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)

Knowledge, perception, and willingness to provide telepharmacy services among pharmacy students: a multicenter cross-sectional study in Indonesia.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic accelerated the provision of telepharmacy services. However, little is known about the knowledge, perception, and willingness of pharmacy students as future key players in telepharmacy adoption to provide such a service, particularly in a setting without well-established telepharmacy services before the COVID-19 pandemic. OBJECTIVE: With this survey we aimed to assess the level of knowledge, perception, and willingness to provide telepharmacy services and to identify associated factors among pharmacy students in Indonesia. METHODS: We applied a multicenter cross-sectional study design with convenience sampling technique among pharmacy students in three public universities in Bandung City, Surabaya City, and Special Region of Yogyakarta, Indonesia. The knowledge, perception, and willingness to provide telepharmacy services were assessed using an online questionnaire. Ordinal regression analysis was performed to determine factors associated with a high knowledge level, whereas binary logistic regression analyses were performed to determine factors associated with a positive perception of telepharmacy services. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. RESULTS: Among 313 respondents, 83.4% were female, and the mean age was 20 years. Although only 13.2% showed a high knowledge level, 66.5% showed a positive perception of telepharmacy services and 97.4% were willing to provide telepharmacy services in the future. An increase in age (OR 1.33; 95% CI 1.14-1.54) and being advance in smartphone usage (OR 5.21; 95% CI 2.03-13.42) are associated with an increased likelihood of having a high knowledge level about telepharmacy services. Male students had a lower likelihood of having a positive perception of telepharmacy services than females (OR 0.46; 95% CI 0.24-0.85). CONCLUSION: Despite limited knowledge of telepharmacy, the majority of pharmacy students reported a positive perception and willingness to provide telepharmacy services in their future careers. Therefore, telepharmacy practice models must be included as a subject course in the curriculum, better preparing future pharmacists to perform their roles effectively. Furthermore, student-specific factors such as age and expertise in smartphone usage that associated with knowledge and gender that associated with perception should be considered to facilitate telepharmacy adoption in Indonesia.

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.

Detection tools for prediction and identification of adverse drug reactions in older patients: a systematic review and meta-analysis.

Tools to accurately predict and detect adverse drug reactions (ADR) in elderly patients have not been developed. We aimed to identify and evaluate reports on tools that predict and detect ADR in elderly patients (≥ 60 years). In this review, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Databases were searched until January 2022 using key terms "elderly," "adverse drug reaction," and "detection instruments." Eighteen studies met the inclusion criteria, and they examined assorted interventions: STOPP/START version 1/2 (n = 10), Beers Criteria 2012 or 2015 (n = 4), Systematic Tool to Reduce Inappropriate Prescribing (STRIP) (n = 2), Tool to Reduce Inappropriate Medications (TRIM) (n = 1), Medication Risk Score (MERIS) (n = 1), Computerized alert systems (n = 1), and Norwegian General Practice-Nursing Home criteria (n = 1). The interventions affected the number of potential prescription omissions (OR, 0.50 [0.37-0.69]; p < 0.0001; four studies). No apparent reduction in the number of drug interactions within 2 months (OR, 0.84 [0.70-1.02]; p = 0.08; two studies) and mortality (OR, 0.92 [0.76-1.12]; p = 0.41; three studies) was observed. In conclusion, there is no definitive and validated assessment tool for detecting and predicting ADR in elderly patients. Thus, more research on refining existing tools or developing new ones is warranted.

Factors related to barriers and medication adherence in patients with type 2 diabetes mellitus: a cross-sectional study.

Purpose: Evidence has shown that 50% of patients, including type 2 diabetes mellitus (DM), are non-adherent to the prescribed antidiabetic medication regimen. Some barriers lead to nonadherence in people with DM type 2. The study aimed to identify factors related to adherence in patient with DM and to assess the correlation between barriers to adherence type 2 DM patients. Methods: The cross-sectional study was conducted in 63 primary healthcare centers in Surabaya, Indonesia. Patients with DM type 2 were recruited between April and September 2019 using convenient sampling technique. Ethics approval was obtained (80/EA/KEPK/2019). Results: A total of 266 patients with type 2 DM participated in this study. Of the respondents, 201 (75.2%) were female. Unwanted drug effects, changes in medication regimens, and refilling the prescription when the drugs run out were most reported factors that affected adherence. Spearman correlations and linear regression tests were used to examine the relationship between barriers to medication adherence, and education with medication adherence. A significant difference was observed between the level of education and adherence (p = 0.031). The results showed an association between barriers to medication and adherence to medication (r = 0.304; p < 0.001) which was confirmed in regression analysis (R = 0.309, R square = 0.095, p <0.001). Conclusions: Barriers to adherence are common and affect adherence to therapy. It is essential to expand the roles of health care professionals in the community to include counseling, barrier-monitoring, education, and problem-solving to improve patient medication adherence.

Educational interventions for health professionals managing chronic obstructive pulmonary disease in primary care.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common, preventable and treatable health condition. COPD is associated with substantial burden on morbidity, mortality and healthcare resources. OBJECTIVES: To review existing evidence for educational interventions delivered to health professionals managing COPD in the primary care setting. SEARCH METHODS: We searched the Cochrane Airways Trials Register from inception to May 2021. The Register includes records from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED) and PsycINFO. We also searched online trial registries and reference lists of included studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and cluster-RCTs. Eligible studies tested educational interventions aimed at any health professionals involved in the management of COPD in primary care. Educational interventions were defined as interventions aimed at upskilling, improving or refreshing existing knowledge of health professionals in the diagnosis and management of COPD. DATA COLLECTION AND ANALYSIS: Two review authors independently reviewed abstracts and full texts of eligible studies, extracted data and assessed the risk of bias of included studies. We conducted meta-analyses where possible and used random-effects models to yield summary estimates of effect (mean differences (MDs) with 95% confidence intervals (CIs)). We performed narrative synthesis when meta-analysis was not possible. We assessed the overall certainty of evidence for each outcome using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Primary outcomes were: 1) proportion of COPD diagnoses confirmed with spirometry; 2) proportion of patients with COPD referred to, participating in or completing pulmonary rehabilitation; and 3) proportion of patients with COPD prescribed respiratory medication consistent with guideline recommendations. MAIN RESULTS: We identified 38 studies(22 cluster-RCTs and 16 RCTs) involving 4936 health professionals (reported in 19/38 studies) and 71,085 patient participants (reported in 25/38 studies). Thirty-six included studies evaluated interventions versus usual care; seven studies also reported a comparison between two or more interventions as part of a three- to five-arm RCT design. A range of simple to complex interventions were used across the studies, with common intervention features including education provided to health professionals via training sessions, workshops or online modules (31 studies), provision of practice support tools, tool kits and/or algorithms (10 studies), provision of guidelines (nine studies) and training on spirometry (five studies). Health professionals targeted by the interventions were most commonly general practitioners alone (20 studies) or in combination with nurses or allied health professionals (eight studies), and the majority of studies were conducted in general practice clinics. We identified performance bias as high risk for 33 studies. We also noted risk of selection, detection, attrition and reporting biases, although to a varying extent across studies. The evidence of efficacy was equivocal for all the three primary endpoints evaluated: 1) proportion of COPD diagnoses confirmed with spirometry (of the four studies that reported this outcome, two supported the intervention); 2) proportion of patients with COPD who are referred to, participate in or complete pulmonary rehabilitation (of the four studies that reported this outcome, two supported the intervention); and 3) proportion of patients with COPD prescribed respiratory medications consistent with guideline recommendations (12 studies reported this outcome, the majority evaluated multiple drug classes and reported a mixed effect). Additionally, the low quality of evidence and potential risk of bias make the interpretation more difficult. Moderate-quality evidence (downgraded due to risk of bias concerns) suggests that educational interventions for health professionals probably improve the proportion of patients with COPD vaccinated against influenza (three studies) and probably have little impact on the proportion of patients vaccinated against pneumococcal infection (two studies). Low-quality evidence suggests that educational interventions for health professionals may have little or no impact on the frequency of COPD exacerbations (10 studies). There was a high degree of heterogeneity in the reporting of health-related quality of life (HRQoL). Low-quality evidence suggests that educational interventions for health professionals may have little or no impact on HRQoL overall, and when using the COPD-specific HRQoL instrument, the St George's Respiratory Questionnaire (at six months MD 0.87, 95% CI -2.51 to 4.26; 2 studies, 406 participants, and at 12 months MD -0.43, 95% CI -1.52 to 0.67, 4 studies, 1646 participants; reduction in score indicates better health). Moderate-quality evidence suggests that educational interventions for health professionals may improve patient satisfaction with care (one study). We identified no studies that reported adverse outcomes. AUTHORS' CONCLUSIONS: The evidence of efficacy was equivocal for educational interventions for health professionals in primary care on the proportion of COPD diagnoses confirmed with spirometry, the proportion of patients with COPD who participate in pulmonary rehabilitation, and the proportion of patients prescribed guideline-recommended COPD respiratory medications. Educational interventions for health professionals may improve influenza vaccination rates among patients with COPD and patient satisfaction with care. The quality of evidence for most outcomes was low or very low due to heterogeneity and methodological limitations of the studies included in the review, which means that there is uncertainty about the benefits of any currently published educational interventions for healthcare professionals to improve COPD management in primary care. Further well-designed RCTs are needed to investigate the effects of educational interventions delivered to health professionals managing COPD in the primary care setting.

Implementation of Computerized Physician Order Entry in Primary Care: A Scoping Review.

PURPOSE: This scoping review aimed to assess the implementation and outcomes of computerized physician order entry (CPOE) in primary care. METHODS: A scoping review was carried out in accordance with the Joanna Briggs Institute's guidelines (JBI). The databases PubMed, CINAHL, Science Direct, and Google Scholar were all searched. The full text of each article was reviewed for eligibility after the title and abstract were evaluated. JBI data extraction were used to extract data. Donabedian's framework served as the foundation for the data discussion. RESULTS: Based on the inclusion criteria, seven studies were included. The studies' main goal in common was to analyze the outcome or impact of implementing CPOE systems in ambulatory or primary care settings. Several studies described the framework, current state of implementation, and evaluation or recommendation following CPOE system implementation. Many positive effects were felt by physicians or prescribers, pharmacists, patients, and primary care providers, with patient safety being the primary goal. CONCLUSION: Although this study discovered some issues and factors associated with CPOE implementation and adoption, such as infrastructure, workflow, level of engagement, and safety culture, CPOE has many positive outcomes for patients, physicians, and primary care. To improve CPOE adoption in healthcare, particularly primary care, more research into the structure, framework, and components of CPOE deployment is required.

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.

Knowledge, attitudes, and practices (KAP) towards COVID-19 among university students in Pakistan: a cross-sectional study.

OBJECTIVES: Pakistan has taken unprecedented measures to control the spread of COVID-19. Complete lockdown followed by smart lockdown and quarantine centres was established. Their awareness and attitude towards COVID-19 had an impact on the individual behaviour of the precautionary measures. The current study examined the knowledge, attitudes and practices of university students in Pakistan. METHODS: An online cross-sectional study was conducted among university students in Pakistan. A questionnaire containing demographic and KAP information related to COVID-19 has been created. RESULTS: A total of 358 students responded to the survey, and 353 participants completed the study. Among the respondents, 61.5% were male, 76.8% were single, and 58.4% enrolled in a bachelor's degree. The results showed that most of the respondents (68%) had good knowledge about COVID-19, while the overall knowledge score was 8.78 ± 1.63 (range 1-10). The majority of the respondents (90.9%) were aware of COVID-19, 95.8% knew the sign and symptoms, and 83% of them knew about its transmission. We found a significant difference in knowledge scores across education and area of study p<0.05. More than half (53.5%) of the respondents were satisfied with the facilities provided by the government of Pakistan. The average practices score among the students was 5.08 ± 1.312. A significant difference was found among practice score and area of study p<0.05. CONCLUSIONS: Most of the students have an adequate level of knowledge and are doing better preventive measures against COVID-19. Health education initiatives are required to ensure best practice among the high-risk groups.

The correlation between self-related adherence, asthma-related quality of life and control of asthma in adult patients.

OBJECTIVES: Medication non-adherence mostly occurs in patients with a wide range of disease severity, including asthma. The aim of the study was to assess the self reported adherence to asthma therapy and investigate the relationship between adherence, asthma control and asthma-related quality of life. METHODS: The study was a cross-sectional study in which participants were recruited from an outpatient department, in one hospital in Surabaya. Patients (aged≥18 years) with asthma who had used any regular asthma medications were included. Standardised questionnaires, including Juniper's Asthma Control Questionnaire (ACQ), Adherence to Refills and Medications Scales (ARMS) and Juniper's Asthma Quality of Life Questionnaire (AQLQ) were used. RESULTS: A total of 82 adults with asthma were recruited in the study. Male participants' mean age was 49.13 ± 14.10 years (n = 23). Approximately 59 participants (72.0%) were females, 30 participants (36.5%) were using Budesonide inhaler, and 73 participants (89.0%) never smoked. The mean of ACQ, AQLQ, and ARMS scores were 1.62 ± 1.19, 4.96 ± 1.24, and 16.98 ± 4.12, respectively. Of 82 patients studied 53 (64.6 %) had "uncontrolled asthma" and more than 85% participants both showed "non adherence" to asthma therapy and nearly 46% of them indicated that their quality of life was affected by asthma. There was a significant association between ACQ and AQLQ (p<0.05), whereas no statistically significant association was found between ACQ and ARMS. CONCLUSIONS: The majority of patients reported non-adherence to asthma medications. Poor controlled asthma has been associated with lower asthma-related quality of life.

Beliefs about medicines in pregnancy: a survey using the beliefs about medicines questionnaire in Indonesia.

Background Many studies examine the use of medicines among pregnant women, however few studies report the pregnant women's belief for taking medication during pregnancy. Individual factors such as patients' beliefs about their medications have been known to influence medication adherence. Objective This study aimed to examine beliefs about medicines among pregnant women in Indonesia and how these varied across pregnancy trimesters. Setting We conducted a cross-sectional survey of pregnant women who had regular visits at 63 community health centres in Surabaya, Indonesia. Methods Participants were approached while they were in the waiting room and were asked to complete the questionnaire. The survey package contained information about the study, an informed consent form, and the Beliefs about Medicines Questionnaire (BMQ). Main outcome measure Beliefs about medicines were assessed using the BMQ, which comprises four subscales: general-overuse, general-harm, specific-necessity, and specific-concern. Differences in medication beliefs between pregnancy trimesters were assessed using suitable statistical tests according to data normality. Results A total of 492 pregnant women completed the survey. The majority were aged 21-30 years (57.1%), housemakers (68.7%), and educated to high-school level (51.4%); 92.9% did not have any chronic diseases, and more than 90% took vitamins and/or supplements. The difference between Specific-Concern and Specific-Necessity scores was calculated for each participant, and more than half of the participants (59.6%) were thus classified as having negative beliefs about medications. In the first trimester of pregnancy, women's beliefs about medication necessity were stronger than in the third trimester (p = 0.033). Conclusion Medication beliefs of pregnant women regarding their concerns and the necessity of medication taken in different trimesters of pregnancy were varied. The results of this study highlight the difference in medication beliefs during trimesters in pregnancy.

The implementation of a chronic disease management program (Prolanis) in Indonesia: a literature review.

Background The Chronic Disease Management Program or Program Pengelolaan Penyakit Kronis (Prolanis) is a program initiated by the Social Insurance Administration Organization or Badan Penyelenggara Jaminan Social (BPJS) in Indonesia. Prolanis aim to provide a proactive healthcare service approach for patients with chronic diseases particularly those with diabetes mellitus and hypertension. Prolanis also aims to achieve the optimal quality of life in patients with chronic disease through effective and efficient healthcare services including cost. All primary healthcare centers and a few of the private clinics in Indonesia have implemented Prolanis, however, the impact of the program has not been reviewed. This review aimed to see the implementation of Prolanis in healthcare facilities in Indonesia. Methods A literature review was conducted by searching articles through Google Scholar and PubMed databases up to August 2019. The following keywords or terms were used: Prolanis, BPJS indexed with terms related to blood pressure or hypertension in Indonesia. The references, citations and similar articles from the identified articles were used to identify additional sources. Results Twenty-four articles were identified through the first search using the key terms although only eight articles met the inclusion criteria. This review showed that the implementation of Prolanis in the healthcare facilities in Indonesia was varied in terms of the activities and services provided. The healthcare professional involved in the implementation of Prolanis were also varied. There were some barriers faced by the healthcare facilities including the availability of funding, the healthcare facilities and infrastructures, the unavailability of standard operating orocedures (SOPs) as well as the limitation of human resources involved in Prolanis. Conclusions The implementation of Prolanis in Indonesia has not been optimized, as there were some barriers during its implementation in the healthcare facilities.

Factors affecting community pharmacist's service for women with chronic diseases during pregnancy and breastfeeding: application of the Health Belief Model.

Background Pharmacists are known as health care professionals who are responsible for the safety and efficacy of medicine to achieve optimal therapeutic results. Community pharmacists have an opportunity to provide direct services including giving an active medication information service in women during pregnancy and breastfeeding. This study aimed to determine the factors associated with the practice of community pharmacists for actively giving the drug information service for women with chronic diseases during pregnancy and breastfeeding based on the Health Belief Model. Methods About 300 community pharmacists were randomly chosen to participate in the study. All participants were asked to complete questionnaires that were designed based on the theory of the Health Belief Models. The questionnaires measured the community pharmacists' knowledge, beliefs, cues to action, and practice for actively giving medication information services. Results About 267 pharmacists in the community agreed to participate in this study. Nearly 80% of the participants were female pharmacists (n = 213). The results show that pharmacists' knowledge had significant influences towards perceived threat (p = 0.009), perceived benefit (p = 0.011), and pharmacists' self-efficacy (p < 0.001). The self-efficacy factor was the most influential factor in the practice of pharmacists to give medication information service actively (p < 0.001). Conclusions The findings of the study indicate that self-efficacy is the most important factor for pharmacist to be able to provide the medication information services successfully particularly in women during pregnancy and breastfeeding. Providing continuous learning programs through seminars and training related to medication use during pregnancy and breastfeeding to pharmacists is needed to optimise the confidence and the ability of pharmacists in providing the services.

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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Cultural Sensitivity and Global Pharmacy Engagement in Asia: India, Indonesia, Malaysia, Philippines, and Vietnam.

Schools and colleges of pharmacy in the United States increasingly interact with those in Asian countries for various purposes such as education and research. For both those visiting and those hosting, it is important to understand and respect the culture of the other's country to enrich these interactions. This paper, the second of two manuscripts on Asian countries, focuses on India, Indonesia, Malaysia, Philippines, and Vietnam. For each country, the following information is provided: general introduction, health care system, pharmacy practice, and pharmacy education, stereotypes and misconceptions, recommendations for US-based health care professionals, faculty members, and students who visit these Asian countries, and recommendations for them to host visitors from these Asian countries. The aim of this paper is to assist US health care professionals, faculty members, and students in initiating and promoting a culturally sensitive engagement.

Efficacy of an Education Session by Pharmacists for Patients With Asthma: Protocol and Design of a Randomized Controlled Trial.

BACKGROUND: Asthma is a chronic disease that requires indefinite long-term therapy. Many approaches have been developed to enable people with asthma to live as normally as possible. In medication therapy management, pharmacists could play important roles in supporting the everyday life of asthmatic patients, such as by providing education therapy management to ensure that patients achieve optimal therapeutic outcomes. A good collaboration between health care practitioners and patients will produce a better system in terms of therapeutic management, which will lead to health care cost savings related to emergency visits. Although the Government has made various efforts to manage asthma in Indonesia, without commitment and support from both patients and health care professionals, the expected outcomes cannot be achieved. OBJECTIVE: This study aims to evaluate the effectiveness of an educational intervention provided by pharmacists compared with that of usual care. METHODS: A randomized controlled trial comparing usual care with an education session by pharmacists is underway. The intervention comprises a one-on-one education session of 60 minutes with a pharmacist comprising information regarding (1) asthma medication that has been used; (2) how to use asthma medication devices correctly; (3) asthma symptoms and how to prevent exacerbation of asthma; and (4) how to manage asthma triggers and environmental control measures. The primary outcome measure is change in asthma control, as measured using the Asthma Control Questionnaire. Secondary outcomes include changes in Asthma Quality of Life Questionnaire score, lung function, asthma-related health visits, days off from work or study, and oral corticosteroid use. Research assistants who are masked to the group allocation will collect outcome data at the baseline and every month for a 3-month period. Informed consent will be sought at enrollment and intention-to-treat analysis will be performed. RESULTS: This study was funded in January 2017 and ethical approval was obtained in June 2017. The enrollment was started in August 2017, and about 72 participants have been enrolled. First results are expected to be submitted for publication in 2019. CONCLUSIONS: This is the first study to evaluate the effectiveness of a pharmacist-guided asthma education session compared with that of usual care in Indonesia. If it is proven effective, this intervention program could improve asthma self-management by patients, which may reduce risks of poorly controlled asthma. This intervention could also be implemented in addition to the current usual care for patients with asthma. TRIAL REGISTRATION: Thai Clinical Trials Registry TCTR20171219001; http://www.clinicaltrials.in.th/index.php? tp =regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=3068 (Archived by WebCite at http://www.webcitation.org/73Ci5eKtv). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/10210.