Pengaruh Implementasi RAPIH (Rational Antibiotic Prescribing Improvement for Hospital) terhadap Tingkat Kolaborasi Interprofesional dan Efektivitas Praktik Penatagunaan Antibiotik di RS Panti Rapih Yogyakarta

Maria Silvia Merry, Dr. dr. Andaru Dahesih Dewi, M.Kes., Sp.PK.Subsp. P.I., Subsp. Onk.K (K); Dr. Drs. Abdul Wahab, M.P.H; Dr. Firman, S.E., M.P.H

2026 | Tesis | MAGISTER KEBIJAKAN DAN MANAJEMEN KESEHATAN

Latar belakang: Resistensi antimikroba merupakan tantangan utama dalam pelayanan kesehatan akibat penggunaan antibiotik yang tidak rasional. Meskipun Program Pengendalian Resistensi Antimikroba (PPRA) telah diterapkan di rumah sakit, implementasinya masih menghadapi kendala berupa keterbatasan dokumentasi, komunikasi klinis, dan kolaborasi interprofesional. Penelitian ini bertujuan menganalisis implementasi Rational Antibiotic Prescribing Improvement for Hospital (RAPIH) melalui kolaborasi interprofesional dalam mendukung penatagunaan antibiotik di RS Panti Rapih Yogyakarta.

Metode: Penelitian menggunakan technical-participatory action research satu siklus dengan pendekatan before–after evaluation without control. Subjek terdiri atas 48 tenaga kesehatan dan 103 kasus infeksi sebelum (n=48) dan sesudah implementasi (n=55). Intervensi RAPIH meliputi penyempurnaan dokumen dan aksesibilitas panduan antibiotik, sosialisasi, pengembangan sistem pre-authorisasi antibiotik ‘reserve’ berbasis web, serta reminder evaluasi antibiotik 72 jam pada rekam medis elektronik dan aplikasi PasienKu. Luaran yang dievaluasi adalah skor kolaborasi interprofesional (AITCS-II), tingkat keterlibatan, dan indikator penatagunaan antibiotik yang meliputi tingkat kegiatan preautorisasi, skor manfaat. FORKKIT, Defined Daily Dose (DDD), metode Gyssens.

Hasil: Implementasi RAPIH meningkatkan skor kolaborasi interprofesional secara bermakna dari 86,50 ± 17,44 menjadi 94,23 ± 17,12 (p=0,027). Tingkat keterlibatan meningkat positif tapi belum berbeda bermakna (p=0,086). Persentase pra-otorisasi antibiotik Reserve meningkat dari 30,43% menjadi 54,54%, sedangkan waktu tunggu menurun signifikan dari 201 menjadi 30,5 menit (p=0,004). Penggunaan meropenem menurun dari 113,67 menjadi 45,33 DDD per 100 hari pasien. Proporsi penggunaan antibiotik rasional (Gyssens kategori 0) meningkat dari 57,95% menjadi 60,55%, meskipun belum berbeda bermakna (p=0,900). 

Kesimpulan: Implementasi RAPIH membantu memperkuat kolaborasi interprofesional, memperbaiki beberapa indikator penatagunaan antibiotik, serta memperoleh dukungan yang tinggi dari tenaga kesehatan. Model ini berpotensi menjadi strategi implementasi PPRA di rumah sakit.

Background: Antimicrobial resistance is a major challenge in healthcare, primarily driven by the irrational use of antibiotics. Although the Antimicrobial Resistance Control Program (Program Pengendalian Resistensi Antimikroba, PPRA) has been implemented in hospitals, its implementation continues to face challenges related to inadequate documentation, ineffective clinical communication, and limited interprofessional collaboration. This study aimed to evaluate the implementation of the Rational Antibiotic Prescribing Improvement for Hospital (RAPIH) program through interprofessional collaboration to support antibiotic stewardship at Panti Rapih Hospital, Yogyakarta.

Methods: This study employed a single-cycle technical-participatory action research design using a before–after evaluation without a control group. The participants consisted of 48 healthcare professionals, while antibiotic stewardship outcomes were evaluated in 103 infection cases before (n = 48) and after (n = 55) the intervention. The RAPIH intervention comprised refinement of antibiotic stewardship documents and guideline accessibility, educational dissemination, development of a web-based pre-authorization system for Reserve antibiotics, and implementation of a 72-hour antibiotic review reminder integrated into the electronic medical record and the PasienKu application. Outcomes included interprofessional collaboration measured using the Assessment of Interprofessional Team Collaboration Scale II (AITCS-II), healthcare professional engagement, and antibiotic stewardship indicators, including the pre-authorization rate, FORKKIT benefit score, Defined Daily Dose (DDD), and appropriateness of antibiotic use assessed using the Gyssens method.

Results: The implementation of RAPIH significantly improved the interprofessional collaboration score from 86.50 ± 17.44 to 94.23 ± 17.12 (p = 0.027). Healthcare professional engagement also increased, although the difference was not statistically significant (p = 0.086). The proportion of Reserve antibiotic pre-authorizations increased from 30.43% to 54.54%, while the median waiting time decreased significantly from 201 to 30.5 minutes (p = 0.004). Meropenem consumption decreased from 113.67 to 45.33 DDD per 100 patient-days. The proportion of rational antibiotic use (Gyssens category 0) increased from 57.95% to 60.55%, although this improvement was not statistically significant (p = 0.900).

Conclusions: The implementation of RAPIH assisted to strengthen interprofessional collaboration, improved several antibiotic stewardship indicators, and received strong support from healthcare professionals. This model has the potential to serve as an implementation strategy for hospital-based antimicrobial stewardship programs.

Kata Kunci : kolaborasi interprofesional, penatagunaan antibiotik, PPRA, RAPIH, resistensi antimikroba