DAFTAR ISI KATA PENGANTAR................................................................................................. vi DAFTAR ISI............................................................................................................. viii DAFTAR GAMBAR.................................................................................................. x DAFTAR TABEL.................................................................................................,..... xi DAFTAR LAMPIRAN ........................................................................................... xiii INTISARI.................................................................................................................. xiv ABSTRACT.............................................................................................................. xv BAB I. PENDAHULUAN A. Latar Belakang Masalah.........................................................................1 B. Perumusan Masalah................................................................................4 C. Tujuan Penelitian....................................................................................4 D. Manfaat Penelitian..................................................................................4 BAB II. STUDI PUSTAKA....................................................................................5 A. Tinjauan Pustaka......................................................................................5 1. Skizofrenia........................................................................................5 a. Definisi gangguan skizofrenia....................................................5 b. Klasifikasi...................................................................................6 c. Epidemiologi...............................................................................7 d. Etiologi........................................................................................8 e. Patogenesis.................................................................................10 f. Manifestasi dan gambaran klinis................................................11 g. Diagnosis....................................................................................12 2. Tatalaksana terapi skizofrenia..........................................................13 a. Terapi farmakologi.....................................................................14 b. Terapi non-farmakologi..............................................................21 c. Masalah dalam pengobatan skizofrenia.....................................22 3. Farmakoekonomi..............................................................................26 a. Definisi farmakoekonomi...........................................................26 viii
b. Tujuan farmakoekonomi.............................................................27 c. Aplikasi farmakoekonomi...........................................................28 d. Metode farmakoekonomi............................................................28 4. Pengobatan Rasional.........................................................................32 BAB III. METODE PENELITIAN........................................................................34 A. Rancangan Penelitian.............................................................................34 B. Waktu dan Tempat Penelitian................................................................34 C. Populasi dan Sampel..............................................................................34 D. Definisi Operasional Variabel................................................................35 E. Pengumpulan Data..................................................................................36 F. Pengolahan dan Analisis Data.................................................................38 HASIL DAN PEMBAHASAN.......................................................................... .....43 A. Karakteristik Pasien.................................................................................43 B. Evaluasi Penggunaan Antipsikotik..........................................................51 C. Analisis Biaya..........................................................................................58 D. Keterbatasan Penelitian...........................................................................74 BAB V. KESIMPULAN DAN SARAN..................................................................75 A. Kesimpulan..............................................................................................75 B. Saran........................................................................................................76 DAFTAR PUSTAKA...............................................................................................77 LAMPIRAN..............................................................................................................80
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DAFTAR GAMBAR Halaman Gambar 1. Anatomi Otak ………………………...................................
11
Gambar 2. Algoritma tata laksana terapi skizofrenia.............................
18
Gambar 3. Skema penelitian..................................................................
42
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DAFTAR TABEL Halaman Tabel I.
Kriteria gangguan Skizofrenia berdasarkan Diagnostic and Statistical Manual of Mental Disorder edisi 4 (DSM-IV)……..............................12
Tabel II.
Dosis dan Nama Obat Antipsikotik ............................……............…....14
Tabel III.
Penggunaan Antipsikotik Secara Umum................................................15
Tabel IV.
Perbedaan Antipsikotik tipikal dan atipikal.........……..…….…………16
Tabel V.
Pemilihan Pengobatan pada Fase Akut Skizofrenia…………..…....…17
Tabel VI.
Efek samping relatif dari Antipsikotik……….……………………….23
Tabel VII.
Kontraindikasi dan Perhatian/Peringatan Antipsikotik............................24
Tabel VIII. Karakteristik demografi pasien skizofrenia di instalasi rawat inap Rumah Sakit Grhasia Periode Tahun 2008………………..…….…....44 Tabel IX.
Subtipe skizofrenia di instalasi rawat inap RS Grhasia Periode Tahun 2008….........................................................................49
Tabel X.
Lama tinggal Pasien skizofrenia di Instalsi Rawat Inap RS Grhasia Yogyakarta Periode Tahun 2008......................................50
Tabel XI.
Macam-macam obat antipsikotik yang diresepkan pada pasien Skizofrenia di Instalasi Rawat Inap RS Grhasia Yogyakarta Periode Tahun 2008..........................................................................................51
Tabel XII.
Ketepatan obat penggunaan antipsikotik di Instalasi Rawat Inap RS Grhasia Tahun 2008 berdasarkan APA Practice Guidelines...….........53
Tabel XIII.
Daftar ketidaktepatan dosis antipsikotik ……….................................55
Tabel XIV.
Biaya Antipsikotik Rata-rata Pasien Skizofrenia di Instalasi Rawat Inap di RS Grhasia Yogyakarta 2008....................………...................59
Tabel XV.
Biaya Rata-rata dan Biaya Total untuk Tiap Kombinasi Antipsikotik Pasien Skizofrenia di Instalasi Rawat Inap di RS Grhasia Yogyakarta Periode Tahun 2008.............................................................................60
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Tabel XVI.
Biaya Obat Non-Antipsikotik Rata-rata Pasien Skizofrenia di Instalasi Rawat Inap RS Grhasia Yogyakarta Periode Tahun 2008...……........62
Tabel XVII.
Biaya Rawat Inap Rata-rata Pasien Skizofrenia di Instalasi Rawat Inap RS Grhasia Yogyakarta 2008…...........................................................64
Tabel XVIII. Biaya Penunjang Rata-rata Pasien di Instalasi Rawat Inap Skizofrenia RS Grhasia Yogyakarta 2008...............................................................66 Tabel XIX.
Biaya Total Rata-rata Pasien Skizofrenia Berdasarkan Kelas Perawatan di Instalasi Rawat Inap RS Grhasia Tahun 2008…….........................68
Tabel XX.
Biaya Total Rata-rata Pasien Skizofrenia Per Hari Berdasarkan Kelas Perawatan di Instalasi Rawat Inap RS Grhasia Tahun 2008.…...........70
Tabel XXI.
Biaya Total Rata-rata pada Pasien Skizofrenia Berdasarkan Kriteria Jenis Pasien di Instalasi Rawat Inap RS Grhasia Yoyakarta Periode Tahun 2008…...…….................................................................……..71
Tabel XXII.
Biaya Total Rata-rata pada Pasien Skizofrenia Berdasarkan Kriteria Jenis Pasien di Instalasi Rawat Inap RS Grhasia Yoyakarta Periode Tahun 2008….....................................................................….............72
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DAFTAR LAMPIRAN Lampiran 1.
Data demografi dan biaya terapi langsung pasien Skizofrenia di Instalasi Rawat Inap RS Grhasia Yogyakarta Periode Tahun 2008....………….............................................................
81
Lampiran 2.
Daftar biaya di RS Grhasia.......................................................... 107
Lampiran 3.
Surat keterangan selesai penelitian dari RS Grhasia Yogyakarta …...................................…………........….. 108
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