Hening Wiwiet Nurwidya, Sartika Ratu Ayu Dewi, Sauriasari Rani
Department of Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok, Indonesia.
Department of Public Health Nutrition, Public Health Faculty, Universitas Indonesia, Depok, Indonesia.
J Res Pharm Pract. 2019 Oct 16;8(3):155-161. doi: 10.4103/jrpp.JRPP_19_67. eCollection 2019 Jul-Sep.
In Indonesia, the role of a hospital pharmacist in pharmaceutical care is still limited or even absent. This study aimed to determine whether counseling by a pharmacist could improve medication adherence, controlling the glycemic status, lipid profile, and blood pressure of type 2 diabetes mellitus (T2DM) outpatients.
We conducted an interventional study at RSUD Kota Depok, a secondary public hospital, Indonesia, from April to October 2018. Counseling was given three times during the 4-month study. The study design was quasi-experimental with pretest-posttest group design on 77 respondents divided into intervention group (IGs) ( = 39 people) who received counseling and booklets from the hospital pharmacist and control group (CG) ( = 38 people) who were only given the booklets. We measured adherence with the Medication Adherence Questionnaire and conducted blood tests for fasting blood glucose (FBG), postprandial blood glucose (PPBG), glycosylated hemoglobin A1, lipid profiles (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and TG), and blood pressure measurements.
In the IG, adherence parameters such as HbA1c and lipid profile improved, whereas in the CG, there were no statistically significant changes in clinical parameters and even nonadherence score increased ( = 0.008). IG showed statistically significant improvement in medication adherence, in parameters such as FBG, PPBG, and HbA1c, compared to CG. Based on the Chi-square test, IG also showed a statistically significant improvement in the number of controlled FBG ( = 0.05) and HbA1c ( < 0.001) compared to CG. In addition, a multivariate analysis showed that counseling by hospital pharmacist was 2.764 times (95% confidence interval [CI]: 1.096-6.794) and 9.964 times (95% CI: 3.434-28.917) better than no counseling in improvement of FBG and HbA1c, respectively. However, the significance disappeared after adjusted by type of medicine, duration of diabetes mellitus drug use, and medication adherence.
Hospital pharmacist counseling is an important and significant factor in improving FBG and HbA1c levels of T2DM outpatients.
在印度尼西亚，医院药剂师在药学服务中的作用仍然有限甚至缺失。本研究旨在确定药剂师提供的咨询服务是否能够提高2型糖尿病（T2DM）门诊患者的用药依从性，控制其血糖状态、血脂水平和血压。
2018年4月至10月，我们在印度尼西亚德波克市的一家二级公立医院RSUD Kota Depok开展了一项干预性研究。在为期4个月的研究中，提供了3次咨询服务。研究设计为准实验性的前后测试组设计，77名受访者分为干预组（IGs）（n = 39人），接受医院药剂师的咨询和手册，以及对照组（CG）（n = 38人），仅提供手册。我们使用药物依从性问卷测量依从性，并进行空腹血糖（FBG）、餐后血糖（PPBG）、糖化血红蛋白A1、血脂谱（总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇和甘油三酯）的血液检测以及血压测量。
在IG组中，HbA1c和血脂谱等依从性参数有所改善，而在CG组中，临床参数无统计学显著变化，甚至不依从得分增加（P = 0.008）。与CG组相比，IG组在用药依从性以及FBG、PPBG和HbA1c等参数方面显示出统计学显著改善。基于卡方检验，与CG组相比Ill组在FBG（P = 0.05）和HbA1c（P < 0.001）控制数量方面也显示出统计学显著改善。此外，多变量分析表明，医院药剂师的咨询在改善FBG和HbA1c方面分别比不咨询好2.764倍（95%置信区间[CI]：1.096 - 6.794）和9.964倍（95% CI：3.434 - 28.917）。然而，在根据药物类型、糖尿病药物使用时长和用药依从性进行调整后，这种显著性消失。
医院药剂师咨询是改善T2DM门诊患者FBG和HbA1c水平的一个重要且显著的因素。
