EVALUASI PENERAPAN DAFTAR OBAT ESENSIAL NASIONAL (DOEN) 2008 PADA FORMULARIUM RSUD TIPE B DI PROVINSI DAERAH ISTIMEWA YOGYAKARTA

seftika sari, dr. Rustamaji, M.Kes

2012 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Berdasarkan Kepmenkes RI No 791/MENKES/SK/VIII/2008 penerapan DOEN dimaksudkan untuk meningkatkan ketepatan, keamanan, kerasionalan penggunaan dan pengelolaan obat yang sekaligus meningkatkan daya guna dan hasil guna sebagai salah satu langkah untuk memperluas, memeratakan dan meningkatkan mutu pelayanan kesehatan kepada masyarakat. Penerapan DOEN harus dilaksanakan secara konsisten dan terus menerus di semua unit pelayanan kesehatan, tak terkecuali di rumah sakit. Penerapan DOEN dalam setiap upaya pelayanan kesehatan baik di tingkat primer, sekunder dan tersier melalui pemanfaatan pedoman terapi dan formularium berbasis bukti ilmiah. Formularium rumah sakit harus mengacu dan konsisten dengan DOEN. Sebelum diberlakukannya otonomi daerah, diperkirakan sampai 80 % dari masyarakat Indonesia memiliki akses terhadap obat esensial, tetapi peresepan obat esensial di rumah sakit pemerintah kurang dari 76%. Berdasarkan permasalahan diatas, maka perlu dilakukannya evaluasi penerapan DOEN pada formularium rumah sakit. Tujuan: Untuk medeskripsikan dan menganalisis penerapan DOEN 2008 pada formularium obat di RSUD tipe B Provinsi Daerah Istimewa Yogyakarta. Metode: Penelitian ini merupakan penelitian deskriptif. Rancangan penelitian menggunakan metode campuran (mix methods) dengan model sequential explanatory untuk memperoleh gambaran tentang penerapan DOEN pada formularium RSUD tipe B di Provinsi Daerah Istimewa Yogyakarta (DIY). Cara pengumpulan data dengan menyesuaikan obat antara DOEN 2008 dengan formularium dengan menggunakan form kesesuaian obat DOEN 2008 dengan formularium, kemudian menggunakan form ceklist penyusunan formularium berdasarkan WHO & MSH (2003) untuk mengetahui proses penyusunan formularium rumah sakit dan melakukan wawancara mendalam untuk mengeidentifikasi penyebab ketidaksesuaian formularium dengan DOEN 2008. Hasil: Persentase penerapan DOEN pada formularium RSUD tipe B di Provinsi DIY adalah untuk RSUD Wirosaban Kota Yogyakarta 96%, RSUD Panembahan Senopati Bantul 81%, RSUD Sleman 39%, RSUD Wates 42%. Proses penyusunan formularium RSUD tipe B di provinsi DIY sudah merujuk pada proses penyusunan formularium berdasarkan WHO & MSH (2003). Penyebab ketidaksesuaian formularium RSUD tipe B di provinsi DIY yaitu belum adanya evaluasi dan monitoring dari pemerintah terkait penerapan DOEN pada formularium rumah sakit, adanya perbedaan pola penyakit dari masing-masing rumah sakit, permintaan usulan obat pada formularium berdasarkan usulan dokter yang tidak mengacu DOEN, adanya obat generik DOEN yang tidak tersedia di pasaran. Kesimpulan: DOEN 2008 belum sepenuhnya diterapkan pada formularium RSUD tipe B di Provinsi DIY.

Background: Based on The Health Ministry Regulation about National Essential Medicine List (NEML) Number 791/MENKES/SK/VIII/2008 implementation of NEML is intended to improve the apoppriateness, safety, rational medicines use, medicines management, and also improving the effectiveness and efficiency as one step to expand, evenly and improve the quality of health services to the society. National Essential Medicine List should be implemented consistently and continuously in all health care units, included in hospital. Implementation of NEML at primary, secondary and tertiary health services level is through the utilization of Standard Treatment Guidelines and hospital formularies based on scientific evidence. Developing Hospital formularies should be based on NEML consistently. Before the enactment of regional autonomy, society access to essential medicines approximately 80%, but essential medicine prescription in public hospitals is less than 76%. Based on the problems, it is necessary to evaluate the implementation of NEML on hospital formularies. Objective: The aim of this study is to describe and analyze the NEML 2008 implementation on medicine formularies in Daerah Istimewa Yogyakarta (DIY) type B hospitals. Method: Descriptive Mixed method design (mixed methods) with the sequential explanatory models is applied to gain an overview of the NEML implementation on the medicine formularies in DIY type B hospitals. Quantitative data collected by adjusting the medicines mention in NEML 2008 with hospital formularies, whereas qualitative data collected using the compliance form to NEML 2008 with hospital formularies, formularies checklist preparation form based on WHO and MS (2003) to find out the hospital formularies process and also in depth-interview for identifying the hospital formularies incompliance refer to NEML 2008. Results: The NEML implementation percentage to DIY Type B hospitals formularies in Wirosaban Public Hospital is 96%, Senopati Panembahan Bantul Public Hospital is 81%, Sleman Public Hospital is 39% and Wates Public Hospital is 42%. Hospital formulary development process in DIY type B hospital has been referred to the process of developing the formulary based on the WHO and MSH (2003). The cause of hospital formularies incompliance to NEML in DIY type B hospital is there is no evaluation and monitoring from government related to the implementation of NEML in hospital formularies, the differences of disease patterns from each hospital, the medicines request by physician which is not based on NEML, some of NEML generic medicines are not available on the market. Conclusion: National Essential Medicine List has not been fully applied to the type B hospitals formularies in DIY Province.

Kata Kunci : Penerapan, DOEN, formularium RSUD tipe B di Provinsi DIY.