Pharmacists' preferences for the provision of services to improve medication adherence among patients with diabetes in Indonesia: Results of a discrete choice experiment.

Little is known about pharmacists' preferences for services to improve medication adherence in patients with diabetes in Indonesia. Identification of such preferences can provide valuable insights on suitable services from a pharmacist's perspective. This study elicits pharmacists' preferences for services to improve medication adherence among their patients. A discrete choice experiment (DCE) method was used to survey pharmacists in all community health centres and three hospitals in Surabaya, Indonesia. Four attributes of consultation, namely duration of consultation, place of consultation, access to a pharmacist and patient copayment, and two attributes on additional services (educational and behavioural-based services) were included. The 16 profiles generated for DCE were partially balanced and partially without overlap. A random-effect logistic regression was used in the analysis. In total, 99 pharmacists completed the questionnaire, but only 80 were included in the study based on a consistency check. All attributes were found to determine preferences for a pharmacist service package. Pharmacists preferred a consultation with a shorter duration accompanied by flexible access to the pharmacist as well as a private consultation room and a lower patient copayment. Providing the patient with a brochure/leaflet was the most preferred additional service to help improve medication adherence. Patient group discussion and medication review were also preferred in combination with a consultation. Pharmacists' socio-demographic background characteristics influence preferences. These findings can be considered in evaluating current practice and designing pharmacist services to help improve medication adherence among patients with diabetes.

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.

Pharmacists' and patients' perceptions about the importance of pharmacist services types to improve medication adherence among patients with diabetes in Indonesia.

BACKGROUND: Various pharmacist services are available to improve medication adherence, including consultation, brochure, etc. Challenges arise on which services are best implemented in practice. Knowledge about patients' and pharmacists' preferences can help to prioritize services. This study explores the pharmacists' and patients' perceptions about the importance of pharmacist services to improve medication adherence among patients with diabetes in Indonesia. METHODS: This questionnaire-based cross-sectional study involved adult outpatients with diabetes type 2 and pharmacists from community health centers (CHCs) and hospitals in Surabaya, Indonesia. Random sampling was used to identify 57 CHCs in the study. In addition, based on convenient sampling, three hospitals participated. All pharmacists working at the CHCs and hospitals, who were willing to participate, were included in the study. For patients, minimum sample size was calculated using Slovin's formula. Patients and pharmacists were asked to rank five pharmacist service types (consultation, brochure/leaflet, patient group discussion, medication review, and phone call refill reminder) according to their importance to improve medication adherence. A face validity test of the self-developed questionnaire was conducted before the data collection. Rank ordered probit models were estimated (STATA 15th software). RESULTS: A total of 457 patients from CHCs, 579 patients from hospitals, and 99 pharmacists from both medical facilities were included. Consultation (CHC patients 56.0% vs hospital patients 39.7% vs pharmacists 75.2%) and brochure (CHC patients 23.2% vs hospital patients 27.5% vs pharmacists 11.9%) were the most preferred pharmacist services. Patients with experience getting medication information from pharmacists valued consultation higher than brochure and patient group discussions. Older patients ranked a brochure higher than other services. Patients without formal education in CHCs had a lower probability of giving a high rank to a brochure to improve medication adherence. There was significant positive correlation between the ranking of phone call refill reminder and medication review (0.6940) for patients in CHCs. CONCLUSION: For both patients and pharmacists, consultation, brochure, and group discussion were the highest-ranked services. Education, age, experience with pharmacist services, and medical facility features need to be considered when evaluating which pharmacist services to implement in Indonesia.

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

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

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

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

Preferences for pharmacist services to enhance medication management among people with diabetes in Indonesia: A discrete choice experiment.

OBJECTIVES: To elicit patients' preferences for pharmacist services that can enhance medication management among people with diabetes in Indonesia. METHODS: A discrete choice experiment (DCE) among 833 respondents with diabetes in 57 community health centers (CHCs) and three hospitals in Surabaya, Indonesia. Consultation was the baseline service. Four attributes of consultation and two attributes of additional services were used in the DCE profiles based on literature and expert opinion. The DCE choice sets generated were partially balanced and partially without overlap. Random effect logistic regression was used in the analysis. RESULTS: Respondents preferred a shorter duration of consultation and flexible access to the pharmacist offering the consultation. A private consultation room and lower copayment (fee) for services were also preferred. Respondents with experience in getting medication information from pharmacists, preferred to make an appointment for the consultation. Total monthly income and experience with pharmacist services influenced preferences for copayments. CONCLUSION: Differences in patients' preferences identified in the study provide information on pharmacist services that meet patients' expectations and contribute to improve medication management among people with diabetes. PRACTICE IMPLICATION: This study provides insight into evaluating and designing pharmacist services in accordance with the preferences of people with diabetes in Indonesia.

Pharmacy-led interventions to improve medication adherence among adults with diabetes: A systematic review and meta-analysis.

BACKGROUND: Control of blood glucose and a reduced risk of complications are important treatment goals in diabetes. Medication non-adherence can influence the outcome of diabetes. Involvement of a pharmacist in diabetes care might help patients to achieve better treatment outcomes. Existing literature reviews have focused on a limited number of interventions and outcome measures, and have involved different healthcare professionals. None of the previous reviews have used a standardized effect size to compare the effects of different pharmacist-led interventions and different outcome measures. OBJECTIVE: To review pharmacist-led interventions to improve medication adherence in patients with diabetes and to assess the effectiveness of these interventions on medication adherence. METHODS: Six databases were systematically searched between March and September 2017 for randomized controlled trials: PubMed, Cochrane library, EMBASE, CINAHL, JSTOR, and Web of Science. The outcome measures used were: medication adherence, HbA1c, fasting plasma glucose (FPG), post-prandial blood glucose (PPG), or random blood glucose (RBG). Cohen's d, a standardized effect size, enabled a comparison of studies with different outcome measures. The Cochrane risk of bias tool was used to assess the quality of the studies. RESULTS: Fifty-nine studies were included in this review. Pharmacist-led interventions enhanced outcomes in patients with diabetes (standardized mean difference (SMD) -0.68; 95% CI -0.79, -0.58; p < 0.001). Sub-group analysis by intervention strategy, the type of intervention and outcome measures produced similar results. Further analysis showed that education, printed/digital material, training/group discussion, were more effective than other interventions. CONCLUSION: This finding supports the role of the pharmacist in diabetes care to enhance medication adherence.

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

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

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

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

No disponible

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

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

Relationship of parasites and pathologies to contaminant body burden in sentinel bivalves: NOAA Status and Trends 'Mussel Watch' Program.

The 1995-1998 database from NOAA's National Status and Trends 'Mussel Watch' Program was used to compare the distributional patterns of parasites and pathologies with contaminant body burdens. Principal components analysis (PCA) resolved five groups of contaminants in both mussels and oysters: one dominated by polycyclic aromatic hydrocarbons (PAHs), one dominated by pesticides, and three dominated by metals. Metals produced a much more complex picture of spatial trends in body burden than did either the pesticides or PAHs. Contrasted to the relative simplicity of the contaminant groupings, PCA exposed a suite of parasite/pathology groups with few similarities between the sentinel bivalve taxa. Thus, the relationship between parasites/pathologies and contaminants differs significantly between taxa despite the similarity in contaminant pattern. Moreover, the combined effects of many contaminants and parasites may be important, leading to complex biological-contaminant interactions with synergies both of biological and chemical origin. Overall, correlations between parasites/pathologies and contaminants were more frequent with metals, frequent with pesticides, and less frequent with PAHs in mussels. In oysters, correlations with pesticides and metals were about equally frequent, but correlations with PAHs were still rare. In mytilids, correlations with metals predominated. Negative and positive correlations with metals occurred with about the same frequency in both taxa. The majority of correlations with pesticides were negative in oysters; not so for mytilids. Of the many significant correlations involving parasites, few involved single-celled eukaryotes or prokaryotes. The vast majority involved multi-cellular eukaryotes and nearly all of them either cestodes, trematode sporocysts, or trematode metacercariae. The few correlations for single-celled parasites all involved proliferating protozoa or protozoa reaching high body burdens through transmission. The tendency for the larger or more numerous parasites to be involved suggests that unequal sequestration of contaminates between host and parasite tissue is a potential mediator. An alternative is that contaminants differentially affect parasites and their hosts by varying host susceptibility or parasite survival.

Chemical contaminants and their effects in fish and wildlife from the industrial zone of Sumgayit, Republic of Azerbaijan.

Sediment from a wetland adjacent to an industrial wastewater treatment plant in Sumgayit contained concentrations of total PAHs, total PCBs, aldrin, biphenyl, chlordane, DDT, mercury, beta-endosulfan, heptachlor, alpha-hexacyclohexane (alpha-HCH), gamma-HCH, and several individual PAH congeners that were elevated relative to published sediment quality guidelines. Chemical analyses of tissues from European pond turtles (Emys orbicularis) had increased levels of many of the same chemicals including aldrin, chlordane, heptachlor, alpha-HCH, total PCBs, total PAHs, and mercury, compared to reference turtles. In addition, turtle tissues contained elevated levels of DDD, hexachlorobenzene (HCB), and pentachlorobenzene that were not elevated in the sediment sample. Some differences were observed in contaminant levels between European pond turtles and Caspian turtles (Mauremys caspica) taken from the ponds in Sumgayit. Salmonella/microsome mutagenicity assays on pond sediments were negative or weakly positive. Micronuclei in European pond turtles were statistically correlated with tissue levels of mercury, heptachlor, DDD, HCB, and trans-nonachlor. Microcosm experiments using Russian sturgeon (Acipenser gueldenstaedtii) showed a positive dose-response relationship between exposure to suspended contaminated pond sediment and acute toxicity. Chemical and biological assays used in this study show the industrial area of Sumgayit is heavily contaminated with a complex mixture of toxic pollutants. Exposure to contaminated sediments produced acute effects in Russian sturgeon, but genotoxic effects appear to be slight.

Preservation and determination of trace metal partitioning in river water by a two-column ion exchange method.

A one-step preconcentration method using two columns in series was used to partition trace metals in natural waters into several operationally defined fractions. The water passed through a Chelex-100 cation exchange column to collect dissolved labile trace metals and then through an AG MP-1 macroporous resin column to collect trace metals complexed with natural organic matter. A third fraction (inert) was obtained from the difference between total dissolved trace metal concentrations, determined after UV irradiation of a separate aliquot, and the sum of the fractions retained on the two columns. This analytical scheme was successfully applied to the determination of Al, Cd, Co, Cu, Fe, Mn, Ni, Pb, V, and Zn in river waters collected from across the state of Texas. Trace metal partitioning between fractions was found to be stable for at least 8 days after the addition of ammonium acetate buffer (pH 5.5). In most samples collected from relatively pristine sections of Texas rivers, the sum of fractions retained on the two columns accounted for better than 80% of the total dissolved trace metal concentrations. In rivers where anthropogenic inputs were more evident (San Antonio and Trinity Rivers), the inert fraction became pronounced, in some cases accounting for up to 95% of the total dissolved concentrations. The preconcentrate is free of matrix interference and can be easily analyzed by atomic absorption spectrometer or inductively coupled plasma mass spectrometer. Using a 1-L sample allows preconcentration factors of 150 or higher for both labile and organic fractions, and therefore, trace metal concentrations and speciation in natural waters at ambient levels can be accurately and precisely determined.