Pengaruh Intervensi Apoteker terhadap Tingkat Bahaya Drug-Related Problems pada Pasien Geriatrik Rawat Inap

https://doi.org/10.22146/jmpf.66776

Margarita Krishna Setiawati(1), Nanang Munif Yasin(2*), I Dewa Putu Pramantara(3)

(1) Magister Farmasi Klinik, Fakultas Farmasi, Universitas Gadjah Mada
(2) Departemen Farmakologi dan Farmasi Klinik, Fakultas Farmasi, Universitas Gadjah Mada
(3) Fakultas Kedokteran, Universitas Gadjah Mada
(*) Corresponding Author

Abstract


Geriatric patients are at high risk of Drug-Related Problems (DRPs) associated with multimorbidity, physiologic changes, and pharmacologic alterations, that caused by the aging process. The pharmacist plays an important role in optimizing the effectiveness and safety of the patient’s drug therapies. This study aims to know the effect of pharmacist intervention in reducing the harmful levels of DRPs and to know the factors associated with the reduction of DRPs harm level in hospitalized geriatric patients. This research uses quasi-experimental study with a one-group pretest and posttest design. This research was conducted in Panti Rapih Hospital between March-April 2021, with patients’ inclusion criteria of ≥ 60 years old, with internal diseases cases, and identified DRPs in the therapy. The exclusion patient criteria are hospitalized in the intensive unit and Covid-19 ward. A pharmacist reviewed patient drug therapy, identified and solved DRPs. The harm level of DRPs was compared before and after pharmacist interventions. The harm level of DRPs was determined through professional adjustment according to The Harm Associated with Medication Error Classification tools, then analyzed using Wilcoxon test with a level of confidence 95%. Factors of age, the number of drugs received by the patient, comorbidities, and acceptance of the intervention were investigated for their effect on reducing the harm level of DRPs using a multivariate logistic regression test. A total of the research subject were 28 inpatients, with 47 DRPs identified. The most frequent DRPs were adverse drug reactions  (27,66%). Among all interventions, 77,36% of them were accepted with full implementation. The pharmacist intervention resulted in a significant reduction in the harm level of both potential and actual DRPs (p < 0,05). A factor of the number of drugs received by patients and acceptance of pharmacist intervention was associated with the reduction of the harm level of DRPs (p < 0,05). This study shows that multidisciplinary collaboration is needed in the care of geriatric patients.

Keywords


tingkat bahaya drug-related problems; intervensi Apoteker; geriatrik

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References

  1. Kementerian Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 79 tentang Penyelenggaraan Pelayanan Geriatri di Rumah Sakit.
  2. Kementerian Kesehatan Republik Indonesia. Analisis Lansia di Indonesia, Jakarta Selatan, Kementerian Kesehatan Republik Indonesia Pusat Data dan Informasi.
  3. Badan Pusat Statistik. Statistik Penduduk Lanjut Usia. Published online 2019. Accessed May 10, 2020. https://www.bps.go.id/publication/2019/12/20/ab17e75dbe630e05110ae53b/statistik-penduduk-lanjut-usia-2019.html
  4. Nigam Y, Knight J, Bhattacharya S, Bayer A. Physiological Changes Associated with Aging and Immobility. Journal of Aging Research. doi:https://doi.org/10.1155/2012/468469
  5. Midlöv P, Eriksson T, Kragh A. Drug-Related Problems in the Elderly. Springer Netherlands; 2009. doi:10.1007/978-90-481-2446-6
  6. Pharmaceutical Care Network Europe. Classification for Drug-Related Problems V9.00. Published online 2019.
  7. Nachtigall A, Heppner HJ, Thürmann PA. Influence of pharmacist intervention on drug safety of geriatric inpatients: a prospective, controlled trial. Ther Adv Drug Saf. 2019;10. doi:10.1177/2042098619843365
  8. Ertuna E, Arun MZ, Ay S, Koçak FÖK, Gökdemir B, İspirli G. Evaluation of pharmacist interventions and commonly used medications in the geriatric ward of a teaching hospital in Turkey: a retrospective study. Clin Interv Aging. 2019;14:587-600. doi:10.2147/CIA.S201039
  9. Kementerian Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 72 Tahun 2016 tentang Standar Pelayanan Kefarmasian di Rumah Sakit. Published online 2016.
  10. Somers A, Robays H, De Paepe P, Van Maele G, Perehudoff K, Petrovic M. Evaluation of clinical pharmacist recommendations in the geriatric ward of a Belgian university hospital. Clin Interv Aging. 2013;8:703-709. doi:10.2147/CIA.S42162
  11. Gates PJ, Baysari MT, Mumford V, Raban MZ, Westbrook JI. Standardising the Classification of Harm Associated with Medication Errors: The Harm Associated with Medication Error Classification (HAMEC). Drug Saf. 2019;42(8):931-939. doi:10.1007/s40264-019-00823-4
  12. Martínez-Mesa J, González-Chica DA, Duquia RP, Bonamigo RR, Bastos JL. Sampling: how to select participants in my research study? An Bras Dermatol. 2016;91(3):326-330. doi:10.1590/abd1806-4841.20165254
  13. Dahlan Sopiyudin M. Besar Sampel Dan Cara Pengambilan Sampel Dalam Penelitian Kedokteran Dan Kesehatan. Edisi 3. Salemba Medika; 2010.
  14. Lam MPS, Cheung BMY. The use of STOPP/START criteria as a screening tool for assessing the appropriateness of medications in the elderly population. Expert Rev Clin Pharmacol. 2012;5(2):187-197. doi:10.1586/ecp.12.6
  15. American Geriatrics Society. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674-694. doi:10.1111/jgs.15767
  16. Rozzini R, Frisoni GB, Ferrucci L, et al. Geriatric Index of Comorbidity: validation and comparison with other measures of comorbidity. Age and ageing. Published online 2002. doi:10.1093/ageing/31.4.277
  17. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533-543.
  18. Overhage JM, Lukes A. Practical, reliable, comprehensive method for characterizing pharmacists’ clinical activities. Am J Health Syst Pharm. 1999;56(23):2444-2450. doi:10.1093/ajhp/56.23.2444
  19. Ahmad A, Mast MR, Nijpels G, Elders PJ, Dekker JM, Hugtenburg JG. Identification of drug-related problems of elderly patients discharged from hospital. Patient Prefer Adherence. 2014;8:155-165. doi:10.2147/PPA.S48357
  20. Aggarwal P, Woolford SJ, Patel HP. Multi-Morbidity and Polypharmacy in Older People: Challenges and Opportunities for Clinical Practice. Geriatrics (Basel). 2020;5(4):85. doi:10.3390/geriatrics5040085
  21. Teka F, Teklay G, Ayalew E, Teshome T. Potential drug–drug interactions among elderly patients admitted to medical ward of Ayder Referral Hospital, Northern Ethiopia: a cross sectional study. BMC Res Notes. 2016;9(1). doi:10.1186/s13104-016-2238-5
  22. Maher RL, Hanlon JT, Hajjar ER. Clinical Consequences of Polypharmacy in Elderly. Expert Opin Drug Saf. 2014;13(1):10.1517/14740338.2013.827660. doi:10.1517/14740338.2013.827660
  23. World Health Organization. ATC/DDD Index 2021. Published 2020. Accessed June 15, 2021. https://www.whocc.no/atc_ddd_index/
  24. Salvi F, Marchetti A, D’Angelo F, Boemi M, Lattanzio F, Cherubini A. Adverse drug events as a cause of hospitalization in older adults. Drug Saf. 2012;35 Suppl 1:29-45. doi:10.1007/BF03319101
  25. Lee JK, Alshehri S, Kutbi HI, Martin JR. Optimizing pharmacotherapy in elderly patients: the role of pharmacists. Integr Pharm Res Pract. 2015;4:101-111. doi:10.2147/IPRP.S70404
  26. Cipolle RJ, Strand L, Morley P. Pharmaceutical Care Practice: The Patient-Centered Approach to Medication Management. Published 2012. Accessed June 14, 2021. https://id1lib.org/book/2542172/71cba1
  27. Landefeld CS, Palmer RM, Kresevic DM, Fortinsky RH, Kowal J. A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. N Engl J Med. 1995;332(20):1338-1344. doi:10.1056/NEJM199505183322006
  28. Koprivnik S, Albiñana-Pérez MS, López-Sandomingo L, Taboada-López RJ, Rodríguez-Penín I. Improving patient safety through a pharmacist-led medication reconciliation programme in nursing homes for the elderly in Spain. Int J Clin Pharm. 2020;42(2):805-812. doi:10.1007/s11096-020-00968-8
  29. Trenaman S, Bowles SK, Mallery L, Koller K, Andrew M. Innovative Collaborative Practice to Optimize Pharmacotherapy for Frail Older Patients. Can J Hosp Pharm. 2014;67(5):373-378.



DOI: https://doi.org/10.22146/jmpf.66776

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