Inovasi Home Care Apoteker melalui Supervisi Penggunaan Obat Geriatri untuk Meningkatkan Kepatuhan Terapi Penyakit Kronis

Yuhansyah Nurfauzi; Djoko Wahyono; Fita Rahmawati; Nanang M. Yasin

doi:10.15416/ijcp.2020.9.2.147

Inovasi Home Care Apoteker melalui Supervisi Penggunaan Obat Geriatri untuk Meningkatkan Kepatuhan Terapi Penyakit Kronis

Yuhansyah Nurfauzi, Djoko Wahyono, Fita Rahmawati, Nanang M. Yasin

Abstract

Pelayanan kefarmasian di Indonesia saat ini bergeser mengikuti paradigma patient-oriented. Meningkatnya jumlah pasien lanjut usia (lansia) dengan penyakit kronis membuat apoteker perlu mengembangkan upaya edukatif dan kolaboratif berbasis komunitas seperti home care. Klien home care yang mendapatkan banyak obat untuk penyakit kronis dari dokter dan apotek sering mengalami Drug Related Problems (DRP) serta dianggap mendapatkan sedikit supervisi atau bahkan tidak mendapatkannya sama sekali di rumahnya. Tujuan artikel review ini adalah untuk membahas aktivitas supervisi apoteker pada pelayanan kefarmasian untuk pasien lansia dalam konteks home care yang dapat mengungkapkan dan meningkatkan kepatuhan terapi. Penelitian yang memenuhi kriteria inklusi diambil dari basis data jurnal Pubmed, Science Direct, dan Google Scholar. Hasil penelusuran pustaka dari 16 artikel menunjukkan bahwa aktivitas supervisi terhadap terapi obat merupakan elemen pelayanan kefarmasian home care. Supervisi penggunaan obat oleh apoteker kepada pasien lansia yang mengalami penyakit kronis terbukti dapat meningkatkan kepatuhan apabila dilaksanakan secara inovatif dalam konteks home care. Model pelayanan yang terintegrasi dan berbasis komunitas seperti pelayanan di klinik atau rawat jalan di rumah sakit memberikan kesempatan kepada apoteker untuk berkolaborasi dengan tenaga kesehatan lainnya dalam rangka meningkatkan kepatuhan. Aktivitas supervisi meliputi rekonsiliasi obat, identifikasi dan manajemen masalah terkait obat, monitoring beberapa parameter klinis, penyesuaian rejimen dan dosis terapi, edukasi serta koordinasi pelayanan dengan tenaga kesehatan lainnya. Supervisi terapi obat dalam home care terbukti mampu mengungkap lebih banyak DRP dan angka ketidakpatuhan sekaligus memberikan solusinya. Kepatuhan dapat ditingkatkan dengan upaya-upaya inovatif untuk mendesain perangkat pendukung yang sesuai dengan kebutuhan pasien dan memudahkan apoteker dalam mentransfer pelayanannya.

Kata kunci: Apoteker, home care, kepatuhan, lanjut usia, penyakit kronis, supervisi

Pharmacist Home Care Innovation through Supervision of Geriatric Drug Use to Improve Adherence with Chronic Disease Therapy

Abstract
There is currently a shift in the pharmaceutical care provided in Indonesia towards the patient-oriented paradigm, alongside the increasing number of elderly with chronic diseases. Therefore, it is important to develop pharmacist activities towards drug therapy management, through community-based education and collaboration, including home care service. This provision by doctors and pharmacies to clients with drugs for chronic diseases often lead to Drug Related Problems (DRP), and are considered to encourage little or no supervision. The purpose of this review, therefore, is to discuss the pharmacist’s supervision activities for elderly patients, in the context of home care, relevant to identify and improve therapy adherence. Furthermore, studies evaluated to have met the inclusion criteria were collected from journal databases, including Pubmed, Science Direct and Google Scholar. A total of sixteen articles showed supervision activities on drug therapy to be the element of pharmaceutical home care services. Hence, improved levels have been implicated in increased adherence, following an innovative implementation in the context of home care. Moreover, integrated and community-based service models, comprising services in clinics or outpatients in hospitals provide opportunities for pharmacists to collaborate with other health workers, and consequently promote adherence. The possible supervision activities include medication reconciliation; DRP identification and management; clinical parameters monitoring; adjusting therapy regimens and doses; education; and coordination of services with other health workers. These approaches have been proven to increase the average DRP per patient, and the non-adherence rate while providing a solution. However, adherence is possibly enhanced by design tools appropriate to the individual needs, and capable of facilitating the transfer of pharmacists’ services.

Keywords: Adherence, chronic disease, elderly, home care, pharmacist, supervision

Keywords

Apoteker, home care, kepatuhan, lanjut usia, penyakit kronis, supervisi

Full Text:

PDF (Bahasa Indonesia)

References

Supper I, Catala O, Lustman M, Chemla C, Bourgueil Y, Letrilliart L. Interprofessional collaboration in primary health care: A review of facilitators and barriers perceived by involved actors. J Public Health. 2015;37(4):716–27. doi: 10.1093/pubmed/fdu102

Onda M, Imai H, Kataoka Y, Takamatsu M, Tanaka M, Tanaka H, et al. A preliminary study about the relationship between workload and the outcomes of community pharmacists’ home visiting service. Jpn J Soc Pharm. 2013;32(2):2–7. doi: 10.14925/32.2

Rojas-Fernandez CH, Patel T, Lee L. An interdisciplinary memory clinic: A novel practice setting for pharmacists in primary care. Ann Pharmacother. 2014;48(6):785–95. doi: 10.1177/1060028014526857

Nigro SC, Garwood CL, Berlie H, Irons B, Longyhore D, McFarland MS, et al. Clinical pharmacists as key members of the patient-centered medical home: An opinion statement of the ambulatory care practice and research network of the american college of clinical pharmacy. Pharmacotherapy. 2014;34(1):96–108. doi: 10.1002/phar.1357

Ong KY, Cheen MHH, Chng JSG, Chen LL, Ng SM, Lim SH, et al. Effectiveness of a multidisciplinary home-based medication review program in reducing healthcare utilization among older adult Singaporeans: Home-based medication reviews for the elderly. Geriatr Gerontol Int. 2017;17(2):302–7. doi: 10.1111/ggi.12706

Tunpichart S, Sakulbumrungsil R, Somrongthong R, Hongsamoot D. Chronic care model for diabetics by pharmacist home health in Bangkok Metropolitan: A community based study. Int J Medicine Med Sci. 2012;4(4):90–6. doi: 10.5897/IJMMS12.009

Boult C, Green AF, Boult LB, Pacala JT, Snyder C, Leff B. Successful models of comprehensive care for older adults with chronic conditions: Evidence for the institute of medicine’s “retooling for an aging America” report: [see editorial comments by Dr. David B. Reuben, pp. 2348–2349]. J Am Geriatr Soc. 2009;57(12):2328–37. doi: 10.1111/j.1532-5415.2009.02571.x

Fredericksen RJ, Gibbons L, Brown S, Edwards TC, Yang FM, Fitzsimmons E, et al. Medication understanding among patients living with multiple chronic conditions: Implications for patient-reported measures of adherence. Res Social Adm Pharm. 2018;14(6):540–4. doi: 10.1016/j.sapharm.2017.06.009

Hassali MA, Al-Tamimi S, Hashmi F, Al-Tamimi SK. Defining clinical pharmacy: A new paradigm. Pharm J. 2016 [Accessed on 31 December 2018]. Available from: http://www.pharmaceutical-journal.com/opinion/comment/defining-clinical-pharmacy-a-new-paradigm/20201798.article

Walus AN, Woloschuk DM. Impact of pharmacists in a community-based home care service: A pilot program. Can J Hosp Pharm. 2017;70(6):435–42. doi: 10.4212/cjhp.v70i6.1718

Boles N, Gowac A. The role of the pharmacist in home healthcare. Home Healthc Now. 2017;35(1):55–6. doi: 10.1097/NHH.0000000000000437

Markle-Reid M, Browne G, Gafni A, Roberts J, Weir R, Thabane L, et al. The effects and costs of a multifactorial and interdisciplinary team approach to falls prevention for older home care clients ‘at risk’ for falling: A randomized controlled trial. Can J Aging. 2010;29(01):139–61. doi: 10.1017/S0714980809990377

Chen JH, Ou HT, Lin TC, Lai ECC, Yang Kao YH. Pharmaceutical care of elderly patients with poorly controlled type 2 diabetes mellitus: A randomized controlled trial. Int J Clin Pharm. 2016;38(1):88–95. doi: 10.1007/s11096-015-0210-4

Sadeghi K, Mohammadi M, Najmeddin F, Mashayekhi M, Mojtahedzadeh M, Javadi M, et al. Pharmacist-led medication review: Supports for new role of pharmacists. J Pharm Care. 2013;1(4):153–60.

Brulhart MI, Wermeille JP. Multidisciplinary medication review: Evaluation of a pharmaceutical care model for nursing homes. Int J Clin Pharm. 2011;33(3):549–57. doi: 10.1007/s11096-011-9506-1

Milos V, Rekman E, Bondesson Å, Eriksson T, Jakobsson U, Westerlund T, et al. Improving the quality of pharmacotherapy in elderly primary care patients through medication reviews: A randomised controlled study. Drugs Aging. 2013;30(4):235–46. doi: 10.1007/s40266-013-0057-0

Azevedo M da GB de, Pedrosa RS, Aoqui CM, Martins RR, Nagashima Junior T. Effectiveness of home pharmaceutical interventions in metabolic syndrome: A randomized controlled trial. Braz J Pharm Sci. 2017;53(2):e16089. doi: 10.1590/s2175-97902017000216089

Wouters H, Scheper J, Koning H, Brouwer C, Twisk JW, van der Meer H, et al. Discontinuing inappropriate medication use in nursing home residents: A cluster randomized controlled trial. Ann Intern Med. 2017;167(9):609–17. doi: 10.7326/M16-2729

Utaminingrum W, Pranitasari R, Kusuma AM. Pengaruh home care apoteker terhadap kepatuhan pasien hipertensi. Indones J Clin Pharm. 2017;6(4):240–6. doi: 10.15416/ijcp2017.6.4.240

Larasanty LPF, Meilinayanti NML, Susanti NMP, Wirasuta IMAG. Pengaruh pelayanan kefarmasian residensial terhadap ketaatan dan luaran klinis pasien hipertensi. Indones J Clin Pharm. 2015;4(3):162–74. doi: 10.15416/ijcp.2015.4.3.162

Icwari NPWP, Wirasuta IMAG, Susanti NMP. Akseptabilitas pelayanan residensial kefarmasian pada pasien diabetes melitus tipe II tanpa komplikasi. J Farm Udayana. 2013;2(2):1–5.

Suryani NM, Wirasuta IMAG, Susanti NMP. Pengaruh konseling obat dalam home care terhadap kepatuhan pasien diabetes melitus tipe 2 dengan komplikasi hipertensi. Jurnal Farmasi Udayana. 2013;2(3):6–12.

Leiva A, Moreno L, Duro RE, Serra F, Dagosto P, Iglesias AA, et al. Efficacy of a brief multifactorial adherence-based intervention in reducing blood pressure: A randomized clinical trial. Patient Prefer Adherence. 2014;8:1683–90. doi: 10.2147/PPA.S66927

Kementerian Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 72 Tahun 2016 Tentang Standar Pelayanan Kefarmasian di Rumah Sakit. Jakarta: Kementerian Kesehatan Republik Indonesia; 2016.

Kementerian Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 73 Tahun 2016 Tentang Standar Pelayanan Kefarmasian di Apotek. Jakarta: Kementerian Kesehatan Republik Indonesia; 2016.

Kementerian Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 74 Tahun 2016 Tentang Standar Pelayanan Kefarmasian di Puskesmas. Jakarta: Kementerian Kesehatan Republik Indonesia; 2016.

Kementerian Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 67 Tahun 2015 Tentang Penyelenggaraan Pelayanan Kesehatan Lanjut Usia di Pusat Kesehatan Masyarakat. Jakarta: Kementerian Kesehatan Republik Indonesia; 2015.

Reidt S, Morgan J, Larson T, Blade MA. The role of a pharmacist on the home care team: A collaborative model between a college of pharmacy and a visiting nurse agency. Home Healthc Nurse. 2013;31(2):80–7. doi: 10.1097/NHH.0b013e3182778f5f

Loganathan M, Singh S, Franklin BD, Bottle A, Majeed A. Interventions to optimise prescribing in care homes: systematic review. Age Ageing. 2011;40(2):150–62. doi: 10.1093/ageing/afq161

Hogg W, Lemelin J, Dahrouge S, Liddy C, Armstrong CD, Legault F, et al. Randomized controlled trial of anticipatory and preventive multidisciplinary team care. Can Fam Physician. 2009;55(12):e76–85.

Setter SM, Corbett CF, Neumiller JJ, Gates BJ, Sclar DA, Sonnett TE. Effectiveness of a pharmacist-nurse intervention on resolving medication discrepancies for patients transitioning from hospital to home health care. Am J Health Syst Pharm. 2009;66(22):2027–31. doi: 10.2146/ajhp080582

Collier IA, Baker DM. Implementation of a pharmacist-supervised outpatient diabetes treatment clinic. Am J Health Syst Pharm. 2014;71(1):27–36. doi: 10.2146/ajhp130200

Biswas A, Sinha N, Ray K, Tripathi SK. A study on drug use and medication management perspectives among elderly and the impact of professional oversight. J Clin Diagn Res. 2018;12(5):FC01–07. doi: 10.7860/JCDR/2018/32786.11518

Olesen C, Harbig P, Buus KM, Barat I, Damsgaard EM. Impact of pharmaceutical care on adherence, hospitalisations and mortality in elderly patients. Int J Clin Pharm. 2014;36(1):163–71. doi: 10.1007/s11096-013-9898-1

Porter AK, Taylor SR, Yabut AH, Al-Achi A. Impact of a pill box clinic to improve systolic blood pressure in veterans with uncontrolled hypertension taking 3 or more antihypertensive medications. J Manag Care Spec Pharm. 2014;20(9):905–11. doi: 10.18553/jmcp.2014.20.9.905

Choe HM, Farris KB, Stevenson JG, Townsend K, Diez HL, Remington TL, et al. Patient-centered medical home: Developing, expanding, and sustaining a role for pharmacists. Am J Health Syst Pharm. 2012;69(12):1063–71. doi: 10.2146/ajhp110470

Elliott RA, Lee CY, Beanland C, Goeman DP, Petrie N, Petrie B, et al. Development of a clinical pharmacy model within an Australian home nursing service using co-creation and participatory action research: the Vi siting P harmacist (ViP) study. BMJ Open. 2017;7(11):e018722. doi: 10.1136/bmjopen-2017-018722

Leendertse AJ, de Koning GHP, Goudswaard AN, Belitser SV, Verhoef M, de Gier HJ, et al. Preventing hospital admissions by reviewing medication (PHARM) in primary care: An open controlled study in an elderly population. J Clin Pharm Ther. 2013;38(5):379–87. doi: 10.1111/jcpt.12069

Basheti IA, Qunaibi EA, Bulatova NR, Samara S, AbuRuz S. Treatment related problems for outpatients with chronic diseases in Jordan: The value of home medication reviews. Int J Clin Pharm. 2013;35(1):92–100. doi: 10.1007/s11096-012-9713-4

Cheen MHH, Goon CP, Ong WC, Lim PS, Wan CN, Leong MY, et al. Evaluation of a care transition program with pharmacist-provided home-based medication review for elderly Singaporeans at high risk of readmissions. Int J Qual Health Care. 2017;29(2):200–5. doi: 10.1093/intqhc/mzw150

Elliott RA, Martinac G, Campbell S, Thorn J, Woodward MC. Pharmacist-led medication review to identify medication-related problems in older people referred to an aged care assessment team. Drugs Aging. 2012;29(7):593–605. doi: 10.1007/BF03262276

Andreassen LM, Kjome RLS, Sølvik UØ, Houghton J, Desborough JA. The potential for deprescribing in care home residents with type 2 diabetes. Int J Clin Pharm. 2016;38(4):977–84. doi: 10.1007/s11096-016-0323-4

Kilcup M, Schultz D, Carlson J, Wilson B. Postdischarge pharmacist medication reconciliation: Impact on readmission rates and financial savings. J Am Pharm Assoc. 2013;53(1):78–84. doi: 10.1331/JAPhA.2013.11250

Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice: The patient-centered approach to medication management services. 3rd edition. United States: McGraw-Hill; 2012.