Determinan Peresepan Polifarmasi pada Resep Rawat Jalan di Rumah Sakit Rujukan

Abstract

Resep polifarmasi (≥5 jenis obat/resep) berpotensi meningkatkan interaksi obat, efek samping obat, dan masalah lain. Pasien yang berobat ke rumah sakit (RS) rujukan umumnya berpenyakit kronik, dengan komorbiditas dan komedikasi. Dilakukan penelitian potong silang untuk menganalisis determinan peresepan polifarmasi dari berbagai klinik rawat jalan di RS rujukan di Bandung. Analisis statistik menggunakan uji chi square dan dihitung rasio prevalensi (RP). Selama bulan Oktober 2012 terdapat 2.548 resep dari lima klinik rawat jalan dengan jumlah resep polifarmasi terbanyak. Prevalensi polifarmasi adalah 32% dan median jumlah jenis obat adalah 5 (rentang: 5–11). Terdapat perbedaan karakteristik pasien dalam hal usia ≥60 tahun (59,8% vs 44,8%; p<0,001), jenis kelamin laki-laki (57,1% vs 44,6%; p<0,001), peserta Askes (73,6% vs 56,1%; p<0,001), dan asal poliklinik: kardiovaskular (72,1% vs 33,1%; p<0,001) antara yang menerima resep polifarmasi dan tidak polifarmasi. Faktor dominan terhadap peresepan polifarmasi adalah dari klinik kardiovaskular (RP:8,80; IK95%: 6,35–12,19). Faktor lain dengan risiko polifarmasi >3 kali adalah dari klinik geriatri (RP:6,68; IK95%: 4,43–10,08) dan peserta Askes (RP:6,23; IK95%: 3,49–11,12). Prevalensi polifarmasi resep gabungan beberapa klinik (574 pasien) lebih besar, yaitu 59,8%. Simpulan, prevalensi peresepan polifarmasi di RS rujukan cukup tinggi, terlebih jika pasien menerima resep dari berbagai klinik. Determinan utama peresepan polifarmasi di RS rujukan adalah dari poli kardiovaskular, poli geriatri, dan peserta Askes.

DETERMINANTS FOR POLYPHARMACY PRESCRIBING OF THE PRESCRIPTION IN THE OUTPATIENT CLINICS OF REFERRAL HOSPITAL

Polypharmacy prescription (≥5 drugs in one prescription) potentially increased drug-drug interaction, side effects, and other problems. Patients who come to referral hospital usually were with chronic diseases, comorbidities and comedications. A cross sectional study was performed to analyze the determinants for polypharmacy prescription from clinics in referral hospital in Bandung. Data were analyzed using chi-square test and prevalence ratio (PR) were calculated. During October 2012, there were 2,548 prescriptions from five clinics with highest number of prescription. Prevalence of polypharmacy prescription was 32%, the median number of drugs written were 5 (ranged: 5–11). The characteristics of the patients showed a difference in aged ≥60 years (59.8% vs 44.8%, p<0.001), gender: males (57.1% vs 44.6%, p<0.001), had health insurrance (73.6% vs 56.1%, p<0.001), and origin cardiovascular clinic (72.1% vs 33.1%, p<0.001) between those receiving polypharmacy prescriptions and those receiving non polypharmacy prescription. The dominant factor for polypharmacy prescription was treated at cardiovascular clinic (PR:8.80, 95%CI: 6.35–12.19), followed by treated at geriatry clinic (RP:6.68, 95%CI: 4.43–10.08) and had health insurrance (RP:6.23, 95%CI: 3.49–11.12). Polypharmacy of combined prescriptions (574 patients) was 59.8%. In conclusions, prevalence of polypharmacy prescription in referral hospital in Bandung is high, even higher in patients received combined prescriptions. Main determinants for polypharmacy prescription in referral hospitals are being treated at cardiovascular clinic, geriatry clinic, and having health insurance.