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.
Conn VS, Ruppar TM, Enriquez M, Cooper PS. Patient-Centered Outcomes of Medication Adherence Interventions: Systematic Review and Meta-Analysis. Value Health. 2016;19(2):277-285. https://doi.org/10.1016/j.jval.2015.12.001
Gillespie D, Hood K, Farewell D, et al. Adherence-adjusted estimates of benefits and harms from treatment with amoxicillin for LRTI: secondary analysis of a 12-country randomised placebo-controlled trial using randomisation-based efficacy estimators. BMJ Open. 2015;5(3):e006160. https://doi.org/10.1136/bmjopen-2014-006160
Reading SR, Go AS, Fang MC, et al. Health Literacy and Awareness of Atrial Fibrillation. J Am Heart Assoc. 2017;6(4):e005128. https://doi.org/10.1161/jaha.116.005128
de Vries ST, Keers JC, Visser R, et al. Medication beliefs, treatment complexity, and non-adherence to different drug classes in patients with type 2 diabetes. J Psychosom Res. 2014;76(2):134-138. https://doi.org/10.1016/j.jpsychores.2013.11.003
Ameh D, Wallymahmmed A, Mackenzie G. Patient knowledge of their dispensed drugs in rural Gambia. Int J Sci: Basic Appl Res. 2014;16(2):61-85.
Umira S. Assessment of patient’s knowledge regarding dispensed medication in a South Indian Government Hospital. Intl J Pharm Pharm Sci. 2015;7(2):544-547.
Tran VD, Dorofeeva VV, Loskutova EE. Development and validation of a scale to measure the quality of patient medication counseling using Rasch model. Pharm Pract (Granada). 2018;16(4):1327. https://doi.org/10.18549/pharmpract.2018.04.1327
Kusch MK, Haefeli WE, Seidling HM. How to meet patients' individual needs for drug information - a scoping review. Patient Prefer Adherence. 2018;12:2339-2355. https://doi.org/10.2147/ppa.s173651
Opare-Addo MN, Buabeng KO, Marfo AF, et al. Source of medicines and medicine information by self-reported persons living with hypertension and diabetes in rural and urban Ghana. Pharm Pract (Granada). 2018;16(3):1151. https://doi.org/10.18549/pharmpract.2018.03.1151
Tarn DM, Paterniti DA, Wenger NS, Williams BR, Chewning BA. Older patient, physician and pharmacist perspectives about community pharmacists' roles. Int J Pharm Pract. 2012;20(5):285-293. https://doi.org/10.1111/j.2042-7174.2012.00202.x
Shah B, Chewning B. Conceptualizing and measuring pharmacist-patient communication: a review of published studies. Res Social Adm Pharm. 2006;2(2):153-185. https://doi.org/10.1016/j.sapharm.2006.05.001
Linn AJ, van Dijk L, Smit EG, Jansen J, van Weert JC. May you never forget what is worth remembering: the relation between recall of medical information and medication adherence in patients with inflammatory bowel disease. J Crohns Colitis. 2013;7(11):e543-e550. https://doi.org/10.1016/j.crohns.2013.04.001
Kessels RP. Patients' memory for medical information. J R Soc Med. 2003;96(5):219-222. https://doi.org/10.1258/jrsm.96.5.219
Roshi D, Burazeri G, Schröder-Bäck P, et al. Understanding of Medication Information in Primary Health Care: A Cross-Sectional Study in a South Eastern European Population. Front Public Health. 2020;8:388. https://doi.org/10.3389/fpubh.2020.00388
Jenkins V, Solis-Trapala I, Langridge C, Catt S, Talbot DC, Fallowfield LJ. What oncologists believe they said and what patients believe they heard: an analysis of phase I trial discussions. J Clin Oncol. 2011;29(1):61-68. https://doi.org/10.1200/jco.2010.30.0814
ASHP guidelines on pharmacist-conducted patient education and counseling. Am J Health Syst Pharm. 1997;54(4):431-434. https://doi.org/10.1093/ajhp/54.4.431
American Society of Consultant Pharmacists. Guidelines for pharmacist counseling of geriatric patients. Available at: http://www/ascp/com (accessed Apr 11, 2020).
Okumura LM, Rotta I, Correr CJ. Assessment of pharmacist-led patient counseling in randomized controlled trials: a systematic review. Int J Clin Pharm. 2014;36(5):882-891. https://doi.org/10.1007/s11096-014-9982-1
World Health Organisation (WHO). WHO report on surveillance of antibiotic consumption: 2016-2018 early implementation. https://apps.who.int/iris/bitstream/handle/10665/277359/9789241514880-eng.pdf?ua=1 (accessed Aug 7, 2020).
Duffy E, Ritchie S, Metcalfe S, Van Bakel B, Thomas MG. Antibacterials dispensed in the community comprise 85%-95% of total human antibacterial consumption. J Clin Pharm Ther. 2018;43(1):59-64. https://doi.org/10.1111/jcpt.12610
Zanichelli V, Monnier AA, Gyssens IC, et al. Variation in antibiotic use among and within different settings: a systematic review. J Antimicrob Chemother. 2018;73(suppl_6):vi17-vi29. https://doi.org/10.1093/jac/dky115
Suda KJ, Hicks LA, Roberts RM, Hunkler RJ, Matusiak LM, Schumock GT. Antibiotic Expenditures by Medication, Class, and Healthcare Setting in the United States, 2010-2015. Clin Infect Dis. 2018;66(2):185-190. https://doi.org/10.1093/cid/cix773
Sanchez GV, Fleming-Dutra KE, Roberts RM, Hicks LA. Core Elements of Outpatient Antibiotic Stewardship. MMWR Recomm Rep. 2016;65(6):1-12. https://doi.org/10.15585/mmwr.rr6506a1
McNulty CA, Lecky DM, Hawking MK, Roberts C, Quigley A, Butler CC. How much information about antibiotics do people recall after consulting in primary care?. Fam Pract. 2016;33(4):395-400. https://doi.org/10.1093/fampra/cmw022
Hassali MA, Arief M, Saleem F, et al. Assessment of attitudes and practices of young Malaysian adults about antibiotics use: a cross-sectional study. Pharm Pract (Granada). 2017;15(2):929. https://doi.org/10.18549/pharmpract.2017.02.929
Francis NA, Gillespie D, Nuttall J, et al. Antibiotics for acute cough: an international observational study of patient adherence in primary care [published correction appears in Br J Gen Pract. 2013 Jan;63(606):12]. Br J Gen Pract. 2012;62(599):e429-e437. https://doi.org/10.3399/bjgp12x649124
Pradipta IS, Ronasih E, Kartikawati AD, et al. Three years of antibacterial consumption in Indonesian Community Health Centers: The application of anatomical therapeutic chemical/defined daily doses and drug utilization 90% method to monitor antibacterial use. J Family Community Med. 2015;22(2):101-105. https://doi.org/10.4103/2230-8229.155385
Hadi U, Duerink DO, Lestari ES, et al. Survey of antibiotic use of individuals visiting public healthcare facilities in Indonesia. Int J Infect Dis. 2008;12(6):622-629. https://doi.org/10.1016/j.ijid.2008.01.002
Yosmar R, Fitria A, Yuliandra Y, Arifin H. Evaluation of parents’ adherence in giving antibiotics on Respiratory Tract Infections (RTI) and factors associated with adherence. Res J Pharm Biol Chem Sci. 2016;7(1):1662-1665.
Widowati I, Wirawan I, Nopiyani N, Sari K. Pharmacist counseling intervention to improve patient antibiotic compliance. Public Health Prev Med. 2018;6(2):128-134. https://doi.org/10.15562/phpma.v6i2.158
Widayati A, Suryawati S, de Crespigny C, Hiller J. Self Medication with Antibiotics in Yogyakarta City Indonesia: A Cross Sectional Population-Based Survey. BMC Res Notes. 2011;4(1):491. https://doi.org/10.1186/1756-0500-4-491
Djawaria DP, Setiadi AP, Setiawan E. [Behavior analysis and attributed factors to non prescription antibiotic used in Surabaya]. Indonesian J Public Health. 2018;14(4):406-417
Badan Pusat Statistik - BPS Kota Malang. [Malang City in figures, 2019]. Malang: PBS; 2019. https://malangkota.bps.go.id/publication/2019/08/16/f398128e03217db7b7af4399/kota-malang-dalam-angka-2019.html (accessed Feb 21, 2020).
Agustina R, Dartanto T, Sitompul R, et al. Universal health coverage in Indonesia: concept, progress, and challenges. Lancet. 2019;393(10166):75-102. https://doi.org/10.1016/s0140-6736(18)31647-7
Lwanga S, Lemeshow S. Sample size determination in health studies. Geneva: WHO; 1991.
Ministry of Health Republic of Indonesia (MoH-RI). [Ministry of Health Regulation number 72 of 2016 on standards of pharmacy practice in hospitals]. Jakarta: MoH-RI; 2016.
Ministry of Health Republic of Indonesia (MoH-RI). [Ministry of Health Regulation number 73 of 2016 on standards of pharmacy practice on pharmacies]. Jakarta: MoH-RI; 2016
Oswald D, Sherratt F, Smith S. Handling the Hawthorne effect: the challenges surrounding a participant observer. Rev Soc Stud. 2014:1(1);53-73.
Ministry of Health Republic of Indonesia (MoH-RI). [Role of pharmacists in patient safety]. https://farmalkes.kemkes.go.id/2013/02/tanggung-jawab-apoteker-terhadap-keselamatan-pasien-patient-safety/ (accessed 2019 Mar 14)
Badan Pengawas Obat dan Makanan. [Indonesian drug formulary]. Jakarta: BPOM; 2015. http://pionas.pom.go.id/ioni/pedoman-umum (accessed Feb 21, 2020).
Davis TC, Wolf MS, Bass PF 3rd, et al. Literacy and misunderstanding prescription drug labels. Ann Intern Med. 2006;145(12):887-894. https://doi.org/10.7326/0003-4819-145-12-200612190-00144
Wolf MS, Davis TC, Shrank W, et al. To err is human: patient misinterpretations of prescription drug label instructions. Patient Educ Couns. 2007;67(3):293-300. https://doi.org/10.1016/j.pec.2007.03.024
Hamrosi KK, Raynor DK, Aslani P. Enhancing provision of written medicine information in Australia: pharmacist, general practitioner and consumer perceptions of the barriers and facilitators. BMC Health Serv Res. 2014;14:183. https://doi.org/10.1186/1472-6963-14-183
Krisnanta IK, Parfati N, Presley B, Setiawan E. Analysis of profile and contributing factors to non-adherence towards antibiotics utilization among caregivers of paediatric patients. J Manag Pharm Pract. 2018;8(1):39-50. https://doi.org/10.22146/jmpf.33730
Wilson HL, Daveson K, Del Mar CB. Optimal antimicrobial duration for common bacterial infections. Aust Prescr. 2019;42(1):5-9. https://doi.org/10.18773/austprescr.2019.001
Republic of Indonesia (RoI). [[Law number 36 of 2014 on healthcare workers]. Jakarta: RoI; 2014.
International Pharmaceutical Federation. FIP guidelines for the labels of prescribed medicines. http://www.fip.org/www/uploads/database_file.php?id=256&table_id (accessed Aug 8,2020).
British Medical Association and the Royal Pharmaceutical Society. British National Formulary. London: BNF; 2020.
Pharmaceutical Society of Australia. Cautionary advisory labels in practice. Australian Pharmacist. 2013;32(8):34-35.
Koster ES, van Meeteren MM, van Dijk M, et al. Patient-provider interaction during medication encounters: A study in outpatient pharmacies in the Netherlands. Patient Educ Couns. 2015;98(7):843-848. https://doi.org/10.1016/j.pec.2015.03.007
Krueger JL, Hermansen-Kobulnicky CJ. Patient perspective of medication information desired and barriers to asking pharmacists questions. J Am Pharm Assoc (2003). 2011;51(4):510-519https://doi.org/10.1331/japha.2011.10069
Wibowo Y, Parsons R, Sunderland B, Hughes J. An evaluation of community pharmacy-based services for type 2 diabetes in an Indonesian setting: patient survey. PeerJ. 2015;3:e1449. https://doi.org/10.7717/peerj.1449
Copyright (c) 2021 Pharmacy Practice and the Authors
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.