DAFTAR ISI HALAMAN PERSEMBAHAN .................................................................................. iii KATA PENGANTAR ................................................................................................. iv DAFTAR ISI............................................................................................................... vii DAFTAR GAMBAR .................................................................................................... x DAFTAR TABEL........................................................................................................ xi DAFTAR LAMPIRAN............................................................................................... xii ARTI SINGKATAN .................................................................................................. xiii INTI SARI.................................................................................................................. xiv BAB I ............................................................................................................................ 1 PENDAHULUAN ........................................................................................................ 1 A. LATAR BALAKANG ....................................................................................... 1 B. RUMUSAN MASALAH ................................................................................... 5 C. KEASLIAN PENELITIAN ............................................................................... 6 D. MANFAAT PENELITIAN................................................................................ 8 E. TUJUAN PENELITIAN.................................................................................... 8 BAB II........................................................................................................................... 9 TINJAUAN PUSTAKA ............................................................................................... 9 A. ASMA ................................................................................................................ 9 B. PENATALAKSANAAN ASMA .................................................................... 19 1.
Terapi Non Farmakologi .............................................................................. 20 vii
2.
Terapi Farmakologi ...................................................................................... 22
C. INTERVENSI FARMASI ............................................................................... 31 1.
KONSELING ............................................................................................... 31 a. Cara Pendekatan/Hubungan Antara Farmasis Dengan Pasien ................... 32 b. Proses Konseling ........................................................................................ 33 c. Alur Pelaksanaan Konseling....................................................................... 38
2.
EDUKASI .................................................................................................... 39
3.
INHALER .................................................................................................... 40
D. KONTROL ASMA .......................................................................................... 47 E. KUALITAS HIDUP ........................................................................................ 48 F.
KERANGKA TEORI ...................................................................................... 53
G. HIPOTESIS...................................................................................................... 55 BAB III ....................................................................................................................... 57 METODE PENELITIAN............................................................................................ 57 A. RANCANGAN PENELITIAN........................................................................ 57 B. VARIABEL PENELITIAN ............................................................................. 58 C. DEFINISI OPERASIONAL ............................................................................ 58 D. ALAT DAN BAHAN PENELITIAN.............................................................. 59 E. TEMPAT DAN WAKTU PENELITIAN........................................................ 61 F.
BESAR SAMPEL ............................................................................................ 61
G. JALANNYA PENELITIAN ............................................................................ 62 BAB IV ....................................................................................................................... 66 viii
HASIL DAN PEMBAHASAN................................................................................... 66 A. KARAKTERISTIK PASIEN........................................................................... 66 B. METODE KONSELING DALAM PENELITIAN ......................................... 71 C. PENILAIAN TERHADAP TINGKAT KONTROL ASMA........................... 76 D. KUALITAS HIDUP PASIEN ASMA ............................................................. 84 E. HUBUNGAN KONTROL ASMA DENGAN KUALITAS HIDUP .............. 90 F.
KETERBATASAN PENELITIAN.................................................................. 91
BAB V......................................................................................................................... 93 KESIMPULAN DAN SARAN................................................................................... 93 DAFTAR PUSTAKA ................................................................................................. 94
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DAFTAR GAMBAR Gambar 1. Bronkokonstriksi pada penderita Asma(ADAM, 2013) ........................... 10 Gambar 2. Interaksi Faktor Genetik dan Lingkungan pada Kejadian Asma(PDPI, 2004) ........................................................................................................................... 14 Gambar 3. Managemen Asma Pada Anak 12 Tahun - Dewasa(NAEPP, 2007)......... 28 Gambar 4. Klasifikasi Keparahan Asma Dan Inisiasi Terapi Pada Anak 12 Tahun – Dewasa(NAEPP, 2007)............................................................................................... 29 Gambar 5. Penilaian Kontrol Asma Pada Anak 12 Tahun - Dewasa (NAEPP, 2007)30 Gambar 6. Inhaler Dosis Terukur (Metered Dose Inhaler/ MDI) (Pope dan Stewart, 2013) ........................................................................................................................... 41 Gambar 7. Inhaler Serbuk Kering (Dry Powder Inhaler/ DPI)(Anonim, 2008)......... 42 Gambar 9. Turbuhaler (Anonim, 2014b)..................................................................... 44 Gambar 8. Nebulizer (Anonim, 2014a) ....................................................................... 45 Gambar 10. Kerangka Konsep Penelitian ................................................................... 56 Gambar 11. Skema Jalannya Penelitian ...................................................................... 65 Gambar 12. Perbandingan Skor ACT Sebelum dan Setelah Pemberian Intervensi pada Kelompok Kontrol di Poli Klinik Rawat Jalan RSUD Panembahan Senopati Bantul .......................................................................................................................... 81 Gambar 13. Perbandingan Skor ACT Sebelum dan Setelah Pemberian Intervensi pada Kelompok Konseling di Poli Klinik Rawat Jalan RSUD Panembahan Senopati Bantul .......................................................................................................................... 81
x
DAFTAR TABEL Tabel I. Keaslian penelitan............................................................................................ 6 Tabel II. Derajat Asma (NAEPP, 2007; PDPI, 2004)................................................. 18 Tabel III. Jenis obat pelega (reliever) dan pengontrol asma(Depkes RI, 2007) ......... 31 Tabel IV. Karakteristik Pasien Asma Rawat Jalan di Poli Klinik Penyakit Dalam RSUD Panembahan Senopati Bantul .......................................................................... 67 Tabel V. Lama Pasien Kembali ke Rumah Sakit Setelah Intervensi Oleh Farmasis .. 75 Tabel VI. Data Karakteristik antara Jenis Keparahan Asma dengan tingkat Kontrol Asma ........................................................................................................................... 77 Tabel VII. Terapi Pemeliharaan Asma yang Digunakan pada Pasien Asma Rawat Jalan di Poli Klinik RSUD Panembahan Senopati Bantul .......................................... 78 Tabel VIII. Skor Kontrol Asma Rata – Rata ACT antara Pretest dan Posttest Pada Tiap Kelompok............................................................................................................ 82 Tabel IX. Skor Perubahan Rata – Rata AQLQ antara Pretest dan Posttest Pada Kelompok Konseling dan Kelompok Kontrol ............................................................ 86 Tabel X. Skor Perubahan Rata – Rata AQLQ Pada Kelompok Konseling dan Kelompok Kontrol ...................................................................................................... 86 Tabel XI.Hubungan antara skor ACT dan skor AQLQ Pada Pasien Asma Persisten di RSUD .......................................................................................................................... 91
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DAFTAR LAMPIRAN Lampiran I. Surat Kelaikan Etik ................................................................................. 99 Lampiran II. Surat Izin Penelitian............................................................................. 100 Lampiran III. Surat Selesai Penelitian ...................................................................... 101 Lampiran IV. Karakteristik Pasien Kontrol .............................................................. 102 Lampiran V. Karakteristik Pasien Konseling............................................................ 106 Lampiran VI. Karakteristik Pasien Asma Persisten – Penyakit Komobid................ 110 Lampiran VII. Skor ACT Kontrol............................................................................. 111 Lampiran VIII. Skor ACT Konseling ....................................................................... 112 Lampiran IX. Skor AQLQ Kontrol Awal ................................................................. 113 Lampiran X. Skor AQLQ Kontrol Akhir.................................................................. 114 Lampiran XI. Skor AQLQ Konseling Awal ............................................................. 115 Lampiran XII. Skor AQLQ Konseling Akhir ........................................................... 116 Lampiran XIII. SPSS ................................................................................................ 117 Lampiran XIV. Kuesioner Kualitas Hidup Asma ..................................................... 132 Lampiran XV. Kuesioner Tes Kontrol Asma ........................................................... 133 Lampiran XVI. Surat Persetujuan ............................................................................. 134 Lampiran XVII. Lembar Pengumpulan data............................................................. 135 Lampiran XVIII. Data Riwayat Pasien Dan Pengobatan.......................................... 136 Lampiran XIX. Data Rekam Medis Pasien............................................................... 137 Lampiran XX. Buku Panduan Asma Pada Dewasa .................................................. 138
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