Factors Related to the Evaluation of Essential Medicines Use in Health Facilities in Indonesia

Background: Indonesia has recently implemented a national policy to ensure equitable access to medicines, promote their rational use, and maintain a reliable and quality supply, specifically for essential medicines. Several organizations have conducted evaluations on essential medicines use but have yielded varying results and cannot reflect the actual situation. Objectives: This study aims to discover the current situation regarding essential medicines and identify the most important factors to be considered during future indicator-based evaluations in health facilities in Indonesia. Methods: This qualitative study was carried out using FGDs and interview from January to February 2022. The sample population consisted of ten experts selected based on predetermined criteria. The discussions were recorded and transcribed verbatim in the original language, thematically coded with Nvivo, and analyzed for common themes. Results: This study found 32 factors related to the use of essential medicines in Indonesia, divided into three categories of components, namely access, medicine handling quality, and rational use. Furthermore, a total of 10, 8, and 14 main factors were related to access, handling quality, and rational use, respectively. The discussion provided various perspectives on measuring drug use, specifically essential medicines. Based on expert opinions, evaluating the utilization of essential medicines by relying on existing guidelines was insufficient due to superficiality and irrelevance within the Indonesian health system. Conclusion: Based on the results, one of the crucial factors to consider during evaluation was the accessibility of medicines, which encompassed their availability in health facilities and affordability to patients... (AU)

Prevalence and predictors of discharge polypharmacy in geriatric patients discharged from an Indonesian teaching hospital: a retrospective observational study / Prevalencia y predictores de polifarmacia al alta en pacientes geriátricos dados de alta de un hospital universitario de Indonesia: un estudio observacional retrospectivo

Objective: The study aimed to investigate the prevalence and risk factors for discharge polypharmacy in geriatric patients in Indonesia. Methods: The retrospective cohort study used the medical record profiles of geriatric patients aged ≥ 60 years admitted to the inpatient ward between July 2018 and October 2019. Using three logistic regression models, we assessed the association of the patient’s demographic, clinical characteristics, and disease condition with discharge polypharmacy. The use of five or more medications was defined as discharge polypharmacy. Results: A total of 1533 patients were included in the study. Most patients (78.21%) aged between 60 and 74 years. The male-to-female patient ratio was almost the same (50.16% versus 49.83%). Of the patients (52.51%) were discharged with polypharmacy. According to regression model I, patients who had a chronic condition, comorbidity, stayed in the hospital for ≥ seven days, had a Charlson comorbidity index score (3-4), and received excessive polypharmacy (≥ 10 drugs) during admission had significantly more risk (p< 0.05) to receive polypharmacy at discharge. The results of model II investigated myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, chronic obstructive pulmonary disease, diabetes mellitus, diabetes with complications, renal disease, and high blood pressure as significant (p<0.05) predictors of discharge polypharmacy. The combined model III evaluated that comorbidity, length of hospital stay (7 or more days), excessive polypharmacy use in the hospital, myocardial infarction, and congestive heart failure were significantly (P < 0.05) associated with discharge polypharmacy. Conclusions: Polypharmacy is common in Indonesia and is linked to certain chronic conditions and other clinical factors. A particular plan that includes a pharmacist and physician collaborative relationship and awareness of the health outcomes of polypharmacy could be critical.(AU)

Cost effectiveness of cervical cancer prevention strategies in Indonesia

Background: The development of several HPV-related control techniques for the prevention of cervical cancer followed the identification of a link between high-risk human papillomavirus (HPV) infection and the occurrence of cervical cancer. Objective: The objective of the current study was to determine how cost-effective the different cervical cancer screening programs and HPV vaccinations in Indonesia. Methods: The lifetime costs and effects of vaccination among adolescent girls or screening with either the VIA, Papanicolaou, or HPV DNA test at various time intervals in a hypothetical cohort of 30-65 years-old women were estimated using a Markov model based on a societal perspective. Results: Based on statistics on transition probabilities, efficacy of HPV vaccination, and diagnostic accuracy of screening procedures. The findings of this study, specifically the cost-effectiveness of preventing cervical cancer with vaccination, revealed that each woman’s vaccination cost was $16. The amount of disease-adjusted life years (DALYs) that may be saved was $213, and the averted cost per death was $1.438. Conclusion: Early cervical cancer screening using the IVA test method has a net cost of $576 for years of quality-adjusted life saved and costs $18 each examination for each woman, $1,532 for each preventable death. When the group of teenage girls who received the HPV, vaccine reaches the age of 30, the VIA screening frequency should be decided depending on the cohort’s overall HPV vaccination coverage. (AU)

Psychometric properties of a mental health literacy questionnaire for university students in Indonesia

Background: Mental health literacy is necessary for early recognition and intervention of mental disorders. Its multifaceted structure provides useful perspectives for developing a tool to assess mental health literacy. Objective: This study aimed to adapt the Mental Health Literacy Questionnaire (MHLq) designed to observe mental health literacy among university students and to test its construct validity and internal consistency. The impact of a sociodemographic variable on mental health literacy score was also explored. Methods: A number of 650 university students participated in this study. The questionnaire items were adapted using a backward forward translation. An exploratory factor analysis was conducted to examine the construct validity. Internal consistency of the questionnaire was tested using Cronbach’s Alpha. Results: The results showed that the MHLq modified version possessed good validity and reliability (total scale α=0.821) that may be used as a screening tool by mental health professionals and researchers to identify intervention needs among university students. Conclusions: This study also found that individuals who identified knowing someone with a mental health problem performed better on the MHLq global score and three-dimensional factors than those who did not. Future studies are needed to further develop and adapt the questionnaire to reach different target-populations. (AU)

The psychometric properties of the Indonesian version of the Willingness to use telemedicine questionnaire in pharmacy students

Backgound: The Willingness to Use Telemedicine Questionnaire (WTQ) was translated into Indonesian and cross-culturally adapted with the intention of analyzing the validity and reliability of the surveys. Our study aims to translate, cross-culturally adapt the Willingness to Use Telemedicine Questionnaire (WTQ) into the Indonesian version and analyze the questionnaires’ psychometric properties. Methods: In Yogyakarta province, 327 pharmacy students were conveniently recruited. Cronbach’s alpha coefficient was used to gauge internal consistency. Analyzing the results of 60 patients who were retested one week later allowed for the calculation of the test-retest reliability using the intraclass correlation coefficient. Results: Pearson’s correlation coefficient (r) was used to assess the construct validity. Additionally, an investigation of the WTQ’s exploratory factor analysis and internal consistency for subscores was done. The mean age was 21.68 ±2.43 years. The internal consistency of each item and the overall WTQ score were excellent (>0.80; ranged from 0.856 to 0.977). The test-retest reliability of all items and the WTQ’s overall score was between satisfactory and outstanding (0.856–0.977). Strong association (r = 0.923, P 0.001) existed between WTQ and WTPQ. The WTQ has high factor loading scores (0.621–0.843). Conclusion: The Indonesian WTQ is reliable and valid among university students. (AU)

Translation, cultural adaptation, and psychometric validation of the Persian hypertension self-management questionnaire in South Sumatera, Indonesia

Background: Poor self-management has been associated with uncontrolled blood pressure in hypertensive patients. A valid instrument is needed to assess the self-management of hypertensive patients, especially to measure self-management changes after health workers’ intervention. Objective: To examine the psychometric properties Persian Hypertension Self-Management Questionnaire among patients with hypertension in Indonesia. Methods: Data collection was carried out cross-sectionally using convenience sampling; obtained 407 hypertensive patients in ten primary health centers in South Sumatra Province. The translation of the questionnaire has been carried out by applying forward-backward methods. The Face validity test based on respondents’ responses to each question item was evaluated descriptively. We evaluated content validity by an expert with qualitative and quantitative; known group validity was analyzed using chi-square. Internal consistency reliability test using Cronbach alpha and test-retest reliability using Pearson correlation test or Pearson Spearman rank correlation. Results: Content validity by the expert shows sentence improvement, and CVI value = 1.00. Face validity shows that respondents can understand well to the questionnaire, and the known group validity was considered very good, as indicated by a significant relationship between the level of self-management and blood pressure control (p <0.001). The reliability assessment on internal consistency was 0.823 with a range of values for each domain, namely 0.710 - 0.823, and Test-retest reliability of 0.707 (p <0.001) with values ranging from 0.600 - 0.906. Conclusions: The Persian Hypertension Self-Management Questionnaire has been translated into the Indonesian version and has satisfactory validity and reliability for assessing self-management in hypertensive patients in Indonesia. (AU)

Primary health care policy and vision for community pharmacy and pharmacists in Indonesia

The practice of community pharmacy in low and middle-income countries, including in Indonesia, is often described as in the state of infancy with several intractable barriers that have been substantially and continuously hampering the practice. Such description might be valid in highlighting how pharmacy is practiced and the conditions within and beyond community pharmacy organizations. Therefore, it is not surprising that the concept of integrating community pharmacy into the primary care system may not be considered in the contemporary discourse despite the fact that community pharmacy has been operating within communities for years. However, in the case of Indonesia, we argue that changes in the health care system within the past decade particularly with the introduction of the universal health coverage (UHC) in 2014, may have significantly amplified the role of pharmacists. There is good evidence which highlights the contribution of pharmacist as a substantial health care element in primary care practice. The initiative for employing pharmacist, identified in this article as primary care pharmacist, in the setting of community health center [puskesmas] and the introduction of affiliated or contracted community pharmacy under the UHC have enabled pharmacist to work together with other primary care providers. Moreover, government agenda under the "Smart Use of Medicines" program [Gema Cermat] recognizes pharmacists as the agent of change for improving the rational use of medicines in the community. Community pharmacy is developing, albeit slowly, and is able to grasp a novel position to deliver pharmacy-related primary care services to the general public through new services, for example drug monitoring and home care. Nevertheless, integrating community pharmacy into primary care is relatively a new notion in the Indonesian setting, and is a challenging process given the presence of barriers in the macro, meso- and micro-level of practice

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