Tesis

Pengaruh Penggunaan Aplikasi mHealth HARKIT iCare terhadap Rehospitalisasi dan Kepatuhan Minum Obat pada Prevensi Sekunder pasca-Sindrom Koroner Akut = Impact of mHealth application HARKIT iCare on Rehospitalization and Medication Adherence in Secondary Prevention Post Acute Coronary Syndrome.

Latar Belakang : Penggunaan aplikasi mobile health (mHealth) berbasis aplikasi ponsel pintar menjadi salah satu modalitas menjanjikan untuk meningkatkan kepatuhan terhadap program prevensi sekunder paska sindrom koroner akut. Tujuan dari studi ini adalah untuk mengetahui pengaruh penggunaan aplikasi mHealth berbasis ponsel pintar HARKIT iCare terhadap angka rehospitalisasi dan kepatuhan minum obat. Tujuan : Mengetahui efek penggunaan aplikasi HARKIT iCare dibandingkan dengan layanan standar terhadap angka rehospitalisasi dan kepatuhan minum obat. Metode : Studi ini adalah uji klinis acak tunggal melibatkan 106 subyek pasien paska sindrom koroner akut. Subyek dirandomisasi dengan permutasi blok acak ke kelompok yang dimonitor menggunakan aplikasi berbasis aplikasi ponsel pintar HARKIT iCare atau layanan standar. Subyek diikuti selama 6 bulan lalu dilihat angka rehospitalisasi dan kepatuhan minum obat menggunakan MMAS-8 (Morisky Medical Adherence Scale 8 point) sebagai parameter luaran. Rehospitalisasi yang dimaksud ada rehospitalisasi tidak terencana, dan rehospitalisasi berulang. Hasil : Angka rehospitalisasi berulang lebih rendah pada kelompok iCare dibandingkan kontrol setelah dilakukan analisis multivariat (2 [3.7%] vs 7 [13.5%], HR 0.11 [IK 95% 0.01- 0.98], p=.048). Angka rehospitalisasi tak terencana lebih rendah pada kelompok iCare dibanding kontrol namun tidak berbeda bermakna secara statistik (13 [24.1%] vs 16 [30.8%], HR 0.73 [IK 95% 0.35-1.53], p=.41). Penggunaan aplikasi HARKIT iCare berkorelasi pada peningkatan tingkat kepatuhan secara signifikan setelah dilakukan analisis multivariat (16 [30.8%] vs 26 [48.1%], RR 2.37 [IK 95% 1.00-5.61], p=.049). Terdapat peningkatan bermakna secara statistik perbedaan nilai median kepatuhan minum obat berdasarkan MMAS awal dan akhir pada kelompok iCare dibandingkan kontrol (iCare - MMAS awal 6.5 [2-8] akhir 8 [4-8] Δ median = +1.5, p=.000 ; kontrol - MMAS awal 7 [3-8], akhir 8 [5-8], Δ median = +1, p=0.053 ). Kesimpulan Penggunaan aplikasi HARKIT iCare berkorelasi dengan angka rehospitalisasi berulang yang lebih rendah. Aplikasi HARKIT iCare berkorelasi dengan peningkatan derajat kepatuhan minum obat dan peningkatan median MMAS secara signifikan.
Kata kunci: mHealth, rehospitalisasi, readmisi, kepatuhan minum obat, sindrom koroner akut, prevensi sekunder


Background Mobile health (mHealth) smartphone applications is a promising platform for increase adherence to cardiac rehabilitation and secondary prevention programs after acute coronary syndrome. The aim of this study is to know the impact of smartphone based mHealth applications HARKIT iCare on rehospitalization and medication adherence. Objective To determine the impact of HARKIT iCare apps on secondary prevention compared to standard care on rehospitalization and medication adherence. Method This study was a single blinded randomized clinical trial involving 106 subjects post-acute coronary syndrome. Subjects were randomized by permuted block randomization into HARKIT iCare (intervention) group or standard care. Subjects were followed for 6 months. The outcome of this study was rates of unplanned and recurrent rehospitalization, and also medication adherence using MMAS-8 (8-point Morisky Medication Adherence Scale). Result Recurrent hospitalization occurred fewer in the iCare group compared to control (Adjusted, 2 [3.7%] vs 7 [13.5%], HR 0.11 [CI 95% 0.01-0.98], p=.048). Unplanned rehospitalization also occured fewer in iCare group compared to control but was not statistically significantly different (13 [24.1%] vs 16 [30.8%], HR 0.73 [CI 95% 0.35-1.53], p=.41). HARKIT iCare application related significantly to increased levels of adherence (Adjusted, 16 [30.8%] vs 26 [48.1%], RR 2.34 [CI 95% 1.03-5.33], p=.049). Comparison between pre and post median MMAS was significant for iCare group but not with control group. (iCare - MMAS pre 6.5 [2-8] post 8 [4-8] Δ median = +1.5, p=.000 ; control - MMAS pre 7 [3-8], post 8 [5-8], Δ median = +1, p=.053). Conclusion HARKIT iCare apps related with fewer recurrent rehospitalization, increase of medication adherence and improvement of median MMAS significantly. Unplanned rehospitalization was fewer in the iCare group compared to controls, but not statistically significant.
Keyword: mHealth, smartphone based application, rehospitalization, readmission, medication adherence, secondary prevention, acute coronary syndrome