This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the author's institution and sharing with colleagues.Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. b s t r a c tBackground: The burgeoning health burden in Indonesia requires strengthening primary care services through interprofessional collaboration. Purpose: to explore factors contributing to interprofessional collaboration within health centres Indonesia. Methods: Eight focus group discussions involving a range of health professionals from health centres were conducted in four districts in East Java, Indonesia. Thematic analysis was used to generate findings. Results: Collaborative practices in Indonesian health centres are directly affected by health professional interactions (personnel level) e hierarchy and lack of role understanding have been reported as barriers to the interactions. These factors are in turn affected by health centre's environment (organisational level) and the Government legislation/policy (health system). The health centre's environment included organisation's culture, team management, physical space, as well as communication and coordination mechanisms. Conclusions: Factors contributing to collaborative practices in this setting were complex and intertwined. Structuring collective actions or strategies would be required to address the identified collaborative issues.

Kasus pneumonia yang disebabkan oleh severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) yang disebut coronavirus diseases 2019 (COVID-19) oleh World Health Organization (WHO) merupakan sebuah tragedi dalam dunia kesehatan secara global. Tata laksana yang tepat dan cepat diharapkan dapat menyelamatkan nyawa pasien. Sampai tulisan ini dibuat, belum terdapat satu jenis obat yang secara resmi diizinkan penggunaannya untuk terapi COVID-19. Kajian literatur ini bertujuan untuk 1) memaparkan tata laksana pengobatan dan 2) mendaftar serta menjelaskan alternatif obat yang dapat digunakan untuk SARS-CoV-2. Proses penelusuran artikel dalam kajian pustaka ini dilakukan pada sebuah database, yakni PubMed dengan kombinasi kata kunci (("corona virus") OR ("covid-19") OR ("SARS-CoV-2")) AND (("treatment") OR ("therapy")). Hasil kajian ini menunjukkan bahwa tata laksana pasien dengan COVID-19 dapat berbeda antar-setting dan negara dengan mempertimbangkan ketersediaan sumber daya, khususnya obat. Pedoman terapi WHO dan pedoman di Indonesia saat ini merekomendasikan supportive therapy untuk penanganan COVID-19, antara lain: terapi untuk gejala yang terjadi, pemberian oksigen, penggunaan antibiotik, terapi cairan, penggunaan vasopresor, dan tindakan medis (termasuk pemasangan ventilator) untuk menyelamatkan nyawa pasien. Belum terdapat obat khusus yang direkomendasikan untuk menekan replikasi SARS-CoV-2. Beberapa jenis obat yang potensial bermanfaat untuk SARS-CoV-2 antara lain: klorokuin atau hidroksiklorokuin, arbidol, ribavirin, favipiravir, lopinavir/ritonavir, remdesivir, oseltamivir, dan interferon. Namun sampai dengan tulisan ini dibuat, terdapat keterbatasan bukti penelitian dengan desain yang baik yang dapat digunakan untuk menarik kesimpulan terkait superioritas suatu jenis obat tertentu dibandingkan dengan alternatif yang lain. Dalam kondisi menunggu hasil penelitian dengan desain penelitian yang baik, penggunaan obat yang memiliki bukti efektivitas (walaupun belum baik) atau diduga efektif, perlu dioptimalkan untuk menyelamatkan nyawa pasien, khususnya mereka yang dalam kondisi parah.

Community-based training provides a potential strategy to improve community knowledge of medications. Findings from this study should inform strategies for a broader uptake amongst local communities in Indonesia.

Perilaku dan faktor dominan penyebab penggunaan antibiotik tanpa resep di Surabaya belum diketahui secara pasti. Tujuan penelitian ini adalah untuk mengidentifkasi perilaku dan faktor yang paling mempengaruhi penggunaan antibiotik tanpa resep. Penelitian dengan desain potong lintang dilakukan pada masyarakat yang membeli antibiotik tanpa resep dokter di 90 apotek di Surabaya selama bulan Desember 2014-April 2015. Identifikasi perilaku dilakukan melalui 8 pertanyaan majemuk, dan identifikasi faktor dilakukan melalui dua metode statistik, yakni analisis deskriptif melalui perbandingan mean pertanyaan dalam masing-masing tema faktor, dan analisis faktor menggunakan orthogonal rotation (varimax). Total 267 responden terlibat dalam penelitian. Mayoritas masyarakat yang membeli antibiotik tanpa resep dokter berusia 21-30 tahun (36,33%), membeli dengan frekuensi 1 kali/bulan (45,70%), membeli untuk diri sendiri (56,55%), membeli segera setelah gejala muncul (33,70%), pembeli untuk indikasi pilek/flu (21,30%). Berdasarkan hasil uji statistik deskriptif ditemukan bahwa tema “halhal yang mendorong” merupakan faktor yang mempengaruhi penggunaan antibiotik tanpa resep di apotek. Pada metode analisis faktor, nilai cumulative percent total variance xplained adalah sebesar 48,03%, dengan nilai terbesar pada faktor pertama yakni sebesar 23,91%. Faktor paling mempengaruhi penggunaan antibiotik tanpa resep adalah kemudahan akses memperoleh antibiotik dan penghematan biaya. Hasil penelitian ini dapat digunakan untuk menentukan metode intervensi yang tepat untuk menanggulangi permasalahan penggunaan antibiotik tanpa resep di apotek. Dengan mempertimbangkan kompleksitas faktor penyebab perilaku tersebut, apoteker tidak seharusnya dituduh sebagai satu-satunya pihak penyebab penggunaan antibiotik tanpa resep.

Introduction: Health cadres have a key role in building awareness related to irrational antibiotic use and antibiotic resistance in Indonesia. Cadres help to bridge the gap between the shortage of health professionals and the need to reach the broader population. This study aimed to identify cadres’ background, antibiotic knowledge and attitudes in an Indonesian setting. Methodology: A paper-based questionnaire survey was validated and conducted among purposefully selected cadres attending a seminar in Malang Indonesia. A 5-point Likert scale was used to identify attitudes, while true/false statements determined their knowledge. A total of 112 cadres responded, giving a 100% response rate. Results: The majority had been cadres for >2 years with previous counseling experience. Their attitudes on antibiotic use, were shown by the lower levels of disagreement to the statements “when I get a sore throat, I prefer to use antibiotics” (37.5%); “I would take antibiotics if I have had a cough for more than one week” (41.1%); and, “when I get influenza, I would take antibiotics to help me recover sooner” (47.3%), within the “indications” domain. For knowledge, lower scores were reported for domains related to “indications” (mean 1.49 ± 0.82/3), “resistance” (mean 1.06 ± 0.94/3), and “storage and disposal” (mean 1.23 ± 0.78/3). Conclusions: These findings indicated a need to improve cadres’ attitudes and knowledge prior their involvement as change agents for improving the rational use of antibiotics to minimise antibiotic resistance in Indonesia.

Socioeconomic impacts on adherence are understudied, particularly in disadvantaged areas. This study aimed to evaluate socioeconomic factors on medication adherence among patients with hypertension in Lombok, Indonesia. A cross-sectional survey was conducted in all six public hospital outpatient clinics in Lombok in 2017. Data was obtained using a validated questionnaire to which the Morisky Green Levine Adherence Scale (MGLS) questionnaire was used to assess medication adherence. Binary logistic regression was performed to determine independent socioeconomic associations. A total of 693 patients with hypertension were included (response rate 84%). The majority had low adherence (76.2%). Significant independent associations were reported between setting and education with adherence (rural versus urban setting: odds ratio 3.54, p<0.001; primary versus university level education: odds ratio 5.39, p<0.001). Socioeconomic associations provide some basis for the development of patient and population-based interventions to improve adherence among patients with hypertension in Indonesia, particularly in disadvantaged areas.

Background:Recent implementation of national health coverage and the increasing health burden in Indonesia require health professionals, including pharmacists, to work more collaboratively to improve access and quality of health care. Nevertheless, relatively little is known about Indonesian pharmacists’ attitude towards collaboration.Objective:To assess and compare the attitude of Indonesian pharmacy students and pharmacists towards collaboration with physicians.Methods:A survey of 95 pharmacy students (Universitas Surabaya) and 114 pharmacists (public health facilities in East Java) in Indonesia was conducted using the validated questionnaire, Scale of Attitudes Toward Physician-Pharmacist Collaboration (SATP2C), which was translated in Bahasa Indonesia. The questionnaire contained 16 items which were based on a 4-point Likert scale. Descriptive statistics were used to summarise the responses, (i.e., individual scores, factor scores and total scores).Results:Response rates of 97.9% and 65.8% were reported for students and pharmacists, respectively. The mean total score of SATP2C among Indonesian students and pharmacists were 56.53 versus 56.77, respectively; indicating positive attitudes toward collaboration. Further analysis of each item of SATP2C confirmed the positive attitudes in which mean and median scores of ≥3 were reported for most items in both groups. Significant differences between students and pharmacists were found regarding the following items: (i) ‘there are many overlapping areas of responsibility between pharmacists and physicians’ (3.28 versus 2.89, respectively; p<0.001), (ii) ‘pharmacist should clarify a physician’s order’ (3.54 versus 3.71, respectively; p=0.046); and (iii) ‘physicians should consult with pharmacists about adverse reactions or refractory to drug treatment’ (3.60 versus 3.44, respectively; p=0.022).Conclusions:Indonesian pharmacists reported positive attitudes toward collaboration with physicians. Further research is needed to understand other factors contributing in translating those positive attitudes into actual practice, and thus, providing a good foundation for policy makers, researchers and practitioners to support pharmacist-physician collaboration in Indonesia.

Counselling by pharmacy staff plays a key role in ensuring the quality use of medications in community settings. Information gathering is the first step and an essential part of counselling. Yet, data on information gathering during counselling in Indonesia is lacking. Objective To identify pharmacy staff’s practice of counselling and information gathered during counselling in an East Javan district, Indonesia. Methods A survey questionnaire was conducted in community-based health facilities in the district (i.e. 3 hospital outpatient clinics, 69 community pharmacies and 24 Community Health Centres [CHCs]); one health facility was represented by one pharmacy staff. Quantitative content analysis was used to summarise data regarding information gathering. Key findings Sixty-six pharmacy staff responded, giving a 69% response rate. Almost all staff reported providing counselling; those at CHCs and outpatient clinics mostly provided prescription medicine counselling (95.5% and 100.0%, respectively), while those at community pharmacies mostly provided non-prescription medicine counselling (symptom-based versus product-based requests: 94.9% versus 71.8%, respectively). For non-prescription counselling, the most frequent information gathered was details of symptoms (symptoms-based versus product-based requests: 97.3% versus 75.0%, respectively). While for prescription medication counseling, pharmacy staff mostly asked the patient’s identity (76.2%). Less than 20% of the pharmacy staff for non-prescription/prescription medication counselling gathered information on concurrent medications or history of allergies or adverse drug reactions. Conclusions Pharmacy staff in these Indonesian settings provided prescription/non-prescription counselling to some extent. Improved information gathering skills are required for effective counselling, especially for prescription medications, thus ensuring rational drug use among Indonesians.