ANALYSIS OF COMPLIANCE WITH DRUG USERS IN TBC PATIENTS ON THERAPY SUCCESS IN MEDAN DELI PUSKESMAS, MEDAN CITY YEAR 2022
ANALYSIS OF COMPLIANCE WITH DRUG USERS IN TBC PATIENTS ON THERAPY SUCCESS IN MEDAN DELI PUSKESMAS, MEDAN CITY
YEAR 2022
- Study Program of Public Health, Sari Mutiara Indonesia University, Kapten Muslim Street No. 79, Sei Sikambing, Medan, 20123
- Head of Entomology & Parasitology Laboratory, Environment Health Office & DC, Medan
ABSTRACT
According to WHO data, there are 6.3 million new pulmonary TB diseases, this figure is the same as 61% of the world’s tuberculosis cases with a value of 10.4 million. The number of patients experiencing TB increased in the number of tuberculosis cases from the previous year, which was 9.6 million people. In addition, the number of deaths caused by tuberculosis worldwide is 40 people per 100,000 of the world’s population. The purpose of this research is to find out the analysis of drug user adherence in TB patients to the success of therapy at the Medan Deli Health Center in 2022. The type of research is descriptive analytic based on a retrospective-prospective study design. The population is pulmonary tuberculosis patients who received treatment as many as 112 people with a sampling technique using total sampling with a total of 112 respondents. The data used include primary data and secondary data. Data analysis used bivariate and multivariate approaches. The results showed that there was a relationship between adherence to the success of therapy for TB patients (p = 0.000), there was a relationship between knowledge and the success of therapy for TB patients (p = 0.000), there was no relationship between age and the success of therapy for TB patients (p = 0.280), there was no relationship between gender with successful therapy of TB patients (p = 0.856), there is a relationship between education and the success of therapy for TB patients (p = 0.200), there is a relationship between work and the success of therapy for TB patients (p = 0.003), there is a relationship between family support and the success of therapy for TB patients. (p = 0.010) and multivariate analysis that non-adherence, lack of knowledge and not working have an 94% chance or chance of not succeeding in therapy. It is hoped that the health workers at the Medan Deli Health Center will provide encouragement, in addition to providing counseling and education about tuberculosis to all ages and genders in order to increase patient knowledge about the factors that support the success of therapy in tuberculosis patients.
Keywords: Compliance, Knowledge, Work, Family Support, Therapeutic Success
Introduction
Success in treatment, in addition to the influence of quality health services, is also influenced by the attitudes, skills of health workers and the patient’s lifestyle and support from their families, in addition to other factors, namely patient compliance in treatment. Patient recovery will not occur if there is no awareness of the patient in treatment, it can even lead to treatment failure, so this will have a fatal impact, which can cause complications that can eventually lead to death in the patient (Ernawati and Feriani Wiyoko 2018).
In determining good and correct treatment given by health workers to patients, it does not necessarily go well if the patient himself does not take treatment properly or according to the procedures for taking medication for pulmonary TB patients. The consistency of patients in becoming TB patients, especially long-term treatment of chronic health problems, with a percentage of fifty percent found in developed countries and the percentage of patient compliance in taking drugs, which is <50%, is found in developing countries (Pamungkas 2021).
TB disease called pulmonary tuberculosis is a type of disease that causes infection in the lungs, in this case the cause of the type of bacteria Myobacterium tuberculosis is and performs and infects the body in a latent and progressive manner. TB is a disease that can transmit to others as much as 80% and this occurs in the lungs. The occurrence of transmission is caused by a gram-positive bacillus that can survive in acidic conditions with very slow growth. In general, as many as 2 billion people are infected with TB and as many as 3 million people die from tuberculosis each year (Wahyuni and Cahyati 2020).
Tuberculosis (TB) is common in poor countries and some developing countries. In the international agreement summarized in the Sustainable Development Goals (SDGs) in 2015, the health problem of dangerous infectious diseases such as TB has become one of the main concerns of the health development goals. Globally, in 2018, according to WHO data, there were 6.3 million new pulmonary TB diseases, this figure is the same as 61% of the world’s tuberculosis cases with a value of 10.4 million. The number of patients experiencing TB increased in the number of tuberculosis cases from the previous year, which was 9.6 million people. In addition, the number of deaths caused by tuberculosis worldwide is 40 people per 100,000 of the world’s population (Unicef, WHO, WBG 2018).
Tuberculosis is an old disease that still occurs today. Based on data in North Sumatra Province, there was an increase in the number of tuberculosis cases, and the data on finding cases of Tuberculosis or pulmonary TB made plans to eradicate this problem. When viewed in 2016 for participants suffering from tuberculosis, there were a total of 189 patients. Based on the Ministry of Health in 2016 there were 5 districts and cities located in North Sumatra that experienced the most tuberculosis. The first is Medan City with a total of 2,397 tuberculosis patients, followed by Peematang Siiantar City with 288 patients, Binjai City with 260 patients, Tnajung Balai City with 150 patients, Tebing Tinggi City with 145 patients and Deli Serdang Regency with 1,554 patients (Damayanti, Erza, and Johan 2020).
The results of observations made by researchers at the Medan Deli Public Health Center, Medan Deli District, Medan City, obtained that the total cases of patients with tuberculosis were 112 cases, this is still high in Medan Deli District, the high number of pulmonary TB sufferers is due to knowledge, attitudes and actions. the population does not understand the infectious diseases besides how to prevent the transmission of infectious diseases, community economic factors, while patients who have suffered but have not recovered this can also be caused by patients who are excluded from therapy and complete their treatment as when taking medicine, while Tuberculosis treatment takes a long time, which is 24 weeks and also up to 9 months if there are more. The patient’s lack of obedience in therapy is due to the low support from the patient’s family so that the patient does not finish doing therapy, besides that it can be supported by a lack of patient knowledge about the harmful effects if the patient is not compliant in completing tuberculosis treatment, besides that there are also health workers in evaluating patients to therapy that has been carried out by the patient.
RESEARCH METHODS
The type of research used is retrospective-prospective with a cross sectional approach. This research was conducted at the Medan Deli Public Health Center, Medan City. This research was conducted from October 2021 to August 2022 at the Medan Deli Public Health Center, Medan City. The population in this study were patients with pulmonary tuberculosis who received treatment as many as 112 people. Sampling using the total population, namely the entire sampling technique in this study were Lung Tuberculosis patients who received treatment as many as 112 people. The data collection technique was carried out using a questionnaire made by the researcher. Secondary data obtained from the results of documentation by other parties, for example data from the Health Center, tuberculosis data. Using univariate data analysis, bivariate analysis using chi square dna multivariate test.
Results
Research Demographics
Medan Deli Health Center is located on Jalan Yos Sudarso Km. 11.1 Neighborhood III Kota Bangun Village, Medan Deli District. With an area of 1900 Ha. The working area of the Medan Deli Health Center consists of 5 villages, namely: Kota Bangun Village, Mabar Village, Mabar Hilir Village, Tanjung Mulia Village, Tanjung Mulia Hilir Village. The number of neighborhoods is 89 neighborhoods with a population of 139,842 people.
Table 1 Frequency Distribution of Respondents Characteristics of TB Patients
| Variable | n | Persentase |
| Age | ||
| 18-40
41->60 |
50
39 |
44.6
34.8 |
| Education | f | % |
| High
Low |
23
89 |
20.5
79.5 |
| Gender | f | % |
| Woman
Man |
39
73 |
34.8
65.2 |
| Work | f | % |
| No Work
Work (PNS, Honor, Wiraswasta) |
64
48 |
57.1
42.9 |
Table 2 shows that most of the patients aged 18-40 years were 44.6%. Most of them have low education as much as 79.5%. mostly men as much as 65.2%. most do not work as much as 57.1%.
Univariate Analysis Table 2 Frequency Distribution of Factors in TB Patient Therapy
| Variabel | n | Persentase |
| Therapeutic Success | ||
| Healed
No Healed |
70
42 |
62.5
37.5 |
| Obedience | ||
| Yes
No |
73
39 |
65.2
34.8 |
| Knowled | ||
| Good
No Good |
79
33 |
70.5
29.5 |
| Family Support | ||
| Yes
No |
81
31 |
72.3
27.7 |
Based on table 2 shows that most of the patients recovered as much as 62.5%, most of the patients were obedient as much as 65.2%, most of the patients had good knowledge as much as 70.5%. most support as much as 72.3%.
Bivariate Analysis
Table 3 Tabulation of the Relationship of Compliance with Treatment Success for TB Patients
| Variable | Therapeutic Success | Total | Ρ | OR (95%CI) | ||||
| Healed | No Healed | |||||||
| n | % | n | % | n | % | |||
| Obedience | ||||||||
| Yes | 64 | 57.1 | 9 | 8.0 | 73 | 65.2 | 0,000 | 39.11
(12.829-119,287) |
| No | 6 | 5.4 | 33 | 29.5 | 39 | 34.8 | ||
| Knowled | ||||||||
| Good | 64 | 57.1 | 15 | 13.4 | 79 | 70.5 | 0,000 | 19.200 (6.731-54.766) |
| No Good | 6 | 5.4 | 27 | 24.1 | 33 | 29.5 | ||
| Age | ||||||||
| 18-40 | 34 | 30.4 | 16 | 14.3 | 50 | 44.6 | 0,280 | 1.535(0.704-3.346) |
| 41->60 | 36 | 51.4 | 26 | 61.9 | 62 | 55.4 | ||
| Education | ||||||||
| High | 14 | 12.5 | 9 | 8.0 | 23 | 20.5 | 0.856 | 0.917(0.358-2.350) |
| Low | 56 | 80.0 | 33 | 78.6 | 89 | 79.5 | ||
| Gender | ||||||||
| Woman | 28 | 25.0 | 11 | 9.8 | 39 | 34.8 | 0,200 | 1.879 (0.813-4.342) |
| Man | 42 | 37.5 | 31 | 27.7 | 73 | 65.2 | ||
| Work | ||||||||
| No work | 48 | 42.9 | 16 | 14.3 | 64 | 57.1 | 0,003 | 3.545(1.591-7.903) |
| Work | 22 | 19.6 | 26 | 23.2 | 48 | 42.9 | ||
| Family Support | ||||||||
| Yes | 57 | 50.9 | 24 | 21.4 | 81 | 72.3 | 0,010 | 3.288
(1.394-7.757) |
| No | 13 | 11.6 | 18 | 16.1 | 31 | 27.7 | ||
Table 3 shows that there is a relationship between adherence to the success of TB patient therapy (p = 0.000) and people who are compliant are 39 times more successful than people who are non-adherent. There is a relationship between knowledge and the success of TB patient therapy (p= 0.000) and good knowledge is 19 times more successful than people with poor knowledge. There was no relationship between age and the success of therapy for TB patients (p= 0.280) at a significant level of more than 0.05, and ages 41->60 years were 2 times more successful than people aged 41->60 years. There was no relationship between education and the success of TB patients’ therapy (p= 0.856) and higher education was only 1 times more successful than people with low education. There was no relationship between gender and the success of therapy for TB patients (p= 0,200) and men were 2 times more successful than women. There is a relationship between work and the success of TB patients’ therapy (p= 0.003) and working is 4 times more successful than people who don’t work. There is a relationship between family support and the success of TB patients’ therapy (p= 0.010) and there is support from family that is 3 times more successful than people who do not receive support from their families.
Multivariate Analysis
Table 4 Probability of variables on the success of therapy
| Variabel | B | OR | Nilai Sig |
| Obedience | 2.858 | 17.420 | 0.000 |
| Knowled | 2.457 | 11.664 | 0.001 |
| Work | 1.357 | 3.884 | 0.037 |
| Constant | -9.668 | .000 | 0.000 |
Based on these results, the logistic regression equation for multivariate test results, namely the Probability or Predicted value is 94% of the variables being less compliant, lack of knowledge and not working affect the failure of therapy.
Discussion
The Relationship of Compliance with the Success of TB Patient Therapy
The table above shows that most of the patients were obedient and managed to do TB therapy as much as 57.1%. the results of statistical tests showed that there was a relationship between adherence to the success of TB patient therapy (p = 0.000) at a significant level of equal to 0.05, with an OR value of 39.11 (12.8292-119.287) stating that people who comply are 39 times more successful than people who do not comply.
This research is in line with Munteh’s research in 2018 with the title of research on the relationship between adherence to medication for pulmonary tuberculosis patients and the rate of recovery in the Kuala Lumpur Health Center Work Area, Langkat Regency. The results showed that the majority of patients were compliant with taking pulmonary TB drugs as many as 49 people (94.2%), non-adherent 3 people (5.8%) and the majority of patients recovered as many as 47 people (90.4%), did not recover 5 people (9 ,6%). The results of the chi square test are known to have p-value = 0.000 <0.05 (Munthe, 2019).
This research is supported by the theory from (Seniantara, Ivana, and Adang 2018) that adherence to TB treatment therapy is very important, because if treatment is not carried out regularly and not in accordance with the specified time, TB germs immunity to Anti-Drugs can arise. TB (OAT) is widely known or called Multi Drugs Resistance (MDR). Generally, patients take medication for 6 months to ensure recovery, but in some circumstances it can take longer
According to the researcher’s assumption that adherence is the main factor that is closely related to the success of TB patient therapy, this is because if the patient does not comply or just leaves one time not to take the drug, this will repeat the patient’s initial treatment so that patient compliance during treatment will definitely determine patient’s success in TB therapy.
Relationship of Knowledge with Successful Therapy of TB Patients
The table above shows that most of the patients had good knowledge and managed to do TB therapy as much as 57.1%. statistical test results show that there is a relationship between knowledge and the success of TB patient therapy (p = 0.000) at a significant level equal to 0.05, with an OR value of 19,200 (6,731-54,766) stating that good knowledge is 19 times more successful than people with poor knowledge .
This research is in line with Tambunan’s research in 2019 with the title Relationship of Knowledge and Attitude to TB Patient Compliance at UPT Puskesmas Belawan. The results of the study where the number of respondents in this study were 71 respondents with the highest age being 15-44 years with male sex. The results of the chi square test obtained that the knowledge variable value with pulmonary TB patient compliance was 40 people (91%) with p value 0.000 <0.05, and the attitude variable with pulmonary TB patient compliance was 47 people (77%) with p value 0.003 < 0 ,05 (Tambunan, 2019).
According to Notoadmojo (2016), knowledge is an indicator of people doing someone’s actions against something. If someone is based on good knowledge of health, then that person will understand how health is and encourage him to apply what he knows (Notoatmodjo, 2016).
Based on the results of the study, it was found that the respondents’ answers were many wrong on the question of how not to get infected with tuberculosis patients, namely tuberculosis patients who covered their nose and mouth when coughing, besides that tuberculosis patients did not spit and dispose of phlegm in any place, which turned out to be a lot of unknown respondents so that they had to further counseling and education to respondents so as to make respondents successful in TB therapy.
Relationship of Age with Successful Therapy of TB Patients
The table above shows that most of the patients aged 41->60 years and did not succeed in TB therapy as much as 61.9%. the results of statistical tests showed that there was no relationship between age and the success of TB patient therapy (p = 0.280) at a significant level of more than 0.05. with an OR value of 1,535 (0.704-3,346) stated that people aged 41->60 years were 2 times more successful than people aged 41->60 years.
This study is in line with Debora’s research in 2020 that the drug taking supervisor is family (97.0%), intensive sputum conversion (54.4%), no advanced stage sputum conversion (100%), complete treatment outcome (48.2% ), Chi-Square test, there is no significant proportion between gender by type of patient (p=0.315), there is no significant proportion between age by type of patient (p=0.661) (Debora, 2020).
Unproductive age (> 50 years) in treating pulmonary TB is complicated by treatment for other accompanying diseases, causing increased drug side effects, drug withdrawal, and increased cases of re-treatment and anti-tuberculosis drug resistance (OAT). This could be due to reduced drug absorption associated with age-related physiological changes and the strength to fight infection (Pamungkas, 2021). At the beginning of birth the body’s defenses are very weak and will increase slowly until the age of 10 years, after puberty the body’s defenses are better at preventing the spread of infection through the blood, but weak in preventing the spread of infection in the lungs. The level of unproductive patient age can affect the effect of the drug, because drug metabolism and organ function are less efficient in infants who are very young and in the elderly, so that it can cause a stronger and longer effect in both age groups (Nursito, Savitri, and Darussalam). , 2016).
The Relationship of Education with Successful Therapy of TB Patients
The table above shows that most of the patients had low education and 80.0% success in TB therapy. The results of statistical tests showed that there was no relationship between education and the success of TB patient therapy (p = 0.856) at a significant level of more than 0.05 with an OR value of 0.917 (0.358-2.350) stating that education once had the opportunity to affect the success of TB therapy.
This research is in line with Yuda’s research in 2019 with the title The Relationship between Education Level and Compliance with Taking Drugs in Patients with Pulmonary Tuberculosis. The results showed that the most pulmonary tuberculosis patients were in the group with primary school education as much as 43%, 76% of the half-adherent patients took medication, and there was no relationship between education level and medication adherence in pulmonary tuberculosis patients (X2: 0.306, dk: 4, : 0.01) (Yuda, 2019).
Education is a factor that makes it easy for a person to receive knowledge and change mindsets, but not all highly educated people understand knowledge from various fields, so education is not someone doing good behavior or actions if it is not based on knowledge (Notoadmodjo, 2016).
The Relationship of Sex with the Success of TB Patients’ Therapy
The table above shows that most of the patients were male and 37.5% were successful in TB therapy. the results of statistical tests showed that there was no relationship between gender and the success of TB patients’ therapy (p= 0.200) stating that the male sex was 2 times more successful than the female gender.
This research is in line with Indriati’s research in 2019 with the title Factors Affecting the Success of Pulmonary Tuberculosis Treatment. The results of the analysis obtained a value of 0.237 > (0.05) which means Ho failed to be rejected and it can be concluded that there is no relationship between gender and the results of microscopic sputum examination after treatment. The results of the analysis obtained an OR value of 0.194 (95% CI = 0.022-1.728) meaning that male respondents had 0.19 times the opportunity to get negative BTA results compared to female respondents (Indriati, 2019).
The higher TB case finding rates in males than females may reflect exposure to risk of infection (including lifestyles such as smoking and occupational exposure to indoor or outdoor pollutants) and disease progression. Factors that influence the success of treatment are due to the difficulty of access to health care facilities, behavior in seeking health care facilities, and stigma. Limited information, transportation, and health and financial dependence (medication costs) can make it difficult for female TB patients to seek treatment due to concerns about the effects of the TB diagnosis they receive (Andarwati, Masrah, and Fauzi, 2020).
Employment Relationship with TB Patient Therapy Success
The table above shows that most of the patients did not work and managed to do TB therapy as much as 42.9%. The results of statistical tests show that there is a relationship between work and the success of TB patient therapy (p = 0.003) at a significant level of equal to 0.05 with an OR value of 3,545 (1,591-7,903) stating that working is 4 times more successful than people who do not work.
This study is in line with Sari’s research in 2016 with the title of evaluation of adherence to the success of pulmonary tuberculosis therapy in outpatients in hospitals. Dr. R.M. Djoelham Binjai. Based on the results of adherence showed that the majority of patients with pulmonary tuberculosis were moderate (48.8%). Assessment of the level of knowledge of patients with good categories as many as 28 people (68.3%). Based on the results of pulmonary TB therapy showed that as many as 26 people (63.4%) with negative BTA. The results of statistical tests showed that there was a significant effect between the level of compliance, occupation, income, and success in the treatment of pulmonary tuberculosis (p < 0.05) (Sari, 2016).
In relation to the success of TB treatment, there are several factors that can affect the success of TB treatment such as work, economic status, role of PMO, level of knowledge, presence of multidrug resistance (MDR TB), medication adherence, role of cadres, role of health facilities, distance and family support. . In this study, researchers obtained data that work affects the treatment success of TB patients. This is because working patients sometimes forget to take the medication they are taking, so this is the trigger for the patient to not recover and follow-up treatment for the patient (Wahyuni and Cahyati, 2020).
Work is a factor that affects the success of patients in TB therapy, this is because if the patient works outside the home, he will be busy so that sometimes he forgets to take medicine or come for control to health services so that busy activities outside the home make the patient’s success in TB therapy unsuccessful.
Relationship of Family Support with Successful Therapy of TB Patients
The table above shows that most of the patients received family support and managed to do TB therapy as much as 50.9%. The results of statistical tests showed that there was a relationship between family support and the success of TB patient therapy (p = 0.010) at a significant level equal to 0.05 with an OR value of 3.288 (1,394-7,757) stating that people who received support from their families were 3 times more successful than people who received support from their families. who do not receive support from their families.
This research is in line with Nia’s 2022 research entitled Family Support With success in the treatment of taking medication in patients with pulmonary tuberculosis. Based on the results of bivariate analysis using the chi square statistical test, the p value = 0.007 > (0.05) it can be concluded that there is a significant relationship between family support and the success of taking medicine in patients with pulmonary TB at the Special Lung Hospital of South Sumatra Province (Nia Ruspiana, 2022).
Family support really supports the success of treatment for pulmonary TB patients by always reminding patients to take medicine, having a deep understanding of patients who are sick and encouraging them to stay diligent in treatment. Family support is needed to encourage pulmonary TB patients by showing concern and sympathy, and caring for patients. Family support that involves emotional concern, help and affirmation, will make the patient feel comfortable. Family support can empower pulmonary TB patients during the treatment period by providing continuous support, such as reminding patients to take medicines and being sensitive if they experience side effects from drugs.
The Most Dominant Factors for Successful Therapy of TB Patients
The results of the analysis of variables using the logistic regression test showed that the Analysis of Compliance with Drug Users in TB Patients on Therapy Success by using linear logistic statistical tests that the Probability or Predicted value was 94% less adherent, lack of knowledge and not working had an effect on the failure of therapy.
This study is in line with Widyanto’s 2017 research. There is a relationship between medication adherence and the recovery of smear-positive TB patients at the Delanggu Public Health Center, Klaten. This is proven by a significance value (P) of 0.006 with (α) = 5% then P < 0.05 (Widiyanto, 2017).
Pulmonary TB treatment that requires a long period of time has a strong effect on the outcome of therapy. Most patients who do not succeed are patients who do not comply with treatment visits because the patient experiences good so they do not return for treatment.
Conclusion
Based on the results of the study, it was found that there was a relationship between the analysis of adherence, knowledge, work, family support with the success of therapy and there was no relationship between the analysis of education, age and gender with the success of therapy. The most dominant factors related to the success of therapy are compliance, knowledge and work. It is hoped that health workers, especially officers who handle patients suffering from tuberculosis, are expected to provide education about the dangers of TB and cooperate with TB families in patient treatment therapy.
Acknowledgement
I would like to thank the Medan Deli Public Health Center which has given permission and helped in this research and thank you to the respondents who participated in this research.
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