Education on

Endocrinology and
Metabolic Disease

Thursday, March 12, 15

Thursday, March 12, 15
 Standar Kompetensi Dokter Indonesia 2012
KONSIL KEDOKTERAN
INDONESIA

SISTEM ENDOKRIN,
METABOLIK, DAN NUTRISI
Tingkat
No Daftar Penyakit
Kemampuan
Kelenjar Endokrin
1 Diabetes melitus tipe 1 4A
2 Diabetes melitus tipe 2 4A
3 Diabetes melitus tipe lain (intoleransi glukosa akibat 3A
penyakit lain atau obat-obatan)
4 Ketoasidosis diabetikum nonketotik 3B
5 Hiperglikemi hiperosmolar 3B
6 Hipoglikemia ringan 4A
7 Hipoglikemia berat 3B
8 Diabetes insipidus 1
9 Akromegali, gigantisme 1
10 Defisiensi hormon pertumbuhan 1
11 Hiperparatiroid 1
12 Hipoparatiroid 3A
13 Hipertiroid 3A
14 Tirotoksikosis 3B
15 Hipotiroid 2
16 Goiter 3A
17 Tiroiditis 2
18 Cushing's disease 3B
19 Krisis adrenal 3B
20 Addison's disease 1
21 Pubertas prekoks 2
22 Hipogonadisme 2
23 Prolaktinemia 1
24 Adenoma tiroid 2
25 Karsinoma tiroid 2
Gizi dan Metabollisme
26 Malnutrisi energi-protein 4A
27 Defisiensi vitamin 4A
28 Defisiensi mineral 4A
29 Dislipidemia 4A
30 Porfiria 1
31 Hiperurisemia 4A
32 Obesitas 4A
33 Sindrom metabolik 3B

Thursday, March 12, 15

 Why do we educate
patients and caregivers?

Thursday, March 12, 15

 only modest benefits are typically observed and adherence assess the performance of this strategy. In virt
improvements are frequently lost following completion of studies, follow-up visits to improve adherenc
Patient Preference and Adherence Dovepress
the study intervention.14,58 out by allied health care professionals, ofte open access to scientific and medical research

Interestingly, non-adherence cannot be prevented even if coordination REVIEW

to the actual prescribing physicia
Open Access Full Text Article

Non-adherence in type 2 diabetes: practical

patient drug costs are completely eliminated. Choudhry et al prescribers could be targets of adherence
considerations for interpreting the literature
examined the influence of eliminating drug costs for whereby aggregate statistics of adherence coul
individuals discharged from the hospital.69 Although the fed back to physicians for the purposes of moni
study was not aimed at type 2 diabetics per se, the study success and following trends over time.
population was madeDavid upF Blackburn
of post-myocardial infarction
Jaris Swidrovich 2
While we await future discoveries in this are
1
Abstract: The rising prevalence of type 2 diabetes poses a serious threat to human health and the
viability of many health care systems around the world. Although several prescription medica-

patients where 35% (2023/5855)

Mark Lemstra
had diabetes at baseline. currently proposed recommendations by key
tions can play a vital role in controlling symptoms and preventing complications, non-adherence
1

to these therapies is highly prevalent and has been linked to increases in morbidity, mortality,
1
College of Pharmacy and Nutrition,
University of Saskatchewan, and health care costs. Although a vast array of significant adherence predictors has been iden-
Surprisingly, full-coverage for statins, angiotensin- represent our best knowledge13,18,62,63 and attem
Saskatoon, Saskatchewan, 2Leslie Dan
Faculty of Pharmacy, University of
tified, the ability to explain or predict non-adherence with known risk-factors remains poor.
Further, the definitions, outcomes, and various measures used in the non-adherence literature
Toronto, Toronto, Ontario, Canada

converting enzyme inhibitors, angiotensin receptor blockers, made to raise awareness about medication non
can be misleading for the unfamiliar reviewer. In this narrative review, a practical overview
of important considerations for interpreting adherence endpoints and measures is discussed.
Also, an organizational framework is proposed to consider published adherence interventions.
and beta-blockers resulted in very little improvement all health care settings and empathize with th
This framework may allow for a unique appreciation into areas of limited knowledge and thus
highlights targets for future research.
Keywords: medication adherence, compliance, type 2 diabetes, adherence interventions

Introduction
Type 2 diabetes mellitus is a metabolic disorder associated with elevations in blood
glucose as well as other important risk factors such as blood pressure, cholesterol,
and coagulation.1 The prevalence of this condition is high and it continues to climb,
Source of adherence Nature of adherence
as a result of an aging population and rising obesity rates across the world.2 In fact, Target of adherence
intervention intervention
it is predicted that the global prevalence of diabetes will increase by 65% over the
next 20 years.2
intervention
Rising prevalence rates are a major concern for governments and health-insurance
Allied health care Motivational
providers because patients with type 2 diabetes suffer from multiple comorbid
conditions in far greater numbers than those without. Fortunately, outpatient
Allied health care
provider interviewing
management with several readily available medications such as glucose-lowering, provider
Professional Behavioral
cholesterol-lowering, and blood-pressure-lowering medications can significantly lower Prescriber
the risks for macrovascular and/or microvascular complications.1 As a result, these
Prescriber intervention
medications are recommended for concurrent use by typical patients, especially those Non-adherent patient
Peer Cost variation
with increasing age or multiple risk factors.1 Adherent/new patient
Institution
Correspondence: David F Blackburn
Reminders
Unfortunately, the requirement for multiple chronic medications is almost
inextricably linked to problems with medication adherence. Indeed, among people
Institution
Health system
College of Pharmacy and Nutrition,
110 Science Place, Saskatoon,
Follow-up
with type 2 diabetes, the prevalence of non-adherence is high3–5 and appears to be Health system
Message-based
Saskatchewan, Canada, S7N 5C9
Tel 1 306 966 2081 Education
an important cause of increased morbidity and mortality.6–11 Moreover, when all
Fax 1 306 966 6377
non-adherence related hospitalizations were identified in four US hospitals, diabetes
Email d.blackburn@usask.ca was the second leading cause behind mental health conditions.12 Considering the

Figure 1 Proposed framework to classify adherence interventions.

submit your manuscript | www.dovepress.com Patient Preference and Adherence 2013:7 183–189 183
Dovepress © 2013 Blackburn et al, publisher and licensee Dove Medical Press Ltd. This is an Open Access article
Thursday, March 12, 15 http://dx.doi.org/10.2147/PPA.S30613 which permits unrestricted noncommercial use, provided the original work is properly cited.
Thursday, March 12, 15
 Endocrine and
Metabolic Disease
• Life style & Diet
• Iatrogenic
• Neoplasm
• Infection
• Trauma
• Autoimmune
• Congenital
• Degenerative

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 Problem in Patients with
Endocrinology and Metabolic
Diseases
• Shopping doctor
• Self medication
• The use of CAM without medical supervision
• Long term treatment
• Drug side effect
• Low adherence/Compliance
• Social support
• Poor stress management

Thursday, March 12, 15

 Choosing effective patient
education materials
• Once you have assessed your patient's needs, concerns,
readiness to learn, preferences, support, and possible barriers to
learning, you will need to:
• Make a plan with your patient and his or her support person
• Agree with the patient on realistic learning objectives
• Select resources that fit the patient
• The first step is to assess the patient’s current knowledge about
his or her condition.
• Some patients need time to adjust to new information, master
new skills, or make short- or long-term lifestyle changes.

http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000455.htm
Thursday, March 12, 15
 Getting Started
• Your patient's preferences can guide your choice of education materials
and methods.
• Find out how your patient likes to learn.
• Be realistic. Focus on what your patient needs to know, not on what's
nice to know.
• Pay attention to the patient's concerns. The person may have to
overcome a fear before being open to teaching.
• Respect the patient's limits. Offer the patient only the amount of
information he or she can handle at one time.
• Organize the information for easier comprehension.
• Be aware that you may need to adjust your education plan based on
the patient's health status and environmental factors.

http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000455.htm
Thursday, March 12, 15
 Basic Priorities
• With any type of patient education, you will likely need
to cover:
• What your patient needs to do and why
• When your patient can expect results (if applicable)
• Warning signs (if any) your patient should watch for
• What your patient should do if a problem occurs
• Who your patient should contact for questions or
concerns

http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000455.htm
Thursday, March 12, 15
 Patient Education
Resource Option
• There are many ways to deliver patient education. Examples include one-on-one
teaching, demonstrations, and analogies or word pictures to explain concepts.
• You can also use one or more of the following teaching tools:
• Brochures or other printed materials
• Podcasts
• YouTube videos
• Videos or DVDs
• PowerPoint presentations
• Posters or charts
• Models or props
• Group classes
• Trained peer educators

http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000455.htm
Thursday, March 12, 15
 Selecting Materials
• The type of resources that a patient or support person
responds to varies from person to person. Using a mixed
media approach often works best.
• Keep your assessment of the patient in mind. Consider
factors such as literacy and culture as you develop a plan.
• Avoid fear tactics. Focus instead on the benefits of
education. Tell your patient what to pay special attention to.
• Be sure to review any materials you plan to use before
sharing them with the patient. Keep in mind that no
resource is a substitute for one-on-one patient teaching.

http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000455.htm
Thursday, March 12, 15
 Choosing effective patient
education materials
• In some cases, it may not be possible to get
the right materials for your patients' needs.
• For example, it may be hard to find
materials on new treatments in certain
languages or on sensitive topics.
• Instead, you may try having a discussion with
the patient on sensitive topics or creating
your own tools for the patient's needs.

http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000455.htm
Thursday, March 12, 15
Thursday, March 12, 15
 Patient Education in
Spesific Conditions

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 Nutrition

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 Diabetes Mellitus

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 Dyslipidemia

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 Obesity

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 Thyroid Disorder

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 Osteoporosis

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 Hyperuricaemia

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Thursday, March 12, 15
 Thank You

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