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 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.

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 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.