Cost burden of chemotherapy for Indonesian healthcare insurance and social security/Jaminan Kesehatan Nasional (JKN) patients with non-Hodgkin lymphoma.

BACKGROUND: Cancer is among the leading causes of death globally, posing a significant economic burden on the healthcare sector. Among other types of cancer in Indonesia, non-Hodgkin lymphoma (NHL) ranks fifth in terms of prevalence. Chemotherapy for NHL patients is funded by a national health insurance scheme through the National Healthcare Insurance and Social Security/Jaminan Kesehatan Nasional (JKN). OBJECTIVE: This study aimed to analyze cost burden of chemotherapy for JKN patients with NHL. DATA SOURCE: A retrospective cross-sectional observational study was conducted among NHL patients receiving chemotherapy at a hospital in East Java, Indonesia in 2021. Data were collected from medical record documents and a total of 44 patient visits were recorded in this study. DATA SUMMARY: The result showed that patient visits were dominated by females (55%), a significant proportion were aged 31 to 40 years (32%), and the majority were JKN participants in the Contribution Assistance Recipients/Penerima Bantuan Iuran (PBI) category (64%). The most chemotherapy regimen given was R-CHOP (68%) and the mean total cost for NHL patients was Indonesian Rupiah (IDR) 5,178,146. The highest mean cost burden was on chemotherapy drugs with a value of IDR 6,333,315. Based on the regimen, the highest cost burden was R-CHOP-Bleo with a mean cost of IDR 8,764,091. CONCLUSION: Based on the results, the highest cost burden for chemotherapy among JKN patients with NHL in Indonesia was attributed to R-CHOP-Bleo regimen with a mean of IDR 8,764,091.

Relationship between knowledge and adherence to hypertension treatment.

Background: Hypertension is a continuous increase in arterial blood pressure. About 50-70% of patients do not comply with hypertension treatment. Adherence is a health behavior that can be influenced by several factors, including knowledge. Objective: This study aimed to analyze the relationship between patients' knowledge and adherence to hypertension medication at the Tanggulangin Primary Healthcare Center, Sidoarjo City. Methods: The research method was analytic-observational with a cross-sectional design. Sixty-five sampled patients participated in this study after meeting inclusion criteria: at the age of over 18 years, having the ability to read and write, and signing the consent forms. The respondents were selected through purposive sampling. Data were analyzed descriptively with the Spearman Rho test to identify a correlation between knowledge and adherence to medication. Results: Patients' knowledge was mostly categorized as good (60%), followed by moderate category (40%). In addition, adherence to medication was all in the moderate category (100%). The correlation test results show a weak relationship between knowledge and adherence to medication (P=0.007; R=-0,331). Conclusion: Patients' knowledge is related to adherence to hypertension treatment.

The association between drug therapy problems and blood pressure control of patients with hypertension in public health center setting.

Background: Patients with hypertension are at risk of experiencing Drug Therapy Problems (DTPs). However, few have studied the pattern of DTPs in Indonesian public health center (PHC) and how it affected the blood pressure control. Objective: This study aims to identify DTPs and its association to blood pressure control among patients with hypertension in Indonesian PHCs. Methods: A descriptive, observational and cross-sectional study involving 150 selected persistent hypertensive patients was conducted from August to December 2019 in 63 PHCs in Surabaya. A questionnaire asking patients' experiences during treatment of hypertension was used. Chi-square test was used to analyze the association between DTPs and blood pressure control. Results: The majority of respondents were aged 50-65 (54.7%), female (76%), only half has controlled blood pressure (52.7%) and most of them used three to four medicines at the same time (57.3%). A total 563 DTPs was identified with 15.6% was unnecessary drug use, 11.4% indicated need for additional drug therapy, one-fifth experienced dosage too low (21.5%) and nonadherence (19.2%) and 26% suffered from adverse drug reactions. There was a significant association between number of DTPs and blood pressure control (P<0.05). Conclusion: Most patients experienced more than two DTPs and undertook more than three medicines at the same time. There is a significant association between the number of DTPs in hypertensive patient and the blood pressure control.

Antibiotic stewardship knowledge and belief differences among healthcare professionals in hospitals: A survey study.

BACKGROUND: Collaborative practice in healthcare has been recommended to improve the quality of antimicrobial stewardship interventions, a behavioral change in antimicrobial use. Insufficient knowledge regarding antibiotic resistance, the fear of complications from infections, and how providers perceive antibiotic use and resistance are likely to influence prescribing behavior. This study's objective was to identify the knowledge and belief healthcare professionals' differences about antibiotic stewardship. METHODS: This cross-sectional survey study of three hospitals in the East Java province, Indonesia utilized a 43-item questionnaire to assess antimicrobial stewardship knowledge and belief. There were 12 knowledge questions (total possible score: 12) and 31 belief questions (total possible score: 155). The Kuder Richardson 20 (KR-20) and Cronbach alpha values of the questionnaire were 0.54 and 0.92, respectively. RESULTS: Out of the 257 respondents, 19% (48/257) had a low scores of knowledge, and 39% (101/257) had low scores on belief about antibiotic stewardship (101/257). Most midwives had a low scores on knowledge (25/61) and low scores on belief (46/61). Respondents with high scores on belief were 17% (10/59) physicians, 15% (4/27) pharmacists, 8% (5/65) nurses, and 3% (2/61) midwives. CONCLUSION: Among healthcare professionals, knowledge and belief differences concerning antibiotic stewardship vary widely. These differences will affect their capability, behavior, and contribution to the healthcare team collaboration and performance. Further studies are needed to evaluate the correlation between the level of inter-professional collaboration and the quality of the antibiotic stewardship implementation.

Evaluation of rational drug use based on World Health Organization prescribing indicators in a primary care center in Pamekasan East Java, Indonesia.

Background The Government of Indonesia has put in place many interventions for rationalizing drug use at all levels of the health services including in primary care centers (puskesmas). One of the programs for the rational use of drugs at the puskesmas is the monitoring and evaluation of drug use conducted by pharmacists. The purpose of this research was to evaluate the rationality of drug use in Pamekasan puskesmas that use World Health Organization (WHO) prescribing indicators and to find the difference in the percentage of rationality of drug use between puskesmas in Pamekasan. Methods This study reviewed official documents considering reporting of rational drug use. The documents were obtained from the district health office or from the public domain from 2014 to 2018. Data were then collated, extracted, and presented as frequencies. Results The percentage prescribed for antibiotics for acute respiratory infection (ARI) non-pneumonia was 47.27% and percentage prescribing antibiotic drugs in a non-specific diarrhea was 59.85%. The percentage prescribed for injection was 36.15%. The average number of drugs prescribed per treatment was 2.61. Conclusions The majority of WHO guidelines stated that prescribing indicators were not met by the puskesmas in Pamekasan, except for the parameters for the average number of drugs prescribed per consultation. This shows an alarming clarion call for the local healthcare stakeholders to improve such situations.

Evaluating current practices and policies in the use of injectable medicines for treating myalgia in a primary care center in Pamekasan, Indonesia.

Background Myalgia in patients can be associated with a large array of conditions, including injuries, infections and inflammations. Treatment for myalgia may include the use of oral, topical and injectable medicines (IM). However, the use of IM has been restricted by the World Health Organization due to the common hazards associated with inappropriate medicine use, risks of disease transmission and more expensive spending for using IM. Accordingly, the Ministry of Health of Indonesia (MoH) has limited the use at the level of ≤1% in every primary care center (Puskesmas) across the nation. The aim of this study was to report and evaluate rational drug use injection in myalgia in a Puskesmas in Pamekasan, Indonesia. Methods This study reviewed official documents, such as rational drug use report, medicine use databases and drug request report. The documents were obtained from the district health office or public domain from 2014 to 2018. Data were then collated, extracted and presented as frequencies. Results The average rate of use of IM for myalgia in Pamekasan was 36.15%. All 20 Puskesmas in Pamekasan conducted injection practice above the recommended level, thus reflecting a major gap between practice and policy implementation. This study implies that a substantial effort is needed to enforce the policy. Conclusions The use of IM for myalgia treatment in Pamekasan from 2014 to 2018 was significantly higher than the recommended level, thus reflecting a major problem in the practice. This is an alarming call for the local healthcare stakeholders to improve such a situation.

Exploration of barriers affecting job satisfaction among community pharmacists.

Background Understanding job satisfaction among community pharmacists is important as it may affect roles and performance. Several barriers in practice may affect job satisfaction. Objectives To explore barriers affecting job satisfaction among Indonesian community pharmacists. Methods This study reported data from the Nationwide Community Pharmacy Survey 2018. The results specific to participants in the East Java region were used for this study. Community pharmacists (507) participated in the survey between September 2018 and March 2019. The survey used questionnaire that asked 22 factors, which may act as barriers affecting job satisfaction. Data were analyzed using descriptive statistics. Results The majority of respondents were female (83.43%), and most respondents were aged 31-40 years (41.63%). Most respondents perceived nine barriers such as lack of time for interaction and lack of recognition that were dominant affecting job satisfaction. On the other hand, respondents were not in major agreement perceiving the remaining barriers as dominant affecting job satisfaction. More than half of the respondents disagreed that the remaining barriers were significant affecting job satisfaction. Conclusions This study identified some significant barriers affecting job satisfaction among community pharmacists. In general, barriers can arise from individual, management, and environmental issues suggesting a specific approach to reduce these barriers.

Adherence behavior assessment of oral antidiabetic medication use: a study of patient decisions in long-term disease management in primary health care centers in Surabaya.

Background Adherence to medication has an important role in the long-term management of diabetes. The Indonesian Endocrinologist Association found that of the 50% of the entire population who have been diagnosed with diabetes, two-thirds are undergoing therapy and only one-third have been achieving the intended outcomes of the drug therapy. This study aimed to identify patients' adherence behavior and the root causes of non-adherence. Methods This study used a non-experimental mixed-methods approach. A total of 40 patients with type 2 diabetes mellitus (T2DM), who were part of the referral program of the National Health Care Security System (BPJS Kesehatan) were recruited by purposive sampling from 17 primary health care centers in Surabaya, Indonesia. Results The adherence behavior assessment revealed non-adherence among 80% of the patients. The highest instances of non-adherence based on the percentage scores involved the following: patients forgot to take the medications (38.23%), patients preferred not to take the medications (20.59%) and the drug products were not available for the patient (14.71%). The factors influencing non-adherence included the complex instructions for taking medication, the absence of a reminder, the unwanted side effects of the drug, the feeling of repetition, the feeling that drugs were ineffective and the concern for the drug's effects on the kidney. Conclusions The high rates of non-adherence identified in this study encourage pharmacists to implement better medication therapy management for chronic diseases. The patients' understanding of drug therapy indications and regimens is very important in increasing the expectations of achieving effective treatment, awareness and concern for medication safety and treatment compliance.