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.

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

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.
.
.
.
2.

.
.
.
.
.

Lisan
Sesuai untuk menyampaikan informasi yg sederhana.
Dapat disampaikan melalui telepon atau secara langsung
Merupakan metode diskusi, sebelum diberikan jawaban
tertulis
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
information
transfer
Level of
information

Medication
information
exchange

Basic, brief,
Detailed,
non
individualized
individualized

Medication
education

Medication
counseling

Comprihensi Detailed
ve, group or
discussion
individualized and guidance

Spontaneous Most often

or planned
spontaneous

Spontaneous or Planned
planned

Planned

Objective of
process

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

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

Essential
information
how to take
prescribed
medication
(monolog)

Collaborative
learning
experience &
process re:
prescribed
medication
(conversa
tion)

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 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 patients need, beliefs, feeling, concern,
knowledge about medication, expectation of the
counseling by:
Using patients history, considering the medical history,
exploring how the patient using the prescribed, nonprescribed, and alternative medications, establishing
whether the patient adheres to medication, determine
whether the information provided by the patient is evidencebased 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)
2)
3)
4)

Strand (di USA)

Pharmaceutical Care Network Europe (di Europe)
Apoteket (di Swedia)
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
P2
P3
P4

Treatment effectiveness
Adverse reactions
Treatment costs
Others

Causes

C1
C2
C3
C4
C5
C6
C7
C8

Drug selection
Drug form
Dos selection
Treatment duration
Drug use/administration process
Logistics
Patient
Other

2. PCNE (cont)
Code

Primary domains

Interventions

I0
I1
I2
I3
I4

No intervention
At prescriber level
At patient (carrier) level
At drug level
Other

Outcomes of
intervention

O0
O1
O2
O3

Outcome intervention unknown

Problem totally solved
Problem partially solved
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.
2.
3.
4.
5.
6.

Regular assessment of the patients medical records.

Study the demography of patients
Study medical and medication records of the patient
Identify the occurrence of DRPs
Group and rank the DRPs
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
Bjrkman, 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.