Clinical Outcomes among Type 2 Diabetes Mellitus Patients: Before and after Universal Health Coverage in Indonesia

Objective: This study was carried out to analyze the impact of universal health coverage in Indonesia, known as Jaminan Kesehatan Nasional (JKN) on percentage of patients who did fasting blood glucose (FBG) tests each hospital visit and clinical outcomes (CO) in type 2 diabetes mellitus (T2DM) patients.Methods: We conducted a longitudinal retrospective study to collect the data from 6-month before JKN and 1-year after JKN at 3 hospitals in Jakarta Province. All T2DM outpatients' services using Asuransi Kesehatan (ASKES) with at least 6 hospital visits were included. The subject with double insurances and died before implementation of JKN were excluded. The clinical outcome before and after JKN were compared with Wilcoxon test.Results: Total samples that collected were 296 patients divided to predominance female with 166(56%) and male 125(44%). From the data, it seemed that there were no all patients who did FBG test. We founded 50% of patients had FBG test before JKN.  Meanwhile, the percentage at the beginning of JKN tended to be lower about 37% than before JKN. Number of patiens decreased associate with JKN but number of hospital visit increased. Based on FBG level, 17(9.19%) patients had better CO and this number increased slightly after JKN to 22(11.89%). In contrast, patients with worse FBG level decreased about 9%. More patients had bad stable and less patients had good stable FBG level. Statistical analysis showed that CO between before and after JKN had P value 0.404 among T2DM outpatients in Type A Hospitals and P value 0.877 in Type B Hospital.Conclusion: Implementation of JKN had impact to decrease percentage of patients who did FBG tests and number of patients but raised hospital visit. CO was different significantly between before and after JKN among T2DM outpatients in Type A Hospitals but was no different in Type B Hospital. Â

Studi Penilaian Klinis Penggunaan Antibiotik pada Pasien Penyakit Ginjal Kronis

A 6-week longitudinal prospective study was conducted to assess the effectiveness and the safety antibiotic used in chronic kidney disease (CKD) patients in internal medicine ward. We compared white blood count and glomerular fi ltration rate before and after antibiotic used. The CKD patients who admitted in the internal medicine ward and age ≥18 years old were included this study. Patients with incomplete laboratory data and renal replacement therapy were excluded in this study. The 25 patients who enrolled in this study were recruited. The majority gender of CKD was male (64%), the mean of age was 61.52±14.17 years old with length of stay (LOS) was 6.92±4.05 days. The highest number of patients was in CKD stage 3 (n=10, 40%) and was followed by CKD stage 2 (n=6, 24%). Most of them were diagnosed community acquired pneumonia. Tablet azithromycin (n=16, 64%) then Cefotaxime intra venous injection (IV) (n= 6, 24%), and Ceftazidime IV (n=5, 20%), Cloxacillin IV (n=4, 16%) were the most antibiotics prescribed. Generally patients had been prescribed appropriate dose of antibiotic and 88% of them showed improved white blood count. In contrast, the glomerular fi ltration rate of 44% CKD patients was getting worse. In conclusion, this study clearly indicate the CKD patients require close monitoring to maintenance of renal function even the antibiotic had been prescribed appropriately.Sebuah studi prospektif longitudinal 6 minggu dilakukan untuk menilai efektivitas dan antibiotik keamanan yang digunakan pada pasien penyakit ginjal kronis (CKD) di bangsal pengobatan internal. Kami membandingkan jumlah darah putih dan tingkat fi ltrasi glomerulus sebelum dan sesudah antibiotik digunakan. Pasien CKD yang dirawat di bangsal penyakit dalam dan usia ≥18 tahun dimasukkan dalam penelitian ini. Pasien dengan data laboratorium yang tidak lengkap dan terapi penggantian ginjal dikeluarkan dalam penelitian ini. 25 pasien yang terdaftar dalam penelitian ini direkrut. Jenis kelamin mayoritas CKD adalah laki-laki (64%), rata-rata usia adalah 61,52 ± 14,17 tahun dengan lamanya tinggal (LOS) adalah 6,92 ± 4,05 hari. Jumlah pasien terbanyak adalah pada CKD stadium 3 (n = 10, 40%) dan diikuti oleh CKD tahap 2 (n = 6, 24%). Sebagian besar dari mereka didiagnosis menderita radang paru-paru. Tablet azitromisin (n = 16, 64%) kemudian Cefotaxime injeksi intra vena (IV) (n = 6, 24%), dan Ceftazidime IV (n = 5, 20%), Cloxacillin IV (n = 4, 16%) adalah antibiotik yang paling diresepkan. Umumnya pasien telah diberi dosis antibiotik yang tepat dan 88% dari mereka menunjukkan peningkatan jumlah darah putih. Sebaliknya, tingkat fi ltrasi glomerulus dari 44% pasien CKD semakin buruk. Kesimpulannya, penelitian ini jelas menunjukkan pasien CKD memerlukan pemantauan ketat terhadap pemeliharaan fungsi ginjal bahkan antibiotik telah diresepkan dengan tepat

THE AVAILABILITY OF ANTIHYPERTENSIVE DRUG IN ERA OF NHI: A STUDY IN THE PRIMARY HEALTH CARE CENTRE JAKARTA-INDONESIA

Objective: The study was carried out to observe the impact of NHI to availability, usage, stock of antihypertensive drug enrolled in a national formulary in one of the primary health care centre in Jakarta. Methods: A longitudinal time series design was performed retrospectively to analyse the availability, usage, and stock of antihypertensive drug. The data period was from January 2013 (1 y before NHI) to December 2015 (2 y after NHI). The Independent-Samples T or Mann-Whitney test was conducted to compare these parameters before and after NHI. Results: We found amlodipine 5 mg and 10 mg tablet, hydrochlorothiazide 25 mg tablet, captopril 12.5 mg and 25 mg tablet, nifedipine 10 mg tablet were available in Primary Health Care. These drug were generic and tablet dosage form. The most common drug used was captopril and Nifedipine, respectively. The highest availability was diuretic hydrochlorothiazide. The availability of amlodipine 5 mg and 10 mg tablet, captopril 12.5 mg tablet increased significantly (P<0.05) after NHI was implemented. Moreover, hydrochlorothiazide decreased (P<0.05) as well. The usage of amlodipine and hydrochlorothiazide risen (P<0.05) but the nifedipine decreased (P<0.05) after NHI. All stock of antihypertensive except captopril 25 mg different significantly (P<0.05) after the application of NHI. Conclusion: This study highlights the implementation of NHI impacted the availability, usage, and stock of antihypertensive drug enrolled in national formulary

Survei Rumah Tangga terhadap Profil Obat pada Responden dengan Jaminan Kesehatan Nasional di Jakarta Timur

Household surveys are one of the methods to obtain accurate information on medicine utilization in society. The study was carried out to identify the access of medicine and medicine utilization profile. A survey using convenient sampling method was conducted in 30 households with national health insurance (JKN) diagnosed with chronic diseases in East Jakarta. Each family was observed once a week for 8 weeks to analyse their diseases, medication used, and medicine access. About 19 (63.3%) respondents enrolled in this study were male. The mean ± SD of age was 55.87±12.486 years old. About 23(76.7%) respondent had access of medicine through hospital and 7(23.3%) by pharmacy directly. The most common chronic diseases identified were cardiovascular and endocrine disorder. Cardiovascular, alimentary tract and metabolism, and nervous system were medications most commonlyused. Most of respondents used about 1-3 kind of medications in a month. About 101 kind of drugs used, 74 kinds of drug among of them were generic and 27 were non generic. About 12 (40%) respondents used vitamin and 8 (26.67%) used supplement. This study highlights respondent access of medicine through hospital and cardiovascular medicines were the most commonly used

Clinical Outcomes of Antibiotic Use on Patients of Diabetic Foot Infection

Resiko amputasi dan resistensi bakteri terhadap antibiotik pada pasien infeksi kaki diabetik (IKD) masih merupakan masalah besar yang belum dapat diatasi. Penelitian bertujuan untuk mengevaluasi clinical outcomes penggunaan antibiotik pada pasien IKD di bangsal penyakit dalam rumah sakit X. Penelitian dilakukan selama 3 bulan dengan metode observasi prospektif longitudinal. Pasien dipilih berdasarkan diagnosa IKD dengan lama rawatan ≥ 3 hari. Total sampel yang diperoleh 30 pasien, perempuan 16 (53,3%) dan laki-laki 14 (46,7%). Tes kultur hanya dilakukan pada 5 (16,67%) pasien. Satu pasien menunjukkan tidak adanya bakteri patogen. Antibiotik yang paling sering digunakan adalah Ampisilin-sulbaktam. Berdasarkan clinical outcomes, 11 (36,7%) pasien membaik, 15 (50%) memburuk dan 4 (13,35%) meninggal. Berdasarkan statistik, jenis kelamin, umur, Indeks masa tubuh dan lama menderita DM tidak mempengaruhi clinical outcomes (P>0,05). Hasil penelitian yang diperoleh dapat disimpulkan bahwa antibiotik yang digunakan masih belum efektif dalam mencapai tujuan terapi.An amputation and antibiotic resistant bacteria on diabetic foot infection (DFI) are still big issue. The research aimed to evaluate clinical outcomes of antibiotic use among patients of DFI in internal medicine ward at Hospital X. An observation of prospective longitudinal methode was conducted during 3 months. Patients were selected based on diagnosis of DFI that had length of stay ≥ 3 days. Total samples were 30 patients, 16(53.3%) women and 14(46.7%) men. Only 5(16.67%) patients who did culture and sensitivity. One of them with no pathogen bacteria. The most frequently antibiotic use was ampicillin-sulbactam. Based on clinical outcomes, 11(36,7%) improve, 15(50%) worse, and others were passed away. Based on statistic, there were no influence among clinical outcomes with gender, age, BMI and duration of diabetes. Therefore based on the research, antibiotics use were still not effective to achieve desired outcomes

Peran Apoteker dalam Meningkatkan Kepatuhan Pengobatan pada Pasien Rawat Jalan Tube

Our previous study showed that one of risk factor may lead treatment failure on tuberculosis was non adherence. The current research was carried out to fi nd the role of pharmacist in increasing on medication adherence of tuberculosis outpatients. A non-randomized controlled study was conducted at one of government hospital in Jakarta during April 2015 to July 2015 using MMAS-8. Total sample were 108 patients that divided each group of 54 patients into experimental group who had education and control group without education. Mean of age were 36.93 (SD=15.02) of experimental group and 38.12 (SD=15.11) of control group. More than 50% respondents were male with education level of senior high school. Control group had higher adherence in pre education than post education (P<0.05). Meanwhile, medication adherence in experimental group of pre education was signifi cantly diff erent with post education, 1.94±1.65 vs 0.54±0.64 (P<0.05). There was no diff erence signifi cant of adherence between experimental group and control group in pre education. Furthermore after patients education had been applied experimental group’s adherence had higher than control group (P<0.05). The fi nding of the study may lead that impact of patient education by pharmacist result in better medication adherence.Penelitian kami sebelumnya menunjukkan bahwa salah satu resiko penyebab kegagalan terapi adalah pasien tidak patuh terhadap pengobatan. Tujuan penelitian adalah untuk mengetahui peran apoteker dalam meningkatkan kepatuhan pengobatan pada pasien tuberkulosis. Penelitian dilaksanakan di salah satu rumah sakit pemerintah Jakarta dengan metode non-randomized controlled study mulai bulan April 2015 sampai dengan Juli 2015 menggunakan kuesioner MMAS-8. Total sampel 108 pasien yang dibagi menjadi dua kelompok masing-masing 54 pasien yaitu kelompok eksperimental dengan edukasi dan kelompok kontrol tanpa edukasi. Rata-rata umur pasien 36,93 (SD=15,02) pada kelompok eksperimental dan 38,12 (SD=15,11) kelompok kontrol. Lebih dari 50% responden adalah laki-laki dengan level pendidikan SLTA. Kelompok kontrol memiliki kepatuhan lebih tinggi sebelum edukasi dibandingkan dengan setelah edukasi (P<0,05). Sementara itu, kepatuhan pasien pada kelompok eksperimental juga berbeda bermakna antara pre dan post edukasi 1,94±1,65 vs 0,54±0,64 (P<0,05). Tidak terdapat perbedaan kepatuhan yang signifi kan antara kelompok eksperimental dan kelompok kontrol pada pre edukasi. Sedangkan setelah diberikan edukasi, kepatuhan kelompok eksperimental lebih tinggi dibandingkan dengan kelompok kontrol (P<0,05). Sehingga dapat disimpulkan bahwa pengaruh edukasi pasien oleh apoteker dapat meningkatkan kepatuhan pengobatan pasien

Profil Pengobatan Pasien Rawat Jalan Diabetes Melitus Tipe 2 setelah Pelaksanaan JKN

In 2014, health insurance entirely colected together into Badan Penyelenggara Jaminan Sosial (BPJS) became Jaminan Kesehatan Nasional (JKN). But there is different payment method that is ASKES used Fee for Services (FFS) method and BPJS use INA-CBGs method.  Diabetes mellitus is a chronic disease that patients with that diagnosed should use drug continuously. Therefore, research with conducted by time series longitudinal retrospective method that aimed to observe impact of JKN about drug treatment profile among outpatients of  type 2 DM in X Hospital Jakarta. Total of samples collected were 84 patients, 31 (36.90%) of male and  53 (63.10%) of female. Most patients (29.76%) were 66-70 years old. There were 38 patients with 10 times of visite, 27 patients with 11 times of visite, 19 patients with 12 times of visit. Based on drug treatment profile, after JKN has launched, decreasing of total of drug use, number of visit increased to 42 visits, kinds of drug appropriate with DPHO decreased until 79%, kinds of drug appropriate with national formularium rised 97%, generic drugs also increased 54% and non generic drug decreased 47%. Based on descriptive analysis, when JKN has launched, there were impact toward drug treatment profile.Pada tahun 2014, Asuransi Kesehatan (ASKES) bergabung dengan Badan Penyelenggara Jaminan Sosial (BPJS) menjadi Jaminan Kesehatan Nasional (JKN). Namun terdapat perbedaan metode pembayaran sebelum bergabung dengan BPJS yaitu dari  metode Fee for Service menjadi  metode INA- CBGs. Diabetes melitus merupakan penyakit kronik yang mengharuskan pasien selalu menggunakan obat. Oleh sebab itu penelitian yang dilakukan dengan metode time series longitudinal retrospective bertujuan untuk melihat dampak JKN terhadap profil pengobatan pada pasien rawat jalan ASKES DM tipe 2 di RS X Jakarta. Total sampel yang diperoleh 84 orang, laki-laki 31 (36,90%) dan perempuan 53 (63,10%). Pasien yang diperoleh berumur ≥50 tahun, 38 pasien dengan 10 kali kunjungan, 27 pasien dengan 11 kali kunjungan, 19 pasein dengan 12 kali kunjungan. Berdasarkan profil pengobatan, setelah pelaksanaan JKN terdapat peningkatan  jumlah kunjungan sebesar 42 kunjungan,  penurunan jumlah obat yang diberikan, penurunan jenis obat yang diresepkan berdasarkan DPHO mencapai 79%, peningkatan jenis obat yang diresepkan berdasarkan formularium nasional mencapai 97%, peningkatan jenis obat generik mencapai 54% dan  penurunan jenis obat non generik  mencapai 47%. Secara deskriptif dapat disimpulkan bahwa penerapan JKN memiliki pengaruh terhadap profil pengobatan

Jumlah Kunjungan, Profil Pengobatan, dan HRQoL Pasien Rawat Jalan DM Tipe 2 pada Era JKN

Asuransi kesehatan pemerintah bertransformasi dari Asuransi Kesehatan (ASKES) menjadi Jaminan Kesehatan Nasional (JKN) sejak 1 Januari 2014. Terdapat perbedaan metode pembayaran antara ASKES dan JKN. ASKES menggunakan metode fee for services dan JKN menggunakan metode INA-CBGs. Tujuan penelitian yaitu untuk melihat dampak pelaksanaan JKN terhadap jumlah kunjungan, profil pengobatan, dan Health Related Quality of Life (HRQoL) pada pasien DM tipe 2 rawat jalan pada salah satu RS tipe B di Jakarta. Penelitian dilakukan secara time series longitudinal. Total sampel yang memenuhi kriteria inklusi sebanyak 103 pasien. Pasien laki-laki sebanyak 36(35%) dan perempuan 67(65%). Terdapat 98% pasien memiliki usia lebih dari 45 tahun. Sebanyak 95(92%) pasien dengan diagnosa DM tanpa komplikasi dan 8(8%) pasien DM dengan komplikasi. Setelah pelaksanaan JKN, terdapat penurunan jumlah kunjungan pasien dan jumlah obat perpasien baik pada pasien DM tanpa komplikasi dan komplikasi. Kami juga menemukan bahwa persentase obat non DM lebih tinggi dibandingkan dengan obat DM. Secara statistik, jumlah obat DM dan non DM tidak berbeda secara signifikan antara sebelum dan setelah JKN (P>0,05). Rata-rata skor HRQoL pada era JKN lebih besar dari 80. Skor ini menunjukkan bahwa pasien memiliki kualitas hidup yang baik. Berdasarkan analisa statistik, kualitas hidup pasien berbeda berdasarkan jenis kelamin dan usia. Secara keseluruhan dapat disimpulkan bahwa terdapat perbedaan jumlah obat dan profil pengobatan setelah pelaksanaan JKN dan pasien memiliki kualitas hidup yang baik pada era JKN baik.Public insurance has transformed since 1st January 2014 from Asuransi Kesehatan (ASKES) to Jaminan Kesehatan Nasional (JKN). There is different payment method between ASKES and JKN. ASKES uses fee for services (FFS) method and JKN uses INA-CBG’s method. The aims of this research were to determine the impact of implementation of JKN to number of hospital visit, treatment profile, and HRQoL among type 2 DM outpatients at one of Hospital type B in Jakarta. The research was conducted by time series longitudinal. Total samples were 103 patients. Among of them were 36(35%) male and 67(65%) female. There were 98% patients with age of more than 45 years old. 95(92%) patients were diagnosed DM without complication and 8(8%) were DM with complication. After implementation of JKN, there were decreasing number of hospital visit and number of drug perpatient among type 2 DM outpatients without and with complication. We also founded that the percentage of non DM drugs was higher than DM drugs. Statistically, number of DM and non DM drugs was not difference significant between before and after JKN (P>0.05). Score average of HRQoL in era of JKN was more than 80. This score showed that patients had good quality of life. Related to statistical analysis, quality of life was difference based on gender and age. In conclusion, there were different number of drugs and treatment profile after JKN implemented and patients performed good quality of life in era of JKN

Karakteristik Sosiodemografi dan Health Related Quality of Life Pasien Rawat Jalan Diabetes Mellitus Tipe 2 pada Era JKN

The aim of  study was carried out to determine differences of health related qualitiy of life (HRQoL) with sociodemographic characteristic in type 2 diabetes mellitus outpatiens at one of government hospital in Jakarta. It was a cross-sectional study conducted  from February  to April 2015. Total of samples were 83 patients. Male 31(37.4%) and female 52(62.6%). HRQoL associated with level education  was difference significantly (P0.05). Furthermore, diabetes duration affected both domain of satisfaction (P=0.005) and frequency of symptoms (P=0.00). In conclusion, only education level of characteristic sociodemographic had difference significantly to HRQoL among type 2 diabetes mellitus outpatients..Penelitian dilakukan untuk mengetahui perbedaan Health Related Quality of Life (HRQoL) terhadap karakteristik sosiodemografi antara pasien diabetes mellitus tipe 2 pada  salah satu rumah sakit pemerintah di Jakarta. Penelitian dilaksanakan secara cross-sectional dari Februari sampai April 2015. Total sampel 83 pasien. Laki-laki 31(37,4%) dan perempuan 52 (62,6%). Terdapat perbedaan yang signifikan (P0,05) HRQoL. Selanjutnya, lama menderita diabetes mempengaruhi nilai domain kepuasan (P=0,05) dan frekuensi gejala (P=0,00). Sehingga dapat disimpulkan, karakteristik sosiodemografi meliputi tingkat pendidikan memiliki perbedaan secara signifikan terhadap kualitas hidup antara pasien rawat jalan diabetes mellitus tipe 2.