Hubungan Faktor Komorbiditas, Intensifikasi Terapi, dan Pengendalian Tekanan Darah

Background: Therapy intensification (TI) is the most important factor in blood pressure control among the adherent patients. The TI is the physician prescription behavior to add the item(s) and/or the dosage of hypertensive medicine when the patients\u27 BP was ≥10mmHg above the target. Comorbid patients have 10mmHg lower BP target. Aims: to evaluate the effect of comorbidity on TI score and blood pressure control; and to correlate the variables of TI and BP control. Method: retrospective cohort study done in 4 hospitals in Yogyakarta for 5 months. The subjects of age >18 years, hypertensive out-patient covered with Askes insurance, and ≥1 visit with uncontrolled BP were included. Hemodialysis subjects were excluded. Subjects were grouped into with/without comorbid. The BP profile was analyzed with T-test, repeatedmeasurement Anova, and odds ratio. Results: subjects consisted of without (WO) (n=268) vs. with comorbid (W) (n=401) patients. Comorbid subjects had older age, more male proportion and more visits (p<0.05). The profiles of final SBP/DBP in WO vs. W subjects were as follow: 148.9/89.1 (WO) vs. 143.8/86.1mmHg (W) (p<0.05); TI score (-) 0.36±0.26 (WO) vs. (-)0.38±0.24 (W) (p>0.05); the final SBP: worse BP control 20.9 (WO) vs.16.2% (W), not controlled in all visits 38.1 vs. 45.9%, improved 17.5 vs. 23.9%, and good controlled in all visit 23.5 vs.13.2%; proportion of subjects reached BP target 40.7% (WO) vs. 37.4% (W) (p>0.05); the different of final minus target SBP: (-)9.0±18.5 vs. (-)13.9±17.4mmHg (p<0.05); correlation between TI and variables of SBP (p<0.05) with the coefficient (r) at 0.4-0.6 (medium). Conclusion: comorbidity had no effect on TI score; but subjects with comorbid had worse BP control (p<0.05); TI score correlated in medium level with SBP

Hubungan Faktor Komorbiditas, Intensifikasi Terapi, dan Pengendalian Tekanan Darah

Background: Therapy intensification (TI) is the most important factor in blood pressure control among the adherent patients. The TI is the physician prescription behavior to add the item(s) and/or the dosage of hypertensive medicine when the patients\u27 BP was ≥10mmHg above the target. Comorbid patients have 10mmHg lower BP target. Aims: to evaluate the effect of comorbidity on TI score and blood pressure control; and to correlate the variables of TI and BP control. Method: retrospective cohort study done in 4 hospitals in Yogyakarta for 5 months. The subjects of age >18 years, hypertensive out-patient covered with Askes insurance, and ≥1 visit with uncontrolled BP were included. Hemodialysis subjects were excluded. Subjects were grouped into with/without comorbid. The BP profile was analyzed with T-test, repeatedmeasurement Anova, and odds ratio. Results: subjects consisted of without (WO) (n=268) vs. with comorbid (W) (n=401) patients. Comorbid subjects had older age, more male proportion and more visits (p<0.05). The profiles of final SBP/DBP in WO vs. W subjects were as follow: 148.9/89.1 (WO) vs. 143.8/86.1mmHg (W) (p<0.05); TI score (-) 0.36±0.26 (WO) vs. (-)0.38±0.24 (W) (p>0.05); the final SBP: worse BP control 20.9 (WO) vs.16.2% (W), not controlled in all visits 38.1 vs. 45.9%, improved 17.5 vs. 23.9%, and good controlled in all visit 23.5 vs.13.2%; proportion of subjects reached BP target 40.7% (WO) vs. 37.4% (W) (p>0.05); the different of final minus target SBP: (-)9.0±18.5 vs. (-)13.9±17.4mmHg (p<0.05); correlation between TI and variables of SBP (p<0.05) with the coefficient (r) at 0.4-0.6 (medium). Conclusion: comorbidity had no effect on TI score; but subjects with comorbid had worse BP control (p<0.05); TI score correlated in medium level with SBP

Translation, adaptation and validation of the diabetes distress scale for Indonesian diabetic outpatients with various types of complications

Objectives: To translate, adapt and validate the Diabetes Distress Scale (DDS) instrument for Indonesian type 2 diabetes mellitus (T2DM) outpatients with various types of complications. Methods: Participants were recruited from four hospitals and two primary healthcare facilities. The procedure of the study included forward and backward translations, an adaptation testing with a small subset of participants, and a validation test. Factor analysis with maximum likelihood estimation and promax rotation was used to investigate the instrument structure. Internal consistency among the items was estimated using Cronbach's alpha for each of the four domains of the DDS. The instrument form resulting from this study was labeled DDS17 Bahasa Indonesia. Results: 324 participants (246 from hospitals and 78 from primary healthcare facilities) were involved in this study. Understanding of the exact meaning of questions by study participants was improved by adding T2DM daily activity examples (e.g. diet, exercise and adherence to therapy) to several questions after the translations and adaptation procedure. The factor analysis showed correlation among the four factors ranging from 0.40 to 0.67. The order in the factor analysis was first interpersonal distress, followed by emotional burden, physician distress, and regimen distress. The internal consistency for the four domains ranged from 0.78 to 0.83. Conclusions: The DDS17 Bahasa Indonesia provides a valid and reliable scale for assessing distress of Indonesian T2DM outpatients. The use of this instrument in future research and clinical trials is recommended for the Indonesian context

'Diabetes is a gift from god' a qualitative study coping with diabetes distress by Indonesian outpatients

BACKGROUND: More than two-thirds of patients diagnosed with type 2 diabetes mellitus (T2DM) in Indonesia encounter medical-related problems connected to routine self-management of medication and the social stigma related to T2DM. The current study aims to explore distress and coping strategies in Indonesian T2DM outpatients in a Primary Healthcare Centre (PHC) in Surabaya, East Java, Indonesia. METHODS: We conducted a qualitative study using two different data collection methods: focus group discussions and in-depth interviews. The guideline of interviews and discussions were developed based on seventeen questions derived from the DDS17 Bahasa Indonesia (a Bahasa Indonesia version of the Diabetes Distress Scale questionnaire), which covered physician distress domain, emotional burden domain, regimen distress domain and interpersonal distress domain. RESULTS: The majority of the 43 participants were females and aged 50 or older. Our study discovered two main themes: internal and external diabetes distress and coping strategies. Internal diabetes distress consists of disease burden, fatigue due to T2DM, fatigue not due to T2DM, emotional burden (fear, anxiety, etc.) and lack of knowledge. Internal coping strategies comprised spirituality, positive attitude, acceptance and getting more information about T2DM. External diabetes distress was evoked by distress concerning healthcare services, diet, routine medication, monthly blood sugar checks, interpersonal distress (family) and financial concern. External coping strategies included healthcare support, traditional medicine, vigilance, self-management, social and family support and obtaining information about health insurance. CONCLUSION: Our study shows that for Indonesian T2DM-patients, spirituality and acceptance are the most common coping mechanisms for reducing DD. Furthermore, our study revealed an overall positive attitude towards dealing with T2DM as well as a need for more information about T2DM and potential coping strategies. Finally, an important finding of ours relates to differences in DD between males and females, potential DD associated with health services provision and the specific challenges faced by housewives with T2DM

Comparing the EQ-5D-3 L and EQ-5D-5 L:studying measurement and scores in Indonesian type 2 diabetes mellitus patients

BACKGROUND: The EuroQoL five-dimensional instrument (EQ-5D) is the favoured preference-based instrument to measure health-related quality of life (HRQoL) in several countries. Two versions of the EQ-5D are available: the 3-level version (EQ-5D-3 L) and the 5-level version (EQ-5D-5 L). This study aims to compare specific measurement properties and scoring of the EQ-5D-3 L (3 L) and EQ-5D-5 L (5 L) in Indonesian type 2 diabetes mellitus (T2DM) outpatients.METHODS: A survey was conducted in a hospital and two primary healthcare centres on Sulawesi Island. Participants were asked to complete the two versions of the EQ-5D instruments. The 3 L and 5 L were compared in terms of distribution and ceiling, discriminative power and test-retest reliability. To determine the consistency of the participants' answers, we checked the redistribution pattern, i.e., the consistency of a participant's scores in both versions.RESULTS: A total of 198 T2DM outpatients (mean age 59.90 ± 11.06) completed the 3 L and 5 L surveys. A total of 46 health states for 3 L and 90 health states for 5 L were reported. The '11121' health state was reported most often: 17% in the 3 L and 13% in the 5 L. The results suggested a lower ceiling effect for 5 L (11%) than for 3 L (15%). Regarding redistribution, only 6.1% of responses were found to be inconsistent in this study. The 5 L had higher discriminative power than the 3 L version. Reliability as reflected by the index score was 0.64 for 3 L and 0.74 for 5 L. Pain/discomfort was the dimension mostly affected, whereas the self-care dimension was the least affected.CONCLUSIONS: This study suggests that the 5 L-version of the EQ-5D instrument performs better than the 3 L-version in T2DM outpatients in Indonesia, regarding measurement and scoring properties. As such, our study supports the use of the 5 L as the preferred health-related quality of life measurement tool. We did not do a trial but this study was approved by the Medical Ethics Committee of Universitas Gadjah Mada Yogyakarta, Indonesia (document number KE/FK/1188/EC, 12 November 2014, amended 16 March 2015).</p

Comparing the EQ-5D-3 L and EQ-5D-5 L:studying measurement and scores in Indonesian type 2 diabetes mellitus patients

BACKGROUND: The EuroQoL five-dimensional instrument (EQ-5D) is the favoured preference-based instrument to measure health-related quality of life (HRQoL) in several countries. Two versions of the EQ-5D are available: the 3-level version (EQ-5D-3 L) and the 5-level version (EQ-5D-5 L). This study aims to compare specific measurement properties and scoring of the EQ-5D-3 L (3 L) and EQ-5D-5 L (5 L) in Indonesian type 2 diabetes mellitus (T2DM) outpatients. METHODS: A survey was conducted in a hospital and two primary healthcare centres on Sulawesi Island. Participants were asked to complete the two versions of the EQ-5D instruments. The 3 L and 5 L were compared in terms of distribution and ceiling, discriminative power and test-retest reliability. To determine the consistency of the participants' answers, we checked the redistribution pattern, i.e., the consistency of a participant's scores in both versions. RESULTS: A total of 198 T2DM outpatients (mean age 59.90 ± 11.06) completed the 3 L and 5 L surveys. A total of 46 health states for 3 L and 90 health states for 5 L were reported. The '11121' health state was reported most often: 17% in the 3 L and 13% in the 5 L. The results suggested a lower ceiling effect for 5 L (11%) than for 3 L (15%). Regarding redistribution, only 6.1% of responses were found to be inconsistent in this study. The 5 L had higher discriminative power than the 3 L version. Reliability as reflected by the index score was 0.64 for 3 L and 0.74 for 5 L. Pain/discomfort was the dimension mostly affected, whereas the self-care dimension was the least affected. CONCLUSIONS: This study suggests that the 5 L-version of the EQ-5D instrument performs better than the 3 L-version in T2DM outpatients in Indonesia, regarding measurement and scoring properties. As such, our study supports the use of the 5 L as the preferred health-related quality of life measurement tool. We did not do a trial but this study was approved by the Medical Ethics Committee of Universitas Gadjah Mada Yogyakarta, Indonesia (document number KE/FK/1188/EC, 12 November 2014, amended 16 March 2015)

Diabetes distress in Indonesian patients with type 2 diabetes:a comparison between primary and tertiary care

BACKGROUND: The number of people living with diabetes mellitus (DM) in Indonesia has continued to increase over the last 6 years. Four previous studies in U.S have found that higher DD scores were associated with worse psychological outcomes, lower health-related quality of life (HRQoL) and increased risk of T2DM complications. In this study, we aimed to firstly compare DD scores in Indonesian T2DM outpatients treated in primary care versus those in tertiary care. Subsequently, we investigated whether socio-demographic characteristics and clinical conditions explain potential differences in DD score across healthcare settings. METHODS: A cross-sectional study was conducted on Java island in three primary care (n = 108) and four tertiary care (n = 524) facilities. The participants completed the Bahasa Indonesia version of the Diabetes Distress Scale questionnaire (DDS17 Bahasa Indonesia). Ordinal regression analysis was conducted with the quartile of the summation of the DD score as the dependent variable to investigate how the association between the level of healthcare facilities and DD altered when adding different variables in the model. RESULTS: The final adjusted model showed that the level of healthcare facilities was strongly associated with DD (p < .001), with participants in primary care having a 3.68 times (95% CI 2.46-5.55) higher likelihood of being more distressed than the participants in tertiary care. This association was detected after including the socio-demographic characteristics and clinical conditions as model confounders. CONCLUSIONS: This is the first study in Indonesia to compare DD scores within different healthcare facilities. We recommend a regular DD assessment, possibly closely aligned with health-literacy partner programs, especially for T2DM patients in primary care settings