Kepatuhan Minum Obat Pada Pasien Lupus Eritematosus Sistemik Di RSUP Dr. Hasan Sadikin Bandung

Lupus eritematosus sistemik (LES) merupakan penyakit autoimun kronik yang mengharuskan penyandangnya minum obat dalam waktu lama bahkan seumur hidupnya. Keadaan ini selain menimbulkan dampak fisik, psikis maupun sosial juga menyebabkab biaya tinggi sehingga LES digolongkan sebagai penyakit catastrophic. Ketidakpatuhan minum obat penyandang LES akan berpengaruh langsung terhadap memburuknya outcome penyakit lupus. Penelitian bertujuan mengeksplorasi pelaksanaan dan kepatuhan minum obat pada pasien LES dengan harapan terjadinya perbaikan penatalaksanaan LES yang berdampak pada peningkatan kualitas hidup serta penurunan angka kematian karena LES. Telah dilakukan penelitian kualitatif terhadap 6 informan pasien LES suku Sunda di klinik reumatologi RSUP Dr. Hasan Sadikin Bandung pada bulan Juli sampai September 2016 dengan menggunakan pedoman wawancara mendalam open question yang dikembangkan sesuai dengan jawaban informan. Paradigma penelitan adalah constructivism dengan triangulasi terhadap 2 orang keluarga pasien dan 3 dokter konsultan klinik reumatologi RSUP Dr. Hasan Sadikin Bandung. Data yang diperoleh dianalisis secara bertahap melalui proses transkripsi, reduksi, koding, kategorisasi, penyusunan tema, interprestasi data serta pembangunan konsep. Hasil penelitian menunjukkan ada 57 koding, 14 kategori, dan 3 tema yang mengarah kepada kepatuhan minum obat pasien LES. Ke-14 kategori kepatuhan tersebut terdiri dari: karakteristik individu, daya ingat, pengetahuan, eksperimen, dan manajemen konsumsi (faktor predisposing); karakteristik penyakit, karakteristik obat, biaya, kebijakan rumah sakit, akses ke rumah sakit, terapi alternatif dan enabler agent (faktor enabling); karakteristik tenaga kesehatan dan dukungan eksternal dari berbagai pihak (faktor reinforcing). Konsep dan konstruk yang ditemukan membangun konstruk lokal Jawa Barat berlatar belakang karakteristik masyarakat Sunda dan bersifat kontekstual terhadap penyakit lupus. Kata kunci: Kepatuhan minum obat, lupus eritematosus sistemik, odapus Drug Adherence Drug in Systemic Lupus Erythematosus Patients in Dr. Hasan Sadikin General Hospital Bandung Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that requires prolonged treatment. SLE creates physical, psychological, social, and economic burden for the patients; therefore, it is categorized as a catastrophic illness. Non-adherence to medication in SLE patient isan important factor that directly leads to poor outcome. The aim of this study was to explore the management and adherence of patients with SLE to improve the quality of life and to reduce the mortality rate. A qualitative study was undertaken to 6 sundanese SLE patients at the Rheumatology clinic in Dr. Hasan Sadikin General Hospital Bandung in July-September 2016 by using open-ended questions in in-depth interviews with probing based on informant answers. The paradigm used was constructivism with triangulation to family members of 2 patients and 3 rheumatologist consultants in Dr. Hasan Sadikin General Hospital Bandung. Data collected were analyzed gradually through transcription, reduction, coding, categorizing, theme analysis, data interpretation, and theorizing. The results showed 57 codes, 14 categories, 3 themes that focused on the medication adherence of Lupus patients.The themes were categorized as predisposing (individual characteristics, memory, knowledge, experimentation, and consumption management), enabling (drug characteristic, cost, hospital policies, access to hospital, alternative therapy, and enabler agent), and reinforcing (characteristics of health care professionals and social support) according to the predetermined theory. This study has also identified the local concepts and constructs Sundanese people in West Java, which is contextual to the lupus disease. Key words: Adherence, systemic lupus erythematosus, odapu

Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study.

BACKGROUND: We have previously estimated that respiratory syncytial virus (RSV) was associated with 22% of all episodes of (severe) acute lower respiratory infection (ALRI) resulting in 55 000 to 199 000 deaths in children younger than 5 years in 2005. In the past 5 years, major research activity on RSV has yielded substantial new data from developing countries. With a considerably expanded dataset from a large international collaboration, we aimed to estimate the global incidence, hospital admission rate, and mortality from RSV-ALRI episodes in young children in 2015. METHODS: We estimated the incidence and hospital admission rate of RSV-associated ALRI (RSV-ALRI) in children younger than 5 years stratified by age and World Bank income regions from a systematic review of studies published between Jan 1, 1995, and Dec 31, 2016, and unpublished data from 76 high quality population-based studies. We estimated the RSV-ALRI incidence for 132 developing countries using a risk factor-based model and 2015 population estimates. We estimated the in-hospital RSV-ALRI mortality by combining in-hospital case fatality ratios with hospital admission estimates from hospital-based (published and unpublished) studies. We also estimated overall RSV-ALRI mortality by identifying studies reporting monthly data for ALRI mortality in the community and RSV activity. FINDINGS: We estimated that globally in 2015, 33·1 million (uncertainty range [UR] 21·6-50·3) episodes of RSV-ALRI, resulted in about 3·2 million (2·7-3·8) hospital admissions, and 59 600 (48 000-74 500) in-hospital deaths in children younger than 5 years. In children younger than 6 months, 1·4 million (UR 1·2-1·7) hospital admissions, and 27 300 (UR 20 700-36 200) in-hospital deaths were due to RSV-ALRI. We also estimated that the overall RSV-ALRI mortality could be as high as 118 200 (UR 94 600-149 400). Incidence and mortality varied substantially from year to year in any given population. INTERPRETATION: Globally, RSV is a common cause of childhood ALRI and a major cause of hospital admissions in young children, resulting in a substantial burden on health-care services. About 45% of hospital admissions and in-hospital deaths due to RSV-ALRI occur in children younger than 6 months. An effective maternal RSV vaccine or monoclonal antibody could have a substantial effect on disease burden in this age group. FUNDING: The Bill & Melinda Gates Foundation