosis Outpatient at RSPAD

Gatot Soebroto Hospital

ACKNOWLEDGEMENT Appreciation are given to RSPAD Gatot Soebroto Hospital for the cooperation during this research

DISCUSSION

In the first 2 weeks of the intensive phase, are patients most likely to experience full motivation to recover. The first target desired by patients are negative sputum smear examination. But over the past 2-4 weeks there will be a possibility when the patients become bored and forget to take their TB drugs along with the improvement of the

patient’s condition. This has led to a decrease in patient’s adherence, which is detected by the shift in the Morisky Scale quadrant. Ten percent of patients in this study

were categorized as experiencing therapy failure and therefore they must receive drugs inserts for 1 month.

Correlation test were conducted between knowledge of TB disease, TB drugs, and patient’s adherence. The test showed that only knowledge of TB disease hase a

significant correlation with patient’s acherence (p value 0.002).

23.33

83.33

20

76.67

56.67

93.33

66.67

33.33

96.67

26.67

76.67

70

100

80

0

20

40

60

80

100

120

The cause of TB

Part of the body infected

The spread of disease

How person are exposed

to TB

TB symptoms Can TB be cured/not

Duration of treatment

Num

ber o

f pat

ient

s an

swer

ed c

orre

ctly

(%)

TB Disease Knowledge

Before therapy After intensive phase therapy

Demography Data

Types of TB Medicines (A) and Insurance (B)

Notes : A.Non-Fixed Dose Combination

(Non-FDC) = R/H/Z/E drugs given single, therefore patients receive single dose of 4 different tablets; Fixed Dose

Combination (FDC) = R/H/Z/E drugs are combined together, therefore patients

only received 1 tablet;

B.Privilege = health insurance

for army patients or their family; Health insurance (ASKES) = insurance given to

civil servants; Jakarta Health Card (KJS) = insurance given

Therapeutic Outcome in

Percentage

Sliding of Patient’s Adherence (Morisky Scale Adherence)

No. Quadrant Percentage of

Patients Before Oral Anti-tuberculosis

Therapy

(%)

Percentage of

Patients After Oral Anti-tuberculosis

Therapy

(%)

1. I - -

2. II - 3.33

3. III - 10

4. IV 100 86,67

Notes : A = age (yr),; B = gender, C = education, D = married status, E= job

LITERATURE

1. Case Management Society of America. Case Management Adherence Guidelines (CMAG). Edisi II. Amerika: Case Management Society of America; 2006.p. 39-41, 28-30. 2. Departemen Kesehatan Republik Indonesia. Pedoman Penanggulangan Tuberkulosis (TB). Edisi ke-2. Jakarta : Depkes RI; 2006

3. WHO. Promoting adherence to treatment for tuberculosis: the importance of direct observation. Bulletin of WHO May 2007; p 325-420

Information :

I = low knowledge, low motivation; II = low knowledge, high motivation; III = high

knowledge, low motivation; IV = high knowledge, high motivation

30

100 100

5046.66

100 100 100

30

100 100

5056.66

100 100 100

0

20

40

60

80

100

120

Drug name How the drugs are

used

Number of drugs taken

When draugs are taken

positive effect of drug

negative effect of drug

How to store drugs

When to refill drugs

Num

ber o

f pat

ient

s ans

wer

ed c

orre

ctly

(%)

TB Drug Knowledge

Before therapy

After intensive therapy