KEPATUHAN PASIEN.pdf

8/11/2019 KEPATUHAN PASIEN.pdf

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PRESENTED BY: DIFA INTANNIA

KEP TUH N P SIEN


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OUTLINE

PENDAHULUAN

LIMA DIMENSI KEPATUHAN BY WHO

MENGUKUR KEPATUHAN

FAKTOR YANG DAPAT MENYEBABKAN

KETIDAKPATUHAN

INTERVENSI

PERAN FARMASIS


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Drugs dont work in patients who dont take them.

C. Everett Koop, M.D


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PENDAHULUAN

Adherence to (or compliance with) a medication regimen is

generally defined as the extent to which patients take

medications as prescribed by their health care providers.

Adherence rates are typically higher among patients with

acute conditions, as compared with those with chronic

conditions; persistence among patients with chronic

conditions is disappointingly low, dropping mostdramatically after the first six months of therapy


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PENDAHULUAN

Poor adherence to medication regimens accounts for substantialworsening of disease, death, and increased health care costs inthe United States

Studies have shown that medication misuse is a significant causeof hospital readmissions and can be prevented in nearly two-thirds of all cases. Patients on complex drug regimens takingmultiple prescriptions are at high risk for non-adherence

Chronic diseases account for 70% of all deaths and are theleading cause of morbidity and mortality in the UnitedStates.3Approximately 20% to 50% of patients are nonadherentto their medications.


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Global Medication Adherence is 50%


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WHOs Five Dimensions of Adherence


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1. Social & Economic

Community Support

Economic


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2. Health Care System

Provider-Patient Relationship


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2. Health Care System

Using two-way communications and asking open

ended questions fosters encouragement.

Shared Decision Making


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3. Condition Related

Chronic conditions, such as hypertension, that

lack symptoms highly impact the level of

adherence.

Peoples belief about the benefits and risks of

medications influence whether they abide by a

regimen.


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4. Therapy Related

Therapy-related factors include the complexity of medication

regimen and unpleasant side effects.

Dosing several times a day may contribute to non-adherence

Adherence rates for once a day medication averaged 87%; twice daily

averaged 81%; three times per day averaged 77%; while adherence to

medications that required four times per day dosing dropped to only 39%.

Evaluating the medication regimen and keeping it as simple as possible for

the patients will promote adherence.

Concern about medication side effects


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5. Patient Related

Perception of need, medication effectiveness, and

safety.

Follow up Appointments

Personalized education and counseling sessions

delivered by telephone, intranet, or in person by

trained personnel.


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MENGUKUR KEPATUHAN

Dapat dibagi menjadi 2 cara: Langsung

Tidak Langsung

Salah satu metode langsung adalah dengan mengukur kadar

obat/metabolit dalam darah

for some drugs,measuring theselevels is a good and commonly used means of assessingadherence

Ex: serum concentration of antiepileptic drugs such asphenytoin or valproic acid will probably re-flect adherence toregimens with these medications, and subtherapeutic levels will

probably reflect poor adherence or suboptimal dose strengths Setiap metode memiliki kelebihan dan kekurangan, dan tidak

ada gold standard.


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FAKTOR YG DAPAT MENYEBABKANKURANGNYA KEPATUHAN


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Common barriers to adherence are under the patients control,so that attention to them is a necessary and important step inimproving adherence

Cause patients not taking their medications: forgetfulness (30 percent)

Other priorities (16 percent)

Decision to omit doses (11 percent)

Lack of information (9 percent)

Emotional factors (7 percent)

27 percent of the respondents did not provide a reason for poor adherence toa regimen


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INTERVENSI

Methods improve adherence can be grouped into fourgeneral categories:

Improving adherence combinations of behavioralinterventions and reinforcements in addition to increasing the

convenience of care, providing educational information aboutthe patients condition and the treatment, and other forms ofsupervision or atten-tion patient education

improved dosing schedules

increased hours when the clinic is open (including evening hours), andtherefore shorter wait times

improved communication


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PERAN FARMASI

Many studies have been done to determine whether pharmacistinterventions can lead to improved adherence and treatmentoutcomes. In a large meta-analysis conducted to determinemedication adherence (along with several other outcomes),

pharmacist interventions were found to improve medicationadherence

Pharmaciststhrough counseling, medication therapymanagement (MTM), disease-state management, and othermeanscan play a pivotal role in patient care. There are

opportunities in every type of pharmacy practice to improvepatients adherence and therapeutic outcomes, and pharmacistsmust embrace and act on them.


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Patients unique Pharmacist must approach each patientindividually to determine the level of adherence and barrier

Education: Helpful but not enough to persuade the patient to comply with the

physicians drug orders. Information clear, easy to understand language,and the patient must understand not only the benefits of adherence, but therepercussions of nonadherence.

Dosing simplification and minimization of adverse effects areextremely successful strategies for improving adherence.

when filling a prescription

review to see whether the dosing schedule is assimple as possible. The pharmacist should inquire frequently about anyadverse effects the patient is experiencing and then consult the physicianregarding suggested alternatives.


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Preparing a dosing card containing only the most essential elements of thepatients medications can be highly beneficial. Including the name of the pill, an image (if possible), the condition it is for, and time of

day taken can be extremely helpful for patients who take many medications or who havecognitive barriers.

Reminder calls, texts, or e-mails are helpful for many patients, especiallythose with busy lifestyles. Automatic refills are a useful strategy. Smalldetails, like splitting a patients pills when necessary and providing easy-offcaps, can be beneficial.

Whatever the barriers to adherence may be, the only way to assess them is totalk to the patient. The pharmacist needs to be diligent about including the

patient in the treatment experience. The more trust the patient has in thepharmacist, the more he or she will open up and disclose any apprehensionsor difficulties about taking his or her medication. Only then can thepharmacist play an integral role in improving a patients adherence.


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If not pharmacists, then who should lead adherence?

Pharmacists, as the medication experts should be leading the way to

ensuring optimal medication use

Pharmacists are in an excellent position to improve medication

adherence


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Cochrane Collaborative:Summary of Adherence Interventions

For long-term treatments, simplifying the dosage regimen

and several complex strategies, including combinations of

more thorough patient instructions and counseling,

reminders, close follow-up, supervised self-monitoring,rewards for success, family therapy, couple- focused therapy,

psychological therapy, crisis intervention, and manual

telephone follow-up can improve adherence and treatment

outcomes. If there is a common thread to these at all, it is

more frequent interaction with patients with attention to

adherence.


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TERIMA KASIH

Documents

KEPATUHAN PASIEN.pdf