PENGARUH PANDEMI COVID-19 PADA KEPATUHAN

BEROBAT, GAYA HIDUP PENYANDANG HIPERTENSI,

DAN PEMANFAATAN POS BINAAN TERPADU DI JAWA
BARAT
JOURNAL ARTICLE

Submitted in partial fulfilment of the requirement for a Bachelor Degree

at the Faculty of Medicine Universitas Padjadjaran

CHRISTIANA LENNY

130110200072

UNIVERSITAS PADJADJARAN

FAKULTAS KEDOKTERAN

BANDUNG

2023

1
 PENGARUH PANDEMI COVID-19 PADA KEPATUHAN
BEROBAT, GAYA HIDUP PENYANDANG HIPERTENSI,
DAN PEMANFAATAN POS BINAAN TERPADU DI JAWA
BARAT

ARTIKEL JURNAL

CHRISTIANA LENNY
130110200072

Lembar ini untuk menyatakan bahwa kami telah memeriksa salinan artikel jurnal dari
kandidat dengan nama di atas dan menyatakan bahwa artikel jurnal ini telah selesai
dengan lengkap serta memuaskan untuk diajukan sebagai salah satu persyaratan dalam
mencapai gelar sarjana di Fakultas Kedokteran Universitas Padjadjaran dan revisi yang
diperlukan baik oleh pembimbing maupun penguji telah dilaksanakan.

Bandung, 5 Juli 2023

Pembimbing I

Dr. Nita Arisanti, dr., M.Sc.FM

NIP. 197512252005012001

Pembimbing II

Dr.med. Muhammad Hasan Bashari, dr., M.Kes.

NIP. 198211122009121003

2
Pengaruh Pandemi Covid-19 pada Kepatuhan Berobat, Gaya
Hidup Penyandang Hipertensi, dan Pemanfaatan Pos Binaan
Terpadu di Jawa Barat
PROPOSAL
Christiana Lenny

1 130110200072

Lembar ini untuk menyatakan bahwa kami telah memeriksa salinan proposal
hasil karya penulis dengan nama di atas dan menyatakan telah layak untuk
diajukan dalam ujian sidang hasil penelitian

Kami merekomendasikan nama berikut sebagai penguji:

Nama Penguji I (ketua) : Dr. Ruswana Anwar, dr., Sp.OG(K)., M.Kes
NIP : 196112011987101002

Nama Penguji II : Anggraini Widjajakusuma, dr., Sp.PD

NIP : 196611261997032001

Nama Penguji III : Mulyanusa Amarullah Ritonga, dr., Sp.OG., Subsp. FER., M.Kes
NIP : 197710242009121002

dan telah berkomunikasi dengan nama-nama di atas dan menyepakati untuk

dilakukan ujian sidang hasil penelitian terhadap mahasiswa tersebut dengan cara
(sidang / desk evaluation)* pada tanggal 18 Juli 2023

Bandung, 7 Juli 2023

Pembimbing I, Pembimbing II,

Dr.med. Muhammad Hasan

Dr. Nita Arisanti, dr., M.Sc.FM Bashari, dr., M.Kes.
NIP 198211122009121003
NIP197512252005012001

)* coret salah satu

3
 SURAT PERNYATAAN

TIDAK MELAKUKAN PLAGIARISME DAN/ATAU

MENGGUNAKAN DATA FIKTIF
DALAM PEMBUATAN/PENULISAN SKRIPSI
FAKULTAS KEDOKTERAN
UNIVERSITAS PADJADARAN

Dengan ini saya menyatakan bahwa naskah artikel jurnal dengan judul:

PENGARUH PANDEMI COVID-19 PADA KEPATUHAN

BEROBAT, GAYA HIDUP PENYANDANG HIPERTENSI,
DAN PEMANFAATAN POS BINAAN TERPADU DI JAWA
BARAT
adalah murni merupakan laporan dari penelitian yang benar telah saya lakukan,

1. Dalam karya tulis ini tidak terdapat karya atau pendapat yang telah ditulis atau
dipublikasikan orang lain kecuali secara tertulis dengan jelas dicantumkan sebagai
acuan dalam naskah dengan disebutkan naskah pengarang dan dicantumkan dalam
daftar pustaka.

2. Pernyataan ini saya buat dengan sesungguhnya dan apabila di kemudian hari
terdapat penyimpangan dan ketidakbenaran dalam pernyataan ini, maka saya
bersedia menerima sanksi akademik berupa pencabutan gelar yang telah diperoleh
karena karya ini, serta sanksi lainnya sesuai dengan norma yang berlaku di
perguruan tinggi ini.

Bandung, 5 Juli 2023

Yang membuat pernyataan,

Christiana Lenny
NPM. 130110200072

4
 IMPACT OF COVID-19 PANDEMIC ON MEDICATION ADHERENCE,
LIFESTYLE, AND POS BINAAN TERPADU UTILIZATION AMONG
HYPERTENSIVE PATIENT IN WEST JAVA

LIANA AWALIA LUTFUNNISA1, NURUL MUFLIHA PATAHUDDIN1, FADILA HEDIATY ZAHRA2,

ALIZHA ROCHANA PUTRI1, CHRISTIANA LENNY1, NITA ARISANTI3, MUHAMMAD HASAN
BASHARI4*
1
UNDERGRADUATE PROGRAM IN MEDICINE, FACULTY OF MEDICINE UNIVERSITAS
PADJADJARAN, BANDUNG, INDONESIA
2
UNDERGRADUATE PROGRAM IN PSYCHOLOGY, FACULTY OF PSYCHOLOGY UNIVERSITAS
PADJADJARAN, BANDUNG, INDONESIA
3
DEPARTMENT OF PUBLIC HEALTH, FACULTY OF MEDICINE UNIVERSITAS PADJADJARAN,
BANDUNG, INDONESIA
4
DEPARTMENT OF BIOMEDICAL SCIENCES, DIVISION OF PHARMACOLOGY AND THERAPY,
FACULTY OF MEDICINE UNIVERSITAS PADJADJARAN, BANDUNG, INDONESIA

* CORRESPONDING AUTHOR: MUHAMMAD HASAN BASHARI, DEPARTMENT OF BIOMEDICAL

SCIENCES, DIVISION OF PHARMACOLOGY AND THERAPY, FACULTY OF MEDICINE, UNIVERSITAS
PADJADJARAN, DR. HASAN SADIKIN HOSPITAL, BANDUNG, INDONESIA, E-MAIL:
BASHARI@UNPAD.AC.ID, PHONE: +62-813-33582383, FAX: +62-22-84288888

Author(s)
1st author
Full Name (with Academic degree(s)): Liana Awalia Lutfunnisa, S.Ked.
Affiliation: Undergraduate Program in Medicine, Faculty of Medicine Universitas
Padjadjaran, Bandung, Indonesia
Address: Jalan Raya Bandung-Sumedang Km.21
Jatinangor, Sumedang
Phone: 085793609267
Email: liana19001@mail.unpad.ac.id

2nd author
Full Name (with Academic degree(s)): Nurul Mufliha Patahuddin
Affiliation: Undergraduate Program in Medicine, Faculty of Medicine Universitas
Padjadjaran, Bandung, Indonesia
Address: Jalan Raya Bandung-Sumedang Km.21
Jatinangor, Sumedang
Phone: +62 852-4231-1554
Email: nurul18011@mail.unpad.ac.id

3rd author
Full Name (with Academic degree(s)): Fadila Hediaty Zahra
Affiliation: Undergraduate Program In Psychology, Faculty Of Psychology
Universitas Padjadjaran, Bandung, Indonesia
Address: Jalan Raya Bandung-Sumedang Km.21
Jatinangor, Sumedang
Phone: +62 838-7893-5917
5
Email: fadila19001@mail.unpad.ac.id

4th author
Full Name (with Academic degree(s)): Alizha Rochana Putri, S.Ked.
Affiliation: Undergraduate Program in Medicine, Faculty of Medicine Universitas
Padjadjaran, Bandung, Indonesia
Address: Jalan Raya Bandung-Sumedang Km.21
Jatinangor, Sumedang
Phone: +62 882-1986-9900
Email: alizharochana@gmail.com

5th author
Full Name (with Academic degree(s)): Christiana Lenny
Affiliation: Undergraduate Program in Medicine, Faculty of Medicine Universitas
Padjadjaran, Bandung, Indonesia
Address: Jalan Raya Bandung-Sumedang Km.21
Jatinangor, Sumedang
Phone: +62 87885588878
Email: christiana20001@mail.unpad.ac.id

6th author
Full Name (with Academic degree(s)): Dr. Nita Arisanti, dr., M.Sc.FM.
Affiliation: Department of Public Health, Faculty of Medicine Universitas
Padjadjaran, Bandung, Indonesia
Address: Jl. Eyckman No. 38 Bandung
Phone: +62 812-2386-276
Email: nita.arisanti@unpad.ac.id

7th author(corresponding author)

Full Name (with Academic degree(s)): Dr.med. Muhammad Hasan Bashari, dr.,
M.Kes.
Affiliation: Department of Biomedical Sciences, Division of Pharmacology and
Therapy, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin Hospital,
Bandung, Indonesia
Address: Jl. Eyckman No. 38 Bandung
Phone: +62 813-3358-2383
Email: bashari@unpad.ac.id

6
ABSTRACT

Introduction: Hypertension is the highest comorbid disease during the Coronavirus

Disease-19 (Covid-19) pandemic thus becoming a concern because people with
hypertension may experience more severe symptoms. Therefore, hypertension needs to
be treated with proper treatment. Handling hypertension in Indonesia (especially West
Java) requires medication adherence, healthy lifestyle modification, and utilization of
Posbindu. This study aims to determine medication adherence and lifestyle of people
with hypertension as well as the utilization of Posbindu before and during the Covid-19
pandemic.
Methods: A comparative analytical study with a quantitative approach using a cross-
sectional study design was conducted in July-August 2021. Respondents were people
with hypertension in West Java (n=151). Data were collected using an online
questionnaire. Result: The results of this study ….
Conclusion: There is no difference in medication adherence and lifestyle (exercise,
consumption of fruits and vegetables, and high salt food consumption) and increase
compliance of high lipid food consumption and smoking cessation of people with
hypertension both before and during the Covid-19 pandemic and decrease utilization of
Posbindu in West Java.

Keywords: Covid-19 Pandemic, Hypertension, Lifestyle, Medication Adherence,

Posbindu

I. INTRODUCTION

Hypertension is one of the most common uncommunicable disease in worldwide.1

Around 1.28 billion adults aged 30-79 years worldwide have hypertension, most

(two-thirds) live in low-and middle-income countries, such as Indonesia. 2 Based on

Basic Health Research in 2018, West Java ranked second as the province with the

highest hypertension cases in Indonesia, which was 39.6%.3 Hypertension acts as

comorbid and mortality factor in Covid-19 patients.4,5

Hypertension management requires medication adherences and modification of

7
patient’s lifestyle.6 Studies found that hypertension patient had low adherence of

antihypertensive medication treatment. Adherence for hypertension patients after

one year of taking prescribed hypertensive medication is reported at below 50%. 7

Effective lifestyle modification can decrease blood pressure by as much as a single

antihypertensive drug8. In Indonesia, there are community health care facilities

called Integrated Guidance Unit (Posbindu) which aims to early detection of non-

communicable disease(NCD) like hypertension and monitor risk factors such as

medication adherence and healthy lifestyles. 9 However, studies in areas of West

Java about medication adherence, healthy lifestyles, and implementation role of

Posbindu for hypertension patient are still lacking.

This study purposes to evaluate medication adherence and healthy lifestyle for

hypertension patients and Posbindu activities before and during the novel

coronavirus SARS-CoV-2 (COVID-19) pandemic. This data can be used as

reference to improve health services which can provide hypertension patient during

pandemic and after pandemic ends, especially in urban and rural areas of West

Java, Indonesia.

II. METHODS

This research consisted of surveying people with hypertension in West Java,

Indonesia. Quantitative data were collected by using online and offline

questionnaires. The final questionnaire instrument and informed consent process

was prepared for online distribution using Glideapp.

8
The questionnaire contains questions regarding medication adherence, lifestyle of

patient with hypertension, and utilization of Posbindu. Questionnaire medication

adherence using a modified Morisky Medication Adherence Scale with 8 Questions

(MMAS-8) to can measure individual medication adherence. The questionnaire has

been validated using Pearson Correlation (test results more than the critical limit of

0.279) and reliability test with using Cronbach's Alpha (test results more than 0.6)

in the official SPSS software version 25 for Windows. The results of the validity

and reliability test of the questionnaire are attached.

The sample was determined using a purposive sampling method followed by non-

discriminative snowball sampling to obtain a total sample of subjects. Subject

selection was also carried out through an inclusion and exclusion process with

inclusion criteria, namely: a) Patients with hypertension, b) He/She has lived in

West Java in Indonesia during period of January 2020-August 2021), and c) Age ≥

18 years. The exclusion criteria is the core members of the structured surveyor

(core members are consisted of: father, mother, and children). We have the help of

structured surveyors from Faculty of Medicine, Padjadjaran University who have

been briefed previously and are tasked with collecting data on people around them

who have hypertension. This pattern continues to repeat until the desired number of

samples is obtained.

Ethics approval was obtained from Padjadjaran University Research Ethics

Commision 6th of August 2021 with approval number 591/UN6.KEP/EC/2021. All

data collected using Glideapp was downloaded, cleaned and error-checked before

analyzed using spreadsheet and SPSS.

9
 III. RESULT

The total collected respondent in this research were 151 participants. The summary

of respondent’s demographic based on sex, domicile, highest education level, age,

and employment status were presented in Table 1. Majority respondent were female

(72,67%). Largest domicile respondent came from Sukabumi Regency (45,69%).

Participant’s Highest education level were mostly come from junior high school.

Our respondent’s age was highest in range of 50-59 years old (32,45%). Our

subject study were mostly unemployed(50,99%).

Tabel 1 Demographic Characteristic of Hypertension Patient

Demographic variable N %
Sex Male 42 27.86
Female 109 72.67

Domicile Bandung Regency 2 1.32

Bekasi Regency 1 0.66
Bogor Regency 3 1.98
Ciamis Regency 1 0.66
Cianjur Regency 3 1.98
Garut Regency 5 3.31
Kuningan Regency 10 6.62
Majalengka Regency 4 2.64
Purwakarta Regency 2 1.32
Subang Regency 1 0.66
Sukabumi Regency 69 45.69
Sumedang Regency 4 2.64
Tasikmalaya Regency 2 1.32
Bandung City 12 7.94
10
 Banjar City 3 1.98
Bekasi City 4 2.64
Bogor City 3 1.98
Cimahi City 1 0.66
Cirebon City 4 2.64
Depok City 2 1.32
Sukabumi City 13 8.6
Tasikmalaya City 2 1.32

Highest Unformal education 1 0.66

Education Elementary school 21 13.9
Junior & Senior high 87 57.61
school
Higher education 42 27.81
degree(College and
university)
Age 18-39 31 20.52
40-49 35 23.17
50-59 49 32.45
60-69 24 15.89
>70 12 7.94

Employment Employed 66 43.7

Status Unemployed 77 50.99
Retired 8 5.29

11
 Participants medication adherence can be determined based on routine monthly

consulation and medication obediences(Figure 1). In this study, there were no

significant difference between medication adherence indicators before and during

Covid-19 pandemic using McNemar test(p>0,05) (Tabel 2). Although there were no

significant changes, we observed highest difference observed in indicators of

medication adherence were regarding decrease of monthly consultation to doctor’s

during Covid-19 pandemic (8.34%). Difficulties in remembering medication

consumption were highest before (73.51%) and during(74.83%) Covid-19 pandemic.

Table 2. Differences in Medication Adherences in Hypertension Patient Before

And During Covid-19 Pandemic

Indicator Before (%) During (%) P Value

Monthly consultation 59.33 50.99 0.067
Forget to take medication 48.34 58.65 0.511
Bring medication while travelling 60.26 58.28 0.735
Finish medication while feeling better 66.89 71.52 0.281
Continue medication when feeling worse 68.87 69.53 1.000
Difficulties remembering medication 73.51 74.83 0.839
consumption
Stopping/reducing medication without 47.02 47.68 1.000
doctor’s approval

This study also identified healthcare that regularly visited by asked where

hypertension patients before and during the pandemic. There was a slight decrease in

the number of patients who had regular monthly consultations between before(59.33%)

and during(50,99%) pandemic (Figure 2). In addition, it is known that most respondents

go for regular consultations at the Public Health Center. However, during the pandemic

there was a decrease in respondent visits to the Public Health Center and there were an

increase of respondents who consulted with telemedicine.

12
 Figure 2 Medical Consultation Locations

The 5 indicators of a healthy lifestyle are exercise, consumption of high-lipid foods,

consumption of fruits and vegetables, consumption high-salt foods, and smoking. The

data shown in table 5 is the data of respondents who did things according to the

indicators (Table 3). The results showed that there was no significant difference

between a healthy lifestyle in rural areas and in urban areas in West Java in most

indicator (p>0.05) both before and during the pandemic. Using McNemar test, we find

there were significant differences in modification of decreasing high lipid food

consumption and smoking lifestyle before and during pandemic Covid-19(p<0.05).

Table 3 Differences Lifestyle in Hypertension Patient Before and During

Pandemic Covid-19

Indicator Before (%) During (%) P-Value

Exercise 29.80 31.78 0.629
High lipid food intake 66.88 58.27 0.011
Fruits and vegetables intake 75.49 78.14 0.454
High salt intake 60.26 55.62 0.092
Smoking 33.11 17.21 0.003

13
 Most survey participant (68.32%) survey participants admitted that they did not

know about Posbindu. Based on the results, there were 3 of participants who knew

about Posbindu but did not know further regarding the activities of Posbindu. There

were 48 participants who know Posbindu and its utilization, we found there was no

significant difference regarding Posbindu utilization. There was seen decreasing trend in

Posbindu monthly activity West Java community by 27.66% accompanied by decrease

of patients with hypertension participation in Posbindu every month by 21.28% during

Covid-19 pandemic (Table 4).

Table 4. Differences Posbindu Utilization for Hypertension Patient Before and

During Covid-19 Pandemic

Indicator Before (%) During (%) P-Value

Monthly activity 70.21 42.55 0.200
Participation 44.68 23.40 0.361

IV. DISCUSSION

This study assessed comparison regarding impact of Covid-19 pandemic with the role of

medication adherence, lifestyle factors and Posbindu utilization.

The success of treatment in patients with hypertension is influenced by medication

adherence. In our study, there were no significant differ rences before and during Covid-

19 pandemic. This result is in line with research by Luis, et. al. where we find no

differences regarding medication adherences before and during Covid-19. 10 This result

contradicts with study by Lorenzo which find significant decrease in therapeutic

adherence during Covid-19 pandemic.11 This differences occur due to multifactorial

factors which could be explored further as potential research topic.

14
There are some changes of monthly consultation methods occur during Covid-19

Pandemic. Small decrease of consultation methods such as clinic (1.99%), puskesmas

(0.66%) and hospital (2.64%) are found during pandemic. Small increase of family doctor

(2.65%) and telemedicine (0.66%) role for monthly checkup for hypertension patients

occur. These changes may occur due to lockdown which limits mobilization.12

There was a slight decrease in the number of patients who had regular consultations

between before(59.33%) and during(50.99%) pandemic. This result correlate with

Veronique, et al study which found decreased number of consultation during pandemic. 13

We suspect that this decrease number of consultation in our study happen due to fear of
12
COVID-19 transmission. We see the potensial to increase adherence through digital

intervention, although it is still not sufficient to increase medication awareness for all

hypertension patients as combination with face-to-face interaction is still necessary for

managing intentional non adherences.14

Other variable regarding hypertension patient medication adherence, such as bring

medication while travelling, finish medication while feeling better, continue medication

when feeling worse, difficulties remembering medication consumption and

stopping/reducing medication without doctor’s approval show increase adherences in

percentage but not significant. We suspect that because of hypertension is risk factors for

comorbidity and mortality for COVID-19, hypertension patient become more aware to
4,5
with increase medication adherences although it was not significant. Therefore, it is

very important for doctors to educate patient to increase awareness for medication

15
adherences for better hypertension prognosis and potentially use digital medication

reminder application to increase patient’s adherences.15

Forgetfulness is the main factor contributed for low medication adherence. 16 Low

medication adherence can occur due to hypertensive patient won’t immediately experience

harmful symptoms when skipping medication. Poor awareness, being busy and incorrect

belief may lead to missing doses or sleeping during medication consumption time. 17 The

average age of hypertensive patients who are elderly which are more likely to forget

medication consumption.18 These reasoning correlate with our findings regarding high

occurrence of difficulties in remembering when to take medication before (73.51%) and

during (74.83%) Covid-19 pandemic.

Other major factor that influences control of hypertension is lifestyle such as smoking,

exercises, and balanced consumption of fat, salt, fruits and vegetable consumption. We

found significant decrease differences between excess lipid consumption and smoking

during pandemic(p<0.05). Decrease of lipid consumption occurred due to and correlate

19
with the findings from Jason, et al. Potential reason for this phenomena are lack of

access to certain high lipid foods due to limitation of mobility with different factors such

as job loss.19 Decrease consumption of smoking during pandemic occurs and correlate

with Nerea and Irene findings which stated due to fear of Covid-19 transmission, severity

progression and less of social interaction.20 Urgency to increase community awareness of

the importance of sodium reduction and lifestyle changes to prevent hypertension are

necessary.

16
One of Indonesian Government program for NCD is Posbindu. It plays important role in

community to control cases of NCD including for hypertension. Posbindu involves

government and community in activities regarding early detection and monitoring of the

major NCD risk factors, which have been carried out in an integrated, routine, and

periodic manner. Goals of Posbindu is to increase community participation in NCD risk

factor early detection and prevention. Healthy, at-risk and community groups NCD

persons aged 18 and older are the main targets.21

However, nowadays the reality in community has changed quite a bit where many patients

do not know about the existence of Posbindu (68.32%). This means that the socialization

of the Posbindu program is still lacking so that the community is still not 100% utilizing

the Posbindu existence. It was even proven from the results of the questionnaires that we

distributed to hypertensive patients, of which almost all of the respondents did not know

about Posbindu. This correlate with Yulia, et. al. findings whereas many hypertension

patient did not know the role of Posbindu.22

Role of Posbindu in management of hypertensive patient were also reduced. Decrease of

Posbindu monthly activity (27.66%) and patient’s participation (21.28%) due to Covid-

19 pandemic are observed. The decrease of Posbindu also occurred in Puskesmas Bandar

Lampung.23 Therefore, socialization of Posbindu’s role in managing hypertension,

utilization of Posbindu’s monthly activity and hypertension community participation need

to be increased after pandemic.

Our research is expected to be a benchmark for the government in managing hypertension

and optimizing the work of Posbindu as the first health facility for non-communicable

17
diseases in Indonesia. If medication adherence has succeeded in achieving stability, the

risk of the severity of hypertension can be reduced with the support of healthy lifestyle

that reduces fatty foods or contains excess salt and smoking cessation.

The limitation in this study only covers the area of West Java, so that further research and

wider studies are needed that cover the island of Java and all regions in Indonesia. This

study also has not covered reasoning behind hypertension patient adherences choices. As

Covid-19 pandemic has ended in Indonesia, further research data about medication

adherences, lifestyles, and Posbindu utilization for hypertension patient after Covid-19

pandemic. These data are needed for government health policy consideration in managing

hypertension.

V. CONCLUSION

Result of this study shows there were no significant difference between medication

adherence before and during Covid-19 pandemic. There was significant decrease in high

lipid consumption and decrease smoking trend during Covid-19 pandemic. Decreased

role of Posbindu were found during Covid-19 pandemic. Hence, we hope for

improvement of hypertensive patient medication adherence and lifestyle with enhancing

Posbindu program in West Java.

VI. REFERENCES

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