Journal of Health Economic and Policy Research (JHEPR)

Correlation of Rationality Empiric Antibiotic with Clinical Outcome in Hospital Acquired Pneumonia Patients

Anisa Ellen Brilyani — 2025-07-28

Background: Irrational use of antibiotics causes high mortality rates from Hospital Acquired Pneumonia (HAP), resulting in the worsening of patients’ clinical outcomes. This study aims to determine the correlation between the rationality of empirical antibiotic use and the clinical outcomes of HAP patients.

Methods: The research was conducted using a retrospective cohort and consecutive sampling with a research sample of adult patients diagnosed with HAP at Gadjah Mada University Academic Hospital who were treated in the period January 2021- October 2023. HAP patients who received empiric antibiotics for less than 48 hours, had infections other than HAP, and cancer were excluded from this study. The rationality of antibiotics was assessed using a Gyssens’ flow diagram, the patients’ clinical outcomes were seen on days 2 to 3rd of empirical antibiotic use, and the chi-square test to see the correlation of antibiotic rationality with clinical outcomes.

Results: A total of 52.63% of patients received rational empirical antibiotics, and 47.37% received irrational empirical antibiotics. Clinical outcomes that did not improve often occurred in the rational group, specifically in 13 patients out of 40 patients. The results of the chi-square test showed that the rationality of empirical antibiotic use did not correlate with clinical outcomes in HAP patients at Gadjah Mada University Academic Hospital, with a p-value of 0.317.

Conclusion: The rationality of empirical antibiotic use does not have a significant relationship with clinical outcomes.

Keywords: Clinical Outcome, Empiric Antibiotics, Gyssens, Hospital-Acquired Pneumonia (HAP), Rationality.

The Compliance of Chronic Kidney Failure Patients Underwent Hemodialysis at Gunung Jati Regional Hospital, Cirebon City

Yulia Sopi Kusdiani — 2025-07-28

Background: Non-compliance in patients with hemodialysis has a tremendous negative impact. Complications of the disease result in a poor quality of life. This study aimed to determine the compliance and characteristics of patients with chronic kidney failure undergoing hemodialysis at Gunung Jati Regional Hospital, Cirebon City.

Methods: This study employed a non-experimental design, with data collected prospectively using a questionnaire. The subjects of this study were chronic renal failure patients who underwent hemodialysis therapy at the Hemodialysis Unit of Gunung Jati Regional Hospital in Cirebon City and were treated at the clinic from January to March 2020. Non-random sampling was used in this study because the sample size was not calculated. The total number of patients undergoing hemodialysis was 133, of whom 44 met the study criteria, with a total of 95 cases. The study tool assessed patients' compliance with chronic kidney failure undergoing hemodialysis, specifically the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ).

Results: The 44 research subjects were patients with chronic kidney failure who underwent hemodialysis therapy at the hemodialysis unit of Gunung Jati Regional Hospital in Cirebon City, and were treated at the clinic from January to March 2020. The data collection method involved filling out a questionnaire through interviews. Data were analyzed using qualitative descriptive analysis. The results showed that all patients with chronic renal failure who underwent hemodialysis at the hemodialysis unit at Gunung Jati Regional Hospital in Cirebon City have good adherence (100%) to therapy.

Conclusion: All patients in this study sample were reported to be compliant with hemodialysis therapy, with major cost consumption of Chronic Kidney Disease (CKD) patients at mental health clinics, and the lowest was for patients seeking treatment at the lung clinic.

Keywords: Chronic Kidney Failure, Compliance, Hemodialysis.

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

Acy Istianty WS — 2025-07-28

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.

Development Strategy of the Pharmacy Department at Nirmala Hospital based on SWOT Analysis

Ari Suwanti — 2025-07-28

Background: Medication management is a critical component of hospital operations, as inefficiencies can adversely affect hospitals medically, socially, and economically. This study aimed to assess the conformity of medication management practices and formulate development strategies at Nirmala Hospital's pharmacy department

Methods: This descriptive analytical study used quantitative and qualitative methods, including observations, interviews, and questionnaires. The assessment was conducted based on standard medication management indicators. The Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis is used to formulate strategies based on the hospital’s internal and external aspects.

Results: Medication selection, planning, and procurement processes generally met the standard indicators. However, the dead stock percentage was 1.54%, exceeding the acceptable limit. Two indicators did not meet standards: the average number of medications per inpatient prescription (6.82) and prescription conformity with the hospital formulary (85.71%). All distribution indicators met the required standards. Based on SWOT analysis, the pharmacy department is positioned in quadrant 1, indicating strong internal and external potential for service improvement.

Conclusion: Under an aggressive growth policy, the recommended strategies include implementing a one-gate system, enhancing human resource capacity, and improving facilities to support pharmacy services.

Keywords: Hospital’s Pharmacy Department, Medication Management, SWOT Analysis.

Modern Wound Dressing from Shallot Skin Waste Extract: A Natural Biomaterial Approach to Alleviate Vasoconstriction in Diabetic Ulcers

Mohammad Rafly — 2025-07-28

Background: Shallot skin possesses various biological activities, including antibiotic, anti-inflammatory, and antibacterial properties, attributed to their secondary metabolites such as flavonoid (quercetin and kaempferol), saponin, and essential oil. This study aimed to determine the antibacterial activity of shallot skin made into a wound dressing patch.

Methods: This research used diabetic rats induced by alloxan. Rats with blood glucose >200 mg/dL and ulcers were divided into negative control (patch base), positive control (oxoferrin), and test groups treated with shallot peel extract at 0%, 45%, 50%, and 55%. Rats were randomly assigned after glucose screening. Data collected included swelling, gel fraction tests, and flavonoid (quercetin) identification via thin-layer chromatography. Healing was measured by wound closure percentage.

Results: Patches with higher shallot peel extract concentrations absorbed more water and maintained structure. In diabetic rats, 45%, 50%, and 55% extract patches accelerated wound closure, with 55% showing the best healing based on the comparison between the positive control and the test formulation. A slight difference was found, so it can be concluded that this formulation has potential as a treatment for diabetic ulcers.

Conclusion: Wound dressings combining calcium alginate and shallot peel extract exhibit antibacterial properties and enhance diabetic ulcer healing in rats. The combination of quercetin as an antibacterial for S. aureus, the leading cause of diabetic ulcers, and alginate, which can condition wounds so that they can accelerate wound healing, is a potential combination in treating cases of diabetic ulcers.

Keywords: Diabetic Ulcer, Patch, Shallot Skin, Wound Dressing.