Rahmawati Riana, Bajorek Beata V
Graduate School of Health, University of Technology Sydney, NSW, Australia
Rural Remote Health. 2018 Aug;18(3):4393. doi: 10.22605/RRH4393. Epub 2018 Aug 15.
Obtaining an adequate supply of medicines is an important step in facilitating medication adherence. This study aimed to determine (1) how people with hypertension in rural villages in Indonesia obtain their supply of anti-hypertensive medications, (2) the type of hypertension medication taken and (3) factors associated with where and how people obtain their medicines supplies.
Data pertaining to people with hypertension (age ≥45 years) were collected from eight rural villages in the Bantul district, Yogyakarta province, Indonesia, using a researcher-administered questionnaire.
Of 384 participants, 203 (52.9%) obtained anti-hypertensive medications from public or private healthcare services. The most common way was by purchasing these medicines without prescription in community pharmacies (n=64, 17%). The medicines obtained this way included captopril, amlodipine, nifedipine, and bisoprolol. One-hundred and nineteen (15%) participants obtained their medicines at no cost by visiting public healthcare services such as community health centres (n=51), the Integrated Health Service Post for the Elderly (n=53), and the public hospitals (n=15). Direct dispensing from clinicians was reported by participants who visited a doctor (n=15), midwife (n=23) or nurse (n=21). Having access to an adequate medication supply (ie for an entire 30 days) was reported by 40 (10.4%) participants, who obtained the medication from a community health centre (n=18), public hospital (n=4), community pharmacy (n=5), private hospital (n=2), or multiple sources (n=11). A higher formal education level was associated with obtaining medicines from multiple sources rather than from the public or private provider only. Living near a community health centre and having government insurance were associated with obtaining medicines from the public health service. Age, gender, employment, presence of other chronic diseases, and knowledge about hypertension were not significantly associated with how participants obtained their medications.
These Indonesian participants obtained their anti-hypertensive medications from various sources; however, the inadequate supplies found in this study could compromise both short- and long-term management of hypertension. Direct dispensing, non-doctor prescribing, and self-medication with anti-hypertensive medications indicate the current complex healthcare system in Indonesia. This study also shows some challenges involved in managing patients with chronic diseases such as hypertension in resource-poor settings. It provides important findings for quality improvement practices that should be considered to improve the health lifespan in populous countries such as Indonesia.
确保充足的药品供应是促进药物依从性的重要一步。本研究旨在确定：（1）印度尼西亚农村地区的高血压患者如何获取抗高血压药物供应；（2）所服用的高血压药物类型；（3）与人们获取药品供应的地点和方式相关的因素。
使用研究人员管理的问卷，从印度尼西亚日惹省班图尔区的八个农村村庄收集了有关高血压患者（年龄≥45岁）的数据。
在384名参与者中，203名（52.9%）从公共或私人医疗服务机构获取抗高血压药物。最常见的方式是在社区药店无处方购买这些药物（n = 64，17%）。通过这种方式获得的药物包括卡托普利、氨氯地平、硝苯地平和比索洛尔。119名（15%）参与者通过前往社区卫生中心（n = 51）、老年综合卫生服务站（n = 53）和公立医院（n = 15）等公共医疗服务机构免费获得药物。看过医生（n = 15）、助产士（n = 23）或护士（n = 21）的参与者报告了由临床医生直接配药的情况。40名（10.4%）参与者报告有足够的药物供应（即够服用一整个30天），他们从社区卫生中心（n = 18）、公立医院（n = 4）、社区药店（n = 5）、私立医院（n = 2）或多个来源（n = 11）获得药物。较高的正规教育水平与从多个来源而非仅从公共或私人提供者处获取药物有关。居住在社区卫生中心附近和拥有政府保险与从公共卫生服务机构获取药物有关。年龄、性别、就业情况、是否存在其他慢性病以及对高血压的了解程度与参与者获取药物的方式没有显著关联。
这些印度尼西亚参与者从各种来源获取抗高血压药物；然而，本研究中发现的供应不足可能会影响高血压的短期和长期管理。直接配药、非医生开处方以及自行服用抗高血压药物表明了印度尼西亚当前复杂的医疗体系。本研究还显示了在资源匮乏地区管理高血压等慢性病患者所面临的一些挑战。它为质量改进实践提供了重要发现，在印度尼西亚等人口众多的国家，应考虑这些发现以改善健康寿命。
