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)

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)

Assessment of prevalence, knowledge and health-related practices of dysmenorrhea among Malaysian women in Kuala Lumpur: a cross-sectional survey.

BACKGROUND: Menstruation is a natural phenomenon considered an important indicator of women's health, reflecting their endocrine function. Women in low middle income countries face substantial menstrual hygiene management challenges. Data on the knowledge of dysmenorrhea and health-related practices among Malaysian women are scarce. The present study aimed to investigate the prevalence of dysmenorrhea among Malaysian women in Kuala Lumpur and its association with socio-demographic factors, knowledge level, and general practices. METHOD: A cross-sectional study was carried out among Malaysian women in Kuala Lumpur. A total of 362 unmarried women, nulliparous and aged between 18 and 25 years old, were included in this study. Participants were conveniently recruited through online platforms as well as face to face using a self-administered questionnaire with five sections consisting of demographics, menstrual characteristics, Working ability, Location, Intensity, Days of pain, Dysmenorrhea (WaLIDD) score for diagnosing and assessing the severity of dysmenorrhea as well as an evaluation of respondents' general knowledge and practices towards dysmenorrhea. The collected data were analysed using the SPSS tool, a descriptive statistic was used to report demographic characteristics. Inferential statistics was used to report the differentiation, association, and correlations of the variables. RESULTS: The prevalence of primary dysmenorrhea was 73.2%. It was found that the majority of the respondents had poor knowledge (60%) and poor practices (61.88%) of dysmenorrhea. The most common preventive practices among the respondents were using dietary supplements, and herbs, taking a rest and exercising. The findings also indicated that dysmenorrhea among the respondents was significantly associated with family history of dysmenorrhea (p = 0.002), monthly income (p = 0.001), and knowledge level (p = 0.001). CONCLUSION: Dysmenorrhea has a high prevalence among women in Malaysia in Kula Lumpur driven by low knowledge and lack of evidence-based practices among these women. Thus, it is critical for Government and healthcare authorities to promote education related to women health among Malaysian women.

Using the Simulated Patient Method to Evaluate the Community Pharmacy Management of Childhood Diarrhoea: A Systematic Review.

The simulated patient method has been widely used to assess community pharmacy practice in the management of childhood diarrhoea. In such a process, a community pharmacist is required to explore a patient's history, choose the right medication and provide drug-related information. The aim of this review was to evaluate the aforementioned practice. A comprehensive literature search was carried out over Sage Journal, PubMed, ScienceDirect and Google Scholar, and the analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Eligible articles were those published from 2011 to 2021 and original studies that used the simulated patient method to examine the pharmaceutical services provided by pharmacists in relation to childhood diarrhoea. The eight studies that satisfied the eligibility criteria were reviewed. These investigations were undertaken in Brazil, Nigeria, Turkey, Ethiopia and Pakistan. Five of the studies focused on history taking with regard to the characteristics of diarrhoea and revealed that the evaluated pharmacists asked about patient histories. In terms of therapy, three studies indicated that the evaluated pharmacists recommended the administration of oral rehydration salts. Pharmacies should improve their history-taking process, provide drug-related information and recommend therapies to increase the knowledge of simulated patients about diarrhoea treatment in children.

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)

Prevalence and Predictors of Excessive Polypharmacy in Geriatric Inpatients: A Retrospective Cross-Sectional Study in Indonesia.

OBJECTIVES: To investigate the prevalence and predictors of excessive polypharmacy in geriatric inpatients in Indonesia. METHODS: This retrospective cross-sectional study included 1533 inpatients over the age of 60 years at Universitas Airlangga Hospital, Indonesia. Effects of a patient's baseline characteristics on excessive polypharmacy were evaluated using logistic regression analysis. RESULTS: Excessive polypharmacy was observed in 133 (8.67%) patients. Ulcer (OR 8.151,95% CI 2.234-29.747, P = .001), cancer (OR 5.551, 95% CI 1.602-19.237, P = .007), and renal diseases (OR 3.710, 95% CI 1.965-7.006, P < .001) were the 3 strongest predictors of excessive polypharmacy. An association between hospital stay of more than 3 days and excessive polypharmacy was identified (OR 2.382, 95% CI 1.109-5.115, P = .026). DISCUSSION: One in 12 elderly Indonesians was found to practice excessive polypharmacy. Several chronic conditions and increased length of hospital stay were the factors associated with excessive polypharmacy.

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)

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)

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)

Breast, cervical, and lung cancer: A comparison of real healthcare costs and INA-CBGs rates in the era of national health insurance.

Background: In Indonesia, the cost of cancer treatment has been determined by the Indonesian Case Base Groups (INA-CBGs) based on a code called the INA-CBG's rates. However, a fair claim should be based on the severity of the disease and the class of treatment in the hospital, not on the rates of code. In fact, the real cost of therapy for cancer is influenced by several factors including stage, comorbidity, and severity (INA-CBGs coding, type of hospital, hospital class, treatment grade, side effects, and length of stay), so in many cases, there are reported differences between the real costs and the INA-CBGs rates charged to patients. Objective: This study aims to investigate the difference between real treatment costs and INA-CBG's rates for cases of lung cancer, cervical cancer, and breast cancer at a cancer center hospital in Indonesia. Methods: This work uses an observational study, and the data were taken retrospectively from hospital financial data and patient medical records. The data were then analyzed using a one-sample t-test to determine the difference between real costs and INA-CBGs costs. Results: The results showed that there was no significant difference between real costs and INA-CBG's cost on stage II lung cancer treatment in grade 2 with a sig. value of 0.683; code C-4-13-II in grade 3 with a sig. value of 0.151; and code C-4-13-III in grade 3 with a sig. value of 0.650; where the significance level (t alpha) is more than 0.05. Furthermore, the treatment costs for cervical cancer with codes C-4-13-I and C-4-13-II in grade 1 had sig. values of 0.155 and 0.720 respectively. Lastly, the treatment cost for breast cancer patients with codes C-4-12-II in grade 3 had a sig. value of 0.145 and code C-4-13-II in grade 3 showed a sig. value of 0.091. Conclusion: Although statistical evaluation showed a significant difference for some cases and not significant for other cases, in real conditions, there is a difference between the INA-CBGs and the real costs that must be evaluated by the government and stakeholders to provide justice for cancer patients.

A Systematic Review of Compensation and Technology-Mediated Strategies to Maintain Older Adults' Medication Adherence.

Elderly medication adherence is a challenge in health care. The elderly are often at higher risk for non-adherence, and more likely to be on multiple prescription medications for many comorbidities. This systematic review aimed to explore the current strategies for maintaining older adults' medication adherence with compensation and technology-mediated strategies. We conducted a systematic review to examine related articles published in the PubMed, Web of Science, and Scopus databases, as well as Google Scholar for additional reference sources by cross-reference review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to guide this review. A total of 217 articles were screened, and 27 studies fulfilled the inclusion criteria. Older adults applied a variety of methods to maintain or enhance their medication adherence. Three studies indicated compensation strategies, 19 studies reported technological assistance, two studies used other strategies (community-offered help or caregivers help), and three studies used a combination of compensation with another strategy or technology. Studies identified various compensation- and technology-based strategies carried out by older adults to help remind them to take medication. This review identified potential benefits of technology and compensation strategy implementation in older adults to increase medication adherence. Although we are conscious of the heterogeneity of the included studies, it remains challenging to determine which elements underpin the most effective approaches.

Factors Associated with Willingness to Pay for Cost-Sharing under Universal Health Coverage Scheme in Yogyakarta, Indonesia: A Cross-Sectional Survey.

BACKGROUND: National Health Insurance (NHI) in Indonesia requires an appropriate cost-sharing policy, particularly for diseases that require the largest financing. This study examined factors that influence willingness to pay (WTP) for cost-sharing under the universal health coverage scheme among patients with catastrophic illnesses in Yogyakarta, Indonesia. METHODS: This was a cross-sectional study using structured questionnaires through direct interviews. The factors related to the WTP for cost-sharing under the NHI scheme in Indonesia were identified by a bivariable logistic regression analysis. RESULTS: Two out of every five (41.2%) participants had willingness to pay for cost-sharing. Sex [AOR = 0.69 (0.51, 0.92)], education [AOR = 1.54 (0.67, 3.55)], family size [AOR = 1.71 (1.07, 2.73)], occupation [AOR = 1.35 (0.88, 2.07)], individual income [AOR = 1.50 (0.87, 2.61)], household income [AOR = 1.47 (0.90, 2.39)], place of treatment [AOR = 2.54 (1.44, 4.45)], a health insurance plan [AOR = 1.22 (0.87, 1.71)], and whether someone receives an inpatient or outpatient service [AOR = 0.23 (0.10, 0.51)] were found to affect the WTP for a cost-sharing scheme with p < 0.05. CONCLUSION: Healthcare (place of treatment, health insurance plan, and whether someone receives an inpatient or outpatient service) and individual socioeconomic (sex, educational, family size, occupational, income) factors were significantly related to the WTP for cost-sharing.

Interventions to Improve Medication Adherence in People with Schizophrenia: A Systematic Review.

Nonadherence to medications is very common in people with schizophrenia. Numerous methods have been implemented to improve medication adherence. The study aimed to determine what interventions have been used and to assess the effectiveness of these in improving medication adherence in people with schizophrenia. Two electronic databases (PubMed and Science Direct) and a manual search were used to locate RCT studies that examined interventions in medication adherence for schizophrenia, published between 2011 and 2022. The search was conducted using the terms (schizophrenia OR schizophrenic) AND (interventions OR adherence therapy) AND (medication adherence OR medication compliance). Sixteen studies were included, and relevant data were extracted and selected. Sixteen studies used interventions that involve family, health professionals (psychiatrists, psychologists, nurses, and pharmacists), SMS, and smart electronic reminders. Medication adherence was measured using medication refill records from hospital dispensing records or claim databases, electronic devices, plasma blood concentration, and participant self-reporting. Thirteen out of 15 studies showed significant improvements in adherence compared to routine care. The other three studies did not result in improved medication adherence. Interventions with diverse strategies delivered to individuals with schizophrenia showed the potential to reduce medication non-adherence in people with schizophrenia so that they can be utilized as an alternative to support treatment in people with schizophrenia in addition to antipsychotic medication. In future research strategies, it will be necessary to identify the main problems regarding nonadherence in people with schizophrenia individually and also identify the patient's perception of medication, illness, and behavior when taking medication in order to determine the next intervention that will be appropriate based on the patient's needs to improve adherence.

Exploring the Experiences and Needs of Patients With Type 2 Diabetes Mellitus in Sleman Regency, Yogyakarta, Indonesia: Protocol for a Qualitative Study.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic disease that can cause adverse effects if not managed effectively. The prevalence of T2DM will continue to rise every year, and data from the International Diabetes Federation show that the number of patients diagnosed with T2DM in Indonesia is predicted to increase from 10.3 million in 2017 to 16.7 million in 2045. Managing T2DM properly is a challenge for the patients because they need to implement lifestyle changes that involve the self-monitoring of blood glucose, consuming prescribed medication properly, maintaining a healthy diet, getting sufficient physical training, keeping a healthy sleeping pattern, managing stress properly, and consulting medical professionals regularly. The worldwide intervention for T2DM focuses on self-management education. The varied results in studies about interventions show that no particular intervention method can be regarded as the most effective. In Indonesia, there are limited studies on educational interventions to improve the quality of life and health of patients with T2DM. OBJECTIVE: This study aims to explore the experiences and needs of patients with T2DM in Sleman Regency, Yogyakarta, Indonesia, to develop effective self-management education. METHODS: The study will use the phenomenology method with purposive sampling to collect data. The inclusion criteria are patients in the Chronic Disease Self-Management Program at the Sleman Regency Public Health Center who are aged ≥18 years, diagnosed with T2DM for more than a year, with hemoglobin A1c levels ≤7.5% and >7.5%, capable of communicating verbally and literate in the Indonesian language, not deaf, and willing to participate. The data collection is based on the Social Cognitive Theory, which involves selecting assessment targets and analyzing personal factors, environment, and behavior that determine the knowledge, attitude, and adherence of persons with T2DM. Researchers will collect the data through in-depth, face-to-face interviews to learn about knowledge, self-efficacy, outcome expectancy, outcome experience, worry, illness belief, treatment belief, diet, physical activity, medicine intake, treatment pattern, support system, as well as ethnic and cultural influences. The results will be taken from unstructured and open-ended questions written in Indonesian according to the interview guidelines. The data analysis process will go through several stages: reading the data thoroughly; coding; sorting the categories; creating the themes; making general descriptions; and presenting the data in charts, narratives, and recorded quotations from the interviews. RESULTS: This study received a grant in May 2021 and gained permission from the Medical and Health Research Ethics Committee of Universitas Gadjah Mada, Indonesia, on July 1, 2021. Data collection started on August 12, 2021, and the results are expected to be published in 2022. CONCLUSIONS: The results of this study will be used to design an educational intervention model to improve the knowledge, attitude, and adherence of patients with T2DM. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37528.

Prediction of Productivity Costs Related to Cervical Cancer Mortality in Indonesia 2018.

Background: Cervical cancer is the second leading cause of death in Indonesia, causing a significant societal burden. This study aims to quantify the burden of cervical cancer in terms of years of life lost (YLL) and productivity cost to support the idea that cervical cancer has substantial economic implications. Methods: Using an epidemiological approach on the prevalence data of 2018, the productivity cost and YLL were estimated by calculating the number of cervical cancer deaths, life expectancy, annual earnings and employment participation rate. Cervical cancer mortality data were obtained from the Global Cancer Observatory (GLOBOCAN) 2018, life expectancy for Indonesia from the WHO Life Tables (2019), and the annual earnings and participation rate of Indonesia were retrieved from the National Statistics Bureau (2018). Results: In 2018, there were 17,253 deaths due to cervical cancer in Indonesia, resulting in 246,350 YLL with a total productivity cost of Indonesian Rupiah (IDR)23,174 trillion. The age group of 50 years old-64 years old experienced the greatest loss of earnings (IDR12,149 trillion), followed by the 35 years old-49 years old (IDR8,944 trillion) and 20 years old-34 years old (IDR8,944 trillion) age groups. Conclusion: The productivity impact of loss of earning due to cervical cancer mortality is significant. This information may assist decision makers in allocating scarce resources among competing priorities.

Exploring of Determinants Factors of Anti-Diabetic Medication Adherence in Several Regions of Asia - A Systematic Review.

BACKGROUND: The determinants of medication adherence in people with diabetes may differ between populations of an area due to social environment, cultural beliefs, socioeconomic conditions, education, and many other factors differences. OBJECTIVE: Therefore, this study aims to explore, identify and classify the determinants of medication adherence in several Asian regions. METHODS: A systematic literature review was conducted to gain insight into the determinants of medication adherence. Seven relevant databases (EBSCO, ProQuest, PubMed, ScienceDirect, Scopus, Wiley, dan Taylor and Francis) and hand searching methods were conducted from January 2011 to December 2020. Keywords were compiled based on the PICO method. The selection process used the PRISMA guidelines based on inclusion, and the quality was assessed using Crowe's critical assessment tool. Textual summaries and a conceptual framework model of medication adherence were proposed to aid in the understanding of the factors influencing medication adherence. RESULTS: Twenty-six articles from countries in several Asian regions were further analyzed. Most studies on type 2 diabetes patients in India used the MMAS-8 scale, and cross-sectional study is the most frequently used research design. The medication adherence rate among diabetic patients was low to moderate. Fifty-one specific factors identified were further categorized into twenty-three subdomains and six domains. Furthermore, the determinants were classified into four categories: inconsistent factors, positively related factors, negatively related factors, and non-associated factors. In most studies, patient-related factors dominate the association with medication adherence. This domain relates to patient-specific demographics, physiological feelings, knowledge, perceptions and beliefs, comorbidities, and other factors related to the patient. Several limitations in this review need to be considered for further research. CONCLUSION: Medication adherence to diabetic therapy is a complex phenomenon. Most determinants produced disparate findings in terms of statistical significance. The identified factors can serve various goals related to medication adherence. Policymakers and health care providers should consider patient-related factors.

Exploring the perceived challenges and support needs of Indonesian mental health stakeholders: a qualitative study.

BACKGROUND: Despite the large treatment gap in Indonesia, limited studies have attempted to explore both service users' and providers' evaluations of the current mental health system holistically. This study aims to explore the perceived challenges and support needs of Indonesian mental health stakeholders. METHODS: This qualitative study collected data from 17 participants from two mental health stakeholders in Yogyakarta (i.e., health professionals and service users) through a semi-structured interview. Thematic analysis was used to analyze the data. RESULTS: Findings reveal that service providers and users shared equally strong concerns regarding challenges and needs for improving mental health literacy, accessibility to services, and government support. However, a distinct emphasis was made in several areas-with service providers hinting more towards issues with interprofessional collaboration. In contrast, service users emphasized the negative attitude of health professionals and poor accessibility to service information. CONCLUSION: The mental health service system is challenged by the lack of accessibility to service information, the limited spread of mental health practitioners, stigma, and lack of mental health literacy among both the public and professionals. A need for improvement in mental health promotion, accessibility, and quality of mental health workers is highlighted to satisfy the needs of both service users and providers.

Personnel knowledge of intravenous admixtures: a survey in a government hospital.

INTRODUCTION: in Indonesia, intravenous admixtures are a common problem in hospitals. The incidence of microbial contamination in hospitals is still increasing every year. As such, knowledge of compounding personnel about intravenous admixtures is crucial in determining product quality. This study aims to assess the compounding personnel´s knowledge regarding intravenous admixtures and determine the relationship between socio-demographic characteristics with knowledge of compounding personnel in a government hospital, Indonesia. METHODS: a cross-sectional study was conducted on 119 compounding personnel selected using purposive sampling from five different hospital units from September to November 2020. Data were collected using a self-administered questionnaire on socio-demographic factors and knowledge of intravenous admixtures. RESULTS: of the 119 compounding personnel who was respondent in this study, only 28 compounding personnel had good knowledge (23.5%). Most of the respondents were female at 52.9%, early adulthood at 63.9%, profession as a nurse of 100%, working period less than five years at 37.0%, civil servants at 53.8%, and employees who have never attended training at 84.9%. Spearman rank correlation test results showed that no significant correlation between sex, profession, working period, and employment status with knowledge. However, age and intravenous admixtures training history have a significant correlation with knowledge. CONCLUSION: we found that most compounding personnel in a government hospital, Indonesia, were sufficiently understood with intravenous admixtures so that they should be aware of the importance of performing intravenous admixtures adequately.

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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Translation, cultural adaptation, and validation of the quality of well being self-administered questionnaire in general population in Indonesia.

Background The quality of well being self-administered (QWB-SA) questionnaire is one of the generic instruments which can be used to measure the utility score to assess the quality-adjusted life years (QALYs) as an outcome parameter in pharmacoeconomics study. This research aimed to study the translation, cultural adaptation, and validation of the QWB-SA questionnaire in Indonesian language. Methods This research was conducted among the general population of 459 people in Yogyakarta city. The translation was done using the forward-backward method by independent linguists, and then reviewed by a team consisting of linguists, methodologists, and pharmacists. The psychometric evaluations included face validity, internal-construct validity, convergent validity, and known-group validity tests, while the reliability test was the test-retest of reliability with the Spearman's rank correlation and Pearson test. Results The translation results and cultural adaptations were modified from the aspect of idiomatic, semantic and conceptual equivalence of the items on the QWB-SA questionnaire. The internal-construct validity showed a very strong and moderate correlation among dimensions and the QWB utility index. The convergent validity showed moderate-to-weak correlation compared to the Euro-quality of life-5 dimension questionnaire. The reliability test showed the Cronbach alpha coefficient of 0.626, and the test-retest of reliability showed a strong and moderate correlation. Conclusions The QWB-SA questionnaire is valid and reliable, and can be used as an alternative to measure utility as a QALY's parameter in the health-economic evaluation.