THE EFFECT OF THE BLOOD PRESSURE FEEDBACK INTERVENTION TO PHYSICIANS ON THE IMPROVEMENT OF THE BLOOD PRESSURE CONTROL

The study aimed to assess the effect of the blood pressure (BP) feedback intervention to physicians on the improvement of the blood pressure control of hypertension subjects. The study was done with controlled repeated intervention design. The adult hypertensive non-hemodialysis subjects from 4 Indonesian hospitals were included as intervention and control subjects. Outcomes were measured as the improvement of systolic BP (SBP). The subjects in intervention (n=385) vs. non-intervention (n=271) groups had similar age and proportion of males (p>0.05); proportion of cardiovascular comorbid 78.7% vs. 91.5% (p<0.01) and the baseline SBP at 144.1±15.8 vs. 139.6±13.8mmHg (p<0.01). The final SBP 138.2±17.2 vs.140.6±15.4mmHg (adjusted p<0.01); the difference between (∆) final-baseline SBP: 5.9±20.3 vs. (-)0.9±20.0mmHg (adjusted p<0.01); ∆final-target SBP: (-)6.1±17.3 vs.                     (-)9.6±15.5 (adjusted p<0.01). There were more intervention subjects with good controlled final SBP; odds ratio (OR) 1.4(CI95%:1.0-1.9, adjusted p<0.05). Based on the ∆final-baseline SBP, the ∆final-target SBP, and OR SBP reached the target; theintervention subjects had significant SBP improvement

HUBUNGAN FAKTOR KOMORBIDITAS, INTENSIFIKASI TERAPI, DAN PENGENDALIAN TEKANAN DARAH

Abstract: Background: Therapy intensification (TI) is the most important factor in bloodpressure control among the adherent patients. The TI is the physician prescription behavior toadd the item(s) and/or the dosage of hypertensive medicine when the patients' BP was ?10mmHgabove the target. Comorbid patients have 10mmHg lower BP target. Aims: to evaluate the effectof comorbidity on TI score and blood pressure control; and to correlate the variables of TI and BPcontrol. Method: retrospective cohort study done in 4 hospitals in Yogyakarta for 5 months. Thesubjects of age 18 years, hypertensive out-patient covered with Askes insurance, and ?1 visitwith uncontrolled BP were included. Hemodialysis subjects were excluded. Subjects weregrouped 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 proportionand more visits (p0.05). 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) (p0.05); TI score (-) 0.360.26 (WO) vs. (-)0.380.24 (W) (p0.05); the final SBP: worse BP control 20.9 (WO) vs.16.2% (W), notcontrolled in all visits 38.1 vs. 45.9%, improved 17.5 vs. 23.9%, and good controlled in all visit23.5 vs.13.2%; proportion of subjects reached BP target 40.7% (WO) vs. 37.4% (W) (p0.05);the different of final minus target SBP: (-)9.018.5 vs. (-)13.917.4mmHg (p0.05); correlationbetween TI and variables of SBP (p0.05) with the coefficient (r) at 0.4-0.6 (medium).Conclusion: comorbidity had no effect on TI score; but subjects with comorbid had worse BPcontrol (p0.05); TI score correlated in medium level with SBP.Keywords: Comorbidity Factor, Therapy Intensification, Blood Pressure Contro

ASSOCIATION OF LIPID PROFILES WITH 10-YEAR ATHEROSCLEROTIC CARDIOVASCULAR DISEASE RISK: STUDY AMONG SUBJECTS IN SLEMAN DISTRICT OF YOGYAKARTA INDONESIA

  Objectives: The subjects in the Sleman District of Yogyakarta had medium Framingham risk score (FRS) in the preceding year study. The 10-year atherosclerotic cardiovascular disease (ASCVD) risk was a newer risk estimator than FRS. This study aimed to associate the lipid profiles with the ASCVD risk.Methods: The study was conducted with a cross-sectional design and the subjects were selected with cluster random sampling. The association of lipid profiles and ASCVD risk was analyzed with Mann–Whitney/Kruskal–Wallis tests and Spearman's rho correlation, whereas the categorical scores within sub-groups were analyzed Chi-square statistics, respectively.Results: The eligible subjects (n=221) had the age at 51.7±8.1 years, systolic/diastolic blood pressure 136.8±22.4/85.0±12.4 mmHg, total-cholesterol (total-C), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), and triglyceride at 202.0±34.9 mg/dl, 52.6±12.5 mg/dl, 126.3±30.0 mg/dl, and 135.9±95.4 mg/dl, respectively; with hypertension treatment 16.7%, smoking 52.9%, diabetes 10.4%, and the median ASCVD risk at 4.4 (0.2-41.4). The ASCVD risk has significant association with non-lipid profiles, total-C, lipid ratio of triglyceride/HDL-C, total-C/HDL-C, and LDL-C/HDL-C, to a lesser extent, HDL-C, LDL-C, and triglyceride.Conclusion: The 10-year ASCVD risk of the subjects was categorized as low and had a significant association with total-C and lipid ratio of triglyceride/ HDL-C, total-C/HDL-C, and LDL-C/HDL-C

THE BLOOD PRESSURE AND THERAPY EXPENDITURE CHANGE DUE TO HYPERTENSION COMORBIDITY: AN ANALYTICAL PROSPECTIVE STUDY IN SECONDARY CARE HOSPITALS IN JOGJAKARTA INDONESIA

Objective: To measure the comorbid effect on blood pressure and therapy expenditure in 4 secondary care hospitals in Jogjakarta.Methods: We conducted an 8-month prospective pharmacoeconomic study with hospital perspective. All hypertensive outpatients, with Askes-insurance whose beneficiaries were governmental employees, with at least 2 moly visits at the index date were included. The subjects with malignancy, hemodialysis, and less than 4 visits were excluded. The expenditure comprised the cost for cardiovascular medicine, doctor, physical/laboratory test, emergency visit, and physiotherapy. We analyzed the expenditure change and sensitivity analysis with Anova-test, whereas the proportion of subjects with good controlled blood pressure with the chi-square test.Results: The eligible subjects (N=656) consisted of no comorbid (n=105), stroke (n=82), cardiovascular (n=209), diabetes mellitus/chronic kidney disease or DM/CKD (n=149), and combined comorbid (n=111) groups. The baseline blood pressure was similar to no comorbid (p>0.05), except for the diastolic blood pressure in a cardiovascular group. The stroke and cardiovascular groups had more subjects at mean systolic blood pressure lower than 140 mmHg with odds ratio (OR) 2.01 (CI95%:1.12-3.62) and 2.10 (CI95%:1.31-3.39) respectively than no comorbid group; but the mean blood pressure was not clinically different. The total therapy expenditure increased at 6.5% (p<0.61); 22.7% (p<0.03); 78.6% (p<0.01); 78.5% (p<0.01) per subject-visit for stroke, cardiovascular, DM/CKD, and combined-comorbid groups than no comorbid group respectively. Except for stroke group, the incremental expenditure was price-sensitive (p<0.05).Conclusion: The total therapy expenditure but not blood pressure was likely to be influenced by hypertension comorbidity. We suggest that preventing hypertension comorbidity has the benefit to reduce total therapy expenditure

THE EFFECT OF HEALTH INSURANCE ON ASTHMA CONTROL IN RESPONDENTS WITH ASTHMA IN YOGYAKARTA, INDONESIA

Asthma is a chronic disease with recurrent breath shortness. Until now, there is no particular therapy to cure the disease and long-term treatment is needed to control the disease. Health insurance has the benefit to support the asthma therapy. This study aimed to assess the effect of health insurance on the asthma control based on Asthma Control Test (ACT) score. The study was done with a cross-sectional design on respondents with asthma who agreed to sign informed consent forms in Yogyakarta. The asthma respondents (n=36) were selected non-randomly, consisting of 23 respondents with health insurance, including universal health coverage or UHC (n=15), UHC and private insurance (n=7), and private insurance only (n=1). The ratio and categorical data were analyzed with the independent T-test or Mann-Whitney test and chi-square statistics, respectively. The study demonstrated that the profiles and number of medicines were similar between groups, except for lower smoking proportion among health insurance groups; the respondents with and without health insurance had the median ACT score at 22 (partial control) and 15 (bad control) respectively, though the scores were not statistically different. Conclusion: the asthma respondents with and without health insurance were not statistically different in the asthma control

Early Implementation of Universal Health Coverage Among Hypertension Subjects in Sleman District of Yogyakarta

Aim: to evaluate the participant rate of the new universal health coverage (UHC) and its impact on the hypertensive subjects from the rural area in the Sleman-District of Yogyakarta during the early implementation. Methods: this epidemiological survey of the new UHC implementation was included as an analytical crosssectional study done with cluster random sampling. The subject criteria were aged 30-85 year, not in pregnancy, and signed the informed-consent. Subjects were grouped based on the health coverage disparity and analyzed with chi-square statistics for the hypertension prevalence, awareness, therapy, and control. The additional variables of BMI, education, occupation, income, smoking, diet control, physical activity, and health facilities were grouped into binomial data and analyzed based-on the health coverage disparity. Results: of 926 total subjects, 602 (65.0%) subjects had the health coverage including 9.2% of the new UHC. The groups of with and without health coverage were not significantly different in hypertension prevalence, the profile of age, blood pressure, and the proportion of the other variables (p>0.05) except for smoking and physical activities. In the high blood pressure sub-group (n=446), the subjects without health coverage had lower proportion of the hypertension awareness p0.05). Conclusion: the participant rate of new UHC was relatively low at 9.2%. Among the subgroup with ≥140/90mmHg blood pressure, the subjects without health coverage were more likely to have lower hypertension awareness and suboptimal therapy than those with the health coverage program.Key words: universal health coverage, hypertension, awareness, therapy

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

EDUKASI DAN SKRINING SINDROM METABOLIK PADA KELOMPOK WANITA GEREJA KRISTEN NAZARENE FILADELFIA YOGYAKARTA

Metabolic syndrome (MS) has been frequently found in the community due to lifestyle changes. The increasing prevalence of MS causes public health problems which can in-crease the risk of cardiometabolic disease. Prevention of metabolic syndrome is an im-portant issue within the community by empowering the subjects with education. The Faculty of Pharmacy had collaborated with the Nazarene Filadelfia Christian Church (GKNF) in conducting a medical examination. In this service activity, the Faculty of Pharmacy provided health education about metabolic syndrome and early detection of MS risk factors. This service activity was done in two separated events, the first and second events were carried out on June 20, 2019 and August 1, 2019 respectively. The activities comprised of 1) providing education about MS using module; 2) screening of MS risk factors including anthropometric examination: height, weight, blood pressure test, and blood tests to measure blood glucose, uric acid and cholesterol levels. Provi-sion of education related to MS did not change the random blood glucose level, uric ac-id level, and systolic blood pressure, but it decreased significantly decrease diastolic blood pressure. The provision of education increased cholesterol levels significantly, though the values were still within normal limits. The subjects participated in the activi-ty of the MS prevention counseling were expected to be able to apply the obtained in-formation to their families, although this education has not reduced their risk of SM

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