Challenges in the management of chronic noncommunicable diseases by Indonesian community pharmacists
Main Article Content
Keywords
Community Pharmacy Services, Professional Practice, Attitude of Health Personnel, Qualitative Research, Indonesia
Abstract
Objectives: We explored factors influencing Indonesian primary care pharmacists’ practice in chronic noncommunicable disease management and proposed a model illustrating relationships among factors.
Methods: We conducted in-depth, semistructured interviews with pharmacists working in community health centers (Puskesmas, n=5) and community pharmacies (apotek, n=15) in East Java Province. We interviewed participating pharmacists using Bahasa Indonesia to explore facilitators and barriers to their practice in chronic disease management. We audiorecorded all interviews, transcribed ad verbatim, translated into English and analyzed the data using an approach informed by “grounded-theory”.
Results: We extracted five emergent themes/factors: pharmacists’ attitudes, Puskesmas/apotek environment, pharmacy education, pharmacy professional associations, and the government. Respondents believed that primary care pharmacists have limited roles in chronic disease management. An unfavourable working environment and perceptions of pharmacists’ inadequate knowledge and skills were reported by many as barriers to pharmacy practice. Limited professional standards, guidelines, leadership and government regulations coupled with low expectations of pharmacists among patients and doctors also contributed to their lack of involvement in chronic disease management. We present the interplay of these factors in our model.
Conclusion: Pharmacists’ attitudes, knowledge, skills and their working environment appeared to influence pharmacists’ contribution in chronic disease management. To develop pharmacists’ involvement in chronic disease management, support from pharmacy educators, pharmacy owners, professional associations, the government and other stakeholders is required. Our findings highlight a need for systematic coordination between pharmacists and stakeholders to improve primary care pharmacists’ practice in Indonesia to achieve continuity of care.
References
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43. Khan TM. Critical considerations in pharmacy curriculum development in South Asian and Southeast Asian developing nations. Am J Pharm Educ. 2010;74(9):176.
44. Hassali MA. Challenges and future directions for public health pharmacy education in developing countries. Am J Pharm Educ. 2011;75(10):95. doi: 10.5688/ajpe7510195
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47. Helper CD. Clinical pharmacy, pharmaceutical care, and the quality of drug therapy. Pharmacotherapy. 2004;24(11):1491-1498.
48. Basak SC, Sathyanarayana D. Pharmacy education in India. Am J Pharm Educ. 2010;74(4):68.
49. Vo T, Bedouch P, Nguyen T, Nguyen T, Hoang T, Calop J. Pharmacy education in Vietnam. Am J Pharm Educ. 2013;77(6):114. doi: 10.5688/ajpe776114
50. Lluch M, Kanavos P. Impact of regulation of community pharmacies on efficiency, access and equity: evidence from the UK and Spain. Health Policy. 2010;95(2-3):245-254. doi:10.1016/j.healthpol.2009.11.002
51. Noyce PR. Providing patient care through community pharmacies in the UK: policy, practice and research. Ann Pharmacother. 2007;41(5):861-868. doi:10.1345/aph.1K015
52. Tangcharoensathien V, Patcharanarumol W, Ir P, Aljunid SM, Mukti AG, Akkhavong K, Banzon E, Huong DB, Thabrany H, Mills A. Health-financing reforms in southeast Asia: challenges in achieving universal coverage. Lancet. 2011;377(9768):863-873. doi:10.1016/S0140-6736(10)61890-9
53. World Health Organization. Country cooperation strategy at a glance: Indonesia. 2014. Retrieved from: www.who.int/countryfocus/cooperation_strategy/ccsbrief_idn_en.pdf (Accessed 24 Sep 2014).
54. Pemerintah Republik Indonesia. [The Presidential Regulation Number 12 Year 2013 on health insurance]. 2013. Jakarta: Pemerintah Republik Indonesia.
55. Dans A, Ng N, Varghese C, Shyong Tai E, Firestone R, Bonita R. The rise of chronic non-communicable diseases in southeast Asia: time for action. Lancet. 2011;377(9766):680-689. doi:10.1016/s0140-6736(10)61506-1
2. World Health Organization. Noncommunicable diseases (NCD) country profiles 2014: Indonesia. 2014. Retrieved from: www.who.int/countries/idn/en (Accessed 24 Sep 2014).
3. Abegunde DO, Mathers C, Adam T, Ortegon M, Strong K. The burden and costs of chronic diseases in low-income and middle-income countries. Lancet. 2007;370(9603):1929-1938. doi:10.1016/S0140-6736(07)61696-1
4. Beaglehole R, Epping-Jordan J, Patel V, Chopra M, Ebrahim S, Kidd M, Haines A. Improving the prevention and management of chronic disease in low-income and middle-income countries: a priority for primary health care. Lancet. 2008;372(9642):940-949. doi:10.1016/s0140-6736(08)6140-x
5. Wagner E. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract. 1998;1(1):2-4.
6. World Health Organization. Revitalizing primary health care. 2008. Retrieved from: http://www.who.int/management/district/RevitalizingPHC2008SEARO.pdf (Accessed 15 Sep 2014).
7. World Health Organization. Revitalizing primary health care: country experience Indonesia. 2008. Retrieved from: http://www.searo.who.int/LinkFiles/conference_INO-13-July.pdf (Accessed 15 Jan 2012).
8. Kementerian Kesehatan Republik Indonesia. [The Minister of Health Regulation Number 71 Year 2013 about health services in the national health insurance]. 2013. Jakarta: Kementerian Kesehatan Republik Indonesia.
9. Supardi S, Susyanti AL, Raharni, Herman MJ. [Pharmacist placement policy in community health centers]. Buletin Penelitian Sistem Kesehatan. 2012;15(2):133-142. Indonesian.
10. Pemerintah Republik Indonesia. [The Government Regulation Number 51 Year 2009 about pharmaceutical work]. 2009. Jakarta: Pemerintah Republik Indonesia.
11. Heywood P, Choi Y. Health system performance at the district level in Indonesia after decentralization. BMC Int Health Hum Rights. 2010;10:3. doi:10.1186/1472-698X-10-3
12. Chee G, Borowitz M, Barraclough A. Private sector health care in Indonesia. Bethesda, MD: Health Systems 20/20 Project, Abt Associates Inc; 2009.
13. Smith F. The quality of private pharmacy services in low and middle-income countries. Pharm World Sci. 2009;31(3):351-361. doi:10.1007/s11096-009-9294-z
14. Puspitasari HP, Faturrohmah A, Hermansyah A. Do Indonesian community pharmacy workers respond to antibiotics requests appropriately? Trop Med Int Health. 2011;16(7):840-846. doi:10.1111/j.1365-3156.2011.02782.x
15. 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.
16. Helper CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533-543.
17. Departemen Kesehatan Republik Indonesia. [The Minister of Health Decree Number 1027 Year 2004 about pharmaceutical practice standards in apotek]. 2004. Jakarta: Departemen Kesehatan Republik Indonesia.
18. Departemen Kesehatan Republik Indonesia. [Pharmaceutical practice guidelines in puskesmas]. 2006. Jakarta: Departemen Kesehatan Republik Indonesia.
19. Kementerian Kesehatan Republik Indonesia. [The Minister of Health Regulation Number 30 Year 2014 about pharmaceutical practice standards in puskesmas]. 2014. Jakarta: Kementerian Kesehatan Republik Indonesia.
20. Kementerian Kesehatan Republik Indonesia. [The Minister of Health Regulation Number 35 Year 2014 about pharmaceutical practice standards in apotek]. 2014. Jakarta: Kementerian Kesehatan Republik Indonesia.
21. Departemen Kesehatan Republik Indonesia. [Pharmaceutical care for diabetes mellitus]. 2005. Jakarta: Departemen Kesehatan Republik Indonesia.
22. Departemen Kesehatan Republik Indonesia. [Pharmaceutical care for hypertension]. 2006. Jakarta: Departemen Kesehatan Republik Indonesia.
23. Departemen Kesehatan Republik Indonesia. [Pharmaceutical care for coronary heart disease: focus on acute coronary syndrome]. 2006. Jakarta: Departemen Kesehatan Republik Indonesia.
24. Hagemeier NE. Transforming the community pharmacy setting: academe’s responsibility. Curr Pharm Teach Learn. 2010;2(3):133-137. doi:10.1016/j.cptl.2010.04.002
25. Nemire RE, Meyer SM. Educating students for practice: educational outcomes and community experience. Am J Pharm Educ. 2006;70(1):20.
26. Birks M, Mills J. Grounded theory a practical guide. 2011. London: Sage Publications.
27. Creswell JW. Qualitative inquiry and research design: choosing among five approaches. Thousand Oaks, CA: Sage Publications; 2013.
28. Puspitasari HP, Aslani P, Krass I. Australian community pharmacists’ awareness and practice in supporting secondary prevention of cardiovascular disease. Int J Clin Pharm. 2013;35(6):1218-28. doi:10.1007/s11096-013-9854-0
29. Puspitasari HP, Aslani P, Krass I. Challenges in the care of clients with established cardiovascular disease: lessons learned from Australian community pharmacists. PLoS ONE. 2014;9(11):e113337. doi:10.1371/journal.pone.0113337
30. Samb B, Desai N, Nishtar S, Mendis S, Bekedam H, Wright A, Hsu J, Martiniuk A, Celletti F, Patel K, Adshead F, McKee M, Evans T, Alwan A, Carissa E. Prevention and management of chronic disease: a litmus test for health-systems strengthening in low-income and middle-income countries. Lancet. 2010;376(9754):1785-1797. doi:10.1016/s0140-6736(10)61353-0
31. Azhar S, Hassali MA, Ibrahim MIM, Ahmad M, Masood I, Shafie K. The role of pharmacists in developing countries: the current scenario in Pakistan. Hum Resour Health. 2009;7:54. doi:10.1186/1478-4491-7-54
32. Basak SC, Foppe van Mil JW, Sathyanarayana D. The changing roles of pharmacists in community pharmacies: perception of reality in India. Pharm World Sci. 2009;31(6):612-618. 10.1007/s11096-009-9307-y
33. Bereznicki B, Peterson G, Jackson S, Haydn Walters E, DeBoos I, Hintz P. Perceived feasibility of a community pharmacy-based asthma intervention: a qualitative follow-up study. J Clin Pharm Ther. 2011;36(3):348-355. doi:10.111/j.1365-2710.2010.01187.x
34. Bryant LJM, Coster G, Gamble GD, McCormick RN. General practitioners’ and pharmacists’ perceptions of the role of community pharmacists in delivering clinical services. Res Social Adm Pharm. 2009;5(4):347-362. doi:10.1016/j.sapharm.2009.01.002
35. Mak VSL, Clark A, Poulsen JH, Udengaard KU, Gilbert AL. Pharmacists’ awareness of Australia’s health care reforms and their beliefs and attitudes about their current and future roles. Int J Pharm Pract. 2012;20(1):33-40. doi:10.1111/j.2042-7174.2011.00160.x
36. Marriot JL, Nation RL, Roller L, Costelloe M, Galbraith K, Stewart P, Charman WN. Pharmacy education in the context of Australian practice. Am J Pharm Educ. 2008;72(6):131.
37. Health Workforce Australia. Clinical training profile: pharmacy. 2014. Canberra: Health Workforce Australia.
38. Ellitt GR, Brien JE, Aslani P, Chen TF. Quality patient care and pharmacists’ role in its continuity – a systematic review. Ann Pharmacother. 2009;43(4):677-691. doi:10.1345/aph.1L505
39. Asosiasi Pendidikan Tinggi Farmasi Indonesia. [Core curriculum for bachelor of pharmacy education program]. 2008. Retrieved from: http://aptfi.or.id/files/kurikulum-inti-program-pendidikan-sarjana-farmasi.pdf (Accessed 19 Sep 2014).
40. Asosiasi Pendidikan Tinggi Farmasi Indonesia. [Curriculum for pharmacist education program]. 2008. Retrieved from: http://aptfi.or.id/files/Kurikulum%20Program%20Pendidikan%20Apoteker.pdf (Accessed 19 Sep 2014).
41. Asosiasi Pendidikan Tinggi Farmasi Indonesia. [Standards for intern pharmacist professional practice]. 2010. Retrieved from: http://aptfi.or.id/files/SPKPA.pdf (Accessed 19 Sep 2014).
42. Babar Z, Scahill SL, Akhlaq M, Garg S. A bibliometric review of pharmacy education literature in the context of low- to middle-income countries. Curr Pharm Teach Learn. 2013;5(3):218-232. doi:10.1016/j.cptl.2013.01.001
43. Khan TM. Critical considerations in pharmacy curriculum development in South Asian and Southeast Asian developing nations. Am J Pharm Educ. 2010;74(9):176.
44. Hassali MA. Challenges and future directions for public health pharmacy education in developing countries. Am J Pharm Educ. 2011;75(10):95. doi: 10.5688/ajpe7510195
45. Pramudiarja U. [Pharmacists are abundant but measly for puskesmas]. 2011. Retrieved from: http://health.detik.com/read/2011/08/22/110159/1708053/763/apoteker-berlimpah-tapi-yang-kerja-di-puskesmas-sangat-sedikit (Accessed 12 Sep 2014). Indonesian.
46. Kementerian Kesehatan Republik Indonesia. [Indonesia’s health profile 2013]. 2014. Jakarta: Kementerian Kesehatan Republik Indonesia.
47. Helper CD. Clinical pharmacy, pharmaceutical care, and the quality of drug therapy. Pharmacotherapy. 2004;24(11):1491-1498.
48. Basak SC, Sathyanarayana D. Pharmacy education in India. Am J Pharm Educ. 2010;74(4):68.
49. Vo T, Bedouch P, Nguyen T, Nguyen T, Hoang T, Calop J. Pharmacy education in Vietnam. Am J Pharm Educ. 2013;77(6):114. doi: 10.5688/ajpe776114
50. Lluch M, Kanavos P. Impact of regulation of community pharmacies on efficiency, access and equity: evidence from the UK and Spain. Health Policy. 2010;95(2-3):245-254. doi:10.1016/j.healthpol.2009.11.002
51. Noyce PR. Providing patient care through community pharmacies in the UK: policy, practice and research. Ann Pharmacother. 2007;41(5):861-868. doi:10.1345/aph.1K015
52. Tangcharoensathien V, Patcharanarumol W, Ir P, Aljunid SM, Mukti AG, Akkhavong K, Banzon E, Huong DB, Thabrany H, Mills A. Health-financing reforms in southeast Asia: challenges in achieving universal coverage. Lancet. 2011;377(9768):863-873. doi:10.1016/S0140-6736(10)61890-9
53. World Health Organization. Country cooperation strategy at a glance: Indonesia. 2014. Retrieved from: www.who.int/countryfocus/cooperation_strategy/ccsbrief_idn_en.pdf (Accessed 24 Sep 2014).
54. Pemerintah Republik Indonesia. [The Presidential Regulation Number 12 Year 2013 on health insurance]. 2013. Jakarta: Pemerintah Republik Indonesia.
55. Dans A, Ng N, Varghese C, Shyong Tai E, Firestone R, Bonita R. The rise of chronic non-communicable diseases in southeast Asia: time for action. Lancet. 2011;377(9766):680-689. doi:10.1016/s0140-6736(10)61506-1
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Challenges in the management of chronic noncommunicable diseases by Indonesian community pharmacists. Pharm Pract (Granada) [Internet]. 2015 Aug. 19 [cited 2024 Dec. 2];13(3). Available from: https://www.pharmacypractice.org/index.php/pp/article/view/578
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Author Biographies
Hanni P. Puspitasari
Faculty of Pharmacy, University of Sydney, Sydney, Australia;
Fakultas Farmasi, Universitas Airlangga, Surabaya, Indonesia
Parisa Aslani
Faculty of Pharmacy, University of Sydney, Sydney, AustraliaInes Krass
Faculty of Pharmacy, University of Sydney, Sydney, AustraliaHow to Cite
1.
Challenges in the management of chronic noncommunicable diseases by Indonesian community pharmacists. Pharm Pract (Granada) [Internet]. 2015 Aug. 19 [cited 2024 Dec. 2];13(3). Available from: https://www.pharmacypractice.org/index.php/pp/article/view/578