Clinical Pharmacy Services in Community Pharmacies at Medan City

Indonesia

Wiryanto

, H. R. Tanjung

and R. A. Dalimunthe

Pharmacist Education Program, Pharmacy Faculty, Universitas Sumatera Utara, Medan, Indonesia

Bachelor of Pharmacy Program,

Pharmacy Faculty, Universitas Sumatera Utara, Medan, Indonesia

Keywords: Clinical pharmacy services, Community pharmacies.

Abstract: Clinical Pharmacy is the practice of pharmacy as part of a multidisciplinary healthcare team directed at

achieving quality use of medicines. The standards of pharmaceutical services in community pharmacies

No.73/2016 consists of two areas; standards of pharmacies management and clinical pharmacy services. The

aim of this study was to describe the level of implementation of clinical pharmacy services in community

pharmacies at Medan city, Indonesia. This pilot study was a descriptive research that used a cross-sectional

survey methodology. The level of implementation of clinical pharmacy services in community pharmacies

obtained by direct survey to selected pharmacies. The clinical pharmacy services implementation level was

obtained from 99 community pharmacies. Overall, the data revealed that the average score of total score from

99 community pharmacies was 6.65±3.25. The highest level of clinical pharmacy services implementation

was fair (42.42%) followed by bad (33.33%) and good (14.14%). The data above showed that the clinical

pharmacy services implementation in community pharmacy still in the fair level (score 6-10).

1 INTRODUCTION

The Ministry of Health of Republic of Indonesia

published the act of Ministry of Health No. 1027 in

September 2004 for standards of pharmaceutical

services in community pharmacies even though the

concept of Pharmaceutical Care in Indonesia was

introduced since the late of 1990’s (Ministry of health

of RI, 2004). Finally, the Government issued the

government regulation No.51/2009 on

pharmaceutical practice as law standards of pharmacy

practice in Indonesia and the most recent Act of

Ministry of Health No. 73/2016 as the up-dated rule

on the standards of pharmaceutical services in

community pharmacies. (Ministry of health of RI,

2016). The standards of pharmaceutical services in

community pharmacies No.73/2016 consists of two

areas; standards of pharmacies management and

clinical pharmacy services. All of the regulations was

the government policy to back up the implementation

of Pharmaceutical Care practice in Indonesia.

Pharmacists can apply their expertise of drug

knowledge to help identify, solve and prevent

medication related problems and increase patient

safety by working with other health professionals

(SHPA, 2005).

Pharmacists administer drug review of

prescription to assess the drug appropriateness and

identify actual or potential drug related problems after

a prescription prescribed. Pharmacists determine

patients accept the most appropriate medicine,

regimen dose and dosage form for their medical

complain and drug related problems are minimized.

Pharmacists contact the physician if there are any

incompatibility/mistake. Pharmacists also have an

obligation to counsel the patients about the drug

information and education to optimize the safe and

appropriate use of medicines (Shah, 2009).

However, until now, there is no data about the

implementation of standards of clinical pharmacy

services in community pharmacies at Medan city

even though the rules were already published by the

Ministry of health years ago. The aim of this study

was to describe the level of implementation of clinical

pharmacy services in community pharmacies at

Medan city, Indonesia

Wiryanto, ., Tanjung, H. and Dalimunthe, R.

Clinical Pharmacy Services in Community Pharmacies at Meda City Indonesia.

DOI: 10.5220/0010093508410844

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

841-844

ISBN: 978-989-758-449-7

841

2 METHODS

This pilot study was a descriptive research that used

a cross-sectional survey methodology. The level of

implementation of clinical pharmacy services in

community pharmacies obtained by direct survey to

the selected community pharmacy at Medan city.

The selection of community pharmacy was done

by purposive random sampling method. Researcher

was offered the pharmacists joined the study by a

whatsapp and facebook app groups and until the date

line time there were 99 pharmacists that joined the

study. The study was conducted on July 2018.

The professional pharmacists in selected

community pharmacy was asked to fill the

questioners that developed according to the standards

of clinical pharmacy services that stated in the Act of

of Ministry of Health No. 73/2016.

The questioners consists of 7 (seven) element of

clinical pharmacy services; the assessment and

prescription services, drug dispensing, drug

information services, drug counselling, home

pharmacy care, medication therapy review, drug’s

side effect monitoring. The pharmacists was asked to

choose the answer about the implementation of the 7

(seven) element in 3 (three) level implementation;

done and documented (score 2), done but not

documented (score 1), not implemented (score 0).

The total score obtained by summed the score of

every element. The score will range from 0 to 14 for

every community pharmacy. The level of

implementation were divided in three levels based on

total score; good (total score 11-14), fair (total score

6-10) and bad (total score 0-5).

3 RESULTS

99 pharmacists of community pharmacies located in

some district at Medan city was filled out the

questioners of the implementation of clinical

pharmacy services in community pharmacies at

Medan City.

3.1 Clinical Pharmacy Services

Implementation

The clinical pharmacy services implementation level

was obtained from 99 community pharmacies.

Overall, the data revealed that the average score of

total score from 99 community pharmacies was

6.65±3.25 as mention in Table 1.

Table 1: Clinical pharmacy services implementation

(n=99)

No. of CP Average score Highest

Score

Lowest

score

99 6.65±3.25 14 1

The data showed that the clinical pharmacy

services implementation in community pharmacy still

in the fair level (score 6-10). The highest score was

14 and the lowest score was 1. This study also

categorized all of 99 community pharmacies based on

its own total score in to three level; good, fair and bad

as mention in Table 2.

Table 2: Clinical pharmacy services implementation level

categorization (n=99)

No Level Frequency Percentage

1 Good 14 14.14

2 Fair 42 42.42

3 Bad 33 33.33

Total 99 100

The highest level of clinical pharmacy services

implementation was fair (42.42%) followed by bad

(33.33%) and good (14.14%).

3.2 Seven Element of Clinical Pharmacy

Services Implementation

The standards of clinical pharmacy stated in Act of

Ministry of health No.73/2016 was consists of 7

elements. The data obtained from this study revealed

that there were three element that still had low

implementation as mention in Table 3.

The three elements with high no implementation

level were the home pharmacy care (62.62%),

followed by the drug’s side effect monitoring

(50.50%) and the medication therapy review

(44.44%).

4 DISCUSSIONS

4.1 Clinical Pharmacy Services

Implementation

This study revealed that the the clinical pharmacy

services implementation in community pharmacy still

in the fair level (score 6-10). This study also showed

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

842

Table 3: Seven element of clinical pharmacy services implementation (n=99)

No. Element of CP services Done and documented

(%)

Done, not documented

(%)

No Implementation

(%)

1 The assessment and prescription

services

33.33 53.53.5 13.13

2 The drug dispensing 35.35 56.56 9.09

3 The drug information services 25.25 65.65 8.08

4 The drug counselling 26.26 65.65 8.08

5 The home pharmacy care 11.11 26.26 62.62

6 The medication therapy review 14.14 41.41 44.44

7 The drug’s side effect monitoring 13.13 36.36 50.50

that some community pharmacies have only score 1

(one) in

implement the clinical pharmacy services.

This condition are becoming important problem

that must be resolved together by the government,

pharmacists professional organization, and other part

of society in order to ensure the providing of the safe,

qualified, and effective pharmaceutical services to the

society.

4.2 Seven Element of Clinical Pharmacy

Services Implementation

The data obtained from this study showed the three

elements that have low implementation level. The

first elements with the highest percentage (62.62%)

of no implementation is the home pharmacy care.

This services were asked the pharmacists to

provide the pharmaceutical services with home visit

session, especially for the old age patients and

patients with chronic diseases. The two others

elements were the drug’s side effect monitoring

(50.50%) and the medication therapy review

(44.44%).

The pharmacists that want to provide this three

elements services must understand and possess the

pharmaceutical care concept and clinical pharmacy

skills. A study revealed that lack of training, lack of

knowledge and confidence, poor understanding about

pharmacist’s role as the barriers towards extended

services in clinical pharmacy services (Nordin, et al,

2017; Cordina, et al, 2008).

This research also revealed that the

implementation of clinical pharmacy services

categorization was predominantly by “done, not

documented”. This condition was far from ideal

condition of clinical pharmacy services. The primary

outcome of documenting clinical pharmacy activities

is to improve the quality of each patient’s care.

Documentation is also an instrument that can be used

to evaluate the accountability of the pharmacist’s and

the evidence of impact of the pharmacist’s services

(SHPA, 2013). Another benefit of pharmacists

documentation were accurate and timely

communication of medication therapy

recommendation, helps to ensure continuity of care,

illustrates the role of the pharmacists in patients care

(Dunkin and Dumont, 2013). Further research is

needed to reveal the barriers of implementation of

clinical pharmacy services in community pharmacies

at Medan city.

5 CONCLUSIONS

The data above showed that the clinical pharmacy

services implementation in community pharmacy at

Medan city was still in the fair level (score 6-10). This

condition must be resolved together by the

government, pharmacist professional organization,

and other part of society in order to ensure the

providing of the safe, qualified, and effective

pharmaceutical services to the society.

ACKNOWLEDGEMENTS

The authors acknowledge that the research was

supported by Rector of the University of Sumatera

Utara. The support is under the research grant

TALENTA USU of year 2018 contract number

2590/UN5.1.R/PPM/2018.

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