HUBUNGAN KARAKTERISTIK PENGAWAS MENELAN OBAT DENGAN PELAKSANAAN PELA KSANAAN TUGAS PENGAWA PENGAWAS MENELAN OBAT DAN KEPATUHAN KEPATUHAN BEROBAT PASIEN TB PARU DI PUSKESMAS ANDALAS KOTA PADANG PADANG
Skripsi Diajukan ke Fakulas Ke!"keran Uni#ersias An!alas Se$a%ai Pe&enu'an Pe&enu'an Sala' Sau S(ara unuk Men!apakan Gelar Sarjana Ke!"keran
Ole'
SRI MARDLANIAH N")BP *+*,-*+,.+
FAKULT FAKULTAS AS KEDOKTE KE DOKTERAN RAN UNI/ERSITA UNI/ERSI TAS S ANDALAS PADANG +,*0
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*
PERN PERN1 1ATAAN ORIS ORISIN INAL ALIT ITA AS
Skripsi ini adalah hasil karya sendiri, dan semua sumber baik yang yang dikutip maupun yang dirujuk telah saya nyatakan dengan benar dan bukan merupakan pelagiat.
Nama : Sri Mardlaniah No. BP : 1210120!2
"anda "a "angan : "anggal : 20 #pril 201$
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PENGESAHAN SKRIPSI
Skripsi ini telah disetujui oleh:
Pembimbing %
Pembimbing %%
&r. %r'an Medison, Sp.P ()* Nip. 1+$0-01200011 1+$0-01200011002 002
&rs. /uliar, M.)es. #pt Nip. 1+$001$1+!+0100 1+$001$1+!+0100
Mengetahui: akil &ekan %, akultas )edokteran 3nand
&r. 4ina 5ustia, Sp.)) Nip. 1+$-0!1+1++102001 1+$-0!1+1++102001
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PENGESAHAN PENGU2I
Skripsi ini telah diuji dan dinilai oleh "im Penguji Pendidikan &okter akultas )edokteran 3nand
Padang, 20 #pril 201$
"im Penguji Na&a
2a$aan
dr. 6essy 6essy Susanty Sabri, Sp.P ()*
)etua Penguji
dr. 7dison, MP8
Sekretaris
dr. %r'an Medison, Sp.P ()*
#nggota 1
&rs. /uliar, M.)es. #pt
#nggota 2
Tan!a Tan%an
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KATA KATA PENGANTAR PENG ANTAR
Bismillahirrahmanirrahiim, #lhamdulillahirabbil9alamiin, puji dan syukur kehadirat #llah S.." dan Shala Shalaat at beserta beserta salam salam untuk untuk Nabi Nabi Muhamm Muhammad ad S.#., S.#., berkat berkat rahmat rahmat dan karunia;Ny karunia;Nyaa penulis penulis dapat menyelesaikan menyelesaikan skripsi skripsi ini dengan dengan judul judul <8ubungan <8ubungan )arakteristik )arakteristik Pengaas Menelan =bat (PM=* dengan dengan Pelaksanaan Pelaksanaan "ugas "ugas PM= dan )epatuhan Berobat Pasien "B Paru di Puskesmas #ndalas )ota Padang> yang merupa merupakan kan salah salah satu syarat syarat untuk untuk mendap mendapatk atkan an gelar gelar sarjana sarjana kedokt kedokteran eran di akultas )edokteran 3ni'ersitas #ndalas. )eberh )eberhasil asilan an dalam dalam penyu penyusun sunan an skrips skripsii ini telah telah banya banyak k dibant dibantu u oleh oleh berbagai pihak. 3?apan terimakasih yang sebesar;besarnya kepada: 1. &r. &r. dr. dr. Masr Masrul ul,, Sp.5) p.5),, M.S? M.S? sela selak ku &eka &ekan n aku akult ltas as )ed )edokte oktera ran n 3ni' 3ni'er ersit sitas as #ndal ndalas as yang yang memb memberi erika kan n duku dukung ngan an dan dan iin iin dala dalam m pembuatan skripsi ini. 2. dr. dr. 4ina 4ina 5ust 5ustia ia,, Sp.) Sp.)) ) sela selaku ku akil kil &eka &ekan n % aku akult ltas as )edo )edokt kter eran an 3ni' 3ni'er ersi sita tass #ndal ndalas as yang ang memb member erik ikan an duku dukung ngan an dan dan iin iin dala dalam m pembuatan skripsi ini. . dr. dr. %r'an %r'an Medi Mediso son, n, Sp.P Sp.P ()* dan dan &rs. &rs. /uli /uliar ar,, M.)e M.)es. s. #pt selak selaku u dosen dosen pembimbing yang telah sabar dan meluangkan aktu untuk memberikan bimbingan, saran, dan arahan dalam penyusunan penyusunan skripsi ini. -. dr. dr. 6essi Susant Susantii Sabr Sabri, i, Sp.P Sp.P dan dr. dr. 7diso 7dison, n, MP8 selak selaku u tim pengu penguji ji skripsi yang telah memberikan masukan serta saran demi kesempurnaan skripsi ini.
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. dr. dr. Nurh Nurhay ayati ati,, M.Bi M.Biom omed ed selak selaku u Pemb Pembim imbi bing ng #kade kademi mik k yang yang telah telah mema?u mema?u semang semangat at penuli penuliss untuk untuk menunt menuntut ut ilmu ilmu lebih lebih giat giat lagi lagi selama selama masa studi. $. Seluruh Seluruh dosen dosen pengajar pengajar di akultas akultas )edoktera )edokteran n 3ni'ersitas 3ni'ersitas #ndalas #ndalas yang yang telah memberikan ilmu pengetahuan kepada penulis. . Berbagai Berbagai pihak pihak yang yang turut membantu membantu dalam dalam menyeles menyelesaikan aikan skripsi skripsi ini. ini. Penulis berharap semoga #llah S" senantiasa men?urahkan rahmat dan hidayah;Nya hidayah;Nya kepada semua pihak yang telah banyak banyak membantu. membantu. Semoga skripsi skripsi ini dapat berman@aat bagi pelayanan puskesmas, dunia pendidikan, instansi terkait dan masyarakat luas. #khir kata, segala saran dan masukan akan penulis terima dengan senang hati demi kesempurnaan skripsi ini.
Padang, #pril 201$
Penulis
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RELATIONSHIP OF DIRE3TL1 OBSER/ED TREANMENT TREAN MENT 3HARA3TERISTI3S WITH THE ROLE OF DIRE3TL1 OBSER/ED TREANMENT AND THE ADHEREN3E PULMONAR1 TUBER3ULOSIS PATIENT PATIENT TREATMENT IN THE ANDALAS PUBLI3 HEALTH HEALTH 3ENTER 3EN TER PADANG B( Sri Mar!lania' ABSTRA3T
"uber?ulosis is an in@e?tious disease remains a health problem in the orld. "he amount o@ ne ?ases o@ pulmonary pulmonary tuber?ulosis tuber?ulosis in Padang Padang totaled 1,10 at 201201- ith ith su??ess su??ess treatme treatment nt rate rate as +.A. +.A. "he highes highestt in?ide in?iden?e n?e rates rates are @ound @ound in #ndal #ndalas as Publi Publi?? 8ealth 8ealth enter enter Padang Padang.. &ire?tl &ire?tly y obser' obser'ed ed treatme treatment nt (&="* to o'ersee and ensure patients adhere to treatment. 4ole o@ the &=" ?an be in@luen?ed in@luen?ed by their ?hara?teristi?s. ?hara?teristi?s. "his study aims to determine the relationship relationship beteen &=" ?hara?teristi?s ith the role o@ &=" and the adheren?e o@ pulmonary tuber?ulosis patient treatment in #ndalas #ndalas Publi? 8ealth enter Padang. "his "his stud study y used used ?ros ?rosss se?t se?tio iona nall desi design gn in pati patien ents ts ith ith pulm pulmon onar ary y tuber?ulosis and &=". "otal sample is $ people using total sampling te?hniCues. "he data as ?olle?ted by using dire?t inter'ies ith patients and &=" based on the Cuestionnaire. %t as analyed by using hi;SCuare test ith signi@i?ant 'alue A. "he "he resu result ltss o@ uni' uni'ar aria iate te anal analy ysis sis obta obtain ined ed @reC @reCue uen? n?y y dist distri ribu buti tion on ?hara?teristi?s o@ the &=" as @ollos: .A male, +-.$A aged D 1! years old, high edu?ated $+.$A, .-A ork, +$.-A o@ @amilies, and +2, +A li'e in the same home home ith ith the patient. patient. .2A .2A &=" per@orm per@orm ell ell and $+.$A $+.$A o@ pulmon pulmonary ary tuber?ulosis patients adherent to treatment. "he results o@ the bi'ariate analysis has a signi@i?ant signi@i?ant relationship relationship beteen &=" edu?ations edu?ations ith role o@ the &=" and the the age, age, edu? edu?at atio ion n and and the the role role o@ &=" &=" ith ith the the adhe adheren ren?e ?e o@ pulm pulmon onary ary tuber?ulosis patient treatment. %n ?on?lusion, there are a signi@i?ant relationship beteen &=" edu?ations ith the role o@ them and the relationship beteen the age, edu?ation and the role o@ &=" ith adheren?e o@ pulmonary tuber?ulosis patient treatment. %n de'ining &=", health pro'ider ha'e to ?onsider the ege and edu?ation.
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HUBUNGAN KARAKTERISTIK PENGAWAS MENELAN OBAT DENGAN PELAKSANAAN TUGAS PENGAWAS MENELAN OBAT DAN KEPATUHAN KEPATUHAN BEROBAT PASIEN TB PARU DI PUSKESMAS P USKESMAS ANDALAS KOTA PADANG Ole' Sri Mar!lania' ABSTRAK
"uber "uberkul kulosi osiss merupa merupakan kan penya penyakit kit in@eks in@eksii yang yang masih masih menjad menjadii masalah masalah kesehatan kesehatan di dunia. dunia. /umlah /umlah kasus baru "B Paru di )ota Padang Padang berjumlah 1.10 di tahun tahun 201201- dengan dengan angka angka keberh keberhasil asilan an pengob pengobatan atan adalah adalah +, +, A. #ngk #ngkaa kejadi kejadian an tertin tertinggi ggi ditemu ditemukan kan di Puskes Puskesmas mas #ndal #ndalas as )ota )ota Padang Padang.. Penga Pengaas as menelan obat (PM=* bertugas mengaasi dan memastikan pasien patuh dalam menj menjal alan anii peng pengob obat atan an.. Pela Pelaks ksan anaa aan n tuga tugass PM= PM= dapa dapatt dipe dipeng ngar aruh uhii oleh oleh karakt karakteris eristik tik PM=. Penelit Penelitian ian ini bertuj bertujuan uan untuk untuk menget mengetahu ahuii hubung hubungan an karakteristik PM= dengan pelaksanaan tugas PM= dan kepatuhan berobat pasien "B Paru di Puskesmas #ndalas )ota Padang. Penelitian ini menggunakan desain cross sectional pada pada pasien "B Paru dan PM=. Sampel berjumlah $ orang dan pengambilan sampel menggunakan teknik total sampling sampling . Pengumpulan data dilakukan dengan aan?ara langsung pada pasien dan PM= dengan berpedoman pada kuisioner. &ata dianalisis se?ara uni'ariat dan bi'ariat menggunakan uji Chi-Square pada Chi-Square pada derajat kemaknaan A. 8asil penelitian didapatkan distribusi @rekuensi karakteristik PM= sebagai berikut: ,A laki;laki, +-,$A umur D 1! tahun, $+,$A berpendidikan tinggi, ,-A bekerja, +$,-A keluarga, dan +2,+A tinggal s erumah dengan pasien. ,2A PM= melaksanakan tugas dengan baik dan $+,$A pasien "B Paru patuh dalam berobat. 8asil uji statistik s tatistik didapatkan hubungan yang bermakna antara pendidikan PM= dengan dengan pelaksa pelaksanaa naan n tugas tugas PM= serta serta hubung hubungan an umur umur,, pendid pendidika ikan n dan pelaksanaan tugas PM= dengan kepatuhan berobat berobat pasien "B Paru. )esimpulan )esimpulan penelitian adalah terdapat terdapat hubungan hubungan pendidikan pendidikan PM= dengan pelaksanaan tugas PM= serta hubungan umur, pendidikan, dan pelaksanaan tugas PM= dengan kepatuhan berobat pasien "B Paru. &ari hasil penelitian disarankan dalam dalam memilih memilih PM= petuga petugass kesehat kesehatan an memerha memerhatik tikan an umur umur dan pendid pendidika ikan n PM=.
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DAFTAR ISI
Sampul &epan Sa&pul Dala& PERN1ATAAN ORISINALITAS HALAMAN PERN1ATAAN ORISINALITAS PENGESAHAN SKRIPSI PENGESAHAN PENGU2I KATA PENGANTAR ABSTRA3T ABSTRAK DAFTAR ISI DAFTAR TABEL DAFTAR GAMBAR DAFTAR ISTILAH DAFTAR LAMPIRAN BAB * PENDAHULUAN 1.1 1.1 Eata Eatarr Bela Belaka kang ng 1.2 1.2 4um 4umusan usan Masa Masala lah h 1. 1. "uju "ujuan an Penel Penelit itian ian 1.. 1..1 1 "uju "ujuan an 3mum 3mum 1.. 1..2 2 "uju "ujuan an )husu )hususs 1.1.- Man@ Man@aa aatt Pene Penelit litia ian n
BAB + TIN2AUAN PUSTAKA
i i ii iii i# # #ii #iii i6 6ii 6iii 6i# 6# * 1 6 6 6 6 7 . 8 8 8 11 14
2.1 2.1 "ube "uberk rkul ulos osis is Par Paru u 2.1.1 &e@inisi &e@inisi "uberku "uberkulosis losis Paru 2.1.2 Patogenesis Patogenesis "uberku "uberkulosis losis Paru 2.1. )lasi@ikasi )lasi@ikasi "uberku "uberkulosis losis Paru 2.1. 2.1.- 5ejal 5ejalaa )lin )linis is 2.1. 2.1. &iag &iagno nosi siss 15 18 2.1. 2.1.$ $ "atal "atalak aksan sanaa 2.2 2.2 Stra Strate tegi gi &="S &="S 21 2. Penga Pengaas as Mene Menelan lan =bat =bat (PM=* (PM=* 22 2.. 2..1 1 Persy Persyar arata atan n PM= 22 2..2 2..2 Siapa Siapa 6a 6ang Bisa Bisa /adi PM= 23 2.. 2.. "ugas "ugas Seoran Seorang g PM= PM= 23 2..- %n@ormasi %n@ormasi Penting yang yang Perlu &ipahami &ipahami PM= untuk &isampaikan &isampaikan )epada )epada
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-..2 "eknik "eknik Pengambilan Pengambilan Sampel Sampel -.- )riteria )riteria %nklusi %nklusi dan dan )riteria )riteria 7ksklusi 7ksklusi -.-.1 -.-.1 )riteri )riteriaa %nklus %nklusii -.-.2 -.-.2 )riteri )riteriaa 7ksklu 7ksklusi si -. Fariabel riabel Peneli Penelitian tian -..1 -..1 Fariabel riabel %ndepen %ndependen den -..2 -..2 Fariabel riabel &epen &ependen den -.$ -.$ &e@i &e@ini nisi si =pera =perasi sion onal al -.$.1 Fariabel Fariabel %ndepen %ndependen den ()arakteri ()arakteristik stik PM=* -.$.2 -.$.2 Fariabel riabel &epen &ependen den -. -. %nstr %nstrum umen en Penel Peneliti itian an -.! Pengam Pengambil bilan an &ata &ata Peneli Penelitian tian -.+ ara ara Pengola Pengolahan han dan dan #nal #nalisis isis &ata &ata -.+. -.+.1 1 Pengo Pengola laha han n &ata -.+. -.+.2 2 #nal #nalisi isiss &ata &ata
BAB 8 HASIL PENELITIAN
32 32 32 33 33 33 33 33 33 35 37 37 37 37 37 -9 39 39 39 40 41 41 42 42 43 43 43 44 44
.1 5ambar 5ambaran an 3mum 3mum Eokas Eokasii Peneli Penelitian tian .1.1 .1.1 )eadaa )eadaan n 5eogra 5eogra@is @is .1. .1.2 2 &ata &ata &emog &emogra ra@i @iss .2 )arakt )arakteri eristik stik 4espon 4esponden den . . #nal #nalisi isiss 3ni' 3ni'ar aria iatt ..1 ..1 )arakt )arakteri eristik stik PM= ..2 ..2 Pelaksa Pelaksanaa naan n "ugas "ugas PM= PM= .. )epatuhan )epatuhan Berobat Berobat Pasien Pasien "B Paru Paru ..- #nal #nalisi isiss Bi' Bi'ar aria iatt .-.1 8ubungan 8ubungan /enis /enis )elamin PM= &engan &engan Pelaksan Pelaksanaan aan "ugas "ugas PM= .-.2 8ubungan 8ubungan 3mur 3mur PM= &engan &engan Pelaksanaan Pelaksanaan "ugas "ugas PM= .-. 8ubungan 8ubungan Pendidikan Pendidikan PM= &engan &engan Pelaksanaan Pelaksanaan "uga "ugass PM= .-.- 8ubungan 8ubungan Pekerjaan Pekerjaan PM= &engan &engan Pelaksanaan Pelaksanaan "ugas "ugas PM= .-. 8ubungan 8ubungan #ntara 8ubunga 8ubungan n )eluarga )eluarga PM= &engan Pelaksan Pelaksanaan aan "ugas PM= 45 .-.$ 8ubungan 8ubungan "empa "empatt "inggal "inggal PM= &engan Pelaksanaan Pelaksanaan "ugas "ugas PM= 46 .-. 8ubungan 8ubungan /enis )elamin )elamin PM= &engan )epatuhan )epatuhan Berobat Berobat Pasien Pasien "B Paru 46 .-.! 8ubungan 8ubungan 3mur 3mur PM= &engan )epatuh )epatuhan an Berobat Berobat Pasien "B Paru 47 .-.+ 8ubungan 8ubungan Pendidikan Pendidikan PM= &engan &engan )epatuhan )epatuhan Berobat Berobat Pasien "B "B Paru
47 .-.108ubungan Pekerjaan PM= &engan )epatuhan Berobat Pasien "B Paru 48 .-.118ubungan #ntara 8ubungan )eluarga PM= )epatuhan Berobat Pasien
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$.2. 8ubungan 8ubungan Pendidikan Pendidikan PM= &engan &engan Pelaksanaan Pelaksanaan "uga "ugass PM= 55 55 $.2.- 8ubungan 8ubungan Pekerjaan Pekerjaan PM= &engan &engan Pelaksanaan Pelaksanaan "ugas "ugas PM= $.2. 8ubungan 8ubungan #ntara 8ubungan 8ubungan )eluarga )eluarga PM= &engan Pelaksana Pelaksanaan an "ugas "ugas PM= 56 $.2.$ 8ubungan 8ubungan "empa "empatt "inggal "inggal PM= &engan Pelaksanaan Pelaksanaan "ugas "ugas PM= 57 $.2. 8ubungan 8ubungan /enis )elamin )elamin PM= &engan )epatuhan )epatuhan Berobat Berobat Pasien Pasien "B Paru 57 $.2.! 8ubungan 8ubungan 3mur 3mur PM= &engan )epatuh )epatuhan an Berobat Berobat Pasien "B Paru 58 $.2.+ 8ubungan 8ubungan Pendidikan Pendidikan PM= &engan &engan )epatuhan )epatuhan Berobat Berobat Pasien "B "B Paru 58 $.2.108ubungan Pekerjaan PM= &engan )epatuhan Berobat Pasien "B Paru 59 $.2.118ubungan #ntara 8ubungan )eluarga PM= )epatuhan Berobat Pasien "B 60 Paru $.2.128ubungan "empat "inggal "inggal PM= &engan )epatuhan Berobat Pasien "B Paru 61 $.2.18ubungan Pelaksanaan "ugas PM= &engan )epatuhan Berobat Pasien "B Paru 61
BAB : KESIMPULAN DAN SARAN .1 .1 )esim esimpu pula lan n .2 Saran
DAFTAR PUSTAKA
07 64 65 00
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DAFTAR TABEL
"abel 2. 1 "abel 2. 2 "abel . 1 "abel . 2 "abel . "abel . "abel bel . "abel . $ "abel . "abel bel . ! "abel "abel . +
: Paduan =#" dalam Pengobatan "uberkulosis Paru 1+ : )isaran &osis =#" Eini Pertama untuk Pasien &easa 20 : &istribusi rekuensi )arakteristik Pasien "B Paru -0 : &istribusi rekuensi )arakteristik PM= -1 : &istribusi rekuensi Pelaksanaan "ugas PM= -2 : &istribusi rekuensi )epatuhan Berobat Pasien "B Paru -2 : 8ubun ubunga gan n /enis enis )ela )elam min &en &engan gan Pela Pelaks ksan anaa aan n "ugas PM= - : 8ubungan 3mur &engan Pelaksanaan "ugas PM= - : 8ubungan Pendidikan &engan Pelaksanaan "ugas PM= -: 8ubu 8ubung ngan an Statu Statuss Peke Pekerja rjaan an &eng &engan an Pela Pelaks ksan anaa aan n "ugas ugas PM= PM= -: 8ubungan 8ubungan #ntara #ntara 8ubung 8ubungan an )eluarg )eluargaa &engan &engan Pelaksan Pelaksanaan aan "ugas PM= - "abel bel . . 10 : 8ub 8ubun unga gan n "empat mpat "ingg inggal al &eng &engan an Pela Pelaks ksan anaan aan "ugas ugas PM= PM= -$ "abel "abel . 11 : 8ubungan /enis )elamin &engan )epatuhan Berobat Pasien "B P ar u -$ "abel bel . . 12 12 : 8ubu 8ubung ngan an 3mur 3mur &eng &engan an )epa )epatu tuha han n Bero Beroba batt Pas Pasie ien n "B "B Par Paru u - "abel "abel . 1 : 8ubungan Pendidikan &engan )epatuhan Berobat Pasien "B Paru -! "abel "abel . 1- : 8ubungan Status Pekerjaan &engan &engan )epatuhan Berobat Pasien "B P ar u -! "abel "abel . 1 : 8ubungan #ntara 8ubungan )eluarga &engan )epatuhan Berobat Pasien "B Paru -+ "abel "abel . 1$ : 8ubungan "empat "empat "inggal "inggal &engan )epatuhan Berobat Pasien "B P ar u 0 "abel "abel . 1 : 8ubungan Pelaksanaan "ugas PM= &engan )epatuhan Berobat Pasien "B Paru 0
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DAFTAR GAMBAR
5#MB#4 5#MB#4 2. 1 5#MB#4 2. 2
: Skema Skema perkem perkembangan bangan sarang tuber?ulosi tuber?ulosiss post primer primer dan perjalanan penyembuhan : #lur diagnosis dan tindak lanjut "B Paru
11 1
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DAFTAR ISTILAH
#%&S B"# (H* &4 &="S 7 8 8%F =#" =#" =#";)&" )&" P# P)) PM= PP"% 4 S SPS SPSS "B M& M&4 "B M4 "B P4 "B 44 "B I& I&4 "B 8= K
G Acquired Immune Immune Deficiency Syndrome G Basil "ahan #sam positi@ G Case Detection Rate G Directly Observed Treatment Treatment Short-course G 7tambutol G %soniaid G uman Immunodeficiency Immunodeficiency !irus !irus G =bat #nti "uberkulosis G =bat =bat #nt #ntii "ube "uberk rkul ulos osis is )omb )ombin inasi asi &os &osis is "et "etap ap G Patologi #natomi G Pembinaan )esejahteraan )eluarga G Pengaas Menelan =bat G Perhimpunan Pemberantasan "uberkulosis %ndonesia G 4i@ampisin G Streptomisin G Seaktu;Pagi;Seaktu G Statistical "ac#age for the Social Science G "u "uberk erkulosis sis Mu Multi &ru &rug g 4e 4esis sistan G "uberkulosis Mono 4esistan G "uberkulosis Poli 4esistan G "uberkulosis 4i@ampisin G "u "uberk erkulosis sis 7J 7Jtensi'e &ru &rug g 4e 4esis sistan G "uberkulosis G $orld ealth Organi%ation G Pirainamid
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DAFTAR LAMPIRAN La&piran La&piran * La&piran + La&piran La&pir La&piran an 7 Eampiran
; Le&$ar Le&$ar Perse Perseuju ujuan an Menja!i Menja!i Resp Resp"n!e "n!en n Peneliia Peneliian n ; Kuisi"ner Peneliian ; Maser Ta$el Ta$el ; Anali Analisis sis Uni#a Uni#aria ria : #nalisis Bi'ariat Bi'ariat
$+ 0 !0
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BAB * PENDAHULUAN *)* Laar Laar Belakan Belakan% % "uberkulosis masih menjadi masalah kesehatan di dunia. 1, juta orang
meninggal akibat tuberkulosis pada tahun 201-. %nsiden "B diperkirakan ada +,$ juta (kisaran +,1;10 juta* yang setara dengan 1 kasus per 100.000 penduduk di seluruh dunia. /umlah kasus "B pada tahun 201- sebagian besar terjadi di #sia (!A* dan #@rika (2!A*L - proporsi yang lebih ke?il kasus terjadi di ilayah timur Mediterania Mediterania (!A*, 7ropa (A* dan #merika (A*. %ndonesia %ndonesia merupakan negara peringkat kedua terbanyak insiden "B setelah %ndia, yaitu 0,;1,- juta orang (8=, 201*. %ndonesia pada tahun 201- mengalami penurunan angka penemuan kasus baru "B paru (Case Detection Rate &4* Rate &4* yaitu -$A, dibandingkan pada tahun 201 dengan dengan &4 $0A. #ngka kejadian "B Paru di %ndonesia %ndonesia terus mengalami peningkatan dari tahun 1+++ ( kasus per 100.000 penduduk* sampai 201- (1
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menerapkan strategi Directly strategi Directly Observed Treatment Treatment Short-course Short-course (&="S* (&inkes )ota Padang, 201*. Strategi Strategi &="S telah direkomendasika direkomendasikan n oleh $orld ealth Organi%ation (8=* pada aal tahun 1++ sebagai strategi dalam penanggulangan "B dan telah terbukti terbukti sebaga sebagaii strateg strategii penang penanggul gulang angan an yang yang se?ara se?ara ekonom ekonomis is paling paling e@ekti@ (cost-efective& (cost-efective&,, yang terdiri dari komponen kun?i yaitu: 1* )omitmen politisL 2* Pemeriksaan dahak mikroskopis yang terjamin mutunyaL * Pengobatan jangka pendek yang standar bagi semua kasus "B dengan tatalaksana kasus yang tepat, termasuk pengaasan langsung pengobatanL -* /aminan ketersediaan =#"
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menyebabka menyebabkan n ketidakpat ketidakpatuhan uhan dalam peraatan peraatan kesehatan kesehatan diantarany diantaranyaa adalah menunda berobat, tidak berpartisipasi dalam program kesehatan, tidak datang saat janji temu dengan tenaga kesehatan, dan gagal mengikuti instruksi medis yang dian dianju jurk rkan an..
&eter &etermi mina nan n
kepa kepatu tuha han n
dapa dapatt
dite ditent ntuk ukan an
berd berdasa asark rkan an
ting tingka katt
pengetahuan terkini tentang gambaran penyakit, gambaran proses rujukan, gamb gambar aran an
situ situas asii
@asi @asili lita tass
pela pelay yanan anan
kese keseha hata tan, n,
dan dan
gamb gambar aran an
tera terapi pi
pengobatannya (jenis, tingkat, durasi, kompleksitas, e@ek dosis, e@ek samping, biaya, dan pengeluaran* (Sidy, (Sidy, 2012*. &alam pengobatan "B Paru harus dilakukan se?ara berkesinambungan dan
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terdap terdapat at hubung hubungan an dengan dengan kepatu kepatuhan han beroba berobatt pasien pasien "B. &ari &ari peneli penelitian tian ini memperlihatkan kepatuhan berobat pasien "B akan lebih baik jika PM= memiliki tingkat pendidikan yang tinggi, hubungan keluarga yang dekat dengan pasien "B, dan tinggal serumah dengan pasien "B tersebut. Sementara dari penelitian yang dilakukan 4ohmana dkk (201-* menyatakan baha tidak terdapat hubungan yang signi@ikan antara karakteristik PM= (umur, jenis kelamin, pendidikan, pekerjaan, dan hubungan keluarga* dengan kepatuhan berobat pasien "B Paru. Sema Semaki kin n ting tinggi gi pend pendid idik ikan an PM= PM= maka maka semak semakin in ting tinggi gi pula pula ting tingka katt pengetahuannya, sehingga se?ara tidak langsung mempengaruhi pelaksanaan
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berpendidikan tinggi dan orang berpendidikan rendahL - orang bekerja dan $ orang tidak tidak berkerjaL dan $ orang orang tinggal serumah serumah dengan dengan pasien dan - orang tidak tinggal serumah dengan dengan pasien. Sementara Sementara dilihat dilihat dari hubungan keluarga, keluarga, semua PM= merupakan keluarga dari pasien "B Paru. #pakah semua PM= yang terdapat terdapat di Puskesmas Puskesmas #ndalas #ndalas ini semuanya semuanya mempunyai mempunyai hubungan hubungan keluarga, keluarga, perlu dilakukan penelitian lebih lanjut untuk hal tersebut. &ari penjabaran di atas, menyatakan baha karakteristik PM= memiliki hubungan dengan pelaksanaan tugas PM= dan kepatuhan berobat pasien "B Paru. &ata dari &inas )esehatan )ota Padang mengungkapkan adanya keberhasilan
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3ntuk 3ntuk mengetahui mengetahui hubungan hubungan karakteristik karakteristik PM= dengan dengan pelaksanaan pelaksanaan tugas PM= dan kepatuhan berobat Pasien "B Paru di Puskesmas #ndalas )ota Padang. *)-)+ *)-)+ Tujuan K'usus K'usus 1* Mengetahui Mengetahui hubungan hubungan jenis kelamin kelamin PM= PM= dengan dengan pelaksan pelaksanaan aan tugas tugas PM=. 2* Menget Mengetahu ahuii hubung hubungan an umur umur PM= denga dengan n pelaksan pelaksanaan aan tugas tugas PM=. PM=. * Mengetahui Mengetahui hubungan hubungan pendidikan pendidikan PM= dengan dengan pelaksan pelaksanaan aan tugas tugas PM=. -* Mengetahui Mengetahui hubungan hubungan pekerjaan pekerjaan PM= PM= dengan dengan pelaksanaan pelaksanaan tugas PM=. * Menget Mengetahu ahuii hubung hubungan an antara antara hubung hubungan an keluarg keluargaa PM= dengan dengan pelaksa pelaksanaa naan n
$* *
tugas PM=. Mengetahui Mengetahui hubungan hubungan tempat tinggal tinggal PM= dengan dengan pelaksan pelaksanaan aan tugas tugas PM=. PM=. Mengetahui Mengetahui hubungan hubungan jenis kelamin kelamin PM= dengan dengan kepatuhan kepatuhan berobat berobat Pasien
"B Paru. !* Meng Mengeta etahu huii hubu hubung ngan an umur umur PM= PM= deng dengan an kepa kepatu tuha han n bero beroba batt Pasi Pasien en "B Paru.
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BAB + TIN2AUAN PUSTAKA +)* Tu Tu$erkul"sis $erkul"sis Paru +)*)* De
kuman kuman 'ycobacterium tuberculosis. tuberculosis. "uber "uberkul kulosi osiss paru paru merupa merupakan kan salah salah satu penyakit saluran pernapasan baah (#lsaga@@ Mukty, 200!*. "uberkulosis paru
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pulmonalis maka terjadi penjalaran ke seluruh bagian paru menjadi "B milier (Setiati dkk, 201-*. &ari sarang primer akan timbul peradangan saluran getah bening menuju hilus hilus (lim@an (lim@angit gitis is lokal* lokal*,, dan diikuti diikuti pembes pembesaran aran kelenj kelenjar ar getah getah bening bening hilus hilus (lim@ad (lim@adenit enitis is region regional*. al*. 5abung 5abungan an dari dari sarang sarang primer primer lim@an lim@angit gitis is lokal lokal dan
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sekund sekunder er terjad terjadii karena karena imunit imunitas as menuru menurun n sepert sepertii malnut malnutrisi risi,, alkoho alkoholism lisme, e, penyakit maligna, diabetes, Acquared Immune Deficiency Syndrome Syndrome (#%& (#%&S* S* , gagal gagal ginjal. ginjal. "uber "uberkul kulosi osiss pas?a pas?a primer primer ini dimula dimulaii dengan dengan sarang sarang dini dini yang yang berlokasi di regio atas paru (bagian apikal;posterior lobus superior atau in@erior*. Sarang dini ini mulanya berbentuk sarang pneumoni ke?il. &alam ;10 hari sarang
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Skema Skema perkem perkemban bangan gan sarang sarang tuberk tuberkulo ulosis sis post post primer primer dan perjala perjalanan nan penyembuhannya penyembuhannya dapat dilihat pada gambar 2.1.
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* "B anak yang terdiagnosis terdiagnosis dengan pemeriksaan pemeriksaan bakteriologis bakteriologis ()emenkes 4%, 201-*. atatan: Semua pasien yang memenuhi de@inisi tersebut diatas harus di?atat tanpa memandang apakah pengobatan "B sudah dimulai ataukah belum ()emenkes 4%, 201-*. b. Pasien "B terdiagnosis se?ara )linis adalah pasien yang tidak memenuhi
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BAB 0 PEMBAHASAN 0)* Analisis Analisis Uni#aria Uni#aria Daa Hasil Hasil Penelii Peneliian an 0)*)* 0)*)* Karaker Karakerisik isik PMO Berd Berdas asark arkan an hasi hasill pene peneli liti tian an dida didapa patk tkan an PM= PM= yang yang berje berjeni niss kelam kelamin in
perempuan lebih banyak dari laki;laki yaitu $2,A dengan mayoritas berumur D 1! tahun yang berjumlah orang (+-,$A*. Pada umumnya PM= di Puskesmas #ndala #ndalass )ota )ota Padang Padang berpen berpendid didika ikan n tinggi tinggi ($+,$A ($+,$A*. *. Sedang Sedangkan kan untuk untuk status status pekerjaan dari PM= lebih banyak yang bekerja (,-* daripada yang tidak bekerja (--,$*. Sebagian besar PM= juga merupakan keluarga dari pasien (+$,-A* dan tingggal serumah dengan pasien (+2,+A*. Peneli Penelitian tian yang yang dilaku dilakukan kan oleh oleh Sidy Sidy (2012* (2012* tentan tentang g analisi analisiss pengar pengaruh uh peran pengaas menelan obatdari anggota keluarga terhadap kepatuhan pengobatan
penderita
tuberkulosis
di
kota
pariaman
tahun
2010;2011
mendapatkan hasil yang berbeda dengan peneliti dalam hal pendidikan PM= dan status pekerjaan PM=, yaitu yaitu kebanyakan berpendidikan rendah dan tidak bekerja.
0)*)+ 0)*)+ Pelaksan Pelaksanaan aan Tu% Tu%as as PMO
Berdasarkan Berdasarkan hasil penelitian penelitian didapatkan didapatkan PM= Puskesmas #ndalas #ndalas )ota Padang melaksanakan tugas dengan baik, yaitu ,2A. Penelitian yang dilakukan Puri (2010* tentang hubungan kinerja pengaas menelan obat (PM=* dengan kesembuhan pasien "B Paru kasus baru strategi &="S juga mendapatkan hasil yang yang sama, sama, terd terdap apat at -A -A PM= PM= memi memili liki ki kine kinerja rja yang yang baik baik dan dan 2$A 2$A PM= PM= memiliki kinerja yang buruk. 8asil aan?ara didapatkan masih adanya PM= yang melaksanakan tugas
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tidak mengetahui tugasnya sebagai pengaas menelan obat, yaitu mengaasi dan memastikan memastikan pasien "B Paru patuh dalam pengobatan. pengobatan. Persentase Persentase jaaban jaaban paling rendah adalah pada pelaksanaan penyuluhan kepada anggota keluarga pasien "B Paru aru
yang ang
memp empuny unyai
geja gejala la;g ;geejala jala
men?u en?uri rig gakan akan
"B
untu untuk k
seg segera era
memerik memeriksak sakan an diri diri ke 3nit 3nit Pelay Pelayanan anan )eseha )esehatan tan,, yaitu yaitu sebesar sebesar !A pasien pasien menjaa menjaab b mendap mendapatk atkan an penyu penyuluh luhan, an, sement sementara ara -2A pasien pasien menja menjaab ab tidak tidak pernah mendapatkan penyuluhan. penyuluhan. 0)*)- Kepau'an Ber"$a Pasien TB Paru Paru
&ari hasil penelitian diketahui sebagian besar pasien "B Paru di Puskesmas #ndalas #ndalas )ota Padang patuh dalam dalam pengobatan, pengobatan, yaitu $+,$A $+,$A dan 0,-A pasien pasien tidak patuh dalam pengobatan. Penelitian yang dilakukan Sisanto dkk (201* tentang hubungan pengetahuan dan dukungan keluarga dengan kepatuhan minum obat anti tuber?ulosis di Puskesmas #ndalas )ota Padang dengan jumlah sampel 2$ orang orang mendaa mendaapatk patkan an hasil hasil yang yang sama, sama, terdapa terdapatt $+,2A $+,2A pasien pasien patuh patuh dalam dalam menelan obat anti tuber?ulosis dan 0,!A pasien tidak patuh dalam menelan obat anti tuberkulosis. &ari hasil aan?ara dengan pasien didapatkan persentase jaaban paling rendah adalah kepatuhan dalam menelan obat, yaitu $+,$A pasien patuh dalam menelan obat, ,1A pasien patuh sebagian dan 2,2A pasien tidak patuh dalam menelan obat.
0)+ Analisis Analisis Bi#aria Bi#aria Daa Hasil Hasil Penel Peneliia iian n 0)+)* 0)+)* Hu$u 2enis Kela&in Kela&in PMO PMO Den%an Den%an Pelaks Pelaks
n T %as PMO PMO
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8asil uji statistik hubungan jenis kelamin PM= dengan pelaksanaan tugas PM= didapatkan didapatkan nilai p-value nilai p-value R0,0 R0,0 (p G 0,$+*, berarti tidak terdapat hubungan yang bermakna antara jenis kelamin PM= dengan pelaksanaan tugas PM=. 8al ini bisa disebabkan karena sebagian besar PM= merupakan keluarga dari pasien. 8ubungan keluarga yang dekat akan menimbulkan rasa kepedulian yang lebih tinggi kepada seseorang. Sehingga dalam melaksanakan tugasnya sebagai PM= mereka akan lebih baik.
0)+)+ 0)+)+
Hu$un%an Hu$u n%an U&ur PMO Den%an Den%an Pelak Pelaksana sanaan an Tu Tu%as PMO
8asil 8asil uji statist statistik ik hubung hubungan an umur umur PM= dengan dengan pelaks pelaksana anaan an tugas tugas PM= didapatkan didapatkan nilai p-value R0,0 p-value R0,0 (p G 0,12*, berarti tidak terdapat hubungan yang bermakna antara umur PM= dengan pelaksanaan tugas PM=. 8asil penelitian ini sejalan dengan penelitian yang dilakukan idjanarko dkk (200$* tentang analisis @aktor;@ak @aktor;@aktor tor yang mempengaruhi mempengaruhi praktik praktik pengaas pengaas menelan menelan obat (PM=* dalam pengaasan penderita tuberkulosis paru di kota Semarang dengan nilai p-value R p-value R 0,0 (p G 1,000*. &ala &alam m pedo pedoma man n nasio nasiona nall pena penang ngan anan an tube tuberk rkul ulos osis is yang yang dike dikelu luar arka kan n )emenkes 4% (201-* tidak ada pembahasan mengenai batasan umur tertentu yang bisa menjadi PM=, yang terpenting PM= dapat melakukan pengaasan terhadap pasien dalam menelan obat dan menginatkan pasien untuk kontrol pengobatannya. pengobatannya. Mesk Meskip ipu un um umur ur me meru rupa paka kan n sal salah ah sat satu u @ak @akto torr ya yang ng da dapa patt me meng nggam gambar barka kan n kemata kem atanga ngan n sese seseora orang ng ,ba ,baik ik kem kematan atangan gan @isi @isik, k, psi psikis kis dan sos sosial ial,, ya yaitu itu umu umur r memp me mpen enga garu ruhi hi
baik ba ik
tida ti dakn kny ya
sese se seor oran ang g
pada pa da
pros pr oses es
bela be laja jarr
meng me ngaj ajar ar
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0)+)0)+)-
Hu$un%an Hu$u n%an Pen!i!ika Pen!i!ikan n PMO Den%an Den%an Pelaksa Pelaksanaan naan Tu%as PMO PMO
8asil 8asil uji statist statistik ik hubung hubungan an pendid pendidika ikan n PM= dengan dengan pelaks pelaksana anaan an tugas tugas PM= didapatkan didapatkan nilai p-value nilai p-value 0,0 0,0 (p G 0,001*, berarti terdapat hubungan yang erat antara pendidikan PM= dengan pelaksanaan tugas PM=. 8asil penelitian ini berbeda dengan penelitian yang dilakukan idjanarko dkk (200$* (200$* tentang analisis @aktor;@ak @aktor;@aktor tor yang mempengaruhi mempengaruhi praktik praktik pengaas pengaas menelan menelan obat (PM=* dalam pengaasan penderita tuberkulosis paru di kota Semarang dengan nilai p-value R p-value R 0,0 (p G 0,$*. Notoatmodjo (200* menyatakan baha semakin tinggi tingkat pendidikan seseora seseorang ng maka maka semaki semakin n tinggi tinggi juga juga tingka tingkatt penget pengetahu ahuann annya ya.. Siagia Siagian n (200-* (200-* menyatakan menyatakan baha semakin semakin tinggi tinggi pendidikan pendidikan seseorang maka semakin semakin besar keinginannya untuk meman@aatkan pengetahuan dan keterampilan yang dimiliki. &engan &engan demiki demikian, an, sebaik sebaikny nyaa dalam dalam memili memilih h PM= harus harus diperh diperhatik atikan an juga juga pendidikan terakhirnya. &ari penelitian ini disarankan pendidikan terakhir PM= sebaiknya minimal tamatan SM#, sehingga tugas seorang PM= dapat terlaksana dengan baik.
0)+)7 0)+)7
Hu$un%an Hu$u n%an Pekerjaa Pekerjaan n PMO Den%an Den%an Pelaksa Pelaksanaan naan Tu%as PMO PMO
8asil uji statistik hubungan pekerjaan PM= dengan pelaksanaan tugas PM= didapatkan didapatkan nilai p-value R0,0 p-value R0,0 (p G 0,1$2*, berarti tidak terdapat hubungan yang bermakna antara status pekerjaan PM= dengan pelaksanaan tugas PM=. 8asil penelitian ini sejalan dengan penelitian yang dilakukan idjanarko idjanarko dkk (200$* tentang analisis @aktor;@aktor yang mempengaruhi praktik pengaas menelan obat
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(PM=* dalam pengaasan penderita tuberkulosis paru di )ota Semarang dengan nilai p-value nilai p-value R R 0,0 (p G 0,$$*. Pengaasan dalam menelan obat bisa dilakukan dimana saja sesuai dengan kesepa kesepakat katan an pasien pasien dengan dengan PM=. PM=. 3ntuk 3ntuk beberap beberapaa pasien pasien,, PM= yang yang bekerja bekerja harus bisa melakukan melakukan inter'ensi jadal kontrol kontrol pengobatan pengobatan dan menelan menelan obat. Sebaliknya, PM= yang tidak bekerja dapat melakukan pengaas lebih leluasa karena memiliki aktu luang yang lebih banyak (3S &epartement oh 8ealth and Ser'i?es, Ser'i?es, 1+++*. 1+++*. Sehingga Sehingga tidak terdapat hubungan hubungan yang bermakna bermakna pelaksanaan pelaksanaan tugas PM= yang bekerja dengan yang tidak bekerja.
0)+) )+)8
Hu$ u$u un%a n%an
Kara arake keris risik ik
Hu$u Hu $un n%an %an
Keluar luar% %a
PMO
Den Den%an %an
Pelaksanaan Tu%as PMO
8asil uji statistik hubungan hubungan karakteristik hubungan hubungan keluarga keluarga PM= dengan pelaksanaan tugas PM= didapatkan nilai p-value nilai p-value R0,0 R0,0 (p G 0,12*, berarti tidak terdapat hubungan yang bermakna antara hubungan keluarga PM= dengan pasien terhadap pelaksanaan tugas PM=. Menuru Menurutt aplan aplan dalam dalam riedm riedman an (1++!* (1++!*,, keluar keluarga ga memilik memilikii beberap beberapaa @ungsi @ungsi dukung dukungan an yaitu yaitu dukung dukungan an in@orm in@ormasio asional nal berupa berupa in@orm in@ormasi asi yang yang dapat dapat meningkatkan sugesti pada indi'idu, dukungan penilaian berupa bimbingan pada penderita, dukungan instrumental berupa perhatian pertolongan pada penderita, dan dukungan emosional berupa perhatian pada penderita. &ukungan keluarga dalam penelitian ini adalah dengan menjalankan tugasnya sebagai PM= dengan baik. mendorong penderita agar patuh meminum obatnya, memberi dorongan
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berbedanya pelaksanaan tugas antara PM= yang memiliki hubungan keluarga dengan dengan pasien pasien dengan dengan PM= yang yang tidak tidak memili memiliki ki hubung hubungan an keluar keluarga ga dengan dengan pasien bisa disebabkan karena jumlah PM= yang tidak memiliki hubungan keluarga hanya dua orang, hal ini memperlihatkan proporsi yang tidak seimbang.
0)+)0 0)+)0
Hu$un%an Hu$u n%an Te Te&pa Tin%% Tin%%al al PMO Den%an Den%an Pelak Pelaksanaa sanaan n Tu% Tu%as as PMO
8asil uji statistik hubungan tempat tinggal PM= dengan pelaksanaan tugas PM= didapatkan didapatkan nilai p-value nilai p-value R0,0 R0,0 (p G 0,2!+*, berarti tidak terdapat hubungan yang yang bermak bermakna na antara antara tempat tempat tingga tinggall PM= dengan dengan pelaks pelaksana anaan an tugas tugas PM=. PM=. Peran PM= yang baik didukung oleh beberapa @aktor antara lain hubungan PM= dengan pasien dan kedekatan PM= dengan pasien yang sebagian besar merupakan keluarga pasien. &idukung oleh kedekatan hubungan pasien dengan PM= dan sebagian besar PM= tinggal serumah dapat meningkatkan peran PM= terhadap kesembuhan pasien (irdaus, 2012*.
0)+): 0)+):
Hu$un% Hu$ un%an an 2enis 2enis Kela&in Kela&in PMO Den%an Den%an Kepa Kepau'a u'an n Ber"$a Ber"$a Pasie Pasien n TB Paru
8asil uji statistik statistik hubungan hubungan jenis kelamin kelamin PM= dengan kepatuhan berobat pasien "B Paru didapatkan nilai p-value R0,0 p-value R0,0 (p G 0,2+*, berarti tidak terdapat
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8asil uji statistik statistik hubungan hubungan umur PM= dengan kepatuhan kepatuhan berobat berobat pasien "B Paru didapa didapatka tkan n nilai nilai p-value 0,0 p-value 0,0 (p G 0,02*, berarti terdapat hubungan yang bermakna antara umur PM= dengan kepatuhan berobat pasien "B Paru. 8asil 8asil peneli penelitian tian ini sejalan sejalan dengan dengan peneli penelitian tian yang yang dilaku dilakukan kan 4ohman 4ohmanaa dkk (201-* (201-* tentang tentang @aktor;@akt @aktor;@aktor or pada PM= yang berhubungan berhubungan dengan dengan kepatuhan kepatuhan berobat penderita "B Paru di )ota irebon dengan nilai p;'alue R 0,0 (p G 1,00*. Menu Menuru rutt Bart Bart (1++ (1++-* -*,, di #meri merika ka Serik Serikat at oran orang g yang ang beru berusia sia dea deasa sa ?enderung mengikuti anjuran dokter. 8al ini didukung oleh Mar yota yang di kutip 7liska 7liska (200*, (200*, baha orang yang berusia berusia tua, lebih memiliki memiliki tanggungja tanggungjaab, ab, lebi lebih h tert tertib ib,, lebi lebih h teli teliti, ti, lebi lebih h berm bermor oral, al, dan dan lebi lebih h berb berbak akti ti dari dari usia usia muda muda.. Menurut Maulana (200+* ?iri orang deasa ditunjukkan oleh kemampuan se?ara @isik, mental, moral, sosial, dan emosional.
0)+)9 0)+)9
Hu$un% Hu$ un%an an Pen!i! Pen!i!ika ikan n PMO Den%an Den%an Kepau' Kepau'an an Ber"$ Ber"$a a Pasien Pasien TB Paru
8asil uji statistik statistik hubungan hubungan pendidikan pendidikan PM= dengan kepatuhan kepatuhan berobat pasien "B Paru didapatkan nilai p-value 0,0 0,0 (p G 0,002* 0,002*,, berart berartii terdapa terdapatt hubungan yang erat antara pendidikan PM= dengan kepatuhan berobat pasien "B
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kemampuan untuk berperilaku sesuai harapan. Pendidikan dapat dikatakan juga sebagai pendeasaan diri (Maulana, 200+*. &engan demikian, sebaiknya dalam memilih PM= harus diperhatikan juga pendidikan terakhirnya. &ari penelitian ini disarankan pendidikan terakhir PM= sebaiknya minimal tamatan SM#, sehingga tugas seorang PM= dapat terlaksana dengan baik dan kepatuhan berobat pasien juga teraasi dengan baik
0)+)*, 0)+)*, Hu$ Hu$un% un%an an Peker Pekerjaa jaan n PMO PMO Den%a Den%an n Kep Kepa au'a u'an n Ber Ber"$ "$a a Pasien Pasien TB Paru
8asil uji statistik hubungan pekerjaan PM= dengan keatuhan berobat pasien "B Paru Paru dida didapa patk tkan an nila nilaii p-value R0,0 R0,0 (p G 0,-1 0,-10* 0*,, bera berart rtii tida tidak k terd terdap apat at hubungan yang bermakna antara status pekerjaan PM= dengan kepatuhan berobat pasien "B Paru. Penelitian ini sejalan dengan penelitian yang dilakukan Sidy (2012* (2012* tentang analisis analisis pengaruh peran peran pengaas pengaas menelan obat obat dari anggota anggota keluarga terhadap kepatuhan pengobatan penderita tuberkulosis di kota Pariaman tahun 2010;2011 mendapatkan nilai p-value nilai p-value R R 0,0 (p G 0,1+*. Menurut #ndersen dalam %'anti (2010*, salah satu @aktor struktur sosial adala adalah h peke pekerja rjaan an.. Peke Pekerj rjaa aan n akan akan memp mempen enga garu ruhi hi pema peman@ n@aat aatan an pela pelahay hayan an keseha kesehatan tan.. Pekerja Pekerjaan an dapat dapat men?erm men?ermink inkan an sedikit sedikit banya banyakny knyaa in@orm in@ormasi asi yang yang
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kepatuhan berobat pasien "B akan lebih banyak bagi PM= yang tidak bekerja dibandingkan PM= yang bekerja. &alam penelitian ini antara PM= yang bekerja maupun tidak bekerja sama;sama melaksanakan tugas PM= dengan baik lebih banyak daripada yang tidak baik.
0)+) 0)+)* ** Hu Hu$u $un% n%an an Kara Karak ker eris isi ik k Hu Hu$u $un% n%an an Ke Kelu luar ar%a %a PMO PMO Ke Kepa pau u'a 'an n Ber"$a Pasien TB Paru
8asil 8asil uji uji stati statisti stik k hubu hubung ngan an karak karakte teris risti tik k hubu hubung ngan an kelu keluar arga ga deng dengan an kepatuhan kepatuhan berobat berobat pasien "B Paru didapatkan didapatkan nilai p-value p-value R0,0 (p G 0,1+*, berarti tidak terdapat hubungan yang bermakna antara hubungan keluarga PM= dengan kepatuhan berobat pasien "B Paru. 8asil penelitian ini berbeda dengan penelitian yang dilakukan Sidy (2012* tentang analisis pengaruh peran pengaas menelan menelan obat dari anggota anggota keluarga keluarga terhadap terhadap kepatuhan kepatuhan pengobatan pengobatan penderita tuberkulosis di kota Pariaman tahun 2010;2011 mendapatkan nilai p-value p-value 0,0 (p G 0,000* 0,000*.. 8al ini menand menandaka akan n adany adanyaa hubung hubungan an bermak bermakna na antara antara tempat tempat tinggal PM= dengan kepatuhan pengobatan pasien "B Paru. &alam penelitian ini diketahui baha kebanyakan PM= merupakan suami atau istri dari pasien itu sendiri. Pengaas Menelan =bat yang memiliki hubungan keluarga merupakan salah satu bentuk dukungan keluarga dalam emosional yang
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0)+)*+ 0)+)*+ Hu$u Hu$un%an n%an Te Te&pa Tin%%al Tin%%al PMO Den%an Den%an Kepau'an Kepau'an Ber"$a Ber"$a Pasien Pasien TB Paru
8asil uji statistik hubungan tempat tinggal PM= dengan kepatuhan berobat pasien "B Paru didapatkan nilai p-value R0,0 p-value R0,0 (p G 0,12*, berarti tidak terdapat hubungan yang bermakna antara tempat tinggal PM= dengan kepatuhan berobat pasien "B Paru. 8asil penelitian ini berbeda dengan penelitian yang dilakukan Sidy (2012* tentang analisis pengaruh peran pengaas menelan obat dari anggota keluarga terhadap kepatuhan pengobatan penderita tuberkulosis di kota pariaman tahu tahun n 2010 2010;2 ;201 011 1 mend mendap apatk atkan an nila nilaii p-value 0,0 0,0 (p G 0,00,00-*. *. 8al ini menand menandaka akan n adany adanyaa hubung hubungan an bermak bermakna na antara antara tempat tempat tingga tinggall PM= dengan dengan kepatuhan pengobatan pasien "B Paru. Namun, kedua penelitian ini telah sesuai dengan kebijakan pemerintah tentang memilihan PM= "B yaitu bertempat tinggal tidak jauh dari pasien (PP"%, 2010 dan )emenkes 4%, 201-*.
0)+)*- Hu$un%an Pelaksanaan Pelaksanaan Tu% Tu%as as PMO Den%an Kepau'an Ber"$a Ber"$a Pasien TB Paru
8asil 8asil uji statisti statistik k hubung hubungan an pelaks pelaksana anaan an tugas tugas PM= dengan dengan kepatu kepatuhan han berobat pasien "B Paru didapatkan nilai p-value 0,0 0,0 (p G 0,000* 0,000*,, berarti berarti terdap terdapat at hubung hubungan an yang yang sangat sangat erat erat antara antara pelaks pelaksana anaan an tugas tugas PM= dengan dengan
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)epa )epatu tuha han n
dalam alam
minum inum
obat obat
adal adalah ah
kun? kun?ii
kesem esemb buhan uhan
pasi pasien en
tuberkulos tuberkulosis. is. &ire?tly &ire?tly =bser'ed =bser'ed "herapy "herapy Short;?ours Short;?oursee merupakan merupakan strategi strategi utama dalam pengendalian tuberkulosis di dunia yang telah direkomendasikan 8= sejak tahun 1++. Sentral dalam strategi ini adalah PM= yang mempunyai peran yang yang sang sangat at pent pentin ing g dala dalam m kepa kepatu tuha han n bero beroba batt pasie pasien n "B dan dan meru merupa paka kan n perpanjangan tangan dari petugas kesehatan yang bertanggung jaab terhadap kepatuhan pasien (6in et al, 2012L irdaus, 2012*. Pengaas menelan obat adalah seseorang yang membantu pasien "B untuk menjalani pengobatan dengan ?ara mengingatkan dan mengaasi untuk menelan obat dan memberi dorongan moril agar agar pasien pasien "B tidak tidak putus putus asa. Minum Minum obat selama $ bulan dapat dapat membuat membuat pasien merasa bosan dan setelah 2; mingu sudah merasa sehat jadi tidak mau meneruskan pengobatan sampai sembuh (PP"%, 2010*. Semakin baik peran PM= maka semakin tinggi keberhasilan pengobatan "B Paru (irdaus, 2012*. #pabila PM= tidak menjalankan tugas;tugasnya dengan
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BAB : KESIMPULAN DAN SARAN :)* Kesi&p Kesi&pula ulan n
Berdasarkan Berdasarkan tujuan dan hasil penelitian penelitian mengenai mengenai hubungan hubungan karakteristik karakteristik PM= dengan pelaksanaan tugas PM= dan kepatuhan berobat pasien "B Paru di Puskesmas )ota Padang, maka dapat ditarik kesimpulan sebagai berikut: 1. "idak "idak terdapa terdapatt hubungan hubungan yang yang bermakna bermakna antara antara jenis kelamin kelamin PM= dengan dengan pelaksanaan tugas PM=. 2. "idak terd terdap apat at hubun ubunga gan n yang ang berm bermak akn na anta antara ra umur PM= den dengan gan pelaksanaan tugas PM=. . "erdap rdapat at hubun ubunga gan n yang ang berm ermakna akna anta antara ra pendi endid dikan ikan PM= deng dengan an pelaksanaan tugas PM=. -. "ida "idak k terd terdap apat at hubu hubung ngan an yang yang berm bermak akna na anta antara ra peke pekerja rjaan an PM= PM= deng dengan an pelaksanaan tugas PM=. . "ida "idak k terd terdap apat at hubu hubung ngan an yang berm bermak akna na anta antara ra hubu hubung ngan an kelu keluar arga ga PM= PM= dengan pelaksanaan tugas PM=. $. "idak "idak terdapa terdapatt hubung hubungan an yang bermakn bermaknaa antara antara tempat tempat tinggal tinggal PM= dengan dengan
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+. "erdapa "erdapatt hubungan hubungan yang yang bermakna bermakna antara pendidik pendidikan an PM= dengan dengan kepatuhan kepatuhan berobat pasien "B Paru di Puskesmas Puskesmas #ndalas )ota Padang. Padang. 10. "idak "idak terdap terdapat at hubung hubungan an yang yang bermak bermakna na antara antara pekerja pekerjaan an PM= dengan dengan kepatuhan berobat pasien "B Paru di Puskesmas #ndalas )ota Padang. 11. 11. "idak "idak terdapa terdapatt hubung hubungan an yang yang bermak bermakna na antara antara hubung hubungan an keluar keluarga ga PM= kepatuhan berobat pasien "B Paru di Puskesmas #ndalas )ota Padang. 12. "idak "idak terdapat hubungan hubungan yang bermakna bermakna antara tempat tinggal PM= dengan dengan kepatuhan berobat pasien "B Paru di Puskesmas #ndalas )ota Padang. 1. "idak "idak terdap terdapat at hubung hubungan an yang yang bermak bermakna na antara antara pelaks pelaksana anaan an tugas tugas PM= deng dengan an kepa kepatu tuha han n bero beroba batt pasie pasien n "B Paru Paru di Pusk Puskes esma mass #ndal ndalas as )ota )ota Padang.
:)+ :)+ Sara Saran n
Berdasarkan Berdasarkan dari penelitian penelitian yang telah dilakukan dilakukan di Puskesmas Puskesmas #ndalas #ndalas )ota Padang, maka peneliti menyarankan beberapa hal sebagai berikut: 1. Bagi Bagi puskes puskesmas, mas, perlu perlu menany menanyakan akan umur dan pendidik pendidikan an terakhir terakhir seseora seseorang ng
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DAFTAR PUSTAKA
#lsaga #lsaga@@ @@ 8 dan Mukty Mukty # (200!*. (200!*. &asar; &asar;das dasar ar ilmu ilmu penya penyakit kit paru. paru. Surab Surabay ayaa : #irlangga 3ni'ersity Press. Bart S (1++-*. Psikologi kesehatan. /akarta: P". 5rasindo. &ei 73 dan )umalasari E (201*. Pengaruh pengaas menelan obat (PM=* terh terhad adap ap kepa kepatu tuha han n minu minum m obat obat pada pada pasi pasien en tube tuberk rkul ulos osis is ("B* ("B* di Puskesmas Puskesmas )edurus )edurus Surabaya. Surabaya. ejournal.ak ejournal.akperil perilliambo liambooth.a oth.a?.id. ?.id. &iunduh &iunduh 1 Maret 201$. &inas )esehatan )ota Padang (201-*. (201-*. Pro@il kesehatan kesehatan kota padang padang tahun 201. Padang. &inas )esehatan )ota Padang (201*. (201*. Pro@il kesehatan kesehatan kota padang padang tahun 201-. Padang. &jojodibroto &4 (200+*. 4espirologi (respiratory medi?ine*. /akarta : 75. 7dginton M7, Sekatane S, 5oldstein S/ (2002*. PatientsT belie@s: do they a@@e?t tuber?ulosis ?ontrolO a study in a rural distri?t o@ south a@ri?a. %nt / "uber? Eung &is $: 10Q10!2. 7liska (200*. Pengaruh karakteristik indi'idu, @aktor pelayanan kesehatan, dan peran pengaas menelan obat (PM=* terhadap kepatuhan berobat penderita "B Paru Paru di Puskes Puskesmas mas "elada "eladan n Medan Medan tahun tahun 200. 200. Medan, Medan, )M 3S3. 3S3. Skripsi.
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)ementrian )esehatan 4% (201*. %n@odatin tb. /akarta. /akarta. Maulana 8&/ (200+*. Promosi kesehatan. /akarta: 75. Morisky &7, 5reen E, E, Ee'ine &M (1+!$*. on?urrent and predi?ti'e 'alidity o@ a sel@;reported measure o@ medi?ation adheren?e. Med are, 2- : $Q-. Munro S#, Eein S, Smith 8/, 7ngel M7, retheim #, and Folmink / (200*. Pati Patien entt adhe adhere ren?e n?e to tube tuber?u r?ulo losi siss treatm treatmen ent: t: a syste systema mati? ti? re'ie re'ie o@ Cualitati'e resear?h. /ournal PMed, 10(11*. Notoatmodjo (200*. Pendidikan Pendidikan dan perilaku kesehatan. /akarta: 4ineka ipta. Notoatmodjo, S (2010*. Metodologi Metodologi penelitian kesehatan. /akarta :4inekaipta. Nurmadya (201-*. 8ubungan penerapan program &="S terhadap pengobatan tb paru di Puskesmas Padang Pasir tahun 2011;201. 2011;201. Padang, ) 3ni'ersitas #ndalas. Skripsi. P&P% P&P% (Perhi (Perhimp mpuna unan n &okter &okter Paru Paru %ndone %ndonesia sia** (2011 (2011*. *. "uber "uberkul kulosi osiss pedoma pedoman n diagnosis dan penatalaksanaan di indonesia. /akarta. PP"% (Perkumpu (Perkumpulan lan Pemberantas Pemberantas "uberku "uberkulosis losis %ndonesia* %ndonesia* (2010*. (2010*. Buku saku PP"%. /akarta. Prin?e Prin?e S# dan ilson EM. (201*. (201*. Pato@isiolog Pato@isiologii : konsep konsep klinis klinis proses;proses proses;proses penyakit 'olume 2 edisi $. /akarta : 75. Puri Puri N# (201 (2010* 0*.. 8ubu 8ubung ngan an kine kinerja rja peng penga aas as menel menelan an obat obat (PM=* (PM=* deng dengan an ke buha buha si "B Pa ka ba strate strategi gi &="S &="S Su kart kart )
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Sisan Sisanto to 1P, 1P, 6asirast sirastii dan 3sman 3sman 7 (201* (201*.. 8ubung 8ubungan an penget pengetahu ahuan an dan dukungan dukungan keluarga keluarga dengan dengan kepatuhan kepatuhan menelan obat anti tuber?ulosi tuber?ulosiss di Puskesmas #ndalas )ota Padang. /urnal / urnal )esehatan #ndalas, -(*. Sormin, Sormin, PP (201-*. 5ambaran peran serta petugas kesehatan kesehatan terhadap terhadap kepatuhan kepatuhan berobat penderita "B Paru di kelurahan 5ambir baru ke?amatan )isaran "imur tahun 201-. Medan, )M 3S3. Skripsi. "B are % and 3S#%& (201-*. %nternationa %nternationall standar standar @or tuber?ulosi tuber?ulosiss ?are rd ed. San ran?is?o. 3S &epartement o@ 8ealth and 8uman Ser'i?es (1+++*. Sel@;study modules on tuber?ulosis: patient adheren?e to tuber?ulosis treatment. 5eorgia. 33 4% No. "ahun 201- tentang Perubahan #tas 3ndang; 3ndang Nomor 2 "ahun "ahun 2002 "entang "entang Perlindungan #nak. #nak. Presiden 4%. /akarta. erdhani rdhani 4# (2002* (2002*.. Pato@i Pato@isio siolog logi, i, diagno diagnosis, sis, dan kla@isi kla@isikas kasii tuberk tuberkulo ulosis. sis. http:sta@@.ui.a?.idsystem@ilesusersretno.astimaterialpatodiagklas.pd@.
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LAMPIRAN La&piran * ; Le&$ar Perseujuan Menja!i Resp"n!en Peneliian Le&$ar Perseujuan Menja!i Resp"n!en Peneliian
Saya Saya Sri Mardla Mardlania niah h BP 12101 1210120! 20!2, 2, saya saya adalah adalah mahasis mahasisa a akult akultas as )edokt )edokteran eran 3ni'er 3ni'ersit sitas as #ndal #ndalas. as. Saat Saat ini saya saya sedang sedang melaku melakukan kan peneli penelitian tian deng dengan an judu judull <8ubu <8ubung ngan an )ara )arakt kter erist istik ik Peng Penga aas as Menel Menelan an =bat =bat deng dengan an Pelaksanaan "ugas Pengaas Menelan =bat dan )epatuhan Berobat Pasien "B Paru &i Puskesmas #ndalas )ota Padang>. penelitian ini merupakan salah satu kegi kegiat atan an dala dalam m meny menyel elesa esaik ikan an skrip skripsi si di aku akult ltas as )edo )edokt kter eran an 3ni' 3ni'er ersit sitas as
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La&piran + ; Kuisi"ner Peneliian KUESIONER PENELITIAN HUBUNGAN KARAKTERISTIK PENGAWAS MENELAN OBAT DENGAN PELAKSANAAN TUGAS PENGAWAS PENGAWAS MENELAN OBAT DAN KEPATUHAN KEPATUHAN BEROBAT PASIEN PASIEN TB PARU PARU DI PUSKESMAS ANDALAS KOTA P PADANG ADANG TAHUN TAHUN +,*0 +, *0 IDENTITAS RESPONDEN
Nomor 4esponden
:
Nama 4esponden
:
3mur
:
/enis )elamin
: 1. Eaki;laki
Pendidikan
:
1
"idak tam tamat S&
2. Perempuan
SMP
. #kad #kadem emi iPe Perg rgur urua uan n
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PELAKSANAAN TUGAS PMO
No
Pertanyaan
1.
#pakah PM= mengaasi Saudara dalam menelan obatO &alam setiap pengaasannya #pakah Saudara Saudara diberi diberi petunjuk petunjuk tentang tentang meminum meminum obat oleh PM=OV #pak #pakah ah PM= PM= per perna nah h men meneg egur ur Sau Sauda dara ra,, bil bilaa Saudara tidakmau atau lalai menelan obatOV #pak #pakah ah PM= PM= mem membe beri rika kan n dor doron onga gan n kep kepad adaa Saudara untuk 4utin BerobatO #pak #pakah ah PM= PM= meng mengin ing gatka atkan n Saud Saudara ara untu untuk k meng mengam ambi bill obat obat atau atau peme pemerik riksaa saan n ulan ulang g dahak pada aktu yang telah ditentukanO #pakah PM= memberi penyuluhan pada k l i "B
2.
. -. .
$.
6a
/aaban )adang; )adang
"idak
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+)
Kepau'an Menelan O$a &en%%unakan Morisky Medication Adherence Adherence Scale =MMAS>
No 1 2
-
Pertanyaan 6a #pakah and anda kada adang lupa untuk min minum ob obat anti tuberkulosis (=#"* andaO )ada adang ada ada alasan san lain kena enapa oran rang tidak minum minum minum obat anti tuberkulosis tuberkulosis (=#"*. (=#"*. oba diingat selam selamaa 2 ming minggu gu yang lalu lalu,, apak apakah ah ada ada hari hari;ha ;hari ri dima dimana na anda anda lupa lupa minu minum m obat obat anti anti tube tuberk rkul ulos osis is (=#"*O Pern ernahk ahkah anda anda men menghen ghenti tik kan atau atau tid tidak mem meminum inum obat obat anti anti tube tuberk rkul ulos osis is (=#" (=#"* anda anda kare karena na anda anda merasa tidak nyaman setelah menggunakannya tanpa memberitahukan dokterpetugas kesehatan andaO Saat beperg ergian ata atau meni eninggalkan rumah, apakah anda anda kad kadang ang lup lupa untu ntuk memb embaa aa obat bat anti anti
"idak
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La&piran - ; Maser Ta$el MASTER TABEL e*a$u+an beroba$
No Umu JK . r
1
2
3
44
25
82
Ka$e# "ama ori Peer!aa Pen#o Pen#o n dia ba$an n ba$an
Kara$eri%$i P&'
Pend i
P ida $ida beer!a $am a$ - " P
a/a(
P
Umu r
Pendi Peer dian !aan
,ubun# em*a em*a 1 an $ Ke(uar# in##a a (
20 in##i ida e(uar# %erum beer! a a+ a
2
2
3
4
5
6 o$a( Ka Ka$e# ori
e*a$u+an on$ro( *en#oba$an 1
2
3 o$a Ka$e#o ( ri
e*a$u+an mene(an oba$ 1
2
3
4
5
6
7
8
$o$ a( a$e#ori
2
2
2
2
2
12
ai
1
1
2
Pa$u+
0
0
0
0
0
0
0
0
a$e#o ri
0
Pa$u+ a$u+ Pa$u+ a$u+
ira%/a (an!u$ %$a an
" ida $ida beer!a $am a$
1
JK
Pe(a%anaan u#a% P&'
a/a(
1
1
P
"
26 in##i beer! e(uar# %erum a a a+
1
60 in##i ida e(uar# %erum beer! a a+ a
1
2 2
2
2
2
11
ai
1
1 1
3
Pa$u+
0
0
0
0
0
0
0
0
0 Pa$u+ a$u+ Pa$u+ a$u+
1
1
2
2
2
9
ai
1
1
1
3
Pa$u+
1
1
1
0
1
1
1
1
7
ida ida
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a 9
52
10 38
11 83
P ida $ida beer!a $am a$ -
(an!u$ an
1
"
54 enda beer! e(uar# %erum + a a a+
1
1
2
2
2
0
8
ai
1
1
1
3
Pa$u+
0
0
0
0
0
0
0
0
0
Pa$u+ a$u+ Pa$u+ a$u+
" -&P ira%/a a/a( %$a
1
" -&P ira%/a (an!u$ %$a an
1
P
P
36 enda ida e(uar# %erum + beer! a a+ a
1
64 enda beer! e(uar# %erum + a a a+
2
0
1
2 2
0
2
0
2
0
2
2
12
ida ai
0
ai
1
0
1 1
0
3
ida Pa$u+
1
Pa$u+
0
1
1
1
1
1
1
1
8 ida ida Pa$u+ Pa$u+
0
0
0
0
0
0
0
0 Pa$u+ a$u+ Pa$u+ a$u+
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12 27
13 70
14 36
15 84
16 54
17 47
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2
1
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