Tesis

Analisis Ketepatan Pengobatan dan Peran Pengawas Minum Obat dalam Penanganan Tuberkulosis di Puskesmas Kecamatan Pademangan Jakarta Utara = Analysis on Treatment Accuracy and Role of Direct Observed Treatment in Tuberculosis Treatment at Pademangan Health Center, North Jakarta .

Pendahuluan:Tuberkulosis (TB) merupakan suatu penyakit infeksi menular yang mendapat perhatian khusus di dunia.Paduan pengobatan TB yang tepat merupakan salah satu faktor yang memengaruhi keberhasilan pengobatan TB.Pengawas Minum Obat (PMO) merupakan bagian dari Directly Observed Treatment Shourtcourse (DOTS), suatu program untuk mendukung keberhasilan pengobatan TB.Penelitian ini dilakukan untuk meningkatkan keberhasilan pengobatan TB masyarakat Indonesia. Metode:Desain penelitian menggunakan potong lintang dan eksperimental, dilakukan di Puskesmas Kecamatan Pademangan Jakarta Utara.Studi potong lintang melibatkan 205 subyek, dari data rekam medis dan TB-01 tahun 20122014, untuk mengetahui ketepatan jenis kategori, indikasi, lama pemberian dan dosis KDT; hubungan efek samping dengan keberhasilan pengobatan TB; efikasi pemberian KDT; proporsi PMO saat pertama datang berobat.Studi eksperimental melibatkan 23 subyek kelompok kontrol dan 23 subyek kelompok terintervensi, untuk mengetahui tingkat pengetahuan PMO, hubungan pengetahuan PMO dengan kepatuhan berobat 6 bulan, hubungan pengetahuan PMO dengan konversi BTA, serta hubungan kepatuhan berobat 6 bulan dengan konversi BTA.Penelitian ini dianalisis secara analitik dan deskriptif menggunakan spss v22.0. Hasil:Pemberian jenis kategori KDT 100% tepat, indikasi pemberian KDT 96,6% tepat, lama pemberian KDT 74,2% tepat, dan pemberian dosis 85,9% tepat.Indikasi pemberian KDT 3,4% tidak tepat, lama pemberian KDT 25,8% tidak tepat dan pemberian dosis KDT 14,1% tidak tepat.Hubungan efek samping KDT dengan keberhasilan pengobatan TB tidak bermakna secara statistik (p=0,173;0,757(IK95%:0,077-1,612)).Jumlah subyek yang berhasil konversi setelah 2 bulan pengobatan 71,2%, gagal konversi 28,8%.Jumlah subyek yang berhasil konversi setelah 6 bulan 81,1%, gagal konversi 18,9%.Proporsi pasien yang memiliki PMO saat pertama berobat 79%, tidak ada PMO 21%.Pada kelompok terintervensi terjadi peningkatan presentase PMO pengetahuan cukup 8,6%, kelompok kontrol meningkat 13%.Presentase pengetahuan PMO pengetahuan kurang kelompok terintervensi menurun 8,6%, kelompok kontrol menurun 13%.Tidak ada hubungan bermakna secara statistik antara hubungan pengetahuan PMO dengan bulan ke-2 (p=0,575;IK95%: 0,978-1,151) dan bulan ke-6 pengobatan (konversi dahak setelah 6 bulan 100%).Tidak ada hubungan statistik bermakna antara kepatuhan obat dengan hasil konversi dahak bulan ke-2 dan bulan ke-6 pengobatan.Kepatuhan berobat pasien selama 6 bulan 100%.
Kesimpulan: Efek samping minor KDT-OAT tidak memengaruhi keberhasilan pengobatan TB, sehingga pengobatan tetap dilanjutkan meskipun muncul efek samping. Tidak ada hubungan antara tingkat pengetahuan PMO dengan kepatuhan berobat, tingkat pengetahuan PMO dengan konversi dahak (bulan ke-2 dan ke-6), serta kepatuhan berobat dengan konversi dahak (bulan ke-2 dan ke-6). Pada Puskesmas ini, kepatuhan berobat selama 6 bulan pasien sudah mencapai 100%.
Kata kunci: kombinasi dosis tetap, pengawas minum obat, tuberkulosis


Introduction: Tuberculosis (TB) is an infectious disease which is under special attention by the world. Guideline of TB treatment is considered as one of the factor that influences the successful outcome of TB treatment. Direct Observed Treatment (DOT) is part of the Directly Observed Treatment Shourtcourse (DOTS), a program to support successful TB treatment. This research is conducted to improve TB treatment success rate in Indonesia. Method: Research design utilized cross sectional and experimental method. The research was conducted at Pademangan Health Center, North Jakarta. Cross sectional study involved 205 subjects which data was obtained from medical record and TB-01 card between 2012-2014 with the purpose to understand given correctly of category type, indication, duration and dosage of FDC; relationship between side effect with successful TB treatment; FDC treatment efficacy; DOT proportion during first medical consultation. Experimental study involved 23 subjects as controlled group and 23 subjects as experimental group to understand DOT’s level of understanding, relationship between DOT’s level of understanding with 6-month-treatment adherence, relationship between DOT’s level of understanding with BTA conversion and relationship between 6-month-treatment adherence with BTA conversion. This research was analyzed in analytic and descriptive method using spss v22.0. Result: FDC treatment according to category type was 100% correct, FDC treatment indication was 96.6% correct, FDC treatment duration was 74.2% correct, and FDC dosage treatment was 85.9% correct. FDC treatment indication was 3.4% incorrect, FDC treatment duration was 25.8% incorrect and FDC dosage treatment was 14.1% incorrect. Relationship of FDC side effect with TB treatment success rate was not statistically significant (p=0.173;0.757(95% CI:0.077-1.612)). Subjects with successful conversion within 2 months of treatment was 71.2% while unsuccessful conversion was 28.8%. Subjects with successful conversion after 6 months of treatment was 81.1% while unsuccessful conversion was 18.9%. Proportion of patient that was with DOT during first medical consultation was 79% while 21% was without DOT. There was 8.6% increase in DOT’s level of understanding in the experimental group while there was 13% increase in the control group. Percentage of DOT without sufficient understanding/knowledge decreased by 13%. There was no statistical significant relationship between DOT’s level of understanding with 2 nd month (p=0.575;95% CI:0,978-1,151) and 6 th month treatment (sputum conversion after 6 months was 100%). There was no statistical significant relationship between medical treatment adherence with sputum conversion in 2 nd and 6 th month of treatment. Medical treatment adherence within 6-month period was 100%. Conclusion: Side effect does not impact TB treatment success rate, therefore patients were still continued the treatment. There is no correlation between DOT’s level of understanding with medical treatment adherence, DOT’s level of understanding with sputum conversion (2 nd month and 6 th month of treatment) as well as between medical treatment adherence with sputum conversion (2 month and 6 th month of treatment). This is due to patients’ 100% adherence to the treatment.
Key words: Fixed Dose Combination, Direct Observed Treatment, Tuberculosis nd