Self Management Pasien Diabetes Melitus dengan Komplikasi Kardiovaskular dan Implikasinya terhadap Indikator Klinik

Abstract

ABSTRAKPenyakit kardiovaskular merupakan salah satu komplikasi utama diabetes melitus (DM) dan berisiko memperburuk prognosis, kualitas hidup serta meningkatkan risiko kematian. Self-management merupakan kunci utama dalam pengelolaan penyakit maupun pencegahan komplikasi dan dampak negatif yang diakibatkanya. Penelitian deskriptif ini bertujuan untuk mengidentifikasi self-management pada pasien DM dengan komplikasi kardiovaskular beserta dampaknya terhadap indikator klinik. Seluruh pasien (123 orang) diabetes mellitus yang didiagnosa menderita penyakit kardiovaskular (hipertensi, dislipidemia, dan/atau coronary artery diseases) dilibatkan dari unit rawat jalan salah satu rumah sakit swasta di Kota Bandung, Jawa Barat secara total sampling. Data self-management dikumpulkan menggunakan kuesioner yang dikembangkan oleh peneliti yang mencakup 6 domain (pemantauan, aktivitas fisik, pencegahan komplikasi, diet, pengobatan, dan merokok) dan mencakup 28 item pernyataan dengan skor Alpha Chronbach 0,738 dan validitas (r 0,377-0,760). Adapun data tentang indikator klinik dikumpulkan berdasarkan data sekunder dari rekam medik yang mencakup tekanan darah, kadar gula darah sewaktu, dan kadar kolesterol. Data yang terkumpul dianalisis menggunakan analisis deskriptif dan uji beda. Hasil penelitian menunjukkan lebih dari setengah responden (54,5%) berada pada kategori self-management rendah dimana domain pemantauan merupakan domain dengan persentase kategori rendah paling besar (62,6%). Rerata skor self-management yang lebih tinggi ditemukan pada pasien yang mencapai target indikator klinik; tekanan darah sistolik 140mmHg, kolesterol darah 200mg%, dan gula darah sewaktu 200mg%. Namun, perbedaan skor self-management yang signifikan hanya ditemukan pada indikator gula darah (p = 0,05). Hasil penelitian ini menunjukkan bahwa pasien DM dengan komplikasi kardiovaskular di tempat penelitian ini perlu meningkatkan perilaku self-management terutama dalam aspek pemantauan. Penting juga bagi pihak rumah sakit untuk mengintensifkan upaya yang sudah dijalankan guna memfasilitasi kebutuhan tersebut. ABSTRACTCardiovascular problem is one of the main diabetes mellitus complications that potentially worsen patients’ prognosis, quality of life as well as increase the patient mortality rate. Self-management in the other hand is a key success of diseases management and complication prevention. This descriptive study aimed to identify self-management of diabetic patients who diagnosed with cardiovascular diseases and its impact on clinical indicators. All 123 diabetic patients with cardiovascular diseases (hypertension, dyslipidaemia, dan coronary artery diseases) were involved in this study (total sampling) and recruited from an outpatient clinic of a private hospital in Bandung Municipality, West-Java. Data self-management were collected using questionnaire developed by the researcher covering 6 domains (monitoring, Physical exercise, complication management and prevention, diet, medication and smoking) consisted of 28 items with Alpha Chronbach 0,738 and inter-item correlation r 0.377 - 0.760. Data regarding clinical indicators were secondarily collected from patients’ medical record including current blood pressure, blood sugar level and cholesterol level. Collected data were analysed descriptively and comparatively with significance at p 0.05. The results suggested that more than half patients (54.5%) report low level of self-management where monitoring domain found as the domain with the biggest percentage of low self-management category (62.6%). In addition, respondents with higher mean score of self-management was found in patient who achieved the clinical outcomes; blood pressure 140mmHg, cholesterol 200mg%, and blood glucose 200mg%. However, statistically significant finding only identified in blood glucose indicator (p = 0.05). These results indicated that diabetic patients with cardiovascular problem in this setting need program or strategy to improve their capability in performing self-management particularly in the monitoring aspect. It also is significance for hospital to address those issues.

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