EFEKTIVITAS PROGRAM MANAJEMEN SKIZOFRENIA STABIL BERBASIS STEPPED CARE MODEL DI LAYANAN PRIMER TERHADAP KEPATUHAN ANTIPSIKOTIK DAN PENCEGAHAN RELAPS : A Systematic Review of Randomized Controlled Trials and Primary Studies
Keywords:
skizofrenia, stepped care model, kepatuhan antipsikotik, pencegahan relaps, long-acting injectableAbstract
Pendahuluan: Skizofrenia merupakan gangguan psikiatri berat dengan prevalensi global 0,32% dan tingkat ketidakpatuhan antipsikotik 30-70% yang berkontribusi pada tingginya angka relaps. Stepped care model (SCM) menawarkan kerangka layanan bertingkat yang mengintegrasikan manajemen pasien skizofrenia stabil di fasilitas kesehatan primer. Penelitian ini bertujuan mengevaluasi efektivitas program manajemen skizofrenia stabil berbasis SCM di layanan primer terhadap kepatuhan antipsikotik dan pencegahan relaps. Metode: Systematic review mengikuti pedoman PRISMA 2020. Kriteria inklusi mencakup RCT, cohort study, case-control, dan cross-sectional study pada pasien skizofrenia fase stabil. Penilaian risiko bias menggunakan Cochrane RoB 2.0 dan Newcastle-Ottawa Scale. Hasil: Dari 1.847 artikel, 18 studi memenuhi kriteria inklusi (7 RCT, 8 cohort, 2 cross-sectional, 1 case-control) dengan total 261.892 partisipan. Kepatuhan antipsikotik meningkat 11-27% pada kelompok intervensi SCM. Long-acting injectable (LAI) antipsikotik menunjukkan superioritas dalam pencegahan relaps (HR 0,46-0,79) dan penurunan rehospitalisasi 20-49%. Intervensi digital dan dukungan tenaga kesehatan komunitas meningkatkan kepatuhan secara signifikan (AMD 0,11; 95% CI 0,04-0,19; p=0,004). Psikoedukasi digital berbasis narasi meningkatkan kepatuhan (MD 1,27; 95% CI 0,30-2,24; p=0,02) dan sikap terhadap medikasi (MD 3,41; 95% CI 1,18-5,65; p=0,002). Diskusi: Bukti secara konsisten mendukung superioritas pendekatan SCM terintegrasi yang menggabungkan LAI antipsikotik, pemantauan digital, dukungan tenaga komunitas, dan psikoedukasi dibandingkan perawatan konvensional. Konteks layanan primer di negara berpenghasilan rendah-menengah menunjukkan intervensi berbasis komunitas dapat mengadaptasi pendekatan ini secara efektif. Kesimpulan: Program manajemen skizofrenia stabil berbasis SCM di layanan primer terbukti efektif meningkatkan kepatuhan antipsikotik dan mencegah relaps. Implementasi di Puskesmas Indonesia memerlukan adaptasi kontekstual, pelatihan tenaga kesehatan primer, dan sistem pemantauan terstandar.References
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