USE OF FAMILY MEMBER-

BASED SUPERVISION Huang et al.

Patient
Preference and
IN THE MANAGEMENT OF Adherence
2014:8
PATIENTS WITH HYPERTENSION 10351042

IN RURAL CHINA

Department of Social Medicine and Health Education,

Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University,
Nanjing, Peoples Republic of China

Dokter Pembimbing:
Dr. Oryzati Hilman Agrimon, M.Sc, CMFM, Ph.D
 ABSTRACT

A b s t r a c t : M e d i c a t i o n n o n a d h e r e n c e i s a m a j o r p r o b l e m i n t h e m a n a g e m e n t of
hyper tension.
T h e a i m : D e v e l o p a f a m i l y m e m b e r - b a s e d s u p p o r t i v e t h e r a p y f o r pa t i e n t s w i t h h y p e r t e n s i o n
to provide an affordable way to access essential health ser vices and to ensure adequate
c o n t r o l of b l o o d p r e s s u r e .
T h i s s t u d y a p p l i e d a m i xe d m e t h o d s a p p r o a c h u s i n g q u a l i t a t i v e a n d q u a n t i t a t i v e s t u d y
d e s i g n s i n Ya n g z h o n g C o u n t y, a r u r a l a r e a i n t h e Pe o p l e s Re p u b l i c of C h i n a . F i n d i n g s f r o m
i n d e p t h i n t e r v i e w s d e m o n s t r a t e d t h a t t h e l i m i t e d e f f e c t s of t r a d i t i o n a l h e a l t h e d u c a t i o n , a
l a c k of p r of e s s i o n a l a d v i c e r e g a r d i n g a n t i h y p e r t e n s i v e t r e a t m e n t , a n d a g e w e r e r e l a t e d t o a
pa t i e n t s a d h e r e n c e w i t h r e g u l a r b l o o d p r e s s u r e m e a s u r e m e n t a n d t a k i n g m e d i c a t i o n .
We a l s o p e r f o r m e d a q u a n t i t a t i v e s t u d y , s e l e c t i n g t w o v i l l a g e s i n Ya n g z h o n g C o u n t y a s
s t u d y s i t e s . A t o t a l of 1 8 8 p a t i e n t s w i t h h y p e r t e n s i o n we r e i n v i t e d t o pa r t i c i pa t e i n a 6 -
month family member -based inter vention trial. The primar y outcomes were the
a c c e p t a b i l i t y a n d f e a s i b i l i t y of t h e i n t e r v e n t i o n s t r a t e g y. S e c o n d a r y o u t c o m e s i n c l u d e d
m e d i c a t i o n a d h e r e n c e a n d c h a n g e s i n b l o o d p r e s s u r e . M o r e t h a n 7 5 % of pa t i e n t s e x p r e s s e d
a wish for external reminders, and 93.5% responded that they would accept the family
m e m b e r - b a s e d s u p e r v i s i o n . T h e pa t i e n t s p r e f e r r e d t h e i r s p o u s e o r a c h i l d a s t h e s u p e r v i s o r.
A f t e r t h e 6 - m o n t h i n t e r v e n t i o n , t h e p r o p o r t i o n of pa t i e n t s w i t h u n c o n t r o l l e d b l o o d
pressure decreased from 87.2% to 45.7%. This pilot study shows that external super vision
b y f a m i l y m e m b e r s i s a c c e p t a b l e a n d f e a s i b l e f o r pa t i e n t s w i t h h y p e r t e n s i o n ; i t a l s o s h o w s
favorable effects with regard to improved treatment adherence and blood pressure control.
Future randomized controlled trials with modifed inter vention measures are needed to
va l i d a t e t h i s f i n d i n g .
Keywords: hyper tension, treatment, adherence, super vision, inter vention
 BACKGROUND

Komplikasi HT Morbiditas dan Mortalitas meningkat

Stroke
PJK
CHF

Kasus TB mirip dengan HT dalam hal:

Jumlah obat yang diminum (>1, kombinasi berbagai jenis)
Lama minum obat
Butuh dukungan keluarga dan lingkungan sosial

Penanganan DOTS dapat diapikasikan ke HT

Directly Observed Therapy Supervised Treatment
 MATERIAL & METHOD

Data Analysis
Study Design EpiData software
Ethical []
Quasi-Experimental and analyzed using
Stata version 10.0

Location:
Study:
Qualitative and quantitative Two villages from
(both mixed) Baqiao Town,
Yangzhong County

The inclusion criteria were:

1. Essential hypertension;
2. Willingness to participate in this study;
3. Absence of hypertension-related Flowchart of Trial
complications;
4. Residence with family members.
 DEFINISI

Hipertensi
Hipertensi didefinisikan sebagai peningkatan
tekanan darah sistolik sedikitnya 140 mmHg
atau tekanan diastolik sedikitnya 90 mmHg
dalam dua kali pengukuran (WHO, 2013).
 DATA ANALYSIS

Karakteristik Populasi:
Buta huruf : 42.6%
Mengetahui kadar normal TD: 67%
Pengukuran berkala, setiap bulan: 48.4%
Yang menggunakan obat anti-hiper tensi: 93.6%
 DATA ANALYSIS

Hasil Penelitian:
Pengukuran TD
sebelum vs sesudah:
Sistole: penurunan
hingga rata-rata 141.2
mmHg, nilai bermakna
(p<0.001)
Diastole: penurunan
hingga rata-rata 83.1
mmHg, nilai bermakna
(p<0.001)
Pasien yang terkontrol
TD-nya: meningkat
 DATA ANALYSIS

Tabel diatas menunjukkan pasien memerlukan super visi dari

keluarga mereka.
Pasangan merupakan super visor yang paling dipilih dan
perhatian dalam melakukan pengawasan.
 QUALITATIVE STUDY

Dilakukan pada 16 orang pasien (6 orang dari desa Sanwei dan 10

orang dari desa Leyuan) dan 2 dokter desa.
Dilakukan dengan panduan semiskematis yang melingkupi baik
per tanyaan secara umum maupun yang spesifik .
The inter views were conducted at local health facilities in the
Chinese Mandarin language, lasted for 2040 minutes, and were
tape-recorded with each respondents permission.
The indepth inter views focused on the patients health care
seeking behavior, knowledge about hyper tension, medication
adherence, and attitudes toward the proposed health care
ser vices for hyper tension
The recorded inter views were transcribed verbatim and later
compared with the audio records to ensure the accuracy of the
transcripts. The transcripts and notes were analyzed thematically
by creating coding nodes for common themes
and subthemes.
 DISCUSSION

Family-based case management is of par ticular interest

because it provides assistance to patients in the management
of their chronic conditions. Well planned, proactive, and
reactive care improves intermediate and long-term disease
outcomes.

In this pilot study, we designed a family member -based

super vision package that aimed to provide external
assistance to patients in a cost -effective and acceptable way.

In recent years, an increasing number of studies have

been performed to explore innovative ways to improve
a patients treatment adherence and outcomes, such as
physician-level and practice-level financial incentives for
treatment of hyper tension, shared decision-making in
antihyper tensive therapy, interdisciplinar y education
programs, and home-based BP tele-monitoring.
 LIMITATIONS

Study that used a quasi-experimental design

Second, 24 patients did not attend the last follow -up visit at
the end of the inter vention period for a variety of reasons
(14 patients were lost to follow -up, and ten patients family
members had left the home or were not willing to
super vise).
This study was performed in two villages from one rural
county so selection bias was unavoidable
 CONCLUSION

In this pilot study, external super vision was essential for BP

control. Family member-based super vision was acceptable
and feasible for patients with hyper tension
 CRITICAL APPRAISAL

P (Population) : Orang dengan hiper tensi

I (Inter vention) : Pengawasan minum obat
C (Comparison) : Tidak diberi pengawasan minum obat
O (Outcome) : Terkontrolnya tekanan darah
 LEMBAR KERJA TELAAH KRITIS
INTERVENSI

1. Apakah lokasi subyek penelitan ke kelompok terapi ya Tidak Tidak

atau kontrol betul betul secara acak (random) atau tidak? diketahui

2. Apakah semua keluaran (outcome) dilaporkan ? ya Tidak Tidak

diketahui

3. Apakah lokasi penelitian menyerupai lokasi anda ya Tidak Tidak

bekerja atau tidak ? diketahui

4.Apakah kemaknaan statistik maupun klinis ya Tidak Tidak

dipertimbangkan atau dilaporkan ? diketahui

5.Apakah tindakan terapi yang dilakukan dapat dilakukan ya Tidak Tidak

ditempat anda bekerja atau tidak ? diketahui

6.Apakah semua subyek penelitian dipertimbangkan ya Tidak Tidak

dalam kesimpulan ? diketahui

17
 TERIMA KASIH

Gunung Pramudito 20164011001

Muhammad Fauzan Hasby 20164011200