Pharmacists’ Experiences and Needs in Pharmaceutical Care to Support Diabetes Medication Adherence in Indonesian Primary Care
Abstract
Introduction: Medication adherence remains a major challenge in the management of diabetes mellitus, particularly in primary health care. Pharmacists play an important role in supporting adherence through pharmaceutical care. However, there is still limited evidence regarding pharmacists’ experiences and needs in implementing pharmaceutical care related to adherence in community health centers (Puskesmas) in Indonesia.
Methods: This descriptive cross-sectional study was conducted among pharmacists working at Community Health Centers (Puskesmas) in South Kalimantan Province, Indonesia, between July and August 2025. A total of 244 pharmacists were invited, and 161 participated (response rate 66.0%). Data were collected using a validated structured questionnaire consisting of 35 items on a five-point Likert scale, covering pharmacists’ experiences, barriers, and needs in implementing pharmaceutical care to support medication adherence among patients with diabetes mellitus. Data were analyzed descriptively.
Results: Pharmacists predominantly relied on indirect adherence assessment, most commonly through prescription refill monitoring (60.9%), while less consistently confirming patients’ understanding of therapeutic goals. Adherence-support interventions were largely limited to face-to-face education, with minimal use of remote/digital modalities (telephone or social media: 60.9% never). Monitoring and follow-up were also inconsistent, including limited assessment of adverse drug reactions. Key systemic and workflow barriers included limited time, lack of training, and restricted access to patients’ clinical information (75.8%). Pharmacists reported strong needs for standardized adherence assessment tools, accessible patient medication records, systematic guidelines, and training programs.
Conclusion: Pharmaceutical care to support medication adherence among patients with diabetes mellitus in Puskesmas is not yet implemented consistently. Strengthening pharmacist competencies through practical tools, clear guidance, and continuous training, together with better access to patient information and appropriate use of digital resources, may improve the delivery of adherence services in primary care.
References
Gow K, Rashidi A, Whithead L. Factors Influencing Medication Adherence among Adults Living with Diabetes and Comorbidities: A Qualitative Systematic Review. Current Diabetes Reports. 2024;24(2):19–25. https://doi.org/10.1007/s11892-023-01532-0
Piragine E, Petri D, Martelli A, Calderone V, Lucenteforte E. Adherence to Oral Antidiabetic Drugs in Patients with Type 2 Diabetes: Systematic Review and Meta-analysis. Journal of Clinical Medicine. 2023;12(5):1981. https://doi.org/10.3390/jcm12051981
Boonpattharatthiti K, Songkla PN, Chantara J, Koomsri C, Krass I, Chaiyakunapruk N, et al. Prevalence of Adherence to Oral Antidiabetic Drugs in Patients with Type 2 Diabetes: A Systematic Review and Meta-analysis. Journal of Diabetes Investigation. 2024;15(11):1614–1625. https://doi.org/10.1111/jdi.14285
Alfian R, Ariani N, Nita Y, Athiyah U. Assessment to Barriers of Medication Adherence among Patients with Type 2 Diabetes Mellitus. Journal of Research in Pharmacy. 2025;29(3):918–927. https://doi.org/10.12991/jrespharm.1693752
Presley B, Groot W, Pavlova M. Pharmacy-led Interventions to Improve Medication Adherence among Adults with Diabetes: A Systematic Review and Meta-analysis. Research in Social and Administrative Pharmacy. 2019;15(9):1057–1067. https://doi.org/10.1016/j.sapharm.2018.09.021
Hassan F, Hatah E, Ali AM, Wen CW. The Intervention Strategies and Service Model for Pharmacist-led Diabetes Management: A Scoping Review. BMC Health Services Research. 2023;23(1):46. https://doi.org/10.1186/s12913-022-08977-1
Alabkal RM, Medlinskiene K, Silcock J, Graham A. Impact of Pharmacist-led Interventions to Improve Clinical Outcomes for Adults with Type 2 Diabetes at Risk of Developing Cardiovascular Disease: A Systematic Review and Meta-analysis. Journal of Pharmacy Practice. 2023;36(4):888–899. https://doi.org/10.1177/08971900211064459
Narain KDC, Moreno G, Bell DS, Chen L, Tseng CH, Follett RW, et al. Pharmacist-led Diabetes Control Intervention and Health Outcomes in Hispanic Patients with Diabetes. JAMA Network Open. 2023;6(9):e2335409. https://doi.org/10.1001/jamanetworkopen.2023.35409
Kutluay NB, Bektay MY, Sumbul-Sekerci B, Sekerci A, Izzettin FV. Impact of Clinical Pharmacist Integration on Diabetes Management: A Prospective Cohort Study. BMC Health Services Research. 2025;25(1):107. https://doi.org/10.1186/s12913-025-12233-7
Alsubahi N, Groot W, Alzahrani AA, Ahmad A, Pavlova M. Patient-centered Care and Satisfaction of Patients with Diabetes: Insights from a Survey among Patients at Primary Healthcare Centers in Saudi Arabia. BMC Primary Care. 2025;26(1):140. https://doi.org/10.1186/s12875-025-02778-1
Sousa Pinto G, Bader L, Billberg K, Criddle D, Duggan C, El Bizri L, et al. Beating Non-communicable Diseases in Primary Health Care: The Contribution of Pharmacists and Guidance from FIP to Support WHO Goals. Research in Social and Administrative Pharmacy. 2020;16(7):974–977. https://doi.org/10.1016/j.sapharm.2019.10.008
Wibowo Y, Parsons R, Sunderland B, Hughes J. An Evaluation of Community Pharmacy-based Services for Type 2 Diabetes in an Indonesian Setting: Patient Survey. PeerJ. 2015;3:e1449. https://doi.org/10.7717/peerj.1449
Hughes JD, Wibowo Y, Sunderland B, Hoti K. The Role of the Pharmacist in the Management of Type 2 Diabetes: Current Insights and Future Directions. Integrated Pharmacy Research and Practice. 2017;6:15–27. https://doi.org/10.2147/IPRP.S103783
Presley B, Groot W, Widjanarko D, Pavlova M. Preferences for Pharmacist Services to Enhance Medication Management among People with Diabetes in Indonesia: A Discrete Choice Experiment. Patient Education and Counseling. 2021;104(7):1745–1755. https://doi.org/10.1016/j.pec.2020.12.005
Marjadi B, Alfian R, Susanto Y, Tjandra L, Pratama ANW, Schneider C. Pharmacists' Continuing Professional Development for Non-communicable Diseases Management: A Consensus Study. Research in Social and Administrative Pharmacy. 2022;18(11):3964–3973. https://doi.org/10.1016/j.sapharm.2022.07.002
White A, Thompson EL, Kim S, Osei JA, Fulda KG, Xiao Y. Enhancing the Role of Community Pharmacists in Medication Safety: A Qualitative Study of Voices from the Frontline. Pharmacy (Basel). 2025;13(4):94. https://doi.org/10.3390/pharmacy13040094
Uddin S, Sanchez Machado M, Alshahrouri B, Echeverri JI, Rico MC, Rao AD, et al. Empowering Pharmacists in Type 2 Diabetes Care: Opportunities for Prevention, Counseling, and Therapeutic Optimization. Journal of Clinical Medicine. 2025;14(11):3822. https://doi.org/10.3390/jcm14113822
Wahidin M, Achadi A, Besral B, Kosen S, Nadjib M, Nurwahyuni A, et al. Projection of Diabetes Morbidity and Mortality till 2045 in Indonesia Based on Risk Factors and NCD Prevention and Control Programs. Scientific Reports. 2024;14(1):5424. https://doi.org/10.1038/s41598-024-54563-2
Hidayat B, Ramadani RV, Rudijanto A, Soewondo P, Suastika K, Ng JSY. Direct Medical Cost of Type 2 Diabetes Mellitus and Its Associated Complications in Indonesia. Value in Health Regional Issues. 2022;28:82–89. https://doi.org/10.1016/j.vhri.2021.04.006
Pertiwi MV, Alfian R, Nita Y, Athiyah U. Medication Adherence of Diabetes Mellitus Patients in Indonesia: A Systematic Review. Pharmacy Education. 2022;22(2):188–193. https://doi.org/10.46542/pe.2022.222.188193
Alfian R, Nita Y, Athiyah U. Evaluation of Pharmacist-Based Services for Type 2 Diabetes Mellitus in the Indonesian Community Health Centers. Journal of Public Health and Pharmacy. 2025;5(1):1–10. https://doi.org/10.56338/jphp.v5i1.5888
Pereira CEO, Bambirra EHF, Fernandes BD, Sousa M, Mendonca SAM, Chemello C. Factors Influencing the Implementation of Pharmaceutical Care in Outpatient Settings: A Systematic Review Applying the Consolidated Framework for Implementation Research. Research in Social and Administrative Pharmacy. 2022;18(4):2579–2592. https://doi.org/10.1016/j.sapharm.2021.06.011
Moecker R, Terstegen T, Haefeli WE, Seidling HM. The Influence of Intervention Complexity on Barriers and Facilitators in the Implementation of Professional Pharmacy Services: A Systematic Review. Research in Social and Administrative Pharmacy. 2021;17(10):1651–1662. https://doi.org/10.1016/j.sapharm.2021.01.013
Alfian R, Athiyah U, Nita Y. Social Media Health Interventions to Improve Diabetes Mellitus Patient Outcome: A Systematic Review. Journal of Basic and Clinical Physiology and Pharmacology. 2021;32(4):297–304. https://doi.org/10.1515/jbcpp-2020-0501
Ghozali MT. Assessment of Knowledge, Perception, and Readiness for Telepharmacy-Assisted Pharmaceutical Services among Young Pharmacists in Rural Indonesia. Exploratory Research in Clinical and Social Pharmacy. 2024;16:100513. https://doi.org/10.1016/j.rcsop.2024.100513
Christy A, Fernanda F, Insani WN, Abdulah R. Pharmacist-Led Digital Health Interventions for Patients with Diabetes: A Systematic Review. Journal of Multidisciplinary Healthcare. 2025;18:101–112. https://doi.org/10.2147/JMDH.S494584
Jauza J, Ghozali MT. Professional Competence and Perception on the Practical Implementation of Telepharmacy among Pharmacists: A Review. Research Journal of Pharmacy and Technology. 2024;17(6):2915–2924. https://doi.org/10.52711/0974-360X.2024.00457
Wang J, Pei Y, Yu F, Kang Z, Zheng Y. Understandings, Attitudes, and Barriers About Diabetes Care: Analysis of Factors Influencing Community Pharmacists in China. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2021;14:1999–2009. https://doi.org/10.2147/DMSO.S304066
Al Assaf S, Kleiner D, Zelko R, Hanko B. Type 2 Diabetes Patients' Views of Local Pharmacists and Fulfilment with Pharmaceutical Diabetes Care in Syria's Latakia Governorate: An Online Survey Research. Healthcare (Basel). 2023;11(12):1720. https://doi.org/10.3390/healthcare11121720
Sendekie AK, Tesfaye AH, Tadesse YB, Dagnaw AD, Belachew EA. Actual Practices of Community Pharmacists in the Management of Diabetes: A Comparison of Simulated Patient-Based Study with Perceived Role of Involvement. Journal of Pharmaceutical Policy and Practice. 2024;17(1). https://doi.org/10.1080/20523211.2024.2326381
Cooney P, Hanley J, Ryan-O'Brien N, Okada H, Bermingham M. The Views and Experiences of People with Type 2 Diabetes Being Cared for by Their Community Pharmacist: A Cross-Sectional Patient Survey. Journal of Diabetes and Metabolic Disorders. 2022;21(2):1619–1624. https://doi.org/10.1007/s40200-022-01111-2
Ilardo ML, Speciale A. The Community Pharmacist: Perceived Barriers and Patient-Centered Care Communication. International Journal of Environmental Research and Public Health. 2020;17(2):536. https://doi.org/10.3390/ijerph17020536
Jairoun A, Al-Hemyari S, Shahwan M, Jairoun S, Alorfi N, Zyoud SE, et al. Current Perspectives, Practices, and Barriers Faced by Community Pharmacists Regarding Pharmaceutical Care Services for Diabetes Mellitus in the United Arab Emirates. Journal of Multidisciplinary Healthcare. 2024;17:2563–2576. https://doi.org/10.2147/JMDH.S447450
Musselman KT, Moczygemba LR, Pierce AL, Plum MF, Brokaw DK, Kelly DL. Development and Implementation of Clinical Pharmacist Services Within an Integrated Medical Group. Journal of Pharmacy Practice. 2017;30(1):75–81. https://doi.org/10.1177/0897190015617667
Davis CS, Ross LAR, Bloodworth LS. The Impact of Clinical Pharmacist Integration on a Collaborative Interdisciplinary Diabetes Management Team. Journal of Pharmacy Practice. 2017;30(3):286–290. https://doi.org/10.1177/0897190016631894
Ruiz-Ramos J, Hernandez MH, Juanes-Borrego AM, Mila R, Mangues-Bafalluy MA, Mestres C. The Impact of Pharmaceutical Care in Multidisciplinary Teams on Health Outcomes: Systematic Review and Meta-Analysis. Journal of the American Medical Directors Association. 2021;22(12):2518–2526. https://doi.org/10.1016/j.jamda.2021.05.038
Alzubaidi H, Saidawi W, McNamara K. Pharmacist Views and Pharmacy Capacity to Deliver Professional Services in the United Arab Emirates. International Journal of Clinical Pharmacy. 2018;40(5):1106–1115. https://doi.org/10.1007/s11096-018-0662-4
Daly CJ, Quinn B, Mak A, Jacobs DM. Community Pharmacists' Perceptions of Patient Care Services Within an Enhanced Service Network. Pharmacy (Basel). 2020;8(3):172. https://doi.org/10.3390/pharmacy8030172
Roach M, Land N, Hernandez J, Rau R, Chou JW, Hickson SS, et al. The Role of Pharmaceutical Innovation in Clinical Practice Guidelines for Chronic Diseases. International Journal of Clinical Practice. 2024;2024:5877687. https://doi.org/10.1155/2024/5877687
Reis L, Gregorio J. Professional Pharmacy Services' Outcomes Performance Measurement: A Narrative Review. Exploratory Research in Clinical and Social Pharmacy. 2024;16:100533. https://doi.org/10.1016/j.rcsop.2024.100533
Leong CM, Lee TI, Chien YM, Kuo LN, Kuo YF, Chen HY. Social Media-Delivered Patient Education to Enhance Self-Management and Attitudes of Patients with Type 2 Diabetes During the COVID-19 Pandemic: Randomized Controlled Trial. Journal of Medical Internet Research. 2022;24(3):e31449. https://doi.org/10.2196/31449
Georgieva N, Tenev V, Kamusheva M, Petrova G. Diabetes Mellitus—Digital Solutions to Improve Medication Adherence: Scoping Review. Diabetology. 2023;4(4):465–480. https://doi.org/10.3390/diabetology4040040
Thomas RL, Alabraba V, Barnard S, Beba H, Brake J, Cox A, et al. Use of Social Media as a Platform for Education and Support for People with Diabetes During a Global Pandemic. Journal of Diabetes Science and Technology. 2023;17(2):353–363. https://doi.org/10.1177/19322968211054862
Yaagoob E, Lee R, Stubbs M, Shuaib F, Johar R, Chan S. WhatsApp-Based Intervention for People with Type 2 Diabetes: A Randomized Controlled Trial. Nursing and Health Sciences. 2024;26(2):e13117. https://doi.org/10.1111/nhs.13117
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