Analisis Profil dan Faktor-Faktor yang Memengaruhi Perilaku Kepatuhan Pengobatan untuk Pasien Diabetes Mellitus Lanjut Usia

  • Andi Makkulawu
  • Adji Prayitno Setiadi Departemen Farmasi Klinis dan Komunitas, Fakultas Farmasi, Universitas Surabaya, Surabaya, Indonesia
  • Tri Budi Wahyuni Rahardjo Center for Aging Studies, Universitas Indonesia, Jakarta, Indonesia
  • Eko Setiawan Pusat Informasi Obat dan Layanan Kefarmasian (PIOLK), Fakultas Farmasi, Universitas Surabaya, Surabaya, Indonesia
Keywords: Adherence factors, Diabetes mellitus, Elderly, Geriatrics

Abstract

Adherence with medication is one of the important factors in controlling blood glucose levels in patients with diabetes mellitus (DM), which in turn also determines the risk of diabetic complications. The profile and factors that influence adherence behaviour in the use of medication in elderly diabetic patients in Indonesia, especially in East Surabaya, are not yet known. The purpose of this study was to identify profiles and factors that influence the behavior of drug use adherence in elderly DM patients. A cross-sectional study was conducted in 32 Karang Werda or support groups for elderly in East Surabaya. Identification of the respondent’s level of adherence was carried out using the Adherence to Refill and Medication Scale (ARMS) questionnaire while the contributing factors towards adherence behaviour were identified using a published questionnaire. Both questionnaires have been validated in elderly people living in Surabaya. Result of adherence profile analysis was expressed in terms of percentage while determinant factors analysis was identified by using the highest mean among 14 sub-domains included in the questionnaire. In total, 281 elderly diabetic patients were recruited in this study. It was identified that 67.26% of the respondents were classified as non-adherence patients. The dominant factors that contribute to the behavior of medication adherence in elderly diabetic patients were social support, product-related factors, health workers, and emotional factors. Appropriate interventions to optimize the use of medications in elderly diabetic patients need to be identified and implemented according to the identified contributing factors.

References

United Nations. World Population Prospects The 2015 Revision. Key Findings and Advance Tables. Cited [2018 Agustus 10]. Available from: https://population.un.org/wpp/Publications/Files/Key_Findings_WPP_2015.pdf

Badan Pusat Statistik. Statistik Penduduk Lanjut Usia 2017. Cited [2018 Agustus 10]. Available from: https://www.bps.go.id/ publication/2018/04/13/7a130a22aa29cc8219c5d153/statistik-penduduk-lanjut-usia-2017.html

Corriere M, Rooparinesingh N, Kalyani RR. Epidemiology of diabetes and diabetes complications in the elderly: an emerging public health burden. Current Diabetes Reports. 2013 Dec;13(6):805-813. DOI: 10.1007/s11892-013-0425-5

Suastika K, Dwipayana P, Saraswati IMR, Kuswardhani T, Astika N, Putrawan IB, et al. Relationship between age and metabolic disorders in the population of Bali. Journal of Clinical Gerontology & Geriatrics. 2011;2:47-52.

Solli O, Stavem K, Kristiansen IS. Health-related quality of life in diabetes: the associations of complications with EQ-5D scores. Health and Quality of Life Outcomes. 2010;8:18. DOI: 10.1186/1477-7525-8-18

Hayes A, Arima H, Woodward M, Chalmers J, Poulter N, Hamet P, et al. Changes in quality of life associated with complications of diabetes: results from the ADVANCE Study. Value Health. 2016;19(1):36-41.

Young BA, Lin E, Von Korff M, Simon G, Ciechanowski P, Ludman EJ, et al. Diabetes complications severity index and risk of mortality, hospitalization, and healthcare utilization. The American Journal of Managed Care. 2008;14(1):15–23.

Wu CX, Tan WS, Toh MP, Heng BH. Stratifying healthcare costs using the Diabetes Complication Severity Index. Journal of Diabetes and its Complications. 2012;26(2):107-12.

Hazel-Fernandez L, Li Y, Nero D, Moretz C, Slabaugh L, Meah Y, et al. Relationship of diabetes complications severity to healthcare utilization and costs among Medicare Advantage beneficiaries. The American Journal of Managed Care. 2015;21(1):e62-70.

Nichols GA, Rosales AG, Kimes TM, Tunceli K, Kurtyka K, Mavros P. The change in HbA1c associated with initial adherence and subsequent change in adherence among diabetes patients newly initiating metformin therapy. Journal of Diabetes Research. 2016;article ID 9687815. DOI: 10.1155/2016/9687815.

Farmer AJ, Rodgers LR, Lonergan M, Shields B, Weedon MN, Donnelly L, et al. Adherence to oral glucose-lowering therapies and associations with 1-year HbA1c: a retrospective cohort analysis in a large primary care database. Diabetes Care. 2016;39(2):258-263.

Gautério-Abreu DP, Santos SSC, da Silva BT, Gomes GC, Cruz VD, Tier CG. Prevalence of medication therapy adherence in the elderly and related factors. Revista Brasileira de Enfermagem. 2016;69(2):313-320.

Jin H, Kim Y, Rhie SJ. Factors affecting medication adherence in elderly people. Patient Preference and Adherence. 2016;10:2117–2125.

IMS Institute for Healthcare Informatics. Avoidable cost in U.S. healthcare: the $200 billion opportunity from using medicines more responsibility. 2013 [cited 2018 Maret 3]. Available from: http://offers. premierinc.com/rs/381-NBB-525/ images/Avoidable_Costs_in%20_US_Healthcare-IHII_AvoidableCosts_2013 %5B1%5D.pdf

Nieuwlaat R, Wilczynski N, Navarro T, Hobson N, Jeffery R, Keepanasseril A, et al. Interventions for enhancing medication adherence. The Cochrane Database of Systematic Review. 2014 Nov 20;(11):CD000011. DOI: 10.1002/14651858.CD000011.pub4.

Gubernur Jawa Timur. Peraturan Gubernur Jawa Timur Nomor 31 tahun 2017 tentang Karang Werda. 2017 [cited 2018 Mei 20]. Available from: http://arsipjdih.jatimprov.go.id/upload/2179/PerGub_No._31_Thn_2017_ttg_Karang_Werda.pdf.

Walikota Surabaya. Peraturan Daerah Kota Surabaya Nomor 3 tahun 2014 tentang Kesejahteraan Lanjut Usia. 2014 [cited 2017 Mei 19]. Available from: https://jdih.surabaya.go.id/pdfdoc/perda_720.pdf.

Cahyadi H, Prayitno A, Setiawan E. Reliability and Validity of Adherence to Refill and Medication Scale (ARMS) in Indonesia Geriatric Population with Diabetes. Paper presented at “Asia-Oceania 2015 International Association of Gerontology and Geriatrics”; Thailand, 2015.

Makkulawu A, Prayitno A, Rahardjo TBW, Setiawan E. The development of a questionnaire on factors affecting non-adherence behaviour among Indonesian elderly population. Pharmaceutical Sciences and Research. 2018;5(2):49-57.

Kementerian Kesehatan Republik Indonesia. Riset Kesehatan Dasar (RISKESDAS) 2013. Kememterian Kesehatan Republik Indonesia Bada nPenelitian dan Pengembangan Kesehatan. Available from: http://labdata.litbang.depkes.go.id/riset-badan-litbangkes/menu-riskesnas/menu-riskesdas/374-rkd-2013.

National Institute on Aging, National Institutes of Health. Global health and aging. 2011 [cited 2018 Mei 20]. Available from: http://www.who.int/ageing/publications/global_health.pdf

Gellad WF, Grenard JL, Marcum ZA. A systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexity. The American Journal of Geriatric Pharmacotheraphy. 2011 Feb; 9(1):11–23.

American Diabetes Association. Pharmacologic approaches to glycemic treatment: standards of medical care in diabetes-2018. Diabetes Care 2018;41(Suppl. 1):S73–S85.

Perkumpulan Endokrinologi Indonesia. Konsensus pengelolaan dan pencegahan diabetes mellitus tipe 2 di Indonesia. 2015 [cited 2018 July 28] Available at: http://pbperkeni.or.id/doc/konsensus.pdf.

Kementerian Kesehatan Republik Indonesia. Keputusan Menteri Kesehatan Republik Indonesia Nomor HK. 01.07/MENKES/659/2017 tentang formularium nasional. 2017 [cited 2018 Juli 20]. Available from: http://e-fornas.binfar.kemkes.go.id/script/file_download/SK%20Fornas%202017.pdf.

Tabasi HK, Madarshahian F, Nikoo MK, Hassanabadi M, Mahmoudirad G. Impact of family support improvement behaviors on anti diabetic medication adherence and cognition in type 2 diabetic patients. Journal of Diabetes and Metabolic Disorder. 2014;13:113. DOI: 10.1186/s40200-014-0113-2

Yap AF, Thirumoorthy T, Kwan YH. Medication adherence in the elderly. Journal of Clinical Gerontology & Geriatrics. 2016;7:64-67. DOI: 10.1016/j.jcgg. 2015.05.001

Salama AA, Yasin AER, Elbarbary W. Medication knowledge as a determinant of medication adherence in geriatric patients, Serse Elian City, Menoufia Governorate, Egypt. Menoufia Medical Journal. 2017;30(1):63–68.

Young A, Tordoff J, Smith A. 'What do patients want?' Tailoring medicines information to meet patients' needs. Research in Social and Administrative Pharmacy. 2017;13(6):1186-1190.

Liu F, Abdul-Hussain S, Mahboob S, Rai V, Kostrzewski A. How useful are medication patient information leaflets to older adults? A content, readability and layout analysis. International Journal of Clinical Pharmacy. 2014;36(4):827-34.

Robben S, van Kempen J, Heinen M, Zuidema S, Olde Rikkert M, Schers H, et al. Preferences for receiving information among frail older adults and their informal caregivers: a qualitative study. Family Practice. 2012;29(6):742-7.

Modig S, Kristensson J, Troein M, Brorsson A, Midlov P. Frail elderly patients’ experiences of information on medication. A qualitative study. BMC Geriatrics. 2012;12:46. DOI: 10.1186/1471-2318-12-46

Reader TW, Gillespie A. Patient neglect in healthcare institutions: a systematic review and conceptual model. BMC Health Services Research. 2013;13:156. DOI: 10.1186/1472-6963-13-156

Sun N, Rau PLP. Barriers to improve physician-patient communication in a primary care setting: perspectives of Chinese physicians. Health Psychology and Behavioral Medicine. 2017;5(1):166-176.

Badan PPSDM Kesehatan-Kementerian Kesehatan Republik Indonesia. Rasio tenaga kesehatan terhadap jumlah penduduk (per provinsi) per 100.000 penduduk. 2016 [cited 2018 August 12]. Available from: http://bppsdmk.kemkes.go.id/ info_sdmk/info/renbut.

Kocurek B. Promoting medication adherence in older adults and the rest of us. Diabetes Spectrum. 2009;22(2):80-84.

Roy NT, Sajith M, Bansode MP. Assessment of factors associated with low adherence to pharmacotherapy in elderly patients. Journal of Young Pharmacist, 2017;9(2):272-276.

Kamimura T, Ishiwata R, Inoue T. Medication reminder device for the elderly patients with mild cognitive impairment. American Journal of Alzheimer's Disease & Other Dementias. 2012;27(4):238-242.

Spoelstra SL, Schueller M, Hilton M, Ridenour K. Interventions combining motivational interviewing and cognitive behaviour to promote medication adherence: a literature review. Journal of Clinical Nursing. 2015;24(9-10):1163-73.

Published
2019-08-30
How to Cite
1.
Makkulawu A, Setiadi A, Rahardjo TB, Setiawan E. Analisis Profil dan Faktor-Faktor yang Memengaruhi Perilaku Kepatuhan Pengobatan untuk Pasien Diabetes Mellitus Lanjut Usia. jki [Internet]. 30Aug.2019 [cited 9Apr.2020];9(2):114-25. Available from: https://ejournal2.litbang.kemkes.go.id/index.php/jki/article/view/405
Section
Articles