Hasil Penelitian Penelitian yang telah peneliti lakukan termasuk
pengembangan keilmuan yaitu menilai hubungan antara kepuasan teapi dengan kepatuhan minum obat dan kontrol glikemik serta menganalisis faktor yang mempengaruhi variabel tersebut, sehingga dapat disusun strategi untuk meningkatkan kepatuhan minum obat pada pasien DM tipe 2, dan pada akhirnya control glikemik menjadi semakin baik.
Rencana Tindak Lanjut
Tindak lanjut yang akan dilakukan oleh peneliti setelah penelitian ini selesai adalah studi lanjut dengan melakukan penelitian terkait hubungan kepatuhan minum obat dengan kualitas hidup pada pasien DM tipe 2
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40 LAMPIRAN Lampiran 1. Bukti Submit Jurnal
Lampiran 2. Bukti Submit Prosiding
41 Lampiran 2. Artikel Jurnal
Relationship of Treatment Satisfaction and Medication Adherence Among Type 2 Diabetes Mellitus Patients at 2 Primary Healthcare Center Area in Jakarta
DANIEK VIVIANDHARI1*, SEPTIANITA HASTUTI1, PUTRI RAHMASENI1, SYIFA’U FAUZIAH1
1Faculty of Pharmacy and Science Universitas Muhammadiyah Prof. Dr. HAMKA Jl. Delima II/IV, Malaka Sari, Jakarta Timur, DKI Jakarta 13460
*Email: [email protected] HP: 085743129092
ABSTRACT
The main issue of type 2 Diabetes Mellitus (DM) patients is the low medication adherence which increases the risk of complications. Studies show the importance of glycemic control (A1c) to prevent complications. The outcome of therapy should also be evaluated from the psychological aspects of the patient, one of which is the treatment satisfaction.
The purpose of this study was to determine the level of treatment satisfaction, medication adherence, glycemic control, and the relationship between the level of treatment satisfaction and medication adherence and glycemic control in type 2 DM patients in two primary healthcare center areas in Jakarta. This cross-sectional study used 110 patients as respondents, a validated SATMED-Q questionnaire to assess treatment satisfaction, a MARS questionnaire to assess medication adherence, and an A1c value to assess glycemic control. The results showed that most patients were somewhat satisfied with therapy (54.55%) and moderate adherence (71.82%). Most of the respondents (61.82%) had a controlled glycemic level. The Spearman Rho test showed that treatment satisfaction had a correlation with medication adherence (p <0.05) (correlation coefficient 0.474) and glycemic control (p <0.05) (correlation coefficient -0.450). The results also showed that medication adherence had a correlation with glycemic control (p <0.05) (correlation coefficient -0.284). The more satisfied the patient with the therapy being undertaken, the more patient adhere to take medication, but higher treatment satisfaction and higher medication adherence did not translate equally to better glycemic control.
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Key words: treatment satisfaction, medication adherence, glycemic control, type 2 diabetes mellitus
INTRODUCTION
Type 2 DM is a group of metabolic disorders characterized by hyperglycemia, abnormalities in carbohydrate, fat, and protein metabolism, and also characterized by a combination of insulin resistance and insulin deficiency (1).
Based on the International Diabetes Federation data, the prevalence of type 2 DM in Indonesia in 2015 was 10 million people and is estimated to increase by 16.1 million people in 2040 (2). Type 2 DM is a disease with complex treatment, which requires a long period of time and constant motivation from patient, therefore patient compliance in using medication (medication adherence) become one of the factors that play an important role in the treatment of type 2 DM patients (3).
Non-compliance is one of the most common cause of treatment failure. Around 50% patients with type 2 DM fail to achieve adequate glycemic control (A1c <7%) (4). Patients with poor management of diabetes are at risk for microvascular and macrovascular complications (5).
Treatment satisfaction is an evaluation whether a treatment meets or exceeds the patient’s expectation.
Some research studies proved that patient-related variable influencing medication adherence and glycemic control, one of which is treatment satisfaction (6), (7). Research showed that treatment satisfaction known to have a relationship with quality of life and high patient satisfaction could increase medication adherence (8).
This study aimed to determine the level of treatment satisfaction, medication adherence, glycemic control, and the relationship between the level of treatment satisfaction and medication adherence and glycemic control in type 2 DM patients in two primary healthcare center areas in Jakarta.
A preliminary study was conducted to validate the SATMED-Q questionnaire. The results of this study are expected to provide information whether treatment satisfaction have a correlation with medication adherence and glycemic control in type 2 DM patient in 2 primary healthcare center area in Jakarta, therefore pharmacist could identify potential problems which influence medication adherence.
43 METHOD
Research Location and Design
This study was conducted at the Prolanis section of the Menteng Primary Healthcare Center and the Jatinegara Primary Healthcare Center. The design of this study was descriptive (non- experimental) and data were collected prospectively. Data were obtained from 2 questionnaires filled out by patients and A1c examination.
Research Tools and Materials
The tools used were the SATMED-Q questionnaire and the MARS questionnaire. The materials used were medical record data for type 2 DM patients and A1c examination data. Demographic characteristics (age, gender, level of education, occupation) and clinical characteristics (comorbidities, duration of diabetes, complications, oral anti-diabetes drugs, use of herbal medicines, frequency of taking medication, and the number of non-DM drugs) were collected simultaneously.
Population and Sample
Type 2 DM patients who were members of the Chronic Disease Control Program (PROLANIS) at Menteng and Jatinegara Primary Healthcare Center for the period of February-July 2020 were the population of this research.
The sample in this research were type 2 DM patients who were members of PROLANIS for the period of February-July 2020 at Menteng and Jatinegara Primary Healthcare Center who met the inclusion criteria.
Inclusion and Exclusion Criteria The inclusion criteria were:
1. Patients with type 2 DM who were taking oral antidiabetic drug
2. Patients who have had type 2 DM for at least 1 month
3. Patients who were willing to be respondents in the research
4. Patients who can read and write 5. Patients who had A1c data The exclusion criteria were:
1. Patients with type 1 DM and gestational DM
2. Patients with type 2 diabetes who cannot answer questionnaires independently because of dementia or mental illness
Data analysis
1. Univariate Analysis
This analysis was used to obtain a description of the frequency distribution and proportion of the variables measured, such as age, gender, level of education, occupation, comorbidities, duration of diabetes, complications, oral anti-diabetes drugs, use of herbal medicines, frequency of taking
44 medication, and the number of non-DM drugs.
2. Bivariate Analysis
This analysis was used to identify the correlation between the SATMED-Q scores and the MARS scores and also A1c value. The test conducted was the Spearman Rho test used to measure the correlation between two variables.
RESULT AND DISCUSSION
This research has been approved by the Ethics Committee of the Universitas Muhammadiyah Prof.
Dr. HAMKA (UHAMKA) with the number: 03 / 20.02 / 0317. Conducted in February-July 2020, this study used a total number of 110 respondents who were members of the PROLANIS, 70 respondents from the Jatinegara Primary Healthcare Center and 40 respondents from the Menteng Primary Healthcare Center.
Characteristics of Type 2 DM Patients
Socio-Demographic Characteristics Based on table 1, most of the patients were older than or equal to 60 years (71.8%). These results are in line with Riskesdas data which stated that the prevalence of type 2 DM patients aged 65- 74 years is higher compared to those aged 45-54 years (9). It is known that aging is a
significant driver for diabetes epidemic and diabetes in elderly link to higher mortality because they are at risk for diabetes complication, the most frequent are cardiovascular diseases (10,11).
People over 60 years old mostly suffer from type 2 DM due to insulin resistance.
Long life expectancy leads to decrease in insulin secretion and environmental factors causing obesity which leads for insulin resistance (11).
The results of` the study showed most of the type 2 DM patients were female (86.4%). Riskesdas data showed the prevalence of type 2 DM in women is 1.8%
higher than men (9). Obesity is more common in women because greater Body Mass Index (BMI) than men, which caused by changes or decreases in androgen and estrogen hormones (12).
Most of respondents were lastly educated from junior and senior high school (64.5%) and most of them were unemployed 87.3%). Patients with high level of education had better awareness of DM complications and a high adherence to diet (13).
45 Clinical Characteristics
Based on this study (table 2), 19.1%
of patients had comorbidities, most comorbidities were hypercholesterolemia (14 respondents). Comorbidities will impact treatment satisfaction and medication adherence, related to the number of drugs received by patients. The more complex the drug therapy of comorbidities, the less treatment satisfaction and medication adherence (14)(15–17).
As many as 63 respondents experienced type 2 DM for more than 5 years. A long duration of type 2 DM required complex regimen (18). This will also affect treatment satisfaction and medication adherence.
Most patients have complications (70.9%). Atherosclerotic cardiovascular disease and heart failure are leading cause of mortality for patients with diabetes.
Hypertension known as a major risk factor for both macrovascular and microvascular complications (19). As many as 72 respondents had hypertension.
As many as 93 respondents (84.5%) used combination of antidiabetic drugs.
The majority is combination of metformin and glimepiride (64 respondents).
Combination therapy could contribute to the complexity of drug regiment which further impact the treatment satisfaction and medication adherence.
Most respondents (84.5%) were not using herbal medicines. Herb medicines used as an alternative agent. Some research proved that herbal medicines can treat type 2 DM effectively (20). Some respondents use turmeric, insulin leaves, Moringa leaves, and noni capsules.
107 (97.3%) patients used the DM drugs equal to or more than 2 times a day.
Again, the frequency of taking DM drugs will also impact the treatment satisfaction and medication adherence. As many as 64.5% patients used less than or equal to 2 non-DM drugs. These drugs were used to treat either comorbidities or complications.
Most patients (57 respondents) used amlodipine.
Description of Treatment Satisfaction Level