Strategies to implement community training to promote responsible self-medication in Indonesia: a qualitative study of trainers.

BACKGROUND: A community-based approach has been identified as one key strategy to improve the health of Indonesians. In 2015, the government initiated the 'Smart Use of Medications Movement' (GeMa CerMat) to promote responsible self-medication. This study aims to explore pharmacist/pharmacy staff trainers' views on strategies to implement GeMa CerMat community training. METHODS: Four focus group discussions were conducted with 38 pharmacist/pharmacy staff trainers in Ngawi, Indonesia and a thematic analysis was used to obtain the key strategies. RESULTS: The identified key strategies were building community readiness via well-designed training (considering participant characteristics, training methods, and materials and resources); policy, regulation and organizational support; access to training in a cultural context; communication media to promote training and the inclusion of active-learning tools. CONCLUSIONS: These identified multilevel strategies require collaboration among national bodies and the involvement of trusted community members ('change agents'). A new strategy using 'active learning tools' was necessary to build critical thinking and understanding of the use of medications in everyday life. Future research should focus on process, impact and outcome evaluation involving GeMa CerMat training implementation and sustainability 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.

Information on antibiotics in an Indonesian hospital outpatient setting: What is provided by pharmacy staff and recalled by patients?

BACKGROUND: The provision of information by pharmacy staff is a key factor to ensure patients' understanding and quality use of medications, including antibiotics. However, little is known regarding the transmission of information between pharmacy staff and patients in Indonesia. OBJECTIVE: This study aimed to identify information on antibiotics provided by pharmacy staff and recalled by patients in an Indonesian outpatient setting. METHODS: The study was conducted in a hospital outpatient clinic in Malang, Indonesia, in 2019. A checklist was used to obtain the data on information provided by pharmacy staff, while interviews were conducted to determine information recalled by patients (only presenting patients were included); a total of 15 information items - i.e. 14 essential and one secondary - were observed. Descriptive analysis was used to summarise data on the checklists ('given' versus 'not given') as well as responses from the interviews ('recalled' versus 'missed'). RESULTS: Eleven pharmacy staff (two pharmacists and nine pharmacy technicians) were involved in providing information for patients obtaining oral antibiotics during the study period. Of 14 essential information items, only about half was given by pharmacy staff, with pharmacists significantly providing on average more information items than pharmacy technicians (7.96 versus 7.67 respectively; p < 0.001). The most frequently information items provided (>90%) included "antibiotic identification", "indication", administration directions (i.e. "dosage", "frequency", "hour of administration", "administration before/after meal", "route of administration"), and "duration of use". A total of 230 patients consented to the study, giving 79.9% response rate. The average number of information items recalled by patients was 7.09 (SD 1.45). Almost all patients could recall information on administration directions [i.e. "route of administration" (97.0%), "frequency" (95.2%), "dosage" (92.6%), "hour of administration" (85.7%), "administration before/after meal" (89.1%)] and "duration of use" (90.9%). Fewer patients were able to recall "antibiotic identification" (76.5%) and "indication" (77.0%). CONCLUSIONS: Pharmacy staff provided antibiotic information in a limited fashion, while patients showed adequate ability to recall the information given to them. Further study is needed to better understand the effective process of information transmission between pharmacy staff and patients, especially if more information was provided, to better optimise the use of antibiotics in outpatient settings in Indonesia

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Information on antibiotics in an Indonesian hospital outpatient setting: What is provided by pharmacy staff and recalled by patients?

BACKGROUND: The provision of information by pharmacy staff is a key factor to ensure patients' understanding and quality use of medications, including antibiotics. However, little is known regarding the transmission of information between pharmacy staff and patients in Indonesia. OBJECTIVE: This study aimed to identify information on antibiotics provided by pharmacy staff and recalled by patients in an Indonesian outpatient setting. METHODS: The study was conducted in a hospital outpatient clinic in Malang, Indonesia, in 2019. A checklist was used to obtain the data on information provided by pharmacy staff, while interviews were conducted to determine information recalled by patients (only presenting patients were included); a total of 15 information items - i.e. 14 essential and one secondary - were observed. Descriptive analysis was used to summarise data on the checklists ('given' versus 'not given') as well as responses from the interviews ('recalled' versus 'missed'). RESULTS: Eleven pharmacy staff (two pharmacists and nine pharmacy technicians) were involved in providing information for patients obtaining oral antibiotics during the study period. Of 14 essential information items, only about half was given by pharmacy staff, with pharmacists significantly providing on average more information items than pharmacy technicians (7.96 versus 7.67 respectively; p<0.001). The most frequently information items provided (>90%) included "antibiotic identification", "indication", administration directions (i.e. "dosage", "frequency", "hour of administration", "administration before/after meal", "route of administration"), and "duration of use". A total of 230 patients consented to the study, giving 79.9% response rate. The average number of information items recalled by patients was 7.09 (SD 1.45). Almost all patients could recall information on administration directions [i.e. "route of administration" (97.0%), "frequency" (95.2%), "dosage" (92.6%), "hour of administration" (85.7%), "administration before/after meal" (89.1%)] and "duration of use" (90.9%). Fewer patients were able to recall "antibiotic identification" (76.5%) and "indication" (77.0%). CONCLUSIONS: Pharmacy staff provided antibiotic information in a limited fashion, while patients showed adequate ability to recall the information given to them. Further study is needed to better understand the effective process of information transmission between pharmacy staff and patients, especially if more information was provided, to better optimise the use of antibiotics in outpatient settings in Indonesia.

Profile of sociodemographics, sources of infection, antiretrovirals and CD4 counts on HIV/AIDS outpatients in Turen Primary Health Centre, Indonesia.

Background The profile of patients with HIV/AIDS is required to develop appropriate HIV/AIDS prevention and treatment programs in Indonesia. Turen is one of the four sub-districts with the highest number of patients with HIV/AIDS in Malang District, Indonesia. The purpose of this study is to determine the sociodemographic profile, sources of infection, use of antiretrovirals and CD4 counts on HIV/AIDS outpatients in Turen Primary Health Centre (PHC). Methods The sociodemographic data, antiretroviral use, and CD4 counts were obtained from medical records on HIV/AIDS outpatients in Turen PHC. A qualitative approach using in-depth interviews was used to explore the source of infection. Descriptive analysis was used to summarise the quantitative data, while thematic analysis was used to analyse the qualitative data derived from interviews. Results A total of 45 HIV/AIDS outpatient medical records were reviewed. Of those, the majority were females (57.8%), ages 26-35 years (51.1%), married (55.6%) and having income less than 2 million rupiah (73.3%). All of them used a combination of antiretroviral therapy from two classes of antiretrovirals, i.e. nucleotide analog reverse transcriptase inhibitor and non-nucleotide analog reverse transcriptase inhibitor; the majority were treated with fixed-dose combination of tenofovir-lamifudin-efavirenz. The CD4 counts data were obtained from 31 patients with an average number of 282 cells/mm3. The qualitative data from interviews with 15 patients revealed that the source of infection was from husband, unsafe/unprotected sex and blood donor. Conclusions The high prevalence of HIV/AIDS among young married women and poor control of the disease in Indonesia warrants further considerations. The government should work together with all related stakeholders in raising awareness of HIV/AIDS, particularly among women, as well as improving treatment and support for people living with HIV/AIDS.