Analysis of the Use of Rational Drugs on the Most Treated Diseases in One of Hospitals in Bandung City

An approved drug is a drug that meets indicators with rational drug use criteria. Identification of DDD values for medical records and prescriptions of outpatients and inpatients using WHO-determined methods. Analysis of rational drug use in a hospital in Bandung using diabetes drugs are Acarbose, Glibenclamide, Glimepirid, Metformin, and Pioglitazon. The use of hypertension drugs are amlodipine, lisinopril, candesartan, bisoprolol, irbesartan, furosemide, hydroclorothiazide, and ramipril. The use of typhoid drugs is chloramphenicol, amoxicillin, cefixime, and levofloxacin. Based on the right criteria the number of rational percentages is 63.43%, the right criteria correspond to the proportion of 95.91%, the right criteria according to the results are 63.43%, and the right criteria based on the results are 46.45%.

of drug use can be easily compared using the DDD method by accessing the website https://www.whocc.no/atc_ddd_index/.
The data used are patient prescription data and medical record data stored at the "X" Hospital in Bandung City for the period of January-March 2020. The prescription data used are patient prescription data and medical record data for the three diseases that are mostly handled at Hospital "X" in the city of Bandung. The population in this study were all patient medical record data and all drug prescribing data obtained in the three most frequently treated diseases, both outpatient and inpatient treatment at the "X" Hospital in Bandung City with a total of 309 patients, based on criteria inclusion: (a) Patients who have complete medical record data and undergo inpatient and outpatient treatment. (b) Medical record data that has complete data including: Patient's data (name, age, gender), drug bio (dosage, drug stock, drug name), and International Statistical Classification of Diseases (ICD). (c) Patients aged ≥ 18 years. (d) Patients suffering from three diseases are mostly treated at the "X" Hospital in Bandung City. Meanwhile, the exclusion criteria in this study were medical record data that did not include the inclusion criteria. Based on these calculations the sample to be analyzed in this study amounted to 175 patients.

Result and Discussion Most Diseases Treated by "X" Hospital
A total of 1,757 inpatients and outpatients at the Bandung City "X" Hospital in January-March 2020. Patients who met the inclusion criteria were patients with complete medical record data; includes the patient's name, age (≥18 years), gender, patients including those suffering the most diseases in the Bandung City "X" Hospital, drug dosage, drug names and the International Statistical Classification of Diseases (ICD). From 1,757 patients, 309 patients were selected as a population who met the inclusion criteria. Of these 309 patients, 175 patients were taken to be analyzed based on the Slovin formula. Table 1. Data Description of Most Diseases in January-March 2020 at "X" Hospital Bandung City Based on a sample count of 175 patients; then obtained data: Diabetes mellitus patients = 81 patients, Hypertensionpatients = 55 patients, and Typhoid patients = 39 patients.
The prevalence of diabetes mellitus in Indonesia increased by 1.6% from 2013. In 2013, people with diabetes mellitus at the age of ≥ 15 years amounted to 6.9%, while in 2018 it was 8.5% (Riskesdas, 2018). WHO predicts an increase in the number of people with diabetes in Indonesia from 8.4 million in 2000 to around 21.3 million in 2030 (Soelistijo et al., 2015)?
The highest prevalence of hypertension in Indonesia by province is South Kalimantan at 44.1% and the lowest is Papua at 22.2% (Riskesdas, 2018).

Rational Use of Medicines
Measurement of rational drug use, using criteria set by the Ministry of Health. This measurement analyzes 4 criteria: (1) the right dose, (2) the right drug, (3) the right duration of the drug, and (4) the right diagnosis. In this study, prescription rationality was reviewed based on the criteria for the accuracy of the dose based on the DDD index guidelines. Typhoid, hypertension, and diabetes mellitus did not meet 100% of the appropriate dose criteria.

Diseases
Diabetes mellitus contained 0.57% incorrect dose and 45.71% correct dose. In the treatment of Diabetes Mellitus, drug dosage should consider the state of the functioning of the body's organs wherever possible; for example, the condition of the function of the kidney organs has decreased work function so that the administration of drug doses as therapy will have an effect (PERKENI, 2011).
Hypertension is a disease with the highest number of irrational prescribing, especially in the drug ramipril. In hypertension, there were 2 drugs in the wrong dose, including Lisinopril and Ramipril. For drug prescription, there were 4% incorrect dose and 27.42% correct dose, because the DDD dose per day was 10 mg, but there was 1 case who received DDD dose reaching 30 mg per day. Captopril uses more than other ACE inhibitors such as lisinopril and ramipril. The administration of an angiotensin-converting enzyme inhibitor (lisinopril) can further reduce arterial stiffness compared to a calisum canal blocker (amlodipine) in hypertensive patients who have never been treated before (Ayuthia, 2015). ISSN 2422-8419 An International Peer-reviewed Journal Vol.86, 2021 38 The fact shows that there are 0.57% typhoid diseases that are handled with the wrong dose and 18.85% are handled with the right dose. Chloramphenicol is still consumed and is one of the standard therapies for typhoid fever, but the drawbacks of chloramphenicol are high recurrence rates, high rates of carrier occurrence, and bone marrow toxicity (WHO, 2011).  In this study, the rationality of prescribing was reviewed based on the criteria for drug accuracy using the national guideline formulary, JNC (Joint National Committee VIII), and PERKENI.
The rationale for prescribing in terms of the accuracy of the drug for diabetes mellitus had met the exact criteria for the drug with the most monotherapy: metformin with a percentage of 8.85%, and combination with metformin + glimepirid with a percentage of 7.42%. Selection of the right drug can be weighed from the accuracy of the class of therapy and the type of drug according to the diagnosis. In addition, drugs must also be proven benefits and safety. The right drug in the type 2 diabetes mellitus therapy is a suitability in the selection of drugs from several types of drugs that have an indication of diabetes mellitus disease (PERKENI, 2011).
In hypertension, the drug has met the exact criteria with the most monotherapy is amlodipine with a percentage of 9.24%, and combination with candesartan + amlodipine with a percentage of 2.85%. A single antihypertensive drug is often not enough and other antihypertensive drugs are usually added gradually until hypertension can be controlled (POM, 2015). Clinical studies show that in patients at high risk of cardiovascular and kidney disease, the administration of ARB therapy with CCB is superior because it reduces metabolic side effects in patients with metabolic disorders (Mallat, 2012).
Meanwhile, typhoid did not yet fully fulfill the criteria for the right drug with the percentage of inappropriate drug being 2.85%. There are five patients who received treatment not using antibiotics that have been stipulated in Fornas. The five patients received the antibiotic levofloxacin. The route of administration of the antibiotic levofloxacin used in this study was mostly intravenous. Oral antibiotics should be the first choice for infection therapy (Permenkes, 2011). The more frequent taking medication per day (for example: 4 times a day), the lower the adherence to taking medication. Medicines that must be taken 3 times a day should mean that the drug must be taken at intervals of every 8 hours (Kemenkes, 2011). 12.57 Based on this study, the rationality of prescribing in terms of accuracy criteria for diabetes mellitus, hypertension, and typhoid did not meet the criteria for precise diagnosis. The percentage of all incorrect diagnoses was 47.42%, while the correct diagnosis was 46.85%. Drug use is called rational if it is given for a correct diagnosis. If the diagnosis is not made correctly, the choice of drug will be forced to refer to the wrong diagnosis. As a result, the drugs given will not match the indications they should be (Ministry of Health, 2011).

CONCLUSION AND SUGGESTION Conclusion
1. The use of drugs in diabetes mellitus is acarbose, glibenclamide, glimepirid, metformin, and pioglitazone.
In hypertension are amlodipine, lisinopril, candesartan, bisoprolol, irbesartan, furosemide, hydroclorothiazide, and ramipril. Typhoid is chloramphenicol, amoxicillin, cefixime, and levofloxacin. 2. Based on the results of the analysis regarding the rationality of drug use based on the 3R (Right dosage, Right drug, and Right diagnosis) in Bandung City "X" Hospital patients on January-March 2020, it can be concluded that the percentage of right dosage is 63.43%, the right drug is equal 95.91%, right diagnosis was 46.45%, and correct duration of drug was 63.43%.

Suggestion
Optimization of improving the quality of services on the rationality of drug use at the "X" Hospital in Bandung City needs to be reviewed on its suitability in terms of: the right dose, the right drug, the right diagnosis, and the duration of the drug with guidelines for rational drug use according to WHO or the Ministry of Health of the Republic of Indonesia.