Evaluation of Medication Therapy Management (MTM) Services to Improve Adherence in Patients with Diabetes Mellitus in Banyumas Regency

Acy Istianty  WS; Budi  Raharjo; Indri Hapsari

doi:10.30595/jhepr.v3i2.185

Authors

Acy Istianty WS Faculty of Pharmacy, Universitas Muhammadiyah Purwokerto
Budi Raharjo Instalation Pharmacy, RSUD Prof. Dr. Margono Soekarjo
Indri Hapsari Faculty of Pharmacy, Universitas Muhammadiyah Purwokerto

DOI:

https://doi.org/10.30595/jhepr.v3i2.185

Keywords:

Adherence, Diabetes mellitus, Medication therapy management, MTM

Abstract

Background: Treatment of diabetes mellitus aims to control blood sugar stability, prevent complications, and improve the patient's quality of life. Low adherence has been shown to increase the incidence of complications, decrease quality of life, inflate and inefficient medical costs, and even increase mortality. Medication Therapy Management (MTM) is a service or program that assists pharmaceutical services in improving adherence and quality of life. The aim is to determine the effect of medication therapy management on patient compliance with diabetes mellitus at the Banyumas Regency Health Center.

Methods: This research is experimental with a randomized control trial method and a pre-test and post-test. The variable measured was compliance of diabetes mellitus type 2 patients with pill counts before the intervention (pre-test) and one month after the MTM-based service intervention (post-test). Inclusion criteria for this research are patients diagnosed with diabetes mellitus type 2 with or without comorbidities, patients who underwent routine check-ups at least one month before the study, patients taking oral antidiabetic drugs without insulin, patients willing to be respondents, and willing to sign informed consent. Exclusion criteria for this research are patients who cannot communicate well, smoking patients, pregnant patients, patients who did not complete the questionnaire, and patients who did not undergo control during the study period. The instruments of this study are the documentation book of MTM-based pharmaceutical service treatment, namely the patient documentation book "BU MENTRY" (a book brought and filled in by the patient), "KU SIAP" (a book brought by the pharmacist), and leaflets.

Results: 180 respondents are divided into 90 in the control group and 90 in the intervention group. The mean compliance score in the control group at the pre-test is 84.6908 ± 7.68219, and at the post-test, it decreased to 83.0165 ± 9.20044 (p = 0.000). Statistically, there was a significant difference in the decline in compliance scores. While in the intervention group, the mean compliance score at the pre-test was 83.9630 ± 7.78213, and at the post-test, it increased to 88.5314 ± 7.87536 after being given MTM-based services (p = 0.000). There was a significant statistical difference in the increased compliance scores. MTM-based services significantly affect adherence in patients with diabetes mellitus, with an increased score of 4.5684 ± 5.31901 and a p-value of 0.000.

Conclusion: Medication Therapy Management (MTM)-based services impact increasing compliance of diabetes mellitus patients. So, the implementation of the MTM method carried out by pharmacists is expected to reduce the incidence of complications, improve quality of life, and save medical costs.

Keywords: Adherence; Diabetes Mellitus; Medication Therapy Management; MTM.

References

World health organization (WHO). Diabetes mellitus. (2021).

International Diabetes Federation. IDF Diabetes Atlas. 9th. ed. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(55)92135-8/fulltext (2019).

Kementrian Kesehatan RI. Laporan Nasional RISKESDAS. Badan Penelitian dan Pengembangan Kesehatan 674 (2019).

Riskesdas. Laporan Provinsi Jawa Tengah Riskesdas 2018. Kementerian Kesehatan RI (2018).

Anggraini, T. D. & Puspasari, N. Tingkat Kepatuhan Penggunaan Obat Antidiabetik Pada Pasien Diabetes Melitus Tipe 2 Di Apotek Sehat Kabupaten Boyolali. Indones. J. Med. Sci. 6, 1–8 (2019).

Triastuti, N., Irawati, D. N., Levani, Y. & Lestari, R. D. Faktor yang Mempengaruhi Tingkat Kepatuhan Konsumsi Obat Antidiabetes Oral pada Pasien Diabetes Melitus Tipe 2 di RSUD Kabupaten Jombang. Medica Arter. 2, 27 (2020).

Schomer, J. C. Medication Therapy Management Digest Tracking the Expansion of MTM in 2010: Exploring the Consumer Perspective. (2011).

Al-Tameemi, N. K. & Sarriff, A. Knowledge, attitude and practice of pharmacists on medication therapy management: a survey in Hospital Pulau Pinang, Penang, Malaysia. J. Pharm. Heal. Care Sci. 5, 1–9 (2019).

Viswanathan, M. et al. Medication therapy management interventions in outpatient settings: A systematic review and meta-analysis. JAMA Intern. Med. 175, 76–87 (2015).

Erku, D. A. et al. The impact of pharmacist-led medication therapy management on medication adherence in patients with type 2 diabetes mellitus: A randomized controlled study. Pharm. Pract. (Granada). 15, 1–7 (2017).

Kautzky-Willer, A., Harreiter, J. & Pacini, G. Sex and gender differences in risk, pathophysiology and complications of type 2 diabetes mellitus. Endocr. Rev. 37, 278–316 (2016).

Al-Goblan, A. S., Al-Alfi, M. A. & Khan, M. Z. Mechanism linking diabetes mellitus and obesity. Diabetes, Metab. Syndr. Obes. 7, 587–591 (2014).

Widiasari, K. R., Wijaya, I. M. K. & Suputra, P. A. Diabetes Melitus Tipe 2: Faktor Risiko, Diagnosis, Dan Tatalaksana. Ganesha Med. 1, 114 (2021).

Purnama, A. & Sari, N. Aktivitas Fisik dan Hubungannya dengan Kejadian Diabetes Mellitus. Wind. Heal. J. Kesehat. 2, 368–381 (2019).

Kassahun, A., Gashe, F., Mulisa, E. & Rike, W. A. Nonadherence and factors affecting adherence of diabetic patients to anti-diabetic medication in Assela General Hospital, Oromia Region, Ethiopia. J. Pharm. Bioallied Sci. 8, 124–129 (2016).

Mamangkey, I., Kapantow, N. H. . & Ratag, B. T. . Hubungan antara tingkat pendidikan dan riwayat keluarga menderita dm dengan kejadian dm tipe 2 pada pasien rawat jalan di poliklinik penyakit dalam BLU RSUP Prof. dr. r. Kandou Manado. Fak. Kesehat. Masy. Univ. Sam Ratulangi 1–6 (2014).

Oktavia, S., Budiarti, E., Masra, F., Rahayu, D. & Setiaji, B. Faktor - Faktor Sosial Demografi yang berhubungan dengan Kejadian Diabetes Melitus Tipe 2. J. Ilm. Permas J. Ilm. STIKES Kendal 12, 1039–1052 (2022).

Rahalus, R., Asrifuddin, A. & Kaunang, W. P. . Faktor-faktor yang berhubungan dengan Kejadian Diabetes Mellitus Tipe 2 di Rumah Sakit TK. III. R. W. Mongisidi Manado. FKM Unsrat Manad. 1–11 (2017).

Persaud, H. and & Williams, S. Occupational Stress and Increased Risk for Type 2-Diabetes: A Narrative Review. J. Complement. Med. Altern. Healthc. 2, 1–6 (2017).

Mulia, S. et al. PERBANDINGAN KUALITAS HIDUP PASIEN DIABETES MELITUS TIPE 2 BERDASARKAN LAMA MENDERITA (Comparison of Life Quality of Type 2 Diabetes Melitus Patients Based on Old). Caring Nurs. 3, 40–51 (2019).

Yulianti, S. R., Mukaddas, A. & Faustine, I. Profil Pengobatan Pasien Diabetes Mellitus Tipe 2 Di Instalasi Rawat Inap Rsud Undata Palu Tahun 2021. J. Nat. Sci. 3, 40–46 (2021).

PERKENI. Pedoman Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 Dewasa di Indonesia. PB PERKENI 1–104, (2021).

Malina, R., Yasin, N. M. & Wiedyaningsih, C. The Effect of Based Services Medication Therapy Management on Treatment Adherence and Quality of Life of Diabetes Mellitus Patients. J. Manaj. DAN PELAYANAN Farm. (Journal Manag. Pharm. Pract. 10, 204 (2020).

Bindu Murali, A. et al. Medication therapy management (MTM): An innovative approach to improve medication adherence in diabetics. Drug Metab. Pers. Ther. 31, 151–155 (2016).

Pratiwi, A. M., Nurmainah & Andrie, M. Analisis Penggunaan Kotak Pil (Pill Box) Terhadap Kepatuhan Penggunaan Obat Pada Pasien Diabetes Melitus Tipe 2. J. Syifa Sci. Clin. Res. 3, 629–36 (2022).

Ningrum, D. K. Higeia Journal of Public Health. Higeia J. Public Heal. Res. Dev. 1, 84–94 (2017).

Jasmine, N. S., Wahyuningsih, S. & Thadeus, M. S. Analisis Faktor Tingkat Kepatuhan Minum Obat Pasien Diabetes Melitus di Puskesmas Pancoran Mas Periode Maret – April 2019. J. Manaj. Kesehat. Indones. 8, 61–66 (2020).

Pramana, G. A., Dianingati, R. S. & Saputri, N. E. Faktor-Faktor yang Mempengaruhi Kepatuhan Minum Obat Pasien Hipertensi Peserta Prolanis di Puskesmas Pringapus Kabupaten Semarang. Indones. J. Pharm. Nat. Prod. 2, 52–58 (2019).

Mokolomban, C., Wiyono, W. I. & Mpila, D. A. Kepatuhan Minum Obat Pada Pasien Diabetes Melitus Tipe 2 Disertai Hipertensi Dengan Menggunakan Metode Mmas-8. Pharmacon 7, 69–78 (2018).

Syatriani, S., Amaliah, A. R. & Marwanti. Faktor Yang Berhubungan Dengan Kepatuhan Minum Obat Penderita Diabetes Melitus Tipe II di Puskesmas Tamamaung. J. Promot. Prev. 6, 394–402 (2023).

Ghimire, M., Vaidya, S. & Upadhyay, H. P. Prevalence of newly diagnosed end-stage renal disease patients in a tertiary hospital of central Nepal, Chitwan: A descriptive cross-sectional study. J. Nepal Med. Assoc. 59, 61–64 (2021).

International Diabetes Federation. IDF Diabetes Atlas. IDF Diabetes Atlas, 8th edition (2017).