PENGARUH PENGELOLAAN PENGOBATAN TERHADAP KEPATUHAN MINUM OBAT PADA PASIEN HEMODIALISIS DENGAN HIPERTENSI: STUDI KASUS

Abstract

ABSTRAK

Hipertensi menjadi kondisi penyulit terbanyak pada pasien yang menjalani hemodialisis. Namun, sering dijumpai ketidakpatuhan dalam pengobatan.  Tujuan penelitian: Menggambarkan upaya pengelolaan pengobatan berdasarkan evidence-based practice dengan cara menguji coba intervensi pengelolaan pengobatan terhadap tingkat kepatuhan minum obat pasien hemodialis.  Keluhan utama pasien: Penelitian ini menggunakan pendekatan studi kasus. Tn. S, 25 tahun, rutin menjalani hemodialisis dua kali/minggu, sering mengalami sakit kepala, penglihatan kabur, serta diketahui tidak menjalani pengobatan sesuai anjuran.  Pasien terdiagnosis gagal ginjal kronis (GGK) stadium V e.c hipertensi sejak tahun 2017. Sejak saat itu pasien rutin melakukan hemodialisis dua kali seminggu di unit Hemodialisis RSUP Dr. Sardjito, Yogyakarta.  Secara umum, terdapat penurunan fungsi ginjal dan penurunan indikator hematologi.  Hasil: Data rekaman medis Tn. S dicatat dalam lembar pencatatan, termasuk penggunaan Morisky medication adherence scale (MMAS-8) untuk kepatuhan pengobatan.  Pengukuran tekanan darah dan indikator hemodialisis dilakukan pemantauan secara berkala. Upaya pengelolaan obat dilakukan dengan mengatur obat sesuai jadwal, memantau konsumsi obat harian, serta mengirimkan SMS pengingat dan motivasi kepada pasien untuk meminum obat tepat waktu selama dua minggu. Setelah dilakukan intervensi, terjadi peningkatan skor MMAS-8 (pre = 4,5, post = 5,75). Rerata tekanan darah selama dilakukan intervensi menjadi terkontrol, terutama prehemodialisis (M = 148/91 mmHg).  Upaya pengelolaan pengobatan yang dilakukan menunjukkan hasil yang baik sejalan dengan temuan evidence based practice. Pasien juga merasa puas dan berkenan melakukannya secara mandiri. Kesimpulan: Terdapat peningkatan tingkat kepatuhan minum obat pasien dan terkendalinya tekanan darah pasien. Intervensi yang dilakukan dapat digunakan sebagai acuan perawat dalam mengelola pasien hemodialisis dengan masalah ketidakpatuhan minum obat.

Kata Kunci: kepatuhan minum obat, hipertensi, hemodialisis, pengobatan, polifarmasi

Effect of Medication Management on Medication Adherence in Hemodialysis Patients with Hypertension: A Case Study

ABSTRACT

Hypertension is the most common complicating condition in patients undergoing hemodialysis. However, medication non-adherence is often found. Objective: To describe medication management efforts based on evidence-based practice by testing medication interventions on the level of medication adherence in hemodialysis patients. Main complaints of the patient: This research employed a case study approach. Mr. S, 25 years old, underwent hemodialysis twice a week, had frequent headaches and blurred vision, and was known not to have received medication as recommended. The patient was diagnosed with stage 5 chronic kidney disease (CKD) e.c hypertension in 2017. Since then, the patient had routinely undergone hemodialysis twice a week at the Hemodialysis unit of Dr. Sardjito Hospital, Yogyakarta. In general, there was a decrease in renal function and a decrease in hematological indicators. Results: Medical record data of Mr. S was recorded in the logs, including the Morisky medication adherence scale (MMAS-8) for medication adherence. Blood pressure and hemodialysis indicators were monitored periodically. Medication was managed by scheduling medicine, combining daily medicine, and sending reminders and motivational SMS to the patient to take medicine on time for two weeks. After the intervention, there was an increase in the MMAS-8 score (pre = 4.5, post = 5.75). The mean blood pressure during the intervention was controlled, especially during prehemodialysis (M = 148/91 mmHg). The medication management indicated good results in line with evidence-based practice findings. Patients also felt satisfied and happy to do it independently. Conclusion: There is an increase in the patient's medication adherence level, and the patient's blood pressure is well controlled. The interventions can be used as a reference for nurses in managing hemodialysis patients with the problem of medication non-adherence.

Keywords: medication adherence, hypertension, hemodialysis, medication, polypharmacy