Pharmacists' clinical decision making when responding to a self-medication request for a cough in a developing country.

BACKGROUND: Some studies have reported that community pharmacies in developing countries, including Indonesia, provided sub-optimal advice when handling patient's self-medication request for cough. The reasons behind such advice, therefore, need to be investigated. OBJECTIVES: To describe Indonesian pharmacists' clinical decision making when handling self-medication cases for a cough. METHODS: An open-ended questionnaire consisting of two cough clinical vignettes (case 1: cough due to asthma worsening and case 2: cough as a symptom of common cold) were developed. Pharmacists were interviewed to provide recommendations and reasons for their recommendations for these scenarios. Content analysis was used to analyse participants' statements for the two scenarios. The number of participants who provided appropriate recommendations and reasons were then counted. RESULTS: A total of 245 community pharmacists participated in the study. In the case of cough due to asthma worsening, recommending a product because the product was indicated to help with the symptoms was the most common recommendation and stated reason (40%). Appropriate recommendation (direct medical referral) with appropriate reasoning (indicating warning symptoms and/or making a symptom diagnosis) was provided by 25% participants. In the case of cough as a symptom of common cold, recommending products to help with the symptoms was also the most common recommendation and stated reason (53%). Appropriate recommendations (recommending product) with appropriate reasoning (providing product to treat the symptoms and/or indicating no warning symptoms and/or making a symptom diagnosis) was provided by 81% participants. CONCLUSION: The ability of Indonesian community pharmacists to provide appropriate recommendations for cough self-medication requests is dependent on whether triage is required. The inability of most community pharmacists to differentiate between major and minor conditions may lead to serious health implications for patients and therefore educational interventions should be undertaken to improve community pharmacists' differential diagnostic skills for triage.

Potential drug-drug interactions and their associated factors in hospitalized COVID-19 patients with comorbidities.

Background: Hospitalized COVID-19 patients with comorbidities receive more complex drug therapy. This increases the probability of potential drug-drug interactions (pDDIs). Studies on pDDIs in hospitalized patients with COVID-19 in countries with limited resources like Indonesia during the later period of the disease are still limited. This study aims to identify the pattern of pDDIs in hospitalized COVID-19 patients with comorbidities and their associated factors, especially in the second wave of the disease in Indonesia. Methods: This study was a longitudinal-retrospective study observing hospitalized COVID-19 patients with comorbidities using medical record data in June-August 2021 at a public hospital in a region in Indonesia. pDDIs were identified using the Lexicomp® database. Data were descriptively analyzed. Factors associated with important pDDIs were analyzed in multivariate logistic regression model. Results: A total of 258 patients with a mean age of 56.99 ± 11.94 years met the inclusion criteria. Diabetes mellitus was the most common comorbidity experienced by 58.14% of the patients. More than 70% of the patients had one comorbidity and the average number of administered drugs was 9.55 ± 2.71 items per patient. Type D pDDIs, which required modification of therapeutic regimens, amounted to 21.55% of the total interactions. Only the number of drugs was significantly and independently associated with type D pDDIs (adjusted odds ratio 1.47 [1.23-1.75], p < 0.01). Conclusion: The drugs involved in the pDDIs of hospitalized COVID-19 patients with comorbidities may differ depending on the disease periods, hospital settings, or countries. This study was small, single center, and of short duration. However, it may give a glimpse of important pDDIs during the delta variant of COVID-19 in a similar limited-resource setting. Further studies are needed to confirm the clinical significance of these pDDIs.

Potential roles of community-based pharmacists in assisting home-quarantined patients with COVID-19 in a resource-challenged setting.

OBJECTIVES: To present the experiences of community-based drug information centre (DIC) pharmacists assisting home-quarantined patients with COVID-19 in Indonesia. METHODS: A prospective case study included home-quarantined patients with suspected/confirmed COVID-19 contacting pharmacists at a DIC in Indonesia in July 2021. Patient characteristics, pharmacist interventions and outcomes were reported. KEY FINDINGS: Fifteen home-quarantined patients were screened for COVID-19 and were provided with follow-up services (i.e. medication review and monitoring). Worsening symptoms and/or reduction in oxygen saturation were reported in seven patients where a referral to medical services was made for them. Most patients recovered at follow-up (4-14 days). CONCLUSIONS: Community-based DIC pharmacists potentially contributed to the frontline emergency response, as observed during the COVID-19 crisis in Indonesia.

Knowing the gap: medication use, adherence and blood pressure control among patients with hypertension in Indonesian primary care settings.

Background: Hypertension is a major risk factor for global disease burden, however, little is known regarding the profiles of patients with hypertension in Indonesian primary care settings. Objective: This study aimed to profile medication use, adherence to medications and lifestyle modifications as well as blood pressure control among patients with hypertension in Indonesian primary health centres (PHCs). Methods: A cross-sectional study design used a structured data collection tool (questionnaire and checklist). Patients aged ≥18 years with a diagnosis of hypertension, and prescribed an antihypertensive medication, and attending follow-up visits in the five PHCs in Surabaya, Indonesia, during a two-week study period (May-October 2019) were included. Descriptive analyses summarised the data, while binary logistic regression provided any independent associations between adherence profiles and blood pressure control. Results: Of 457 eligible patients, 276 patients consented: PHC A (n = 50/91), PHC B (n = 65/116), PHC C (n = 47/61), PHC D (n = 60/88), PHC E (n = 54/101), giving an overall response rate of 60.4%. Patients were mainly treated with a single antihypertensive medication, i.e., amlodipine (89.1%), and many had not achieved blood pressure targets (68.1%). A majority reported notable levels of non-adherence to medication (low/intermediate, 65.2%) and poor healthy lifestyle behaviours, particularly physical activity (inadequate, 87.7%) and discretionary salt use (regularly, 50.4%). Significant associations were found between low medication adherence, discretionary salt use and smoking, with blood pressure control. Conclusions: The study findings provide the evidence needed to improve the current level of sub-optimal blood pressure management among patients with hypertension in these Indonesian primary care settings. Particular emphasis should be placed on antihypertensive medication adherence and healthy lifestyle behaviours through locally tailored hypertension-related interventions.

Strategies to implement community training to promote responsible self-medication in Indonesia: a qualitative study of trainers.

BACKGROUND: A community-based approach has been identified as one key strategy to improve the health of Indonesians. In 2015, the government initiated the 'Smart Use of Medications Movement' (GeMa CerMat) to promote responsible self-medication. This study aims to explore pharmacist/pharmacy staff trainers' views on strategies to implement GeMa CerMat community training. METHODS: Four focus group discussions were conducted with 38 pharmacist/pharmacy staff trainers in Ngawi, Indonesia and a thematic analysis was used to obtain the key strategies. RESULTS: The identified key strategies were building community readiness via well-designed training (considering participant characteristics, training methods, and materials and resources); policy, regulation and organizational support; access to training in a cultural context; communication media to promote training and the inclusion of active-learning tools. CONCLUSIONS: These identified multilevel strategies require collaboration among national bodies and the involvement of trusted community members ('change agents'). A new strategy using 'active learning tools' was necessary to build critical thinking and understanding of the use of medications in everyday life. Future research should focus on process, impact and outcome evaluation involving GeMa CerMat training implementation and sustainability in Indonesia.

A cross-sectional assessment of Indonesian female health cadres' knowledge and attitude towards antibiotics.

INTRODUCTION: Health cadres have a key role in building awareness related to irrational antibiotic use and antibiotic resistance in Indonesia. Cadres help to bridge the gap between the shortage of health professionals and the need to reach the broader population. This study aimed to identify cadres' background, antibiotic knowledge and attitudes in an Indonesian setting. METHODOLOGY: A paper-based questionnaire survey was validated and conducted among purposefully selected cadres attending a seminar in Malang Indonesia. A 5-point Likert scale was used to identify attitudes, while true/false statements determined their knowledge. A total of 112 cadres responded, giving a 100% response rate. RESULTS: The majority had been cadres for >2 years with previous counseling experience. Their attitudes on antibiotic use, were shown by the lower levels of disagreement to the statements "when I get a sore throat, I prefer to use antibiotics" (37.5%); "I would take antibiotics if I have had a cough for more than one week" (41.1%); and, "when I get influenza, I would take antibiotics to help me recover sooner" (47.3%), within the "indications" domain. For knowledge, lower scores were reported for domains related to "indications" (mean 1.49 ± 0.82/3), "resistance" (mean 1.06 ± 0.94/3), and "storage and disposal" (mean 1.23 ± 0.78/3). CONCLUSIONS: These findings indicated a need to improve cadres' attitudes and knowledge prior their involvement as change agents for improving the rational use of antibiotics to minimise antibiotic resistance in Indonesia.

The competency of Indonesian pharmacy students in handling a self-medication request for a cough: a simulated patient study

Background: Cough is a common symptom for which people frequently present to community pharmacies. Previous articles from developing countries have shown that the provision of self-medication consultation for cough in community pharmacies were suboptimal, with knowledge deficiency being a contributing factor. However, little is known regarding the ability of pharmacy students in handling self-medication consultations in developing countries. Objectives: To measure the competency of Indonesian pharmacy students in providing self-medication consultations for patients with chronic cough and to identify factors associated with the provision of appropriate advice. Method: This study is a cross-sectional study. A simulated patient method using a product and a symptom-based request of chronic cough was used in students from a pharmacy school in Indonesia. The nature and amount of information gathered and advice provided by pharmacy students were noted and audio-recorded. A logistic regression analysis was performed to identify factors associated with the provision of appropriate advice. Results: The information gathered by participating students was not comprehensive. The most common types of information gathered were related to the nature and duration of the cough. Information relating to accompanying symptoms, medications, and allergies was gathered in less than 60% of the participating students for both product and symptom based scenarios. The appropriate advice of direct medical referral was provided in 54% and 56% of the 183 participating students for the product and symptom-based request scenarios respectively. Asking about symptom duration and prior medical conditions were positively associated with the provision of appropriate advice in the symptom and product based requests respectively (AU)

The competency of Indonesian pharmacy students in handling a self-medication request for a cough: a simulated patient study.

BACKGROUND: Cough is a common symptom for which people frequently present to community pharmacies. Previous articles from developing countries have shown that the provision of self-medication consultation for cough in community pharmacies were suboptimal, with knowledge deficiency being a contributing factor. However, little is known regarding the ability of pharmacy students in handling self-medication consultations in developing countries. OBJECTIVES: To measure the competency of Indonesian pharmacy students in providing self-medication consultations for patients with chronic cough and to identify factors associated with the provision of appropriate advice. METHOD: This study is a cross-sectional study. A simulated patient method using a product and a symptom-based request of chronic cough was used in students from a pharmacy school in Indonesia. The nature and amount of information gathered and advice provided by pharmacy students were noted and audio-recorded. A logistic regression analysis was performed to identify factors associated with the provision of appropriate advice. RESULTS: The information gathered by participating students was not comprehensive. The most common types of information gathered were related to the nature and duration of the cough. Information relating to accompanying symptoms, medications, and allergies was gathered in less than 60% of the participating students for both product and symptom based scenarios. The appropriate advice of direct medical referral was provided in 54% and 56% of the 183 participating students for the product and symptom-based request scenarios respectively. Asking about symptom duration and prior medical conditions were positively associated with the provision of appropriate advice in the symptom and product based requests respectively. CONCLUSION: Student competency in self-medication consultation for chronic cough needs to be improved. Appropriate information-gathering is a predictor of appropriate advice. Further qualitative research identifying factors affecting students' competence in providing self-medication consultation is required, so that suitable interventions are developed and implemented.

Information on antibiotics in an Indonesian hospital outpatient setting: What is provided by pharmacy staff and recalled by patients?

BACKGROUND: The provision of information by pharmacy staff is a key factor to ensure patients' understanding and quality use of medications, including antibiotics. However, little is known regarding the transmission of information between pharmacy staff and patients in Indonesia. OBJECTIVE: This study aimed to identify information on antibiotics provided by pharmacy staff and recalled by patients in an Indonesian outpatient setting. METHODS: The study was conducted in a hospital outpatient clinic in Malang, Indonesia, in 2019. A checklist was used to obtain the data on information provided by pharmacy staff, while interviews were conducted to determine information recalled by patients (only presenting patients were included); a total of 15 information items - i.e. 14 essential and one secondary - were observed. Descriptive analysis was used to summarise data on the checklists ('given' versus 'not given') as well as responses from the interviews ('recalled' versus 'missed'). RESULTS: Eleven pharmacy staff (two pharmacists and nine pharmacy technicians) were involved in providing information for patients obtaining oral antibiotics during the study period. Of 14 essential information items, only about half was given by pharmacy staff, with pharmacists significantly providing on average more information items than pharmacy technicians (7.96 versus 7.67 respectively; p < 0.001). The most frequently information items provided (>90%) included "antibiotic identification", "indication", administration directions (i.e. "dosage", "frequency", "hour of administration", "administration before/after meal", "route of administration"), and "duration of use". A total of 230 patients consented to the study, giving 79.9% response rate. The average number of information items recalled by patients was 7.09 (SD 1.45). Almost all patients could recall information on administration directions [i.e. "route of administration" (97.0%), "frequency" (95.2%), "dosage" (92.6%), "hour of administration" (85.7%), "administration before/after meal" (89.1%)] and "duration of use" (90.9%). Fewer patients were able to recall "antibiotic identification" (76.5%) and "indication" (77.0%). CONCLUSIONS: Pharmacy staff provided antibiotic information in a limited fashion, while patients showed adequate ability to recall the information given to them. Further study is needed to better understand the effective process of information transmission between pharmacy staff and patients, especially if more information was provided, to better optimise the use of antibiotics in outpatient settings in Indonesia

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Information on antibiotics in an Indonesian hospital outpatient setting: What is provided by pharmacy staff and recalled by patients?

BACKGROUND: The provision of information by pharmacy staff is a key factor to ensure patients' understanding and quality use of medications, including antibiotics. However, little is known regarding the transmission of information between pharmacy staff and patients in Indonesia. OBJECTIVE: This study aimed to identify information on antibiotics provided by pharmacy staff and recalled by patients in an Indonesian outpatient setting. METHODS: The study was conducted in a hospital outpatient clinic in Malang, Indonesia, in 2019. A checklist was used to obtain the data on information provided by pharmacy staff, while interviews were conducted to determine information recalled by patients (only presenting patients were included); a total of 15 information items - i.e. 14 essential and one secondary - were observed. Descriptive analysis was used to summarise data on the checklists ('given' versus 'not given') as well as responses from the interviews ('recalled' versus 'missed'). RESULTS: Eleven pharmacy staff (two pharmacists and nine pharmacy technicians) were involved in providing information for patients obtaining oral antibiotics during the study period. Of 14 essential information items, only about half was given by pharmacy staff, with pharmacists significantly providing on average more information items than pharmacy technicians (7.96 versus 7.67 respectively; p<0.001). The most frequently information items provided (>90%) included "antibiotic identification", "indication", administration directions (i.e. "dosage", "frequency", "hour of administration", "administration before/after meal", "route of administration"), and "duration of use". A total of 230 patients consented to the study, giving 79.9% response rate. The average number of information items recalled by patients was 7.09 (SD 1.45). Almost all patients could recall information on administration directions [i.e. "route of administration" (97.0%), "frequency" (95.2%), "dosage" (92.6%), "hour of administration" (85.7%), "administration before/after meal" (89.1%)] and "duration of use" (90.9%). Fewer patients were able to recall "antibiotic identification" (76.5%) and "indication" (77.0%). CONCLUSIONS: Pharmacy staff provided antibiotic information in a limited fashion, while patients showed adequate ability to recall the information given to them. Further study is needed to better understand the effective process of information transmission between pharmacy staff and patients, especially if more information was provided, to better optimise the use of antibiotics in outpatient settings in Indonesia.

A pilot study of cadre training to promote responsible self-medication in Indonesia: Which is better specific or general modules?

In 2015, the Indonesian Government initiated 'Smart Use of Medications Movement' ('GeMa CerMat') which included cadre training to promote responsible self-medication. Evaluation of a pilot training conducted across Indonesia suggested the need to improve those training modules. This study aimed to assess cadre' knowledge gained following training with newly developed general or specific training modules. Five types of modules were developed and used to train cadres at five Community Health Centres (CHCs) in Surabaya, Indonesia: 1) Sidosermo CHC (general-drugs module), 2) Tenggilis CHC (common cold drugs module), 3) Gunung Anyar CHC (analgesic drugs module), 4) Kalirungkut CHC (anti-diarrhoeal drugs module), and 5) Jagir CHC (indigestion drugs module). Cadres' knowledge improvements were evaluated using pre-/post-test scores and the difference scores depending on the module being tested. Multifactorial ANOVA explored the effects of the type of module on difference scores. A total of 279 cadres across five CHCs were involved in the training, giving response rates from 65% to 93%. There was an increase in the post-test scores after the training with all modules. However, significant differences were reported only for the specific-drugs module groups (all p < .001). Furthermore, the general module group had the lowest difference score (1.12; 95% CI [-0.45, 2.92]) while the common cold module group had the highest gain (5.02; 95% CI [1.95, 5.17]). Multifactorial ANOVA revealed that there was a significant main effect of the type of modules on difference scores [F (4, 263) = 8.37, p <.001]. In conclusion, this preliminary study indicated that the development of modules for specific minor illnesses could be beneficial in facilitating effective community-based training to promote responsible self-medication in Indonesia. The priority for therapeutic areas chosen for the module should be based on the local needs. Further research is required to confirm the findings in broader community members.

Knowledge of stroke and medication adherence among patients with recurrent stroke or transient ischemic attack in Indonesia: a multi-center, cross-sectional study.

BackgroundThere is a limited data in Indonesia regarding the stroke knowledge and medication adherence among stroke survivors.ObjectiveTo assess the level of stroke knowledge and medication adherence along with their relationship among stroke survivors.SettingTwo tertiary-care hospitals in Surabaya, East Java, Indonesia.MethodsA prospective, cross-sectional study was conducted among 215 stroke survivors. Stroke Knowledge Test and the Morisky Green Levine Adherence Scale questionnaires were used to evaluate stroke knowledge and medication adherence, respectively. Binary logistic regression was performed to assess the rela tionship between stroke knowledge and medication adherence. Main outcome measuresRelationship between stroke knowledge and medication adherence.ResultsA total of 215 patients with mean age of 56.34 ± 8.69 years were recruited into this study. Mean Stroke Knowledge Test score was 7.89 ± 3.38 with 76.7% had low level of stroke knowledge. Mean Morisky Green Levine Adherence Scale was 3.05 ± 1.11 with 52.1% had low to medium medication adherence. Education and duration of stroke correlated with stroke knowledge level (Spearman's correlation coefficient: 0.307, p = 0.001 and 0.128, p = 0.041, respectively). Age and disability correlated with medication adherence (Spearman's correlation coefficient: 0.169; p = 0.013 and 0.171; p = 0.012), respectively. After adjustment for covariates, stroke knowledge level was independently associated with medication adherence (adjusted OR: 4.37, 95% CI 2.00-9.53; p < 0.001).ConclusionStroke knowledge was low among Indonesian stroke survivors and independently related to medication adherence. Attempts should be made to increase stroke knowledge which may improve medication adherence among stroke survivors.

The role of pharmacists in community education to promote responsible self-medication in Indonesia: an application of the spiral educational model.

Background Community empowerment is one key strategy to improve the health of Indonesians. In 2015, the Government initiated the 'Smart Use of Medications Campaign' to empower Indonesians to practice responsible self-medication. Analysis of a pilot training program established in 2016 identified that improvements were needed in the content and organisation of the module. Objective To evaluate a revised module (applying a spiral model approach) to guide community training as part of the 'Smart Use of Medications Campaign'. Setting The Ngawi District, Indonesia in May 2018. Method Eight pharmacists (trainers) and 39 community representatives (participants) were involved in the training based on the revised module. The module adopted the spiral approach and consisted of three progressive steps: (1) understanding basic concepts of information on the label/package of one medication product; (2) re-enforcing that concept to understand medication classification (applied using three products); and (3) expanding the concept to understand medication classification (applied using a pack of 40 products). Pre-/post-test scores were used, and Focus Group Discussions were conducted to explore the participants' knowledge gain. Main outcome measure: participants' and trainers' views on the spiral process. Result Participants' mean overall knowledge gain increased from 12.53/15 to 13.44/15 (p = 0.001). Six focus groups of participants and two focus groups of trainers perceived that both trainers and participants found the spiral model better facilitated understanding, as it involved step-by-step learning. They also indicated the importance of the role of pharmacists as suitably qualified trainers as well as the development of appropriate training aids/media and arrangements. Conclusion Training based on the spiral model has the potential to be implemented in community training to improve self-medication literacy among the Indonesian public. Support from pharmacists as well as the relevant national and professional bodies is essential for successful implementation of the training.

Profile of sociodemographics, sources of infection, antiretrovirals and CD4 counts on HIV/AIDS outpatients in Turen Primary Health Centre, Indonesia.

Background The profile of patients with HIV/AIDS is required to develop appropriate HIV/AIDS prevention and treatment programs in Indonesia. Turen is one of the four sub-districts with the highest number of patients with HIV/AIDS in Malang District, Indonesia. The purpose of this study is to determine the sociodemographic profile, sources of infection, use of antiretrovirals and CD4 counts on HIV/AIDS outpatients in Turen Primary Health Centre (PHC). Methods The sociodemographic data, antiretroviral use, and CD4 counts were obtained from medical records on HIV/AIDS outpatients in Turen PHC. A qualitative approach using in-depth interviews was used to explore the source of infection. Descriptive analysis was used to summarise the quantitative data, while thematic analysis was used to analyse the qualitative data derived from interviews. Results A total of 45 HIV/AIDS outpatient medical records were reviewed. Of those, the majority were females (57.8%), ages 26-35 years (51.1%), married (55.6%) and having income less than 2 million rupiah (73.3%). All of them used a combination of antiretroviral therapy from two classes of antiretrovirals, i.e. nucleotide analog reverse transcriptase inhibitor and non-nucleotide analog reverse transcriptase inhibitor; the majority were treated with fixed-dose combination of tenofovir-lamifudin-efavirenz. The CD4 counts data were obtained from 31 patients with an average number of 282 cells/mm3. The qualitative data from interviews with 15 patients revealed that the source of infection was from husband, unsafe/unprotected sex and blood donor. Conclusions The high prevalence of HIV/AIDS among young married women and poor control of the disease in Indonesia warrants further considerations. The government should work together with all related stakeholders in raising awareness of HIV/AIDS, particularly among women, as well as improving treatment and support for people living with HIV/AIDS.

Evaluation of a community-based training to promote responsible self-medication in East Java, Indonesia.

OBJECTIVE: To explore pharmacist/pharmacy staff trainers' perspectives on conducting community-based training to promote responsible self-medication, and to evaluate knowledge gained among community representatives participating in the training. METHODS: Training was conducted in four districts/cities in East Java, Indonesia in 2016. A pre-test/post-test study was used to evaluate the knowledge of 129 community representatives (participants) before/after the training; pre-test and post-test scores as well as absolute gain were determined. Four focus group discussions with 20 pharmacist/pharmacy staff (trainers) were conducted after the training, and the data were thematically analysed. KEY FINDINGS: Overall mean test scores for community representatives significantly improved from 14.11 to 15.70 after the training (P < 0.001). The average total absolute gain was 1.85 (95% CI 1.29 to 2.39). To reach local communities, trainers suggested improvements to the content and structure of the module, training aids, trainer competency, approach and time allocation. CONCLUSIONS: Community-based training provides a potential strategy to improve community knowledge of medications. Findings from this study should inform strategies for a broader uptake amongst local communities in Indonesia.

Indonesian pharmacists' and pharmacy students' attitudes towar ds collaboration with physicians

Background: Recent implementation of national health coverage and the increasing health burden in Indonesia require health professionals, including pharmacists, to work more collaboratively to improve access and quality of health care. Nevertheless, relatively little is known about Indonesian pharmacists’ attitude towards collaboration. Objective: To assess and compare the attitude of Indonesian pharmacy students and pharmacists towards collaboration with physicians. Methods: A survey of 95 pharmacy students (Universitas Surabaya) and 114 pharmacists (public health facilities in East Java) in Indonesia was conducted using the validated questionnaire, Scale of Attitudes Toward Physician-Pharmacist Collaboration (SATP2C), which was translated in Bahasa Indonesia. The questionnaire contained 16 items which were based on a 4-point Likert scale. Descriptive statistics were used to summarise the responses, (i.e., individual scores, factor scores and total scores). Results: Response rates of 97.9% and 65.8% were reported for students and pharmacists, respectively. The mean total score of SATP2C among Indonesian students and pharmacists were 56.53 versus 56.77, respectively; indicating positive attitudes toward collaboration. Further analysis of each item of SATP2C confirmed the positive attitudes in which mean and median scores of ≥3 were reported for most items in both groups. Significant differences between students and pharmacists were found regarding the following items: I) 'there are many overlapping areas of responsibility between pharmacists and physicians’ (3.28 versus 2.89, respectively; p<0.001), (II) 'pharmacist should clarify a physician's order' (3.54 versus 3.71, respectively; p=0.046); and (III) ‘physicians should consult with pharmacists about adverse reactions or refractory to drug treatment’ (3.60 versus 3.44, respectively; p=0.022). Conclusions: Indonesian pharmacists reported positive attitudes toward collaboration with physicians. Further research is needed to understand other factors contributing in translating those positive attitudes into actual practice, and thus, providing a good foundation for policy makers, researchers and practitioners to support pharmacist-physician collaboration in Indonesia (AU)

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Indonesian pharmacists' and pharmacy students' attitudes towards collaboration with physicians.

BACKGROUND: Recent implementation of national health coverage and the increasing health burden in Indonesia require health professionals, including pharmacists, to work more collaboratively to improve access and quality of health care. Nevertheless, relatively little is known about Indonesian pharmacists' attitude towards collaboration. OBJECTIVE: To assess and compare the attitude of Indonesian pharmacy students and pharmacists towards collaboration with physicians. METHODS: A survey of 95 pharmacy students (Universitas Surabaya) and 114 pharmacists (public health facilities in East Java) in Indonesia was conducted using the validated questionnaire, Scale of Attitudes Toward Physician-Pharmacist Collaboration (SATP2C), which was translated in Bahasa Indonesia. The questionnaire contained 16 items which were based on a 4-point Likert scale. Descriptive statistics were used to summarise the responses, (i.e., individual scores, factor scores and total scores). RESULTS: Response rates of 97.9% and 65.8% were reported for students and pharmacists, respectively. The mean total score of SATP2C among Indonesian students and pharmacists were 56.53 versus 56.77, respectively; indicating positive attitudes toward collaboration. Further analysis of each item of SATP2C confirmed the positive attitudes in which mean and median scores of ≥3 were reported for most items in both groups. Significant differences between students and pharmacists were found regarding the following items: (i) 'there are many overlapping areas of responsibility between pharmacists and physicians' (3.28 versus 2.89, respectively; p<0.001), (ii) 'pharmacist should clarify a physician's order' (3.54 versus 3.71, respectively; p=0.046); and (iii) 'physicians should consult with pharmacists about adverse reactions or refractory to drug treatment' (3.60 versus 3.44, respectively; p=0.022). CONCLUSIONS: Indonesian pharmacists reported positive attitudes toward collaboration with physicians. Further research is needed to understand other factors contributing in translating those positive attitudes into actual practice, and thus, providing a good foundation for policy makers, researchers and practitioners to support pharmacist-physician collaboration in Indonesia.

The role of the pharmacist in the management of type 2 diabetes: current insights and future directions.

Type 2 diabetes is a chronic disease occurring in ever increasing numbers worldwide. It contributes significantly to the cost of health globally; however, its management remains in the most part less than optimal. Patients must be empowered to self-manage their disease, and they do this in partnership with health care professionals. Whilst the traditional role of the pharmacist has been centered around the supply of medicines and patient counseling, there is an evergrowing body of evidence that pharmacists, through a range of extended services, may contribute positively to the clinical and humanistic outcomes of those with diabetes. Further, these services can be delivered cost-effectively. This paper provides a review of the current evidence supporting the role of pharmacists in diabetes care, whilst providing a commentary of the future roles of pharmacists in this area.

Pharmacist and physician perspectives on diabetes service delivery within community pharmacies in Indonesia: a qualitative study.

OBJECTIVE: To explore perspectives of physicians and pharmacists on diabetes service delivery within community pharmacies in Indonesia. METHODS: In depth interviews were conducted with 10 physicians and 10 community pharmacists in Surabaya, Indonesia, using a semi-structured interview guide. Nvivo version 9 was used to facilitate thematic content analysis to identify barriers/facilitators for community pharmacists to provide diabetes services. KEY FINDINGS: The identified themes indicating barriers/facilitators for diabetes service delivery within Indonesian community pharmacies included: (1) pharmacist factors - i.e. positive views (facilitator) and perceived lack of competence (barrier); (2) pharmacist-physician relationships - i.e. physicians' lack of support and accessibility (barriers); (3) pharmacist-patient relationships - i.e. perceived patients' lack of support and accessibility (barriers); (4) pharmacy environment - i.e. business orientation (barrier), lack of staff and poor pharmacist availability (barriers), and availability of supporting resources, such as counselling areas/rooms, procedures/protocols and IT systems for labelling and patient records (facilitators); and (5) external environment - i.e. a health system to support pharmacist roles, remuneration, marketing and professional assistance (facilitators). CONCLUSION: Issues related to the pharmacist-physician-patient relationships, pharmacy environment and external environment need to be addressed before Indonesian community pharmacists can provide additional pharmacy services for type 2 diabetes patients. Collaboration between the Government, Ikatan Apoteker Indonesia (Indonesian Pharmacists Association) and Ikatan Dokter Indonesia (Indonesian Medical Association) is required to improve the pharmacy professional environment and facilities.

An evaluation of community pharmacy-based services for type 2 diabetes in an Indonesian setting: patient survey.

Background. Diabetes is an emerging chronic disease in developing countries. Its management in developing countries is mainly hospital/clinic based. The increasing diabetes burden in developing countries provides opportunities for community pharmacists to deliver a range of services. Since the management of diabetes requires the patient's own involvement, it is important to gain their views in order to develop pharmacy-based diabetes services. Studies on diabetes patients' views have been limited to developed countries. Objectives. To investigate, within a developing country setting (Indonesia), current use of pharmacy services by type 2 diabetes patients, and to evaluate their views regarding community pharmacists' roles, and the characteristics that influence their views. Methods. A questionnaire survey was conducted within 10 purposefully selected community pharmacies in Surabaya, Indonesia. Each pharmacy recruited approximately 20 patients seeking antidiabetic medications. Usage of pharmacy services was identified using binary responses ('yes'/'no') and views on pharmacists' roles were rated using Likert scales; an open-ended question was used to identify patient perceived priority roles. Logistic regression models were used to determine characteristics associated with patients' views. Results. A total of 196 pharmacy patients with type 2 diabetes responded (58.3% response rate). Most patients used community pharmacies for dispensing (100%) and education on how to use medications (79.6%). There were mixed views towards pharmacists providing services beyond dispensing. The highest priorities identified were from the 'patient education' domain: education on medications (i.e., directions for use (64.5%), storage (26.6%), common/important adverse effects (25.5%)); and the 'monitoring' domain: monitoring medication compliance (37.3%). Patients with higher incomes or who were working were less supportive of these expanded services, whereas patients who previously used a service, those with risk factors for complications or having poor/unknown glycaemic control were more supportive. Conclusions. Community pharmacies in Surabaya, Indonesia in this study were mainly utilised for dispensing. However, many type 2 diabetes patients using these pharmacies report limited monitoring of blood glucose levels and poor glycaemic control, which indicates an opportunity for greater pharmacist involvement. Yet for this to occur, patients' limited expectations of pharmacists roles will need to be broadened. Characteristics influencing these views should inform the development of pharmacy-based diabetes services in the environment of the burgeoning burden of diabetes.