The provision of advice by pharmacy staff in eastern Indonesian community pharmacies

Main Article Content


Community Pharmacy Services, Counseling, Self Medication, Professional Practice, Pharmacies, Pharmacists, Patient Simulation, Surveys and Questionnaires, Indonesia


Background: Indonesian community pharmacies hold a strategic position from which to promote the rational use of medicines by providing appropriate advice for patients requesting self-medication. To date, published studies related to the provision of advice in Indonesian community pharmacies are limited and have been conducted only in more developed western Indonesia. No studies have been undertaken in eastern Indonesia, which is less developed than and culturally different from the western region.

Objectives: This paper aims to: (1) describe the types and amount of advice provided by pharmacy staff for three scenarios in a patient simulation study and for two scenarios in pharmacy staff interviews; and (2) ascertain the frequency of appropriate advice given in response to the scenarios.

Methods: A patient simulation study was conducted at community pharmacies in an eastern Indonesian provincial capital. Four weeks after completing a patient simulation study, structured interviews with pharmacy staff were conducted. Two cough scenarios and one diarrhoea scenario were developed for the patient simulation study. Meanwhile, two scenarios (an ACE inhibitor-induced cough and a common cough and cold) were developed for pharmacy staff interviews. The types and amount of advice provided by pharmacy staff were recorded on paper and assessed for its appropriateness. The determination of appropriate advice was based on the literature and by consensus of two Indonesian experts.

Results: In patient simulation, the most common type of advice provided in all scenarios was product recommendations. In interviews, medical referrals and recommending cough and cold medicine were the most common types of advice provided for ACE inhibitor-induced cough and common cough and cold scenarios respectively. Appropriate advice was provided in less than 0.5% in the patient simulation study, but two-third of participants in the interviews responded to the scenarios appropriately.

Conclusions: Pharmacy staff did not provide appropriate advice in practice, although they may have adequate knowledge. A contributing factor was insufficient information gathered in patient encounters. Optimising information-gathering practice by pharmacy staff is needed.

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1. World Health Organization. Session Guide- Problems of irrational drug use. 2000; (accessed Mar 3, 2019).
2. World Health Organization. Promoting rational use of medicines: core components. 2002; (accessed Jan 1, 2019).
3. Ofori-Asenso R, Adom AA. Irrational use of medicines-A summary of key concepts. Pharmacy. 2016;4(4):35.
4. World Health Organization. Managing for Rational Medicine Use. 2012; (accessed Jan 4, 2019).
5. World Health Organization. The role of the pharmacist in self care and self medication. 1998; (accessed Jan 4, 2019).
6. Hassali MA SA, Al-Qazaz H, Tambyappa J, Palaian S, Hariraj V. Self-medication practices among adult population attending community pharmacies in Malaysia: an exploratory study. Int J Clin Pharm. 2011;33(5):794-799.
7. Awad AI, Eltayeb IB, Capps PA. Self medication practices in Khartoum State, Sudan. Eur J Clin Pharmacol. 2006;62(4):317-324.
8. Sawalha A. A descriptive study of self medication practices among Palestinian medical and nonmedical university students. Res Social Adm Pharm. 2008;4(2):164-172.
9. Agbor MA, Azodo C. Self-medication for oral health problems in Cameroon. Int Dent J. 2011;61(4):204-209.
10. Sihavong A, Lundborg C, Syhakhang L, Akkhavong K, Tomson G, Wahlstrom R. Antimicrobial self medication for reproductive tract infections in two province in Lao People's Democratic Republic. Sex Transm Infect. 2006;82(2):182-186.
11. Hoffmann W, Herzog B, Muhlig S, Kayser H, Fabian R, Thomsen M, Cramer M, Fiss T, Gresselmeyer D, Janhsen K. Pharmaceutical care for migraine and headache patients: a community-based, randomized intervention. Ann Pharmacother. 2008;42(12):1804-1813.
12. Krishnan HS, Schaefer M. Evaluation of the impact of pharmacist's advice giving on the outcomes of self-medication in patients suffering from dyspepsia. Pharm World Sci. 2000;22(3):102-108.
13. Williams KA, Emmerton LM, Taylor R, Werner J, Benrimoj SI. Non-prescription medicines and Australian community pharmacy interventions: rates and clinical significance. Int J Pharm Pract. 2011;19(3):156-165.
14. Westerlund LT, Marklund BR, Handl WH, Thunberg ME, Allebeck P. Nonprescription drug-related problems and pharmacy interventions. Ann Pharmacother. 2001;35(11):1343-1349.
15. Badan Pusat Statistik. Statistical yearbook of Indonesia 2014. 2014; (accessed Jan 4, 2019).
16. Kementrian Kesehatan Republik Indonesia. Riset Kesehatan Dasar 2013. 2013; (accessed Jan 4, 2019).
17. Chee G, Borowitz M, Barraclough A. Private Sector Health Care in Indonesia. 2009; (accessed Jan 4, 2019).
18. Brata C, Schneider CR, Everett A, Fisher C, Clifford RM. A review of the information-gathering process for the provision of medicines for self-medication via community pharmacies in developing countries. Res Social Adm Pharm. 2013;9(4):370-383.
19. Blenkinsopp A, Paxton P, Blenkinsopp J. Symptoms in the Pharmacy A Guide to the Management of Common Illness. 6th ed. West Sussex: Wiley-Blackwell; 2009.
20. Brown L, Issets B. Patient assessment and consultation. In: Berardi RR, Ferreri SP, Hume AL, Kroon LA, Newton GD, Popovich NG, Remington TL, Rollins CJ, Shimp LA, Tietze KJ, et al., eds. Handbook of nonprescription drugs: An interactive approach to self care. Washington DC: American Pharmacists Association; 2009:21-25.
21. Brata C, Marjadi B, Schneider CR, Murray K, Clifford RM. Information-gathering for self-medication via Eastern Indonesian community pharmacies: a cross-sectional study. BMC Health Serv Res. 2015;15:8.
22. Rosmeli, Nurhayani. [Comparative study of regional inequality between the western region of Indonesia and Eastern Indonesia]. Mankeu. 2014;3(1):374-463.
23. Hermawati D. Pengaruh edukasi terhadap tingkat pengetahuan dan rasionalitas pengunjung obat swamedikasi di dua apotek kecamatan Cimaggis, Depok. [Bachelor of Pharmacy Thesis]. Jakarta, Universitas Indonesia; 2012.
24. Tietze KJ . Cough. In: Berardi RR FS, Hume AL, Kroon LA, Newton GD, Popovich NG, Remington TL, Rollins CJ, Shimp LA, Tietze KJ, ed. Handbook of Nonprescription Drugs: An Interactive Approach to Self Care. 16th ed. Washington DC: American Pharmacists Association; 2009:203-212.
25. World Health Organization. The Treatment of Diarrhoea : A manual for physicians and other senior health workers. 2005;;jsessionid=4B4D653604F2804DDC1D6F001A333E13?sequence=1 (accessed Jan 4, 2019).
26. Berg BL, Lune H. Qualitative research methods for the social sciences. Boston: Pearson; 2012.
27. Kondracki NL, Wellman NS, Amundson DR. Content analysis: review of the methods and their application in nutrition education. J Nutr Educ Behav 2002;34(4):224-230.
28. Elo S, Kyngas H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107-115.
29. Berardi RR, Ferreri SP, Hume AL, et al. Handbook of nonprescription drugs: An interactive approach to self care. 16th ed. Washington DC: American Pharmacists Association; 2009.
30. Altman DG. Practical statistics for medical research. 1st ed. London: Chapman and Hall; 1991.
31. Dicpinigaitis PV. Angiotensin-converting enzyme inhibitor-induced cough : ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):169S-173S.
32. Sebastian JL, McKinney WP, Kaufman J, Young MJ. Angiotensin-Converting Enzyme Inhibitors and cough: prevalence in an outpatient medical clinic population. Chest. 1991;99(1):36-39.
33. Kosamu T, Mwanza K, Mbayo E, Gondwe K, Besa C. An unrecognised adverse drug reaction of enalapril led to suspicion of pulmonary tuberculosis infection. Med J Zambia. 2012;31(2):71-72.
34. Vegter S, de Jong-van den Berg LTW. Misdiagnosis and mistreatment of a common side-effect – angiotensinconverting enzyme inhibitor-induced cough. Br J Clin Pharmacol. 2010;69(2):200-203.
35. Vegter S, de Boer P, van Dijk KW, Visser S, de Jong-van den Berg LT. The effects of antitussive treatment of ACE inhibitor-induced cough on therapy compliance: a prescription sequence symmetry analysis. Drug Saf. 2013;36(6):435-439.
36. Lombardi C, Crivellaro M, Dama A, Senna G, Gargioni S, Passalacqua G. Are physicians aware of the side effects of angiotensin-converting enzyme inhibitor?: a questionnaire survey in different medical categories. Chest. 2005;128(2):976-979.
37. Saengcharoen W, Lerkiatbundit S. Practice and attitudes regarding the management of childhood diarrhoea among pharmacies in Thailand. Int J Pharm Pract. 2010;18(6):323-331.
38. Ross-Degnan D, Soumerai SB, Goel PK, Bates J, Makhulo J, Dondi N, Sutoto, Adi D, Ferraz-Tabor L, Hogan R. The impact of face to face educational outreach on diarrhoea treatment in pharmacies. Health Policy Plan. 1996;11(3):308-318.
39. Zamora Gutiérrez AD, Aguilar Liendo AM, Cordero Valdivia D. Attitudes of Bolivian pharmacists in dealing with diarrhea cases. Bull Pan Am Health Organ. 1995;29(4):322-327.
40. Wachter DA, Joshi MP, Rimal B. Antibiotic dispensing by drug retailers in Kathmandu, Nepal. Trop Med Int Health. 1999;4(11):782-788.
41. Duong DV, Le TV, Binns CW. Diarrhoea management by pharmacy staff in retail pharmacies in Hanoi, Vietnam. Int J Pharm Pract. 1997;5(2):97-100.
42. Aktekin M, Erozgen C, Donmez L. Pharmacy approach to a case of acute diarrhoea with dehydration in Antalya, Turkey. Public Health. 1998;112(5):323-326.
43. Ogbo PU, Aina BA, Aderemi-Williams RI. Management of acute diarrhea in children by community pharmacists in Lagos, Nigeria. Pharm Pract (Granada). 2014;12(1):376.
44. Smith RD, Coast J. Antimicrobial resistance: a global response. Bull World Health Organ. 2002;80(2):126-133.
45. Chalker J, Chuc NT, Falkenberg T, Do NT, Tomson G. STD management by private pharmacies in Hanoi: practice and knowledge of drug sellers. Sex Transm Infect. 2000;76(4):299-302.
46. Larsson M, Binh NT, Tomson G, Chuc NT, Falkenberg T. Private pharmacy staff in Hanoi dispensing steroids-theory and practice. Pharm Pract (Granada). 2006;4(2):60-67.
47. Chuc NTK, Larsson M, Falkenberg T, Do NT, Binh NT, Tomson GB. Management of childhood acute respiratory infections at private pharmacies in Vietnam. Ann Pharmacother. 2001;35(10):1283-1288.
48. Kementrian Kesehatan Republik Indonesia. Petunjuk Teknik Pelaksanaan Standar Pelayanan Kefarmasian di Apotek. KEPMENKES 1027/MENKES/SK/2004. In. Jakarta: Kementrian Kesehatan Republik Indonesia; 2008.
49. Ambwani S, Mathur AK. Rational drug use. Health Administrator 2006;19(1):5-7.
50. Davidow LW. Self-care and nonprescription pharmacotherapy In: Berardi RR FS, Hume AL, Kroon La, Newton GD, Popovich NG, Remington TL, Rollins CJ, Shimp LA, Tietze KJ, ed. Handbook of nonprescription drugs: An interactive approach to self care. 16th ed. Washington DC: American Pharmacists Association; 2009:13-14.
51. Hornsby LB, Whitley HP, Hester EK, Thompson M, Donaldson A. Survey of patient knowledge related to Acetaminophen recognition, dosing, and toxicity. J Am Pharm Assoc (2003). 2010;50(4):485-489.
52. Cham E, Hall L, Ernst AA, Weiss SJ. Awareness and use of over-the-counter pain medications: A survey of emergency department patients. South Med J. 2002;95(5):529-535.
53. Jayasutha J, Saipavan, Roshini KV. Assessment of impact of patient counseling on knowledge, attitude and practices in asthma patients. Global J Pharmacol. 2014;8(4):486-489.
54. Ponnusankar S, Surulivelrajan M, Anandamoorthy N, Suresh B. Assessment of impact of medication counseling on patients’ medication knowledge and compliance in an outpatient clinic in South India. Patient Educ Couns. 2004;54(1):55-60.
55. Alkatheri AM, Albekairy AM. Does the patients’ educational level and previous counseling affect their medication knowledge? Ann Thorac Med. 2013;8(2):105-108.
56. Schneider CR EA, Geelhoed E, Kendall PA, Murray K, Garnett P, Salama M, Clifford RM. Provision of primary care to patients with chronic cough in the community pharmacy setting. Ann Pharmacother. 2011;45(3):402-408.
57. Watson MC, Bond CM, Grimshaw JM, Johnston M. Factors predicting the guideline compliant supply (or nonsupply) of non-prescription medicines in the community pharmacy setting. Qual Saf Health Care. 2006;15(1):53-57.
58. Zurmatias R. Pharmaceutical Services in Community Pharmacy in East Jakarta [Master Thesis]. Thailand, Chulalongkorn University; 2007.
59. Purwanti A, Harianto, Supardi S. [An overview of the implementation of pharmaceutical service standards in DKI Jakarta pharmacies in 2003].Majalah Ilmu Kefarmasian. 2004;1(2):102-115.
60. Kroeger A, Ochoa H, Arana B, Diaz A, Rizzo N, Flores W. Inadequate drug advice in the pharmacies of Guatemala and Mexico: the scale of the problem and explanatory factors. Ann Trop Med Parasitol. 2001;95(6):605-616.
61. Brata C, Fisher C, Marjadi B, Schneider CR, Clifford RM. Factors contributing to the provision of self-medication consultations in eastern Indonesian community pharmacies: a qualitative study. BMC Health Serv Res. 2016;16:179.
62. Thang DX. An investigation of non-prescription medicine supply in community pharmacies in Hanoi, Vietnam. Nottingham, University of Nottingham; 2013.
63. Perraudin C, Brion F, Bourdon O, Pelletier-Fleury N. The future of pharmaceutical care in France: a survey of final-year pharmacy students' opinion. BMC Clin Pharmacol. 2011;11:6.
64. Shearer B, Ng S, Dunford D, Kuo IF. Training needs of Mannitoba pharmacists to increase application of assessment and prescribing for minor ailments into practice: a qualitative and quantitative survey. Pharmacy (Basel). 2018;6(3):82.
65. Goel P, Ross-Degnan D, Berman P, Soumerai S. Retail pharmacies in developing countries: a behavior and intervention framework. Soc Sci Med. 1996;42(8):1155-1161.
66. Ross-Degnan D, Laing R, Santoso B, Ofori-Adjei D, Lamoureux C, Hogerzeil H. Improving pharmaceutical use in primary care in developing countries: A critical review of experience and lack of experience. Paper presented at: International conference on improving use of medicines.1997; Chiang Mai, Thailand.
67. Marjadi B. Challenges in developing infection control programmes for Indonesia. Aust Infect Control 2001;6(1):22-25.
68. Smith F. Community pharmacy in Ghana: enhancing the contribution to primary health care. Health Policy Plan. 2004;19(4):234-241.
69. Departemen Kesehatan Republik Indonesia. [Health worker pocket book: Cross Diarrhea]. Jakarta: Departemen Kesehatan RI; 2011.
70. Simasek M, Blandino DA. Treatment of the Common Cold. Am Fam Physician. 2007;75(4):515-520.
71. Covington TR, Henkin R, Miller S, Sassetti M, Wright W. Treating the common cold : An expert panel consensus recommendation for primary care clinicians. Am J Nurse Pract. 2004;8(11):77-88.