The Pharmacists’ and pharmacy technicians’ scopes of practice in the management of minor ailments at community pharmacies in Indonesia: a cross-sectional study
Background: Managing minor ailments in community pharmacy is an evolving pharmacy service in developing countries. Defined scopes of practice for pharmacy staff are essential for the safe management of minor ailments. Limited research exists regarding the perceptions of Indonesian pharmacists’ and pharmacy technicians’ scopes of practice in providing minor ailments management services.
Objective: To evaluate pharmacists’ and pharmacy technicians’ understanding of their scopes of practice, perceived competency and factors influencing the delivery of minor ailments services in Indonesian community pharmacies.
Methods: Cross-sectional surveys were conducted during January-February 2020 of pharmacists and pharmacy technicians attending seminars conducted by relevant Indonesian Associations in Central Java, Indonesia. Percentage of common responses (PCR) described similarity of perceived scopes of practice for pharmacists and pharmacy technicians. Univariate and multivariate analyses identified associations of scopes of practice with pharmacy characteristics.
Results: A total of 185 pharmacists and 142 pharmacy technicians participated. Pharmacy technicians performed minor ailment consultations, however, if considered beyond their scope of practice, they referred the patient to the pharmacist (T=120/142, 84.5%). Vaginal thrush, bacterial conjunctivitis, gastro-oesophageal reflux disease, and acute pain were minor ailments perceived only within a pharmacist’s scope (PCR above 60%). Of 34 minor ailments, 11 showed PCR values between 40-60% overlapping pharmacists and pharmacy technicians perceived scopes of practice (allergy/rash, back pain, cold sores, dermatitis, diarrhoea, eczema, hayfever, haemorrhoids, rheumatism, sore throat, and superficial wounds). Back pain, cold sores, dermatitis, and sore throat associated pharmacists’ scope of practice with years of practice experience (p-value<0.05). Pharmacy technicians perceived their scopes of practice to be wider than perceived by pharmacists.
Conclusions: Discordance between pharmacists’ and pharmacy technicians’ perceived scopes of minor ailments management highlights the need for clearly defined scopes of practice for each professional group. Each professional group must practise within their competence to ensure safe pharmacy practices.
Pharmaceutical Society of Australia. Delivering Safe and Sustainable Clinical Services. https://www.dhhs.tas.gov.au/__data/assets/pdf_file/0003/194934/Pharmaceutical_Society_of_Australia.pdf (accessed Sep 20, 2019)
Hassell K, Whittington Z, Cantrill J, Bates F, Rogers A, Noyce P. Managing demand: transfer of management of self limiting conditions from general practice to community pharmacies. BMJ. 2001;323(7305):146-147. https://doi.org/10.1136/bmj.323.7305.146
Yadav S. Pharmacists rather than GPs should be first contact for minor ailments, report says. BMJ. 2008;337:a775. https://doi.org/10.1136/bmj.a775
Dineen-Griffin S, Garcia-Cardenas V, Rogers K, Williams K, Benrimoj SI. Evaluation of a Collaborative Protocolized Approach by Community Pharmacists and General Medical Practitioners for an Australian Minor Ailments Scheme: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc. 2019;8(8):e13973. https://doi.org/10.2196/13973
Paudyal V, Watson MC, Sach T, et al. Are pharmacy-based minor ailment schemes a substitute for other service providers? A systematic review. Br J Gen Pract. 2013;63(612):e472-e481. https://doi.org/10.3399/bjgp13X669194
Erni P, von Overbeck J, Reich O, Ruggli M. netCare, a new collaborative primary health care service based in Swiss community pharmacies. Res Social Adm Pharm. 2016;12(4):622-626. https://doi.org/10.1016/j.sapharm.2015.08.010
Taylor JG, Joubert R. Pharmacist-led minor ailment programs: a Canadian perspective. Int J Gen Med. 2016;9:291-302. https://doi.org/10.2147/IJGM.S99540
Dineen-Griffin S, Benrimoj SI, Rogers K, Williams KA, Garcia-Cardenas V. Cluster randomised controlled trial evaluating the clinical and humanistic impact of a pharmacist-led minor ailment service. BMJ Qual Saf. 2020;29(11):921-931. https://doi.org/10.1136/bmjqs-2019-010608
McKeirnan KC, Garrelts MacLean L. Pharmacist, physician, and patient opinions of pharmacist-treated minor ailments and conditions. J Am Pharm Assoc (2003). 2018;58(6):599-607. https://doi.org/10.1016/j.japh.2018.08.008
Sheridan J, Kelly F, Basheer M, Jan R, Lee A. Can I help you? A qualitative study of pharmacist and pharmacy assistant views on the role of pharmacy assistants in New Zealand. Int J Pharm Pract. 2011;19(4):228-235. https://doi.org/10.1111/j.2042-7174.2011.00096.x
Ministry of Health Indonesia. [The Recapitulation of Community Pharmacy in Indonesia]. http://apif.binfar.depkes.go.id/grafik-apotek.php (accessed Jan 21, 2020).
Kementerian Kesehatan Republik Indonesia. [Minister of Health Regulation No.922/MENKES/PER/X/1993 on provisions and procedures for issuance of pharmacy license]. http://iai.id/uploads/libraries/Permenkes_No._922_thn_1993_ttg_Ketentuan_dan_Tata_Cara_Pemberian_Izin_Apotik.pdf (accessed Jan 21, 2020).
Athiyah U, Setiawan CD, Nugraheni G, Zairina E, Utami W, Hermansyah A. Assessment of pharmacists' knowledge, attitude and practice in chain community pharmacies towards their current function and performance in Indonesia. Pharm Pract (Granada). 2019;17(3):1518. https://doi.org/10.18549/pharmpract.2019.3.1518
Ministry of Health Indonesia. [Basic Health Research (Riskesdas) referring to over-the-counter and cautionary labelling required medicines usage guideline from the Department of Health in 2007]. Jakarta, Indonesia: Indonesian Ministry of Health; 2013.
The Indonesia Central Bureau of Statistics (BPS). [Indonesia Health Indicator 1995-2008]. Jakarta: BPS; 2018.
Zurmatias R, Palanuvej C, Ruangrungsi N. Pharmaceutical services in community pharmacy In East Jakarta. J Health Res. 2008;22 (suppl):63-67.
Badan Pusat Statistik Provinsi Jawa Tengah Indonesia. Population in Central Java Province 2019. Available at: https://jateng.bps.go.id/statictable/2020/07/14/1820/jumlah-penduduk-dan-rasio-jenis-kelamin-menurut-kabupaten-kota-di-provinsi-jawa-tengah-2019.html (accessed Jan 21, 2020).
Herman MJ, Susyanty AL. An Analysis of pharmacy services by pharmacist in community pharmacy. Buletin Penelitian Sistem Kesehatan. 2013;15(3):271-281.
Hermansyah A, Pitaloka D, Sainsbury E, Krass I. Prioritising recommendations to advance community pharmacy practice. Res Social Adm Pharm. 2018;14(12):1147-1156. https://doi.org/10.1016/j.sapharm.2018.02.003
Hermansyah A, Sainsbury E, Krass I. Multiple policy approaches in improving community pharmacy practice: the case in Indonesia. BMC Health Serv Res. 2018;18(1):449. https://doi.org/10.1186/s12913-018-3258-8
Hermansyah A, Sukorini AI, Setiawan CD, Priyandani Y. The conflicts between professional and non professional work of community pharmacists in Indonesia. Pharm Pract (Granada). 2012;10(1):33-39. https://doi.org/10.4321/s1886-36552012000100006
Kementerian Kesehatan Republik Indonesia. [Minister of Health Decree No.1027/ MENKES/SK/2004 on the standard of pharmacy services in community pharmacy: A technical guideline]. http://hukor.kemkes.go.id/uploads/produk_hukum/KMK_No.1027-MENKES-SK-IX-2004_ttg_Standar_Pelayanan_Kefarmasian_di_Apotek_.pdf (accessed Jan 21, 2020).
Paudyal V, Hansford D, Cunningham S, Stewart D. Pharmacy assisted patient self care of minor ailments: A chronological review of UK health policy documents and key events 1997–2010. Health Policy. 2011;101(3):253-259. https://doi.org/10.1016/j.healthpol.2011.05.010
Mansell K, Bootsman N, Kuntz A, Taylor J. Evaluating pharmacist prescribing for minor ailments. Int J Pharm Pract. 2015;23(2):95-101. https://doi.org/10.1111/ijpp.12128
Chapman C, J Marriott, Van den Bosch D. The nature, extent and impact of triage provided by community pharmacy in Victoria. http://guildorgau/services-programs/research-and-development/archive—fourth-agreement/iig-008 (accessed Jan 21, 2020).
Curley LE, Moody J, Gobarani R, et al. Is there potential for the future provision of triage services in community pharmacy? J Pharm Policy Pract. 2016;9:29. https://doi.org/10.1186/s40545-016-0080-8
Kementerian Kesehatan Republik Indonesia. [Minister of Health Regulation No.35/2014 on the standard of pharmacy services in community pharmacy]. http://hukor.kemkes.go.id/uploads/produk_hukum/PMK%20No.%2035%20ttg%20Standar%20Pelayanan%20Kefarmasian%20di%20Apotek.pdf (accessed Jan 21, 2020).
The Indonesian Pharmacists Association-Ikatan Apoteker Indonesia. [Indonesian Pharmacist Competency Standard]. Jakarta: Pengurus Pusat Ikatan Apoteker Indonesia; 2011.
Marx RG, Menezes A, Horovitz L, Jones EC, Warren RF. A comparison of two time intervals for test-retest reliability of health status instruments. J Clin Epidemiol. 2003;56(8):730-735. https://doi.org/10.1016/S0895-4356(03)00084-2
McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012;22(3):276-282. https://doi.org/10.11613/BM.2012.031
Hanel PHP, Maio GR, Manstead ASR. A new way to look at the data: Similarities between groups of people are large and important. J Pers Soc Psychol. 2019;116(4):541-562. http://dx.doi.org/10.1037/pspi0000154
Nulty DD. The adequacy of response rates to online and paper surveys: what can be done? Assessment & Evaluation in Higher Education. 2008;33:301-314. https://doi.org/10.1080/02602930701293231
Apriansyah A. Drug information services in the community pharmacies at South Tangerang City [Thesis]. Universitas Islam Negeri Syarif Hidayatullah, 2017.
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.
Supardi S, Handayani SR, Herman JM, Susyanty LA. The implementation of the pharmaceutical care standard in pharmacy: need for the training for the pharmacist. Indonesian Bulletin of Health Research. 2011;39(3):138-144.
Ayele AA, Mekuria AB, Tegegn HG, Gebresillassie BM, Mekonnen AB, Erku DA. Management of minor ailments in a community pharmacy setting: Findings from simulated visits and qualitative study in Gondar town, Ethiopia. PLoS One. 2018;13(1):e0190583. https://doi.org/10.1371/journal.pone.0190583
Rutter P, Jignaben, P. Decision making by community pharmacists when making an over-the-counter diagnosis in response to a dermatological presentation. SelfCare. 2013;4(6):125-133.
Copyright (c) 2021 The Authors
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.