Pengaruh Edukasi oleh Apoteker dengan Metode Brief Counseling terhadap Tingkat Pengetahuan, Kepatuhan, dan Outcome Klinik Pasien Hemodialisis

apt. Ulfa Filliana, Dr. apt. Nanang Munif Yasin, S.Si., M.Pharm; Prof. Dr. apt. Susi Ari Kristina, M. Kes.

2024 | Tesis | S2 Mag.Farmasi Klinik

Latar Belakang: Terapi obat pada pasien hemodialisis rata-rata menerima 12 jenis obat setiap hari yang menyebabkan ketidakpatuhan pasien. Pendekatan intensif berupa edukasi apoteker merupakan tantangan pada pasien hemodialisis untuk meningkatkan pengetahuan, kepatuhan, serta outcome klinik. 

Tujuan: Penelitian ini bertujuan untuk mengetahui adakah pengaruh edukasi oleh apoteker dengan metode brief counseling terhadap pengetahuan, kepatuhan dan outcome klinik pasien hemodialisis. 

Metode: Quasi experimental dengan desain pretest-posttest with control group. Penelitian ini dilakukan secara prospektif dengan metode brief counseling dan alat bantu leaflet. Penelitian dilaksanakan di unit hemodialisis RSUP Dr. Kariadi Semarang. Sampel berjumlah 57 orang yaitu 28 kelompok intervensi dan 29 kelompok kontrol. Intervensi dan follow-up 1x seminggu selama 1 bulan. Instrumen yang digunakan kuesioner Medication Adherence Report Scale (MARS-5) untuk kepatuhan, kuesioner Kidney Disease Knowledge Survey (KiKS) untuk pengetahuan, outcome klinik berupa pengukuran tekanan darah predialisis, postdialisis dan intradialisis, kadar ureum dan kreatinin. Pengaruh edukasi antara sebelum dan sesudah intervensi dianalisis menggunakan Paired sample t-test dan Wilcoxon test, untuk membandingkan antar kelompok menggunakan Independent sample T-test, dan Mann-Whitney test. Uji Ancova untuk mengetahui pengaruh variabel antara.

Hasil: Pada kelompok intervensi dibandingkan kelompok kontrol menunjukkan edukasi brief counseling apoteker mempengaruhi pengetahuan dengan peningkatan skor 8,79±7,802 (p=0,000), kepatuhan dengan peningkatan skor 2,71±1,822 (p=0,000), ketika predialisis penurunan tekanan darah sistolik 12,07±8,969 mmHg (p=0,000), penurunan diastolik 5,03±5,439 mmHg (p=0,004). Ketika postdialisis penurunan tekanan darah sistolik 16,35±8,051 mmHg (p=0,000) dan penurunan diastolik 5,07±5,388 mmHg (p=0,000), namun penurunan tekanan darah tersebut tidak bermakna secara klinis. Edukasi tidak berpengaruh terhadap tekanan darah intradialisis, kadar ureum dan kreatinin (p>0,05). 

Kesimpulan: Edukasi brief counseling apoteker dapat meningkatkan pengetahuan, kepatuhan, dan perbaikan tekanan darah predialisis dan postdialisis.

Background: Drug therapy in hemodialysis patients receives an average of 12 types medication every day which causes patient non-compliance. An intensive approach of education by pharmacists is a challenge for hemodialysis patients to improve treatment knowledge, compliance, and clinical outcomes.

Aims: This study aims to determine an influence of education by pharmacists using brief counseling method on medication knowledge, compliance, and clinical outcomes for hemodialysis patients.

Method: Quasi-experimental with a pretest-posttest design with control group. This research was conducted prospectively using the brief counseling method and leaflet tools. The research was carried out in the hemodialysis unit of RSUP Dr. Kariadi Semarang. The sample consisted of 57 people, 28 in the intervention group and 29 in the control group. The intervention and follow-up was once a week for 1 month. The instruments used were the Medication Adherence Report Scale (MARS-5) questionnaire for compliance, the Kidney Disease Knowledge Survey (KiKS) questionnaire for knowledge, clinical outcomes of predialysis, postdialysis and intradialysis blood pressure measurements, urea and creatinine levels. The effect of education before and after the intervention was analyzed using the Paired sample t-test and Wilcoxon test, to compare between groups using the Independent sample T-test, and the Mann-Whitney test. Ancova test to determine the effect of confounding variables.

Results: In the intervention group compared to the control group showed that pharmacist brief counseling education influenced knowledge with an increase in score of 8.79±7.802 (p=0.000), compliance with an increase in score of 2.71±1.822 (p=0.000), when predialysis decreased systolic blood pressure 12 .07±8.969 mmHg (p=0.000), diastolic decrease 5.03±5.439 mmHg (p=0.004). During postdialysis, systolic blood pressure decreased 16.35±8.051 mmHg (p=0.000) and diastolic blood pressure decreased 5.07±5.388 mmHg (p=0.000), however the reduction in blood pressure was not clinically significant. Education had no effect on intradialysis blood pressure, urea and creatinine levels (p>0.05).

Conclusion: pharmacist education brief counseling can increase knowledge, compliance, improve predialysis and post-dialysis blood pressure.

Kata Kunci : brief counseling, hemodialisis, pengetahuan, kepatuhan, outcome klinik