PELAYANAN INFORMASI OBAT (PIO)

OBJECTIVES:

Memahami beberapa terminologiTujuan PIOMemahami 3 kelompok sumber informasi obat, kelemahan keunggulannyaMemahami strategi pelaksanaan penelusuran pustaka

yg efektifDokumentasi informasi dan manfaat

PELAYANAN INFORMASI OBAT (PIO)

Terminologi:

Informasi obat adalah proses pemberian informasi secara lisan atau tertulis kpd tenaga kesehatan lain, organisasi dan masyarakat termasuk pasien tentang penggunaan obat yg aman dan efektif.

PIO menguraikan kegiatan yg dilakukan oleh apoteker dalam pemberian informasi untuk mengoptimalkan penggunaan obat.

Dalam pemberian informasi obat, diperlukan sumber informasi obat.

•Memperbaiki image thdp karir farmasis

•Meningkatkan percaya diri shg dpt berperan secara alami di bidang kesehatan

•Mendukung evidence-based practice

•Memenuhi tuntutan pasien dlm pemberian pelayanan kefarmasian

•Meningkatkan kepatuhan pasien thdp pengobatan

•Aktivitas komite farmasi dan terapi•Evaluasi penggunaan obat•Pengendalian obat•Publikasi•Edukasi utk profesi kesehatan

FUNGSI PIO

SUMBER INFORMASI OBAT

Sumber infomasi

tersier

Sumber informasi sekunder

Sumber informasi primer

diklassifikasikan sbb:

KLASSIFIKASI… (lanjut)

Sumber Informasi Tersier (SIT) Umumnya berupa buku2 yg berisi materi umum, padat dan mudah dibaca spt Handbook of Injectable Drugs, compendia spt BNF.Tidak mutakhir krn memerlukan wkt yg lama dlm menyiapkan publikasi.

Manfaat SIT:Memahirkan pembaca ttg topik yg akan diinformasikan

KLASSIFIKASI…(lanjut)

Sumber Informasi Sekunder (SIS)Merupakan sistim indeks yg umumnya berisi kumpulan artikel jurnal. Contoh: International Pharmaceutical Abstract (IPA), Medline, OVID, EBSCO. Review, biografi, dan meta-analysis juga termasuk ke dlm SIS.Sangat membantu dlm proses pencarian informasi yg terdapat dlm sumber informasi primer.

Sumber Informasi Primer (SIP)Berisi informasi terbaru yg asli dan dipublikasikanInformasi yg terdapat di dalamnya umumnya merupakan hasil penelitian yg diterbitkan di jurnal ilmiah, proceeding conference, tesis, disertasi, laporan kasus. Kualitas informasi yg terdapat di dalamnya bervariasi

STRATEGI PENELUSURAN INFORMASI

Dalam menyiapkan jawaban dari suatu pertanyaan, diperlukan strategi pencarian informasi yg efektif. Penelusuran informasi dimulai dari SIT, dilanjutkan ke SIS dan ke SIP.

6. Formulasikan & berikan response (lisan atau tulisan)

5. Laksanakan evaluasi, analysis & synthesis

4. Kembangkan strategy pengamatan dan lakukan search

3. Tentukan dan kelompokkan pertanyaan

2. Temukan informasi mendasar

1. Pelajari demography penanya/pasien

DOKUMENTASI

PIO dilengkapi dgn dokumentasi.

Manfaat dokumentasi:

1) Bahan utk menjawab pertanyaan

2) Sumber informasi apabila ada pertanyaan yg sama di kemudian hari

3) Catatan yg mungkin diperlukan oleh penanya

4) Media utk pelatihan

5) Databases utk penelitian

6) Dasar utk menyusun jaminan kualitas (quality assurance) dan audit (counseling practices evaluated externally)

Contoh format dokumentasi spt tertera pd slide berikut:

FORMULIR PERTANYAAN

Nama penanya : (nama inisial bila ada permintaan)Pertanyaan lengkap :Penerima pesan :Tanggal diterima :Urgensi :Tanggal dijawab :Cara menghubungi :Alasan pengajuan pertanyaan :Demografi : (Jenis kelamin/BB/Tinggi badan)Terapi saat ini dan sebelumnya :Riwayat penyakit :Hasil uji laboratorium yg relevan :Lain-lain (spt allergi, kehamilan) :

PENYAMPAIAN JAWABAN

1. Lisan Sesuai untuk menyampaikan informasi yg sederhana. Dapat disampaikan melalui telepon atau secara langsung Merupakan metode diskusi, sebelum diberikan jawaban

tertulis

2. Tulisan

Sesuai utk menyampaikan informasi yg kompleks

Format standard terdiri dari: Rangkuman pertanyaan. Respons (berisi: pendahuluan, kesimpulan temuan yg

dilengkapi dgn komentar thdp keterbatasan data). Kesimpulan yg berisikan jawaban. Opini dan rekomendasi. Daftar pustaka

JENIS PERMASALAHAN

Contoh

1. Cara pemakaian obat/besarnya dosis

-Berapa dosis gentamisin untuk penderita gagal ginjal?

-Berapa besarnya dosis theophyllin untuk pasien asthma?

2. Reaksi obat yang tidak diinginkan (adverse drug reaction)

Apakah efek samping INH pd anak-anak

3. Pilihan terapi/indikasi/kontraindikasi

-Apakah cotrimoxazole aman utk wanita hamil

4. Farmakologi/farmakokinetika

Apakah anticonvulsan dpt berinteraksi dgn kontrasepsi

Jawab: Lakukan strategi penelusuran informasi (langkah 1 sd 6) untuk masing2 pertanyaan di bawah ini:

1. Dosis gentamisin hrs disesuaikan dgn laju filtrasi glomerulus (LFG).

2. Amankah co-trimoxazole diberikan kpd wanita hamil?

Cotrimoxazole terdistribusi ke dlm placenta, menghalangi metabolisme asam folat, dan dpt mengakibatkan congenital abnormalities

3. Jelaskan efek samping INH pada anak-anak

Red rash on the body

4. Anticonvulsan (antiepileptic) dgn kontrasepsi

Anticonvulsants induce hepatic cytochrome P450 enzyme

COUNSELING

Counseling is:a two-way interactive process (participants are invited to response and seek further information if they need itMedication counseling is an approach that focuses on enhancing the problem solving skills of the patient for the purpose of improving and maintaining quality of health or quality of life (USP)

Objective of the counseling:

To offer guidance to the patients in order to fulfill the needs in managing his/her own medical condition and prescribed medication.

Medication counseling stages

Medication information transfer

Medication information exchange

Medication education

Medication counseling

Level of information

Basic, brief, non individualized

Detailed, individualized

Comprihensive, group or individualized

Detailed discussion and guidance

Spontaneous or planned

Most often spontaneous

Spontaneous or planned

Planned Planned

Objective of process

Essential information how to take prescribed medication (monolog)

Provider response to & asked question related to prescribed medication(Dialogue)

Collaborative learning experience & process re: prescribed medication (conversation)

Guidance to assist the needs in managing medical condition & prescribed medication (discussion)

Ada bbrp tahap counseling spt tertera pada Tabel di bawah ini:

Medication counseling… (cont)Product to patient

Focused on save and proper use of drug product

Answer question regarding drug product, adapt information to individual , and increase knowledge how to use drug properly

Increase knowledge re: proper and save use of medication for specific condition

Increase problem solving skill and assist with proper management of medical condition and effective use of medication

Nature of relationship

Passive receives information provided by healthcare provider

Questions and answers are exchanged by provider and patient

Interactive learning about the implication of the medication shared by prescriber and patient

Interactive collaborative discussion and learning between prescriber and patient

AKTIVITAS KONSELING

Clinical pharmacists (CP) dpt mempengaruhi attitude dan prioritas tenaga kesehatan lain dlm pemilihan terapi yg benarCP memonitor mendeteksi, dan mencegah DRPsCP perlu memberi konseling khusus thdp dosis obat yg memerlukan TDM misalnya obat dgn range terapi sempitCP perlu konseling utk penderita peny kronis: asma, diabetes, CVDKonseling thdp pasien lansia, anak2Konseling utk penderita yg sering mengalami alergiKonseling utk meningkatkan kepatuhan thdp obat yg diberikan

PELAKSANAAN KONSELING

Hendaknya dilakukan di ruang tersendiri

Konseling dpt dipermudah dgn menyediakan leaflet menyangkut patofisiologi penyakit dan mekanisme kerja obat

Assessment criteria for counseling skills

Some assessment criteria for patient counseling skills can comprise (Federation International Pharmaceutical, FIP):

1. Type of information provided

2. The amount of appropriateness of the provided counseling

3. Arrangement (pengaturan) of the patient counseling session

4. The verbal communication skills and demonstrated techniques

5. Non verbal communication skills such as eye contact

6. The degree of two-way interaction with a patient

7. The use of written information as a tool of a counseling

STRATEGIES TO PERFORM COUNSELING

A. Making contact with the patient

1. Approach the patient

2. Explain the purpose of the counseling session

B. Assessment of patient’s need, beliefs, feeling, concern, knowledge about medication, expectation of the counseling by:

Using patient’s history, considering the medical history, exploring how the patient using the prescribed, non-prescribed, and alternative medications, establishing whether the patient adheres to medication, determine whether the information provided by the patient is evidence-based or subjective.

C. Provision of information to solve problems covering:

Indication, dosage regimen adjustment, onset of action,

interactions, how to use the drug, side effects,

contraindications, recommendation regarding storage

etc.

D. Summary and review

Summarize the provided information and check if the

patient has understood it.

DRUG-RELATED PROBLEMS (DRPs)MASALAH TERKAIT PENGGUNAAN OBAT (MTPO)

I. Background

DRP didefinisikan sbg suatu kejadian atau keadaan akibat penggunaan obat yang secara nyata atau potensial mempengaruhi outcomes yang diharapkan (Pharmaceutical Care Network Europe, 2010). Many patients are subject to DRPs everyday resulting in overdose, sub-optimal therapy, decrease in quality of life, high cost, and even death.

II. Klassifikasi

DRPs telah telah diklassifikasikan oleh berbagai grup dengan sistim klassifikasi yg berbeda. Diantaranya 4 yg paling lazim diaplikasikan yi:

1) Strand (di USA)

2) Pharmaceutical Care Network Europe (di Europe)

3) Apoteket (di Swedia)

4) Granada-II (di Spanyol)

1. Strand method

Strand classification system is based on the philosophy of care, a care process, and a drug therapy assessment process. This system addresses indication, effect, safety, and user convenience.

1. Medical condition without receiving drug therapy

Patient is indicated to have a disease, but no drug is administered to cure the disease. For example, a patient is diagnosed to have CKD and based on the laboratory tests there is an indication that the patient has anemia and no antianemic drug is provided to treat the anemia.

2. Administration of wrong drug

A less effective and is being administered to a patient instead of the more effective one.

3. Medication condition with too low dose

This condition is noted when the desired outcome of a disease treatment of a patient is not achieved. Example, improvement of an infection treated with an antibiotic in which sub level therapeutic range occur in the body.

4. Medication condition with too high dose

An example is administration of certain drug with normal dosing rate to a patient with CKD may elevate plasma drug concentration and produce toxic effect since rate of elimination of the drug is interfered in patient with CKD.

5. Medical condition resulting from adverse drug reaction (ADR)

For example of ADR is the peptic ulcer induced by long-term administration of non-steroid anti-inflammatory drugs (NSAIDs).

6. Medical condition resulting from not receiving the prescribed drug

Noncompliance with a drug regimen due to apathy is included in to this type of DRP.

7. Drug interactionPharmacokinetic drug interactionPharmacodynamic drug interactionChemical interaction

8. Medical condition resulting from taking a drug with invalid indication

For example is administration of paracetamol to a patient without fever.

2. PCNEIn PCNE, the basic classification of DRPs consists of 4 primary domains for problems, 8 primary domains for causes, and 5 primary domains for interventions as shown in the following Table:

Code Primary domains

Problems P1P2P3P4

Treatment effectivenessAdverse reactionsTreatment costsOthers

Causes C1C2C3C4C5C6C7C8

Drug selectionDrug formDos selectionTreatment durationDrug use/administration processLogisticsPatientOther

2. PCNE… (cont)

Code Primary domains

Interventions I0I1I2I3I4

No interventionAt prescriber levelAt patient (carrier) levelAt drug levelOther

Outcomes of intervention

O0O1O2O3

Outcome intervention unknownProblem totally solvedProblem partially solvedProblem not solved

3. Apoteket

In Apoteket system, DRPs are categorized as follows:

1. Overuse

2. Problems with swallowing tablet

3. Other dosage problem

4. Other drug-related problem

5. Side effect

6. Drug duplication

7. Interaction

8. Contraindication

4. Granada II

In Granada II, problems are categorized according to necessity, effectiveness, and safety as described below:

1. A patient receives a drug not needed

2. A non-quantitative ineffective problem (when expected outcomes are not achieved)

3. A quantitative safety problem (magnitude of drug effect is involved)

4. A non-quantitative safety problem (magnitude of drug effect is not involved)

PENATALAKSANAAN INTERAKSI OBAT (STRATEGI SOLUSI DRPs)

1. Regular assessment of the patient’s medical records.

2. Study the demography of patients

3. Study medical and medication records of the patient

4. Identify the occurrence of DRPs

5. Group and rank the DRPs

6. Prepare recommendation to avoid the same DRPs and to improve clinical pharmacy services.

7. Evaluate the significance of improvement.

8. Make suggestion to related healthcare providers as well as policy makers

REFERENCES

Björkman, I. K., Sanner, M. A., & Bernsten, C. B. (2008). Comparing 4 classification systems for drug-related problems: Processes and functions. Research in Social and Administrative Pharmacy, 4(4), 320-331.