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

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

The development and validation of the health belief model questionnaire for measuring factors affecting adherence in the elderly with hypertension.

OBJECTIVES: This study aimed to validate the questionnaire on the health belief model questionnaire to assess health beliefs that could influence adherence to hypertension in the elderly. METHODS: The questionnaire was based on a study of the literature and discussion with experts. The questionnaire was then circulated via social media. Participants who met the following criteria were asked to participate in the study: (1) aged 60-79 years of age, (2) had antihypertensive medications in the last three months, and (3) had a mobile phone with an active number. The questionnaire consists of six domains: perceived susceptibility, perceived severity, perceived threat, perceived benefits, perceived barriers, and perceived self efficacy. The findings were grouped by domain and tested for reliability and validity using SPSS ver.24. RESULTS: Thirty participants completed the questionnaire. Each domain was tested for its reliability and validity at a value of 0.05. The result shows that each domain had a Cronbach's alpha value greater than 0.7, with a total score of 0.89 indicating that all domains in the questionnaire were reliable. Furthermore, of the 49 items in the questionnaire, only two items were invalid while the rest of the items demonstrated their validity based on the Pearson Correlation (>r table 0.361; p<0.05). CONCLUSIONS: This self administered health belief model questionnaire was a valid and reliable instrument to assess health beliefs in elderly with hypertension.

Translation and cross-cultural adaption of an instrument measuring patient's well-being under treatment for schizophrenia.

OBJECTIVES: The Subjective Well-Being under Neuroleptic (SWN) Scale is a self-rating scale measuring the well-being of patients with schizophrenia under antipsychotic drug treatment. The instrument has been globally used, with issues regarding the well-being assessment scale across different cultures, patient characteristics, and country-setting remains a controversy. This study aimed to translate and culturally adapt the SWN scale into the Indonesian version (Indonesian Modified SWN or IM-SWN) and evaluate its validity and reliability. METHODS: The SWN instrument was translated and culturally adapted following internationally accepted procedures, including forward translation, expert panel review, backward-translation, pretesting and cognitive interviewing, and psychometric analysis for the final version of the scale. The translated instrument was tested on 108 schizophrenia patients. The instrument's validity and reliability were assessed using Pearson's correlation and Cronbach's Alpha coefficient. Additional analysis for the socio-demographic and psychometric properties of the patient was also conducted. RESULTS: The range of IM-SWN total score between 30 and 112. IM-SWN was found to have a high-reliability coefficient (0.897), and the internal consistency values of each question item ranged between 0.885 and 0.910. The results also showed a high correlation between five order factors (Physical functioning, mental functioning, self-control, emotional regulation, and social integration), with a total score of between 0.768 and 0.885. CONCLUSIONS: This study highlighted that the IM-SWN is a valid and reliable instrument for measuring well-being among the Indonesian population with schizophrenia.

Social media health interventions to improve diabetes mellitus patient outcome: a systematic review.

OBJECTIVES: The use of modern technology and social media has revolutionized the way health information is distributed to diabetes mellitus patients. Social media can be used as a medium of providing health interventions to improve patient health outcomes. Social media is able to provide a more intensive communication facility between healthcare professionals and patients. We aim to systematically review and describe the effect of social media interventions on health outcomes of patients with diabetes mellitus. METHODS: A systematic review was carried out from three electronic databases (Pubmed, Scopus, and Medline). Eligible publications are studies that describe the application of social media interventions on the health outcomes of patients with diabetes mellitus. RESULTS: Fourteen studies were selected for this systematic review, 10 studies with a randomized controlled trial design, and 4 studies with a nonrandomized controlled trial design. Six studies only used interventions using social media, A blend of face-to-face social media intervention was used in 6 studies, 2 studies used a combination of telephone and social media intervention. One study had treatment behavior outcomes with improvement in treatment behavior, 6 studies had clinical outcomes (an improvement in HbA1c values in the four studies), 6 studies had treatment behavior outcomes and clinical outcomes (1 study had improved treatment behavior and clinical outcomes, 3 studies had improved treatment behavior outcome only), and 1 study had medication adherence outcome (no improvement in medication adherence). CONCLUSIONS: These findings indicate that the intervention using social media can improve the health outcomes of diabetes mellitus patients.

The effect of pillbox use and education by pharmacist toward medication adherence in diabetes mellitus patients in a Primary Health Care Center in Mataram.

OBJECTIVES: Nonadherence to a long-term therapy, including diabetes mellitus, is one of the global problems that need to be overcome. This study aims to determine the effect of pillbox use and education by pharmacists toward medication adherence in patients with diabetes mellitus in a Primary Health Care Center in Mataram. METHODS: This research was an experimental research design with pretest-posttest with control group design. The study was conducted from October to December 2019 at Tanjung Karang Primary Health Care Center, Mataram. Measurement of adherence was done using the Adherence to Refill and Medication Scale questionnaire. The higher the score, the more nonadherence the patients. Patients were divided into three groups, which were the control group, educational intervention group, and pillbox and educational intervention group. Each group consisted of 11 patients. RESULTS: Patients' medication adherence increased from 19.54 (SD 4.37) to 15.18 (SD 2.64) in the education and pillbox intervention group (p=0.004). Whereas, in the education and control group, the adherence did not provide a significant change (p>0.05). Based on the difference in adherence scores, it was known that what contributed to changes in compliance was refilling medicine and intentional nonadherence in taking medicine subscale (p=0.024). CONCLUSIONS: Providing education and pillbox done by pharmacists at the Primary Health Care Center can increase adherence to the therapy of diabetes mellitus patients. Pharmacists at the Primary Health Care Center can use the intervention model to improve the level of adherence of patients with chronic illness.

Knowledge, attitude, and practice of pharmacists towards management of hypertension in primary care centers.

Background Hypertension is one of the major health problems of the world and one of the most important causes of death in Indonesia. Complication due to hypertension leads to myocardial infarction, stroke, and renal failure. Pharmacist in primary care centers (Puskesmas) plays an important role in the management of hypertension. The purpose of this study was to assess the knowledge, attitude, and practice (KAP) of pharmacists working in Puskesmas in Surabaya, Indonesia, towards the management of hypertension. Methods A cross-sectional survey was conducted from March to July 2019 in 63 Puskesmas in Surabaya. A questionnaire was developed from the literature to assess KAP and administered to the pharmacists. Data was analyzed using SPSS version-17 and presented in terms of descriptive variables. The mean age of the participants was 34.6 ± 4.9 years (24-45 years old), and 82.5% were females. Majority of the respondents (74.6%) had more than 5 years of experience in Puskesmas. Results Overall, pharmacists had moderate knowledge, and the majority had good attitude and showed satisfactory practice in the management of hypertension. Conclusions There is still a need for continuing education, workshops, and seminars for pharmacists in order to maintain their performance.

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

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

Medication adherence in diabetes mellitus patients at Tanjung Karang Primary Health Care Center, Mataram.

Background The prevalence of diabetes mellitus continues to increase every year, including in Indonesia. To prevent complications of diabetes mellitus, patients need to adhere to therapy. The aim of this study was to assess patient adherence to diabetes mellitus drug therapy at Tanjung Karang Primary Health Care Center, Mataram. Methods A total of 60 participants were recruited in April-May 2019. The inclusion criteria of respondents were patients who were diagnosed with diabetes mellitus, treated at Tanjung Karang Primary Health Care Center for more than 1 month, and aged at least 18 years. Assessment of adherence to therapy was carried out using a validated questionnaire, which was the Adherence to Refill Medication Scale (ARMS) questionnaire. The scale used was the Likert scale (1-4) with a score range of 12-48. The higher the total score, the lower the compliance. Results The average age of the respondents was 54.97 years. The average ARMS score was 19.52 ± 5.688 with the lowest score of 12 and the highest score of 33. Among all respondents, only 8.3% had good adherence (total score of 12). Based on the subscales, the average score for refilling medicine and intentional nonadherence in taking medicine was 7.18 ± 2.383, the unintentional nonadherence in taking medicine was 8.13 ± 2.764, and the persistence in refilling medicine was 4.12 ± 1.738. Conclusions Patient medication adherence to the treatment of diabetes mellitus needs to be improved. An approach through healthcare professionals can be achieved so that the therapeutic outcome will be achieved.

The prescription patterns of second-generation antipsychotics in schizophrenia outpatient setting.

Background Schizophrenia is a chronic disorder that requires long-term treatment to achieve symptom remission and quality of life improvement. Antipsychotic medications are primary treatments for schizophrenia patients. Second-generation antipsychotics (SGAs) have been recognized as first-line drugs in the treatment of schizophrenia. This study aimed at determining the prescription patterns of SGAs in schizophrenia outpatients in the National Mental Hospital in Indonesia. Methods A retrospective study with descriptive analysis was conducted between October and December 2018, exclusive to data of the patients with schizophrenia only. Data were collected from the prescription records of schizophrenia outpatients. This study performed a descriptive analysis of patient characteristics, percentage of SGAs prescribed, regimen doses of SGAs, average number of SGAs prescribed per patient, and pattern of antipsychotics prescribed. Results The most commonly used SGAs were risperidone 55%, followed by clozapine 38%, aripiprazole 3%, quetiapine 3%, and olanzapine 1%. Antipsychotics were generally prescribed in their recommended doses. Almost all SGAs were prescribed as polypharmacy, and the most common combination of SGAs were risperidone and clozapine. Conclusions This study highlighted that risperidone was the major choice for treatment in the outpatient setting. Polypharmacy is the most common pattern prescription of SGAs in the National Mental Hospital in Indonesia. New studies should focus on the analyses of polypharmacy prospectively, and the role of pharmacist in collaboration with other health professionals in the managing of schizophrenia therapy.

Assessment of pharmacists' knowledge, attitude and practice in chain community pharmacies towards their current function and performance in Indonesia.

BACKGROUND: The introduction of universal healthcare coverage in 2014 has affected the practice of community pharmacies in Indonesia. Studies regarding the practice of pharmacist in the chain community pharmacy setting in Indonesia are very limited. The chain community pharmacies in Indonesia are operated and controlled by the same management. The chain community pharmacies usually show better services compared to independent community pharmacies in Indonesia. OBJECTIVE: The study aimed to assess the knowledge, attitude and practice (KAP) of pharmacist working in chain community pharmacy towards their current function and performance in delivering pharmacy services. METHODS: A cross-sectional study using questionnaires was conducted between January and March 2017 in KF, one of the largest chain community pharmacies in Indonesia. The total sampling method was used in the recruitment process. The data were analyzed using descriptive statistics, independent t-Test and one-way ANOVA. The KAP scores were assessed and categorized as "poor", "moderate" and "good" based on the standardized scoring system. RESULTS: A total of 949 KF's pharmacists (100% response rate) were participated in the study. The majority of pharmacists showed a good score in terms of knowledge and attitude, which is in contrast to practice as majority only obtained a moderate score. Working experience, age and the availability of standard operating procedures (SOP) for both dispensing and self-medication services were found to be statistically significant (p<0.005) aspects to KAP of pharmacists in delivering pharmacy services. CONCLUSIONS: This study identified several important aspects that could affect the KAP of pharmacists working in chain community pharmacies in Indonesia. Specific policies should be conceived to improve the competencies of pharmacist and to ensure the compliance with the SOP and standardization system within pharmacy sector.

Assessment of pharmacists' knowledge, attitude and practice in chain community pharmacies towards their current function and performance in Indonesia

Background: The introduction of universal healthcare coverage in 2014 has affected the practice of community pharmacies in Indonesia. Studies regarding the practice of pharmacist in the chain community pharmacy setting in Indonesia are very limited. The chain community pharmacies in Indonesia are operated and controlled by the same management. The chain community pharmacies usually show better services compared to independent community pharmacies in Indonesia. Objective: The study aimed to assess the knowledge, attitude and practice (KAP) of pharmacist working in chain community pharmacy towards their current function and performance in delivering pharmacy services. Methods: A cross-sectional study using questionnaires was conducted between January and March 2017 in KF, one of the largest chain community pharmacies in Indonesia. The total sampling method was used in the recruitment process. The data were analyzed using descriptive statistics, independent t-Test and one-way ANOVA. The KAP scores were assessed and categorized as "poor", "moderate" and "good" based on the standardized scoring system. Results: A total of 949 KF's pharmacists (100% response rate) were participated in the study. The majority of pharmacists showed a good score in terms of knowledge and attitude, which is in contrast to practice as majority only obtained a moderate score. Working experience, age and the availability of standard operating procedures (SOP) for both dispensing and self-medication services were found to be statistically significant (p<0.005) aspects to KAP of pharmacists in delivering pharmacy services. Conclusions: This study identified several important aspects that could affect the KAP of pharmacists working in chain community pharmacies in Indonesia. Specific policies should be conceived to improve the competencies of pharmacist and to ensure the compliance with the SOP and standardization system within pharmacy sector

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