Rahmawati, Fita
Department Of Pharmacology And Clinical Pharmacy, Faculty Of Pharmacy, Universitas Gadjah Mada, Sekip Utara, Yogyakarta, Indonesia 55281

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Hubungan Penggunaan Obat Psikoaktif dengan Risiko Jatuh pada Pasien Geriatri di Klinik Penyakit Dalam Rumah Sakit di Madiun Lily Annisa; I Dewa P. Pramantara; Arianti Arianti; Fita Rahmawati
Indonesian Journal of Clinical Pharmacy Vol 8, No 3 (2019)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (288.576 KB) | DOI: 10.15416/ijcp.2019.8.3.217

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Jatuh merupakan salah satu masalah kesehatan serius pada pasien lanjut usia (lansia). Risiko jatuh dapat disebabkan oleh beberapa faktor, salah satunya adalah penggunaan obat psikoaktif yang masuk ke dalam golongan Medication Fall Risk (MFR). Penelitian ini bertujuan untuk mengidentifikasi hubungan penggunaan obat psikoaktif dan karakteristiknya (dosis dan durasi penggunaan obat) terhadap risiko jatuh pada pasien lansia. Penelitian ini dilakukan secara observasional dengan pendekatan cross-sectional. Lokasi penelitian adalah Klinik Penyakit Dalam di dua Rumah Sakit di Kota Madiun (RSUD dr. Soedono Madiun dan RSUD Kota Madiun) pada bulan Oktober sampai Desember 2018. Risiko jatuh diukur menggunakan Time Up and Go (TUG) test. Penelitian diikuti oleh 290 pasien yang terbagi menjadi dua kelompok, yaitu kelompok risiko jatuh rendah (TUG ≤14) sejumlah 231 pasien dan kelompok risiko jatuh tinggi (TUG>14) sejumlah 59 pasien. Hasil penelitan ini menunjukkan adanya hubungan penggunaan obat psikoaktif dengan peningkatan risiko jatuh (adjusted OR 2,158 95% CI 1,176–3,961). Hasil adjusted multivariat menunjukkan dosis 0,1–0,5 DDD/hari atau lebih berhubungan dengan peningkatan risiko jatuh. Dosis obat >0,5 DDD/hari memiliki hubungan yang paling kuat dengan risiko jatuh (adjusted OR 4,463 95% CI 1,120–17,784). Perlu dipertimbangkan risiko dan keuntungan dalam pemberian obat psikoaktif pada pasien lansia. Pemberian dosis efektif seminimal mungkin perlu dipertimbangkan apabila pemberian obat psikoaktif diperlukan.Kata kunci: Lanjut usia, psikoaktif, time up and go test Association between Psychoactive Drug Use and Fall Risk in Elderly Patients at Internal Medicine Clinic of Madiun HospitalsAbstractFalling is one of serious health problems in elderly patients. The risk of falling can be caused by several factors, one of which is the use of psychoactive drugs that included in the Medication Fall Risk (MFR) class. This study was conducted to identify the relationship between psychoactive drug use and its characteristics (doses and duration of drug use) to the risk of falling in elderly patients. This study was conducted in an observational manner using a cross-sectional approach. This study took place at internal medicine clinic of two hospitals in the city of Madiun (Dr. Soedono Hospital Madiun and Regional Public Hospital of Madiun) from October to December 2018. Fall risk was measured using Timed Up and Go (TUG) test. A total of 290 patients was divided into two groups, namely low-risk group (TUG ≤14, 231 patients) and high-risk group (TUG >14, 59 patients). Results of this study indicated a correlation between the use of psychoactive drugs and an increased fall risks (adjusted OR 2.158 95% CI 1.176–3.961). Adjusted multivariate results showed doses of 0.1–0.5 DDD/day or more was associated with an increased fall risks. Drug doses of >0.5 DDD/day had the strongest relationship with fall risks (adjusted OR 4.463 95% CI 1.120–17.784). It is necessary to consider the risks and benefits of giving psychoactive drugs to elderly patients. Giving a minimum effective dose should be considered if the administration of psychoactive drugs is needed.Keywords: Elderly, psychoactive, time up and go test
Inovasi Home Care Apoteker melalui Supervisi Penggunaan Obat Geriatri untuk Meningkatkan Kepatuhan Terapi Penyakit Kronis Yuhansyah Nurfauzi; Djoko Wahyono; Fita Rahmawati; Nanang M. Yasin
Indonesian Journal of Clinical Pharmacy Vol 9, No 2 (2020)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15416/ijcp.2020.9.2.147

Abstract

Pelayanan kefarmasian di Indonesia saat ini bergeser mengikuti paradigma patient-oriented. Meningkatnya jumlah pasien lanjut usia (lansia) dengan penyakit kronis membuat apoteker perlu mengembangkan upaya edukatif dan kolaboratif berbasis komunitas seperti home care. Klien home care yang mendapatkan banyak obat untuk penyakit kronis dari dokter dan apotek sering mengalami Drug Related Problems (DRP) serta dianggap mendapatkan sedikit supervisi atau bahkan tidak mendapatkannya sama sekali di rumahnya. Tujuan artikel review ini adalah untuk membahas aktivitas supervisi apoteker pada pelayanan kefarmasian untuk pasien lansia dalam konteks home care yang dapat mengungkapkan dan meningkatkan kepatuhan terapi. Penelitian yang memenuhi kriteria inklusi diambil dari basis data jurnal Pubmed, Science Direct, dan Google Scholar. Hasil penelusuran pustaka dari 16 artikel menunjukkan bahwa aktivitas supervisi terhadap terapi obat merupakan elemen pelayanan kefarmasian home care. Supervisi penggunaan obat oleh apoteker kepada pasien lansia yang mengalami penyakit kronis terbukti dapat meningkatkan kepatuhan apabila dilaksanakan secara inovatif dalam konteks home care. Model pelayanan yang terintegrasi dan berbasis komunitas seperti pelayanan di klinik atau rawat jalan di rumah sakit memberikan kesempatan kepada apoteker untuk berkolaborasi dengan tenaga kesehatan lainnya dalam rangka meningkatkan kepatuhan. Aktivitas supervisi meliputi rekonsiliasi obat, identifikasi dan manajemen masalah terkait obat, monitoring beberapa parameter klinis, penyesuaian rejimen dan dosis terapi, edukasi serta koordinasi pelayanan dengan tenaga kesehatan lainnya. Supervisi terapi obat dalam home care terbukti mampu mengungkap lebih banyak DRP dan angka ketidakpatuhan sekaligus memberikan solusinya. Kepatuhan dapat ditingkatkan dengan upaya-upaya inovatif untuk mendesain perangkat pendukung yang sesuai dengan kebutuhan pasien dan memudahkan apoteker dalam mentransfer pelayanannya.Kata kunci: Apoteker, home care, kepatuhan, lanjut usia, penyakit kronis, supervisi Pharmacist Home Care Innovation through Supervision of Geriatric Drug Use to Improve Adherence with Chronic Disease Therapy AbstractThere is currently a shift in the pharmaceutical care provided in Indonesia towards the patient-oriented paradigm, alongside the increasing number of elderly with chronic diseases. Therefore, it is important to develop pharmacist activities towards drug therapy management, through community-based education and collaboration, including home care service. This provision by doctors and pharmacies to clients with drugs for chronic diseases often lead to Drug Related Problems (DRP), and are considered to encourage little or no supervision. The purpose of this review, therefore, is to discuss the pharmacist’s supervision activities for elderly patients, in the context of home care, relevant to identify and improve therapy adherence. Furthermore, studies evaluated to have met the inclusion criteria were collected from journal databases, including Pubmed, Science Direct and Google Scholar. A total of sixteen articles showed supervision activities on drug therapy to be the element of pharmaceutical home care services. Hence, improved levels have been implicated in increased adherence, following an innovative implementation in the context of home care. Moreover, integrated and community-based service models, comprising services in clinics or outpatients in hospitals provide opportunities for pharmacists to collaborate with other health workers, and consequently promote adherence. The possible supervision activities include medication reconciliation; DRP identification and management; clinical parameters monitoring; adjusting therapy regimens and doses; education; and coordination of services with other health workers. These approaches have been proven to increase the average DRP per patient, and the non-adherence rate while providing a solution. However, adherence is possibly enhanced by design tools appropriate to the individual needs, and capable of facilitating the transfer of pharmacists’ services.Keywords: Adherence, chronic disease, elderly, home care, pharmacist, supervision
Risk factors of adverse drug reactions of first-line antiretroviral therapy in HIV patients at RSUD Dr. Moewardi Ana Amalia; Fita Rahmawati
Pharmaciana Vol 10, No 2 (2020): Pharmaciana
Publisher : Universitas Ahmad Dahlan

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (422.064 KB) | DOI: 10.12928/pharmaciana.v10i2.15658

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Acquired Immuno Deficiency Syndrome (AIDS) is an infection caused by the Human Immunodeficiency Virus (HIV). The antiretrovirals (ARVs) combination is the basis for the management of therapy in HIV/AIDS patients, but it often raises problems like adverse drug reactions (ADRs). This study was conducted to determine the risk factors for the occurrence of ADRs in the use of first-line ARVs. It employed a cross-sectional design with retrospective data collection in patients visiting the Voluntary Cell Counting (VCT) room of RSUD Dr. Moewardi in November-December 2018. The data collected were sociodemographic, behavioral, and clinical characteristics, laboratory test results, and ARV profiles. Findings show that the risk factors for ADRs in the use of first-line ARVs are CD4 of <200 and 0-24 months of taking ARVs.
EVALUASI TERAPI ADJUVAN DAN KEJADIAN RELAPS PADA PASIEN PREMENOPAUSAL EARLY BREAST CANCER DI RSUP DR. SARDJITO YOGYAKARTA Fef Rukminingsih; Tri Murti Andayani; Fita Rahmawati; Kartika Widayati
JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Vol 7, No 1
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jmpf.364

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Terapi adjuvan pada pasien early breast cancer (EBC) bertujuan untuk meningkatkan disease free survival, menurunkan risiko relaps dan menurunkan angka kematian. Tetapi pada kenyataannya masih sering dijumpai, pasien EBC yang telah mendapat terapi adjuvan mengalami relaps. Kejadian relaps sering dihubungkan dengan meningkatnya risiko kematian tanpa memperhatikan jenis pengobatan. Tujuan penelitian ini adalah mengetahui angka kejadian relaps pada pasien premenopausal EBC yang telah mendapatkan terapi adjuvan di RSUP dr. Sardjito Yogyakarta. Penelitian ini merupakan penelitian deskriptif observasional dengan desain cross sectional study menggunakan data retrospektif yang diperoleh dari data rekam medik pasien premenopausal EBC di Poliklinik Kanker Terpadu “Tulip” RSUP dr. Sardjito Yogyakarta yang telah mengalami tindakan pembedahan pada tahun 2010-2013, bersifat hormon responsif dan HER-2 negatif, mendapatkan terapi adjuvan, perempuan dengan umur 18-60 tahun dan  riwayat pemeriksaan sampai bulan Desember 2016. Pasien akan di eksklusi bila mempunyai penyakit penyerta. Dari 30 pasien diketahui sebanyak 46,67% berumur 41-50 tahun, sebanyak 63,33% menunjukkan ekspresi ER-PR positif, sebanyak 93,34% merupakan invasive ductal carcinoma (IDC). Semua pasien mendapatkan terapi adjuvan kemoterapi menggunakan regimen kombinasi dan semua pasien mendapatkan terapi endokrin berupa tamoksifen. Relaps terjadi pada 11 pasien (36,67%) dan kejadian relaps paling banyak adalah metastasis tulang yaitu pada 8 pasien (26,67%).
COMPARISON THE REAL COST WITH INA-CBG’S PACKAGE TARIFF AND ANALYSIS ON THE FACTORS INFLUENCING THE REAL COST FOR THALASEMIA INPATIENTS USING JAMKESMAS IN RSUP Dr. SARDJITO YOGYAKARTA Aditya Maulana Perdana Putra; Fita Rahmawati; I Dewa Putu Pramantara
JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Vol 3, No 1
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jmpf.94

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In 2011, health insurance in patients with thalassemia major help families of patients because thalassemia treatment cost is quite high. In the implementation of INA-CBGs there are some problems, one of which is related to the payment in which difference occurs between tariff of INA-CBGs with real cost.The aim of this research was to find out the extent of the difference between the real tariff and the tariff of INA-CBGs, factors that influence real cost and the description of the appropriateness of therapy towards the Jamkesmas inpatients with Thalassaemia at Sardjito Hospital Yogyakarta.This was an analytical-observational research with of retrospective research design. The object of the research was the files of the inpatient claims and medical records of Jamkesmas patients with Thalassaemia in the period of April 2011 – March 2012 in Sardjito Hospital Yogyakarta. The data analysis was conducted with one sample test to compare between the rate of the real cost and the INACBG’s tariff. Meanwhile, the correlation test and the linear regression test were conducted to find out factors that influence the cost. The result of the research showed that a positive difference between the real cost and the tariff of INA-CBGs was IDR104.498.068 from 138 episodes of care. The average cost of healthcare for Thalassaemia based on the tariff of Sardjito Hospital at the severity level 1 was IDR1.058.823 + 591.923. The three most significant cost components included the blood bag, drugs or medical stuffs and accommodation/hospitalization cost. The result of the correlation test showed that the blood bag, drugs and medical stuffs, hospitalization/accommodation, clinical pathology examination and visite had a strong influence towards the real cost. Meanwhile, from the value of variable coefficients (B), it was known the order of variable that influence the real costs were visite, hospitalization/accommodation, blood bag, drugs and medical stuffs, and clinical pathology examination. From the analysis of the suitability of an indication, there were 5 drugs that are not consistent with the diagnosis of patients and one drug that was not appropriate for the patient.Keywords: INA-CBGs, Thalassaemia, cost, appropriateness of therapy
COMPARISON THE REAL COST WITH INA-CBG’S PACKAGE TARIFF AND ANALYSIS ON THE FACTORS INFLUENCING THE REAL COST FOR DIEBETES MELLITUS INPATIENTS USING JAMKESMAS IN RSUP Dr. SARDJITO YOGYAKARTA Ratih Pratiwi Sari; Fita Rahmawati; I Dewa Putu Pramantara
JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Vol 3, No 1
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jmpf.95

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The problem usually found in the Jamkesmas (Society Health Insurance) realization is the difference between the real cost and INA-CBGs package tariff for patients using Jamkesmas, especially in inpatient department. This study was to find out how much the margin between the real cost and the INA-CBG’s package tariff and the factors influence the real cost, and to know the suitability of drug indications in diabetes mellitus inpatients using Jamkesmas in RSUP Dr. Sardjito Yogyakarta. This study was analytical observation. The data were taken retrospectively from the Jamkesmas claim files and patients’ medical record. Subjects were patients with diabetes mellitus type 2.The research object included the claim files and the medical record of the diabetes mellitus patients using Jamkesmas in RSUP Dr. Sardjito Yogyakarta during period of July 2010 – May 2012 with the diagnosis code INA-CBGs E-4-10-I, E-4-10-II, and E-4-10-III. The data were analyzed descriptively. Moreover, One sample test statistical analysis was conducted to find the difference between the real cost and INA-CBGs tariff and the ifference between hospital LOS and INA-CBGs package LOS. In addition,bivariate correlation test and regression linier test were used to study the relation among the factors that affect the real cost. The result of the study showed that the difference between the real costand INA-CBGs package tariff of the diabetes mellitus Jamkesmas patients with the severity level I was Rp 5,325,126 in 2 episodes of cares; severity level II was Rp -22,411 in 10 episodes of care, and severity level III was Rp -3,038,240 in 12 episodes of care. The factors that affect the real cost of treatment of patients with the severity level II were cost of clinical pathology examination, blood, and drug/medical cost, while in patient with severity level III werethe cost of visite, service in dialysis department, clinical pathology examination and drug/medical cost. From the analysis between the used drug and indication, it was found that 22 episodes of care was appropriate with the diagnosis and 2 episodes of care was not fit with the diagnosis.Keywords: Jamkesmas, INA-CBG’s, diabetes mellitus, cost components, indication of suitability
The Anticholinergic Drug Effect on Decreasing Cognitive in Geriatric Patients at Kota Surakarta General Hospital Nurlena Ikawati; Fita Rahmawati
JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Vol 7, No 3
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jmpf.33257

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This leads the geriatric patients to receive multiple drugs regimen (polypharmacy) which include using anticholinergic drugs. Risk of anticholinergics drug use is associated with cognitive impairments that have been demonstrated in experimental and cohort studies. The objective of this study is to determine the profile of anticholinergic drug use and its impact on cognitive reduction in elderly patients at Outpatient Unit Department of Kota Surakarta General Hospital. This study used cohort design. Data were collected through patient medication records and direct interviews to measure the cognitive status of patients using a six-item cognitive impairment test questionnaire (6-CIT). This study divided the respondents into two group; 178 patients (50,6%) took anticholinergic agents, and 174 patients (49,4%) did not use the anticholinergic drugs. Data analysis used Chi-square comparative test and linear regression test with SPSS (Statistical Package for Social Science). The results showed 136 patients or 58,12% use level one anticholinergic drug. The most widely used anticholinergic are diazepam (13,9%) and furosemide (12,5%). The anticholinergic drugs were extensively used by patients who suffer circulatory system diseases as much as 171 (32,1%), followed by endocrine disease, nutrition and metabolic diseases were 83 (15,6%). The number between women and men who take anticholinergics is not significantly different, 91 (51.41%) for women. Whereas by age, the number of most anticholinergic prescribed for patients who are 60 to 74 years is 124 patients (69,66%). There was a significant correlation between anticholinergic drug use in decreasing cognitive function of the geriatric at Outpatient Unit Department of Kota Surakarta General Hospital (p <0,005) proven by r value 0.631.
Comparison of Treatment Outcomes among Second-Line Antiretroviral Regimens in HIV/AIDS Patient Winda Dwi Puspitasari; Nanang Munif Yasin; Fita Rahmawati
JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Vol 8, No 3
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (625.35 KB) | DOI: 10.22146/jmpf.36414

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Antiretroviral (ARV) therapy can increase life expectancy of people living with HIV/AIDS (PLWHA). If the therapy fails and causes severe toxicity to first-line ARV, the first-line ARV regimen is switched to the second line. Studies on the outcome of the second-line ARV therapy have not been widely conducted in Indonesia. This study aims to identify the comparison of outcomes of the second-line ARV therapy regimens in HIV/AIDS patients. The study employed retrospective cohort design. Medical record data were collected from patients treated from January 2008 until December 2017 at Dr. Kariadi Hospital of Semarang. The number of samples that met the inclusion criteria was 42 patients. The comparison between incidence of opportunistic infections and survival among the regimens was presented descriptively. The comparison of regimens based on changes in CD4 level was performed by using Kruskal-Wallis test. The switch occurred in 24 patients (57.14%) due to toxicity of the first-line ARV and in 18 patients (42.86%) due to treatment failure. Mean CD4 and viral load during the switches were 164.68 ± 204.98 cells/mm3, 154,726.14 ± 296,797.12 copies/ml respectively. After 6 months of the second-line ARV therapy, there was an increase in CD4 level (p 0.05) among the three regimens after 6 months of the second-line ARV therapy.
Potential Incompatibility Problem of Intravenous Drugs’ Administration among Intensive Care Unit (ICU) Patients at PKU Muhammadiyah Yogyakarta Hospital Ardhanarishwari Umi Salamah; Fita Rahmawati; Fivy Kurniawati
JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Vol 9, No 4
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jmpf.40930

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Drugs’ administration among hospitalized patients in ICU commonly is given intravenously. Mixing the intravenous drugs may result in incompatibility problem that might affect the drugs’ stability and bioavailability. The aim of the study was to investigate the potential incompatibility problem of  intravenous mixing drugs’ administration among ICU patients at PKU Muhammadiyah Yogyakarta Hospital. This study was a cross-sectional study in which design and data was obtained from ICU patients’ medical record retrospectively with purposive sampling in order to observe the pattern of intravenous drug’s combination. The potential incompatibility problem was analyzed using Handbook on Injectable Drugs. There were 79 out of 119 medical records which fulfilled sample inclusion criteria taken in this study. Parenteral dosage form was commonly used rather than non parenteral (62.06%) among ICUs’ patients. The potential incompatibility pattern consisted of incompatibility of intravenous drugs, electrolyte solutions/parenteral nutritions in mixture form, and the electrolyte solutions/parenteral nutritions, which are administrated simultaneously. Potential incompatibility of intravenous dosage was found in 50 events out of 79 patients (0.63 events per patients), which consisted of 8 events (8.51%) in using of drugs administrated simultaneously, 10 events (19.23%) in using of electrolyte solutions/parenteral nutritions in mixture form, and 32 events (11.72%) in using of electrolyte solutions/parenteral nutritions administrated simultaneously. Common potential incompatibilities types were precipitation of drugs and drug’s adsorption to packaging materials.
The Usage of Dosing GAMA Application to Evaluate the Appropriateness of Drug Doses in Hospitalized Patients with Renal Impairment Vidiya Gunarsih; Fita Rahmawati; Djoko Wahyono
JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Vol 10, No 3
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jmpf.58534

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An application named ‘Dosing GAMA’ has developed for drug doses adjustment in patients with renal and hepar impairment. Dosing GAMA is targeted for clinical Pharmacists to calculate and make dose recommendations for patients, based on renal and hepatic conditions. This study aims to identify the appropriateness of drug dosage adjustment by using Dosing GAMA application in hospitalized patients with renal impairment and to determine the risk factors for the drug dose inappropriateness. This study was a retrospective observational descriptive study, cross-sectional design, used a consecutive sampling technique. The source of the data was Medical Record of hospitalized patients with renal impairment (creatinine clearance ≤50 mL/min) from 2018 of February till 2020 of March in the Academic Hospital of UGM. The names and the doses of the drugs were filled to Dosing GAMA application, and it would evaluate the appropriateness of drug doses. There were 570 drugs of 73 medical records included in this study. This study revealed Dosing GAMA could assess 144 drugs (25,6%) need to adjust, and 82 drugs (56,9%) were inappropriate doses. There were significant correlations of the age characteristic (p=0,000) and the creatinine clearance value (p=0,012) to the drugs dose appropriateness. There were inappropriate doses need to adjust in the hospital. So, the use of health-based technology expected for pharmacists to improve the use of drugs rationally.