Efek Konseling Menggunakan Brief Counseling 5A Modifikasi Disertai Pesan Motivasional Farmasis dalam Peningkatan Perilaku dan Outcome Klinik Pasien Diabetes Melitus dengan Hipertensi Rawat Jalan di RSUD Panembahan Senopati, Bantul

Abstract

AbstrakDiabetes melitus (DM) dengan hipertensi merupakan penyakit komplikasi sindrom metabolik dengan terapi lebih dari satu obat. Selain faktor pengetahuan, faktor perilaku dan motivasi dari luar dapat menjadi salah satu faktor kebosanan pasien dalam menjalani terapi jangka panjang. Dibutuhkan edukasi dan motivasi untuk kepatuhan perilaku berobat dalam mencapai target terapi pasien DM-hipertensi. Penelitian ini bertujuan untuk mengetahui pengaruh brief-counseling 5A modifikasi oleh apoteker dan dukungan motivasi pesan singkat dalam meningkatkan perilaku dan outcome klinis pasien DM-hipertensi rawat jalan di RSUD Panembahan Senopati Bantul, Yogyakarta. Penelitian ini menggunakan metode kuasi-eksperimental dengan desain prepost. Pengambilan data dilakukan secara prospektif selama periode Maret-Mei 2017. Sebanyak 99 orang yang memenuhi kriteria inklusi dibagi menjadi 3 kelompok yang terdiri dari 33 pasien. Tingkat perilaku pasien diukur melalui wawancara menggunakan kuesioner perilaku pasien DM-hipertensi, sedangkan data outcome klinis pasien diambil dari data rekam medis. Hasil penelitian ini menunjukkan bahwa proporsi tingkat perilaku pada tahap aksi kelompok perlakuan 1 (brief counseling 5A modifikasi) dan 2 (brief counseling 5A modifikasi + SMS motivasi) lebih besar (masing-masing sebesar 21,2%) dibandingkan kelompok kontrol (12,1%). Pemberian brief counseling 5A modifikasi dapat menurunkan tekanan darah sistolik sebesar 8,36±12,21 mmHg (p=0,000), diastolik 2,42±10,69 mmHg (p=0,202) dan gula darah sewaktu (GDS) 24,66 mg/dL (p=0,017). Pemberian brief counseling 5A modifikasi + SMS motivasi dapat menurunkan tekanan darah sistolik sebesar 8,79±17,32 mmHg (p=0,012), diastolik 5,0±9,92 mmHg (p=0,007), dan GDS 24,91 mg/dL (p=0,079). Kelompok brief counseling 5A modifikasi disertai pesan (SMS) motivasi lebih efektif dalam meningkatkan perilaku pasien dan pengontrolan outcome klinik dibandingkan kelompok kontrol maupun brief counseling 5A modifikasi.Kata kunci: Brief counseling 5A modifikasi, diabetes melitus, hipertensi, pesan motivatif (SMS motivasi) AbstractDiabetes mellitus (DM) with hypertension is a complicating disease of metabolic syndrome with more than one drug therapy. Aside from knowledge, behavior and motivation also can be factors that trigger patient's boredom in undergoing long-term therapy. Education and motivation are needed for adherence to treatment in order to achieve therapeutic target of DM-hypertensive patients. This study aimed to determine the effect of brief counseling 5A modification by pharmacists and short message (SMS) motivation to improve behavior and clinical outcomes of DM-hypertensive outpatients at Panembahan Senopati Hospital, Bantul, Yogyakarta. This study used a quasi-experimental method with pre-post design, and data collection was conducted prospectively during the period of March-May 2017. A total of 99 patients who were eligible for inclusion criteria were divided into 3 groups consisting of 33 patients. Level of patient's behavior was measured through interviews using behavi...

Modified brief counseling-5A, motivational SMS on medication-taking behavior and compliance among diabetic patients

“…The content of the brief counseling-5A model was redeveloped for DM patients and to incorporate a religious approach. It refers to a previous study on brief counseling-5A for Patients with DM-Hypertension [9]. The modified brief counseling-5A was a pharmaceutical intervention that was delivered in a focus group discussion (FGD).…”

“…In this study, the questionnaire on medication-taking behavior was developed from a previous study, i.e., Saputri et al by adjusting the content to the research subject, namely DM patients. The next step was validity testing by experts like doctors, pharmacists, and clinical psychologists [9].…”

“…Previous study claims that brief counseling by pharmacists can help to improve medication-taking behavior,and adherence to medication. It also improve the quality of life among DM-hypertensive patients [9]- [12].…”

“…Brief counseling-5A is a modified model of brief counseling by pharmacists. Combined with a text reminder to hypertensive patients, it has been reported to exhibit a positive outcome, that is, improved quality of life [9], [10]. A further investigation in Saputri et al reveals that the levels of behavior of the treatment group 1 (brief counseling-5A) and treatment group 2 (brief counseling-5A+motivational short message services (SMS)) have more significant proportions (21.2% each) than that of the control group (12.1%) [9].…”

“…Combined with a text reminder to hypertensive patients, it has been reported to exhibit a positive outcome, that is, improved quality of life [9], [10]. A further investigation in Saputri et al reveals that the levels of behavior of the treatment group 1 (brief counseling-5A) and treatment group 2 (brief counseling-5A+motivational short message services (SMS)) have more significant proportions (21.2% each) than that of the control group (12.1%) [9]. For the reasons above, brief counseling by pharmacists and motivational reminder via SMS positively contribute to the successful treatment of hypertensive diabetic inpatients.…”