PERBEDAAN PERESEPAN SEBELUM DAN SESUDAH PENERAPAN STANDAR PELAYANAN MEDIS (SPM) PADA PASIEN RAWAT JALAN DI RSUD DEMANG SEPULAU RAYA LAMPUNG TENGAH
FERANI ARI PERDANI, dr. Sulanto Saleh Danu, Sp.FK.
2013 | Tesis | S2 Ilmu Kesehatan MasyarakatLatar belakang : Peresepan obat yang rasional, dipengaruhi salah satunya oleh adanya Standar Pelayanan Medis (SPM) sebagai suatu pedoman pengobatan. RSUD Demang Sepulau Raya mulai menerapkan SPM di tahun 2012. Karena itu perlu dilakukan evaluasi untuk melihat apakah terdapat perbedaan peresepan sebelum dan sesudah penerapan SPM sehingga dapat meningkatkan peresepan menjadi lebih rasional. Tujuan : Untuk mengetahui perbedaan peresepan sebelum dan sesudah penerapan SPM pada pasien rawat jalan di RSUD Demang Sepulau Raya Lampung Tengah. Metode penelitian : penelitian observasional deskriptif analitik dengan disain penelitian case study. Data penelitian berupa data kuantitatif dan kualitatif. Data kuantitatif diperoleh dari resep rawat jalan pada penyakit katarak, diabetes melitus, epilepsi, tuberkulosis paru, hipertensi dan dispepsia di bulan Juni- Agustus 2011 (sebelum penerapan SPM) dan resep bulan Juni-Agustus 2012 (sesudah penerapan SPM). Data kualitatif diperoleh dari wawancara mendalam. Hasil : Persentase kesesuaian obat dengan SPM sebelum penerapan SPM 0-53% dan sesudah penerapan SPM 0-61%. Persentase kesesuaian resep dengan SPM sebelum penerapan SPM 0-18% dan sesudah penerapan SPM 0-29%. Rata-rata jumlah obat tiap resep sebelum penerapan SPM 1,66-4,60 dan sesudah penerapan SPM 1,76-4,09.Persentase jumlah obat generik yang diresepkan sebelum penerapan SPM 13-87% dan sesudah penerapan SPM 26-82%. Persentase antibiotik yang diresepkan sebelum penerapan SPM 1-22% dan sesudah penerapan SPM 1-13%. Persentase injeksi yang diresepkan sebelum penerapan SPM 0% dan sesudah penerapan SPM 0-1%. Persentase obat yang sesuai dengan DOEN sebelum penerapan SPM 12-67% dan sesudah penerapan SPM 22-66%. Persentase obat terlayani sebelum penerapan SPM 97-99% dan sesudah penerapan SPM 97-100%. Kesimpulan : terdapat peningkatan kesesuaian obat dengan SPM sesudah penerapan SPM. Terdapat peresepan yang tidak sesuai indikasi dan peresepan polifarmasi baik sebelum maupun sesudah penerapan SPM. Pengembangan SPM RSUD DSR diadopsi dari SPM yang sudah ada, kemudian dilakukan penyesuaian dengan kondisi RSUD DSR. Belum semua dokter di RSUD Demang Sepulau Raya mendapat SPM dan belum dilakukan sosialisasi SM secara reguler. Dalam pelaksanaan SPM di RSUD Demang Sepulau Raya perlu didukung oleh regulasi, upaya manajerial dan pembiayaan serta edukasi terhadap sumber daya manusia.
Background: Rational drug prescribing, influenced one of by Standard Treatment Guidelines (STGs). Demang Sepulau Raya Hospital began implementing STGs in 2012. Therefor it needs to be evaluated to see whether there are differences in prescribing before and after the application of STGs so that it can increase to more rational prescribing. Objective: To determine differences in prescribing before and after the application of STGs in outpatients department hospitals Demang Sepulau Raya public hospital, Lampung Tengah Methods : Observational descriptive analytic case study, using quantitative and qualitative data. Quantitative data obtained from outpatient prescription on cataract, diabetes mellitus, epilepsy, pulmonary tuberculosis, hypertension and dyspepsia in the month of June-August 2011 (before the application of STGs) and the prescription in June- August 2012 (after the application of STGs). Qualitative data obtained from in-depth interviews. Results: Percentage of medicines in accordance with STGs before the application were 0- 53% and 0-61% after the application of STGs. Percentage of prescribing in accordance with STGs before application were 0-18% and 0-29% after the application of STGs. Average number of drugs per encounter before the application were 1.66 - 4.60 and 1.76 - 4.09 after the application of STGs. The percentage of drugs prescribed by generic name before the application were 13-87% and 26-82% after the application of STGs. Percentage of encounters of antibiotics prescribed before the application were 1-22% and 1-13% after the application of STGs. Percentage of encounters of injections prescribed before the application were 0% and after the application of STGs were 0-1%. Percentage of drugs prescribed accordance with national essential drugs list (DOEN) before the application were 12-67% and 22-66% after the application of STGs. Percentage of drug actually dispensed before applying were 97-99% and 97-100% after applying of STGs. Conclusion: there is an increase in drug accordance with STGs after implementation of STGs. There are unappropriate prescribing with uncorrect indications and polypharmacy prescribing both before and after the application of STGs. Development of Demang Sepulau Raya Hospital’s STGs adopted from an existing one, and then be adjusted to the conditions of Demang Sepulau Raya Hospital. Not all physician in Demang Sepulau Raya Hospital got STGs and STGs’ socialization has not done on a regular basis. The implementation of STGs in Demang Sepulau Raya Hospital need to be supported by regulatory, managerial and funding efforts, and education on human resources.
Kata Kunci : penggunaan obat rasional, standar pelayanan medis, pedoman pengobatan, peresepan, instalasi farmasi rumah sakit
