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.

Objectives This study aimed to define the problems of the current use of the e-Catalogue and the national formulary (NF)—two elements of medicine pricing and reimbursement policies in Indonesia for achieving universal health coverage (UHC)—by examining the knowledge and attitudes of stakeholders. Specifically, to investigate (1) the perceived challenges involved in the further implementation of the e-Catalogue and the NF, (2) reasons of prescribing medicines not listed in the NF, and (3) possible improvements in the acceptance and use of the e-Catalogue and the NF. Methods Semi-structured interviews were conducted with stakeholders (policymakers, healthcare providers, a pharmaceutical industry representative, and experienced patients) to collect the qualitative data. The data was analysed using directed content analysis, following the guidelines of the COnsolidated criteria for REporting Qualitative studies (COREQ) in reporting the findings. Results Interestingly, 20 of 45 participants decided to withdraw from the interview due to their lack of knowledge of the e-Catalogue and the NF. All 25 stakeholders who fully participated in this research were in favor of the e-Catalogue and the NF. However, interviewees identified a range of challenges. A major challenge was the lack of harmonization between the lists of medicines in the e-Catalogue and the NF. Several system and personal reasons for prescribing medicines not listed in the NF were identified. Important reasons were a lack of incentives for physicians as well as a lack of transparent and evidence-based methods of selection for the medicines to be listed in the NF. Conclusions The e-Catalogue and the NF have not been fully utilized for achieving UHC in Indonesia. Some possible improvements suggested were harmonization of medicines listed in the e-Catalogue and the NF, restructuring incentive programs for prescribing NF medicines, and increasing the transparency and evidence-based approach for selection of medicines listed in the e-Catalogue and the NF.

Over a 10 year + follow-up period Asian subjects had a higher risk of stroke than CHD. Contrary to CVD prevention in Western countries, strategies should also consider stroke instead of CHD only.

ABSTRAKPemberian terapi antibiotik untuk pasien diare akut anak yang kurang tepat merupakan salah satu tantangan dalam bidang kesehatan di berbagai negara, termasuk Indonesia. Fenomena tersebut berpotensi meningkatkan biaya kesehatan yang seharusnya dapat dihindari di era implementasi program Jaminan Kesehatan Nasional (JKN). Tujuan penelitian ini adalah untuk memberikan deskripsi profil penggunaan dan biaya antibiotik pada pasien diare akut anak yang menjalani rawat inap. Penelitian observasional ini dilakukan secara prospektif selama April-Juli 2015. Rekam medis pasien serta data tagihan biaya perawatan (billing) pasien digunakan sebagai bahan penelitian. Konfirmasi dengan tenaga kesehatan lain, jika diperlukan, dilakukan pada saat proses visite bersama dengan tenaga kesehatan lain. Analisis deskriptif digunakan untuk mendeskripsikan penggunaan antibiotik dan biaya. Sebanyak 43 pasien anak memenuhi kriteria inklusi penelitian ini. Hampir seluruh pasien (93,02%) mendapatkan antibiotik dan sefalosporin generasi ketiga (69,23%) merupakan golongan antibiotik yang paling banyak diresepkan baik dalam bentuk tunggal maupun kombinasi. Sebanyak 45,49% (rentang 2,13%-79,48%) dari total biaya obat dialokasikan untuk penggunaan antibiotik. Rata-rata lama perawatan pada pasien diare akut non disentri dengan dan tanpa terapi antibiotik adalah 4,72 hari dan 2,5 hari, secara berturut-turut. Penggunaan antibiotik yang lazim diberikan kepada pasien diare akut anak tidak memperpendek lama tinggal di rumah sakit. Peresepan antibiotik pada pasien anak dengan diare akut perlu dipertimbangkan lebih lanjut dengan mempertimbangkan peta kuman lokal rumah sakit.Kata kunci: diare akut, anak, antibiotik, biaya obat ABSTRACT Inappropriate antibiotics prescription for pediatric patients with acute diarrhea is one of the most challenging health care problem among countries in the world, including Indonesia. Thus phenomenon will potentially increase the health expenditures that, actually, could be avoided in the era of Jaminan Kesehatan Nasional (JKN). The aim of this study was to provide the profile of antibiotics utilization and its' cost among pediatric inpatients with acute diarrhea. This prospective observational study was conducted during April-Juli 2015. Patient medical records and billing charts were used as the main source of information. If it was needed, confirmation with other health care prefessionals was conducted during ward round session. Descriptive analysis was used to provide information regarding antibiotics utilization and cost profiles. There were 43 pediatric patients involved in the present study. Almost all of patients (93.02%) received antibiotics and the 3 rd generation of cephalosporin was the most frequent antibiotic given to the patients either as single or combination antibiotics. As much as 45.49% (ranged from 2.13% to 79.48%) of drug cost was allocated for antibiotics. The average of length of stay in the hospital for pediatric patients with non-dysentri diarrhea with or without antibiotics prescription were 4...

ObjectivesThis study aimed to identify the barriers and facilitators to improve the use of health technology assessment (HTA) for the selection of medicines listed in the e-Catalogue and the national formulary in Indonesia.MethodsSemi-structured interviews were conducted to collect qualitative data. Purposive sampling was used to recruit the stakeholders consisting of policymakers, a pharmaceutical industry representative, healthcare providers, and patients. The data were analyzed using directed content analysis and following the COnsolidated criteria for REporting Qualitative studies (COREQ).ResultsThe twenty-five participants interviewed agreed with the use of HTA for supporting the e-Catalogue and the national formulary and perceived the advantages of HTA implementation outweighed the disadvantages. Barriers mentioned were a lack of capability of local human resources, financial incentives, a clear framework and insufficient data. Strategies suggested to overcome the barriers were establishing (inter)national networks to build up capacity, setting up departments of HTA in several universities in Indonesia, and introducing a clear HTA framework. Facilitators mentioned were the ambition to achieve universal health coverage, the presence of legal frameworks to implement HTA in the e-Catalogue and the national formulary, and the demands for appropriate medicine policies.ConclusionsSeveral barriers are currently hampering broad implementation of HTA in medicine pricing and reimbursement policy in Indonesia. Solutions to these issues appear feasible and important facilitators exist.

Real-world evidence on a potential statin effect modification by sex is inconclusive, especially for the primary prevention of cardiovascular disease (CVD). We aimed to quantify the differences in the effect of statins on lipid parameters between men and women. The PharmLines Initiative linked the Lifelines Cohort Study and the IADB.nl prescription database. This database covers a representative population from the Netherlands. We selected participants aged ≥40 years at the index date: the date of the first prescription of any statin monotherapy in the study period 2006 to 2017. Multivariate regression modeling was used to compare the difference of the mean percentage change of lipid parameters (% mean difference [MD]) from baseline to follow-up measurement between the sexes. Out of 5366 statin users from approximately 50,000 participants available in the final linked database, 685 were statin initiators. At baseline, women had significantly higher levels of mean total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) than men (all P values <.01). At follow-up, women had a significantly higher mean percentage change of HDL-C compared to men (adjusted % MD 5.59, 95% confidence interval [CI] 2.42-8.75, P < .01). There was no significant sex difference in other parameters, nor in the proportion of men and women who achieved LDL-C ≤2.5 mmol/L. Statins appear to have a greater effect on increasing HDL-C levels in women than men while showing similar effect on other lipid parameters in both sexes. Men should not be treated differently than women.

Kompatibilitas merupakan salah satu faktor penentu kualitas sediaan intravena (IV) yang berdampak pada keberhasilan terapi pasien Intensive Care Unit (ICU). Tujuan penelitian ini adalah mengidentifikasi profil kompatibilitas dan inkompatibilitas sediaan obat IV yang diberikan kepada pasien ICU. Penelitian observasional ini dilakukan secara prospektif pada pasien di ICU sebuah rumah sakit swasta Surabaya selama periode Oktober-Desember 2014. Pada penelitian ini, data pencampuran obat IV dengan pelarutnya dibandingkan dengan menggunakan brosur sediaan dan Handbook on Injectable Drugs Edisi 17 (2013) sebagai acuan untuk menganalisis kompatibilitas sediaan IV. Campuran antara obat IV dan pelarutnya diklasifikasikan sebagai campuran yang kompatibel, inkompatibel, no information (NI), not applicable (NA), dan not clear (NC) dengan menggunakan kriteria tertentu. Hasil penelitian menunjukkan terdapat 1.186 pencampuran antara senyawa obat IV dengan pelarut dari total 39 pasien ICU yang diamati. Tidak ditemukan pencampuran antara senyawa obat dengan pelarut yang inkompatibel, baik pada pasien dewasa maupun anak. Sebagian besar senyawa obat dicampur dengan pelarut yang kompatibel (dewasa: 72,31%; anak: 69,84%). Akan tetapi, berdasarkan 3 pustaka rujukan untuk kasus kompatibilitas sediaan IV yang digunakan dalam penelitian ini, masih terdapat campuran antara senyawa obat dengan pelarut yang belum diketahui informasi kompatibilitasnya sehingga diklasifikasikan sebagai NI (dewasa: 19,68%; anak: 30,16%). Sebagian kecil dari pencampuran senyawa obat IV dengan pelarutnya, diklasifikasikan sebagai NA dan NC, yaitu sebesar 7,48% dan 0,53%, secara berturut-turut. Terbatasnya informasi terkait kompatibilitas dan stabilitas sediaan IV tersebut mendorong dilakukannya pemantauan kondisi pasien dan kadar obat secara berkesinambungan.

ObjectivesTo elicit key factors influencing physicians’ decision to prescribe statins.DesignA qualitative study using a phenomenological approach within a pragmatism interpretive framework. A combination of purposive and snowball sampling was used to recruit physicians. Data were collected through face-to-face, semistructured interviews with physicians working in primary healthcare facilities in a capital of a province in Indonesia. We recorded and verbatim transcribed the interviews. Coding was done independently by two researchers and data were analysed using phenomenological data analyses. Key factors influencing physicians’ decision to prescribe statins were classified into factors at the microlevels, mesolevels and macrolevels according to the structural model by Scoggins et al.Participants and settingPhysicians working in primary healthcare facilities in a capital of a province in Indonesia.ResultsTen physicians were included in the study. Key factors at the microlevel were that physicians knew guidelines in general, but there was uncertainty how to take into account the level of total cholesterol in combination with other cardiovascular risk factors such as diabetes and hypertension. At the macrolevel, the new National Health Insurance System (NHIS) that appeared to facilitate the prescription of statins though more clinical information should be integrated in the system’s platform to support appropriate prescribing.ConclusionsThe findings indicate lack of awareness of specific details in current guideline recommendations. Appropriate prescribing of statins should be enhanced using the new NHIS.