PELAYANAN INFORMASI OBAT (PIO)

OBJECTIVES:

 Memahami beberapa terminologi

Tujuan PIO
Memahami 3 kelompok sumber informasi obat, kelemahan
keunggulannya
Memahami strategi pelaksanaan penelusuran pustaka
yg efektif
Dokumentasi 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.
 informasi obat.
Dalam pemberian informasi obat, diperlukan sumber
• 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 PIO
• Meningkatkan kepatuhan pasien thdp FUNGSI
pengobatan
• Aktivitas komite farmasi dan terapi
• Evaluasi penggunaan obat
• Pengendalian obat
• Publikasi
• Edukasi utk profesi kesehatan
 SUMBER INFORMASI OBAT

diklassifikasikan sbb:

Sumber
infomasi
tersier

Sumber informasi
sekunder
Sumber informasi
primer
 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 dipublikasikan
Informasi 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.

1. Pelajari demography penanya/pasien

2. Temukan informasi mendasar

3. Tentukan dan kelompokkan pertanyaan

4. Kembangkan strategy pengamatan dan lakukan

search

5. Laksanakan evaluasi, analysis & synthesis

6. Formulasikan & berikan response (lisan atau

tulisan)
 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 it
Medication 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
Ada bbrp tahap counseling spt tertera pada Tabel di bawah ini:
Medication Medication Medication Medication
information information education counseling
transfer exchange
Level of Basic, brief, Detailed, Comprihensi Detailed
information non individualized ve, group or discussion
individualized individualized and guidance
Spontaneous Most often Spontaneous or Planned Planned
or planned spontaneous planned
Objective of Essential Provider Collaborative Guidance to
process information response to & learning assist the
how to take asked question experience & needs in
prescribed related to process re: managing
medication prescribed prescribed medical
(monolog) medication medication condition &
(Dialogue) (conversa prescribed
tion) medication
(discussion)
 Medication counseling… (cont)
Product to Focused on Answer Increase Increase
patient save and question knowledge problem
proper use of regarding drug re: proper solving skill
drug product product, adapt and save use and assist
information to of medication with proper
individual , and for specific management
increase condition of medical
knowledge how condition and
to use drug effective use
properly of medication
Nature of Passive Questions and Interactive Interactive
relationship receives answers are learning collaborative
information exchanged by about the discussion
provided by provider and implication of and learning
healthcare patient the between
provider medication prescriber
shared by and patient
prescriber
and patient
 AKTIVITAS KONSELING

Clinical pharmacists (CP) dpt mempengaruhi attitude dan

prioritas tenaga kesehatan lain dlm pemilihan terapi yg benar
CP memonitor mendeteksi, dan mencegah DRPs
CP perlu memberi konseling khusus thdp dosis obat yg
memerlukan TDM misalnya obat dgn range terapi sempit
CP perlu konseling utk penderita peny kronis: asma,
diabetes, CVD
Konseling thdp pasien lansia, anak2
Konseling utk penderita yg sering mengalami alergi
Konseling 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 interaction
Pharmacokinetic drug interaction
Pharmacodynamic drug interaction
Chemical interaction
8. Medical condition resulting from taking a drug with
invalid indication
For example is administration of paracetamol to a patient
without fever.
2. PCNE
In 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 P1 Treatment effectiveness

P2 Adverse reactions
P3 Treatment costs
P4 Others

Causes C1 Drug selection

C2 Drug form
C3 Dose selection
C4 Treatment duration
C5 Drug use/administration process
C6 Logistics
C7 Patient
C8 Other
2. PCNE… (cont)

Code Primary domains

Interventions I0 No intervention
I1 At prescriber level
I2 At patient (carrier) level
I3 At drug level
I4 Other

Outcomes of O0 Outcome intervention unknown

intervention O1 Problem totally solved
O2 Problem partially solved
O3 Problem 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.