PHARMACIST INTERVENTION MODEL THROUGH COLLABORATION WITH HEALTH PROFESSIONALS AND FAMILY EMPOWERMENT IN IMPROVING ADHERENCE AMONG PRE ELDERLY AND ELDERLY HYPERTENSIVE PATIENTS IN PEKANBARU

• Main Author: Husnawati
• Format: Dissertations
• Language: Indonesia
• Online Access: https://digilib.itb.ac.id/gdl/view/53181
• Institution: Institut Teknologi Bandung

Hypertension is one of the diseases that need serious awareness. The prevalence of hypertension increases with age. Nonadherence have been demonstrated to be associated to difficulty to access the drugs, especially, in patients living far from the health care center, as happened in some districts in Pekanbaru city. To get an effective treatment, there needs to be education about hypertension and the importance of medication adherence. Pharmacists undoubtedly need to work with other health profesionals and patient’s family in supporting the success of patient treatment. This study aimed to produce a model of pharmacist intervention, so it can be utilized as a form of pharmacist intervention, improving patient adherence. This research was a mixed methods consisted of 3 stages: the stage 1 was a descriptive study; stage 2 wasusing grounded theory, and stage 3 which was quasi experiment with control group pretest postest design. The samples in this study were patients with hypertension (?45 years old) who underwent therapy and received antihypertensive. Sampling was carried by purposive sampling technique and the data was analyzed using SPSS. The results of the phase 1 research showed the following characteristics of pharmacist: the majoritiy were women (80%), age in the range of early adulthood/18-40 years (80%), and length of work of >1-5 years (60%). While for other health workers the characteristics were: all female (100%), age range of 18-40 years (50%) and middle adults/41-60 years (50%), with 6-10 years of work experience (40%). As for patient characteristics it was revealed that the majority of were women (72.3%), age range of 45-59 years/middle age (50%), mostly completed elementary education or equivalent (48.6%), had the disease 1-5 years (49.1%), mostly did not smoke (89.1%),and did not drink alcohol (98,2%), slept for 6-8 hours/day (61.4%), and did not exercise regularly (50%). The patient's family were mostly female (60.9%), with an age range of 36-45 years (28,6%), high school graduates (41.4%) and mostly were children/grand chlidren of the patients(59.1%). Results of phase 1 study further unveiled the level of knowledge on hypertension among pharmacists, other health professionals, patients and family, which were 100%, 80%, 65% and 76.8%, respectively. Perception on the role of pharmacists according to pharmacists, other health professionals, patients and the majority of their families were also at a moderate level, with the respective percentages of 80%, 60% 81.4%, and 83.2%. The descriptive test results regarding pharmacist collaboration with other health workers according to pharmacists and other health professionals were the same, namely at a moderate level of 80%. Family empowerment by pharmacists, according to pharmacists, other health profesionals, patients and families were considered at a moderate level with the respective percentages of 80%, 90% and 77.7% and 86,8%. The role of pharmacists in the management of hypertension were considered moderate, (80%) by the majority of respondents. Finally, the majority of the respondents considered thatthe role of the family in the management of hypertension at home were also moderate (84.1%). Qualitative results of phase 1 study through FGD indicated that the role of pharmacits is limited to drug delivery and provision and brief information albeit their involvement in direct community interaction, such as in integrated service center and exercise classes. It was further found that there were problems with the heavy burden of pharmacists and the lack of training as well as limitedness of number of pharmacists and the fact that some of them had to undertake multiple roles. The need to increase the number of pharmacists quantitatively and qualitatively, through some forms of training, was also unveiled. Collaboration of pharmacists and familiy empowerment had not been well-implemented, and collaboration was still limited to drug delivery. Results of the phase 1 study further showed the need for socialization of pharmacist’s role in the primary care center (puskesmas), and patients’ expectation on drug information and counseling which accompany drug delivery. Based on the phase 1 study, an intervention model was developed in the phase 2 study. The developed pharmacist intervention model consisted of two stages, namely pre-intervention (socialization and training) and intervention (collaboration and family empowerment). The phase 3 study was the application of intervention model. Prior to the application of the model a trial was conducted in 110 subjects, divided into intervention and control groups. The result showed significant improvement of adherence in the intervention group (p<0.05) compared to control. This result was in line with the significant decrease in systole as well diastole blood pressures in the intervention group (p<0.05). The positive trial results continued with the application of the intervention model in 110 subjects in different areas having similar characteristics. Similar results with regard to adherence and blood pressures were obtained in the application of the model, which demonstrate that the model of pharamacist intervention through collaboration of health profesionals and family empowerment improves medication adherence.