Indonesian Journal of Pharmacy <p>Thank you for visiting the Indonesian Journal of Pharmacy (ISSN-e: 2338-9486, ISSN-p: 2338-9427), formerly Majalah Farmasi Indonesia (ISSN: 0126-1037). The journal has been established in 1972, and online publication was begun in 2008. Since 2012, the journal has been published in English by Faculty of Pharmacy, Universitas Gadjah Mada (UGM), Yogyakarta, Indonesia, in collaboration with Ikatan Apoteker Indonesia (IAI) or the Indonesian Pharmacist Association and since then we only receive manuscripts in English. The Indonesian Journal of Pharmacy is accredited by the Directorate General of Higher Education (DGHE) DIKTI of Indonesia with no. 30/E/KPT/2018.</p> en-US (Prof. Dr. Abdul Rohman, M.Si., Apt.) (Puma Arfah) Thu, 02 Jun 2022 00:00:00 +0700 OJS 60 Identification of Problems or Barriers in Medicine Procurement Process in Low- and Lower-Middle-Income Countries: A Narrative Review <p>Medicine procurement at LLMIC still becomes a challenge regarding to low medicine availability. There is no study yet that identifies the problems of medicine procurement at LLMIC countries so that it becomes the objective of this narrative review. PUBMED, Science Direct, Google Schoolar, PLOS from May 14<sup>th</sup>, 2021 to May 22<sup>n</sup>d, 2021 were used. The problems of procurement were found since the processes of selection, planning, and procurement. Factors of human resources, organization, management information system, and parties excluding health facilites (government, distributor, and pharmacy industry) also contribute to hinder the medicine procurement. The effort to solve this problem should include multisectors with the aim to strengthen the medicine management and the supply chain.</p> <p>Keywords: supply chain, developing countries, medicine management</p> <p>&nbsp;</p> Faradiba Faradiba, Satibi Satibi, Hardika Aditama, Septimawanto Dwi Prasetyo Copyright (c) 2022 Indonesian Journal of Pharmacy Tue, 18 Jan 2022 00:00:00 +0700 Educational Interventions to Improve Pharmacy Students’ Empathy Towards Geriatrics: A Systematic Review <h1 style="text-align: justify; text-indent: 29.2pt;"><span style="font-size: 11.0pt; font-family: 'Arial',sans-serif; font-weight: normal;">Empathy is defined as the ability to understand other's feelings, thereby allowing them to feel understood. Empathy must be cultivated in the educational method to help pharmacy students to learn about patients, particularly the elderly. The main objective of this systematic review was to find, evaluate, and synthesize studies about educational interventions that improve the empathy of pharmacy students towards geriatrics. Three databases (PubMed, Science Direct, and Google Scholar) searched for articles with criteria that were educational intervention articles and focused on outcome measures related to improving empathy (or its subdivision) towards geriatrics. The Medical Education Research Study Quality Instrument was used to assess the possibility of bias. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to guide this review. Of the nine included studies, eight studies have been designed with quasi-experimental pre-post-test measurements. Four studies were carried out at the university in the United States, two in Malaysia, one in Australia, one in Brazil, and one in Singapore. Three studies used simulation and three studies used direct interaction with the elderly, as an educational intervention. Significant increase in empathy reported that 8 reviewed studies resulted from the statistically significant increase in empathy toward geriatrics. It was obvious that the educational intervention could help pharmacy students to develop empathy for the elderly. We recognize that the included studies are heterogeneous, implying that more research is needed to determine the best effective empathy education methods. Transfer to practice and longer-term changes in empathy should also be considered as study outcomes in future investigations.</span></h1> Hening Pratiwi, Susi Ari Kristina, Anna Wahyuni Widayanti, Yayi Suryo Prabandari Copyright (c) 2022 Indonesian Journal of Pharmacy Fri, 22 Apr 2022 00:00:00 +0700 Comparison of the Mortality and Bleeding Risk of Anticoagulant Doses in COVID-19 Patients: A Systematic Review and Meta-analysis <p style="margin: 0cm; text-align: justify;"><span lang="EN-US" style="font-family: 'Arial',sans-serif; color: black;">Anticoagulant therapy becomes critical to preventing further complications caused by the hypercoagulative state in COVID-19 patients. The optimal dose and time-dependent administration of anticoagulants remains unknown. </span><span lang="EN-US" style="font-family: 'Arial',sans-serif; color: black;">The purpose of this study was to determine the mortality and bleeding risks of anticoagulants administered to COVID-19 patients. </span><span lang="EN-US" style="font-family: 'Arial',sans-serif; color: black;">We collected data from articles that compared prophylactic and therapeutic anticoagulants in COVID-19 patients recorded online from studies that were published around 2020 to 2021. We were taking the articles from a scientific database such as ScienceDirect, Cochrane, ProQuest, PubMed, and Google Scholar based on the inclusion criteria. Data analysis was conducted using Review Manager Version 5.4.1 (Cochrane, Copenhagen, Denmark) using Mantel-Haenzel statistical method for categorical data to measure Relative Risk (RR) and 95% Confidence Interval (CI). We use a random-effect analysis model if P for heterogeneity (pHet &lt;0.1) and a fixed-effect analysis model if pHet ≥0.1. </span><span lang="EN-US" style="font-family: 'Arial',sans-serif; color: black;">Based on time dependent-manner, therapeutic anticoagulant showed no benefit in reducing mortality (RR = 0.69; 95% CI = 0.47 to 1.02). Beside, based on dose-dependent manner, prophylactic anticoagulant was found beneficial to prevent mortality (RR = 0.49; CI 95%; p = 0.02) compared to therapeutic. Therapeutic anticoagulants also showed higher risk of bleeding (RR = 0.27; CI 95%; p &lt; 0.000001) compared to prophylactic.&nbsp;</span><span lang="EN-US" style="font-family: 'Arial',sans-serif; color: black;">Therapeutic have no significantly benefit over prophylactic dose in reducing mortality rates. Therapeutic anticoagulant has a higher risk of bleeding in patients with COVID-19. Administer prophylactic dose is recommended due to the fewer side effects compared to the therapeutic dose.</span></p> Athaya Ferbiantyo Purnomo, Mokhamad Fahmi Rizki Syaban, Icha Farihah Deniyati Faratisha , Firstya Diyah Ekasiwi, Muthi’ah Adira Juwono, Nur Hudayana, Edwin Kinesya, Yusuf Mannagalli, Erwin Alexander Pasaribu Copyright (c) 2022 Indonesian Journal of Pharmacy Fri, 22 Apr 2022 00:00:00 +0700 Chemical composition of Bryophyllum pinnatum (Lam.) Oken <p style="text-align: justify;">Natural chemicals with medicinal qualities are an endless source of chemical molecules, making them a valuable source of pharmacologically active molecules. Humans have always looked for these plants, not only for food but also for medicinal purposes. <em>Bryophyllum pinnatum</em> is a succulent perennial herb native to Africa and Asia. The plants is traditionally used in northern Nigeria for the treatment and management of various ailments. To date, no studies have been carried out on the chemical composition of <em>B. pinnatum </em>in Northern, Nigeria. The study examine the chemical composition of <em>B. pinnatum </em>leaves in Northern, Nigeria. Hydrodistillation was used to extract the essential oil using three different solvents (dichloromethane, hexane and hexane-acetone). The chemical composition of the essential was identified with Gas chromatography coupled with mass spectrometry. Thirty five compounds were identified from the essential oil extracted with dichloromethane, twenty five compounds from the essential oil extracted with hexane and twenty three compounds from essential oil extracted hexane-acetone. But the three solvents were found to be dominant by Bis(2-ethylhexyl) phthalate. The study provides the first chemical composition of <em>B. Pinnatum </em>which can be fully utilised industry and pharmaceutical companies. Further studies is needed to ascertain the pharmacological and industrial usage of each identified compound.</p> Abdulrahman Mahmoud Dogara Copyright (c) 2022 Indonesian Journal of Pharmacy Wed, 13 Apr 2022 00:00:00 +0700 Utilization of UV-visible and FTIR spectroscopy coupled with chemometrics for differentiation of Indonesian tea: an exploratory study <p>Ultraviolet (UV)-visible and Fourier-transformed infrared (FTIR) spectroscopy are two of the most popular and readily available laboratory instruments. Fingerprinting analysis of the UV-visible and FTIR spectra has been applied for food classification and authentication studies. In this study, the UV-visible and FTIR spectra of brewed tea, and their data fusion data sets, were used to build models for the classification of tea based on tea types and origins. The study included black and green tea samples from several provinces in Sumatra and Java Islands (Indonesia). Chemometric models of principal component analysis (PCA), k-nearest neighbor (kNN), and logistic regression were developed for classification purposes. All PCA models were able to well-separate the tea groups. kNN and logistic regression models based on UV-visible spectra successfully classified green and black tea with &gt;0.8 classification accuracy. The kNN model of FTIR spectra had good accuracy (0.903) for classifying tea based on its origin. ReliefF algorithm was employed to select the best features among the data fusion data sets of UV-visible and FTIR spectra. The data fusion data sets of UV-visible and FTIR spectra demonstrated good separation of tea types and origins with a high area under the ROC curve (&gt;0.8) and moderate accuracy (0.548). Therefore, UV-visible and FTIR spectroscopy may provide complementary information for tea classification based on tea types and origins.</p> Mitsalina Fildzah Arifah, Agustina Ari Murti Budi Hastuti, Abdul Rohman Copyright (c) 2022 Indonesian Journal of Pharmacy Tue, 29 Mar 2022 00:00:00 +0700 Fat Analysis of House Rat (Rattus tanezumi) in Meatball Using Gas Chromatography-mass Spectrometry (GC-MS) Combined with Principal Component Analysis <p>Counterfeit food products are starting to become a new problem around the people of Indonesia. Problems that are getting special attention especially the concern of contamination of food products by non-halal meat. This research aim was to analyze the fatty acids contained in house rat. The method that used was GC-MS method combined with Principle Component Analysis (PCA). Method of extraction grease was using oven at 90ºC - 100ºC for approximately one hour. After that, the derivatization process changed the fat into a methyl esters that easily evaporated. The derivatization process were using NaOCH<sub>3 </sub>and BF<sub>3</sub>. Methyl Esther compounds were injected into the chromatography instrument system GC-MS. GC-MS analysis results shows that the composition of fatty acid compounds from house rat fat with SI values &gt; 90. Composition of fatty acids of house rat fats include: Myristate (0,19±0,03)%, Palmitoleat (2,40±0,29)%, Methyl Palmitate (27,65±0,32)%, oleate (45,81±3,25)%, and Stearate (4,65±0,28)%. Total content of house rat fatty acids was as high as 48.21% of unsaturated fatty acid and 31.49% of saturated fatty acids. The GC-MS method combined with PCA can post the fat of house rat. House rat fatty acids based on PCA's chemetrics demonstrate the resemblance of chemical physical properties with chicken fatty acids.</p> Nina Salamah, Any Guntarti, Putri Ayu Lestari, Ibnu Gholib Gandjar Copyright (c) 2022 Indonesian Journal of Pharmacy Tue, 08 Feb 2022 00:00:00 +0700 Cyclooxygenase (COX) and 15-Lipoxygenase (15-LOX) Inhibitory Activity and HPTLC Profile of Asplenium Nidus, Diplazium Esculentum, and Drynaria Quercifolia in Bukidnon, Philippines <p><em>Diplazium esculentum, Drynaria quercifolia</em>, and <em>Asplenium nidus </em>are among the fern species found in Bukidnon, Philippines which are used as traditional herbal medicines.&nbsp; The HPTLC profile and the anti-inflammatory properties against cyclooxygenase (COX) and 15-lipoxygenase (15-LOX) of the frond ethanolic extracts of <em>D. esculentum, D. quercifolia</em>, and <em>A. nidus </em>were determined.&nbsp; The High-Performance Thin Layer Chromatography (HPTLC) profile was obtained using ethyl acetate: formic acid: water (16:2:2) as mobile phase and Natural Products (NP) as derivatizing reagent.&nbsp; The HPTLC profile of the <em>D. esculentum</em>, <em>D. quercifolia</em>, and <em>A. nidus</em> extracts showed 10 (R<sub>f</sub> = 0.02-0.97), 13 (R<sub>f</sub> = 0.03-0.90), and 14 (R<sub>f</sub> = 0.02-0.99) bands, respectively. The profiles for each fern species may be used as marker for quality evaluation and standardization of herbal formulations containing these plants.&nbsp; For the anti-inflammatory properties, <em>D. esculentum</em> and <em>D. quercifolia </em>extracts which inhibited more than 50% of the COX enzymes showed significantly higher activity than <em>A. nidus</em> and were considered active against COX-2 and COX-1. <em>D. esculentum</em>, however, gave a selectivity ratio (COX-2/COX-1) of 1.03 making its inhibitory activity selective against COX-2.&nbsp; The percent 15-LOX inhibitory activity of <em>D. quercifolia</em> (58.62%) is significantly higher than that of <em>A. nidus</em> (38.70%) but statistically comparable to <em>D. esculentum</em> (51.19%).&nbsp; Among the extracts, <em>D. quercifolia</em> and <em>D. esculentum</em> which inhibited more than 50% of the 15-LOX were considered active. <em>D. esculentum</em> and <em>D. quercifolia</em> can therefore be potential sources of anti-inflammatory lead compounds for future drug development.&nbsp;&nbsp;&nbsp;</p> Aileen May G. Ang, Roxan D. Sabesaje, Gina B. Barbosa, Reggie Y. dela Cruz, Rainear A. Mendez, Melania M. Enot Copyright (c) 2022 Indonesian Journal of Pharmacy Thu, 02 Jun 2022 00:00:00 +0700 Bioinformatic and Molecular Interaction Studies Uncover That CCA-1.1 AND PGV-1 Differentially Target Mitotic Regulatory Protein and Have a Synergistic Effect against Leukemia Cells <p style="text-align: justify;">Numerous studies demonstrated CCA-1.1, the modified compound from PGV-1, inhibits tumor cells growth in breast and colorectal cancer. This time, we used bioinformatics and molecular interaction approaches to ascertain the potential CCA-1.1 activity target focusing on leukemia, along with the cytotoxic test in leukemia cells. Genomics data expression was collected through the COSMIC database by selecting gene sets from K562 cells as a model for chronic myelogenous leukemia (CML).&nbsp; We identified CCA-1.1 and PGV-1 predicted targets through SwissTargetPrediction. The overlapping genes between the CCA-1.1, PGV-1, and K562 cells were chosen for further analysis. We narrowed down the potential targets by using the list of genes involved in the cell cycle and mitosis collected through GeneCards. A molecular docking study was applied to determine the molecular interaction between CCA-1.1 or PGV-1 and the predicted protein target. We carried out a cytotoxic test using a trypan blue exclusion assay. We treated K562 cells with CCA-1.1 and PGV-1 in single and combination treatment to determine the half concentration of growth inhibitory (GI<sub>50</sub>) and combination index (CI) score. CCA-1.1 and PGV-1 shared similar predicted target genes in mitosis, and interestingly CCA-1.1 were mainly targeted in Aurora A (AURKA) in K562 cells with lower docking scores against the inhibitor in molecular docking analysis. Moreover, each compound exhibited an inhibitory effect similarly, and the co-treatment resulted in a synergistic effect in K562 cells. Collectively, we indicated that CCA-1.1 and PGV-1 possibly targeted mitosis in cell cycle progression, and along with their specific targets, led to their synergistic activity in CML. These findings should be validated through experimental studies to provide more pharmacological activities of CCA-1.1 to cure CML.</p> Edy Meiyanto, Dhania Novitasari, Rohmad Yudi Utomo, Ratna Asmah Susidarti, Dyaningtyas Dewi Pamungkas Putri, Jun-ya Kato Copyright (c) 2022 Indonesian Journal of Pharmacy Thu, 24 Feb 2022 00:00:00 +0700 The Characteristic, Antibacterial Activities, and Hydrogel Formulation of Nanosilver Biosynthesis using Curcuma longa L. Juice <p style="text-align: justify;">Turmeric juice contains of aldehyde groups as bioreductor. Silver ion can be done as nanosilver by green synthesis method using plant extracts. Biosynthesis nanosilver can induce the antibacterial activity. Nanosilver then developed for topical product to treat acnes. The aims of this study are to determine the characteristics and antibacterial activity of nanosilver and the effect of it is concentration on the physical and chemical properties of gel. &nbsp;Nanosilver biosynthesis was prepared by mixing turmeric juice and AgNO<sub>3 </sub>solution for 24 hours at 25 ºC, then analyzed. Gel is made in variations concentration of nanosilver. Gel was evaluated including pH, viscosity, and dispersibility test during storage for 12 days at 25 ºC. Nanosilver biosynthesis with ratio of 5:38 mL was the best formula with absorption peak at 407 nm, round shape, particle size of 17.96 nm, and has broad spectrum antibacterial activity with strong category. FTIR spectra showed exist of interaction with spesific peaks. The concentration of nanosilver can affect to physical and chemical properties of gel, but all formulas meet the requirements and did not significantly change during 12 days at 25 ºC.</p> Dian Eka Ermawati, Safira Rahma Novachiria, Berliana Rizka Ramadhan , Saptono Hadi Copyright (c) 2022 Indonesian Journal of Pharmacy Wed, 13 Apr 2022 00:00:00 +0700 The Effects of Media and Blanching Time on the Antioxidative Properties of Curcuma aeruginosa Roxb. <p>Black saffron (<em>Curcuma aeruginosa </em>Roxb.) belongs to the family&nbsp;of <em>Zingiberaceae</em>&nbsp;is one of rhizomes widely used as raw material in Indonesian Traditional Medicines. Black saffron (BS) contains some bioactive compounds responsible for certain biological activities including antioxidant. Blanching has been reported to increase the antioxidant activity of BS. This study aims to formulate BS containing high antioxidant activity. This research was performed by varying blanching medium (citric acid and aquadest) and blanching time (0; 2.5; 5; 7.5 and 10 min). The fabrication stage of BS powder included peeling, cleaning, blanching, slicing drying, grinding, and sieving. After that, the treated BS was analyzed for the antioxidant activity, total phenolic, total flavonoid, tannin, crude fiber, and water contents. BS powder subjected to blanching process showed better antioxidant activity than that without blanching process. Blanching using citric acid media 0.05% for 5 min showed the best antioxidant activities, as indicated by high contents of total phenolic, total flavonoid, and tannins. Powdered BS is potential to be used as materials to be applied as fortifying agents in food products.</p> Dwiyati Pujimulyani, Sulkhan Windrayahya, Irnawati Irnawati Copyright (c) 2022 Indonesian Journal of Pharmacy Mon, 06 Jun 2022 00:00:00 +0700 Preparation and Characterization of Pregelatinized Sago Starch (PSS) from Native Sago Starch (NSS) (Metroxylon sp.) and its Evaluation as Tablet Disintegrant and Filler-Binder on Direct Compression Tablet <p style="text-align: justify;">Starches are biodegradable and relatively inexpensive natural biopolymers which are widely used in the food and pharmaceutical industries. Sago starch is one of the starches which can be potentially used as the excipient in pharmaceutical formulation. The purpose of this study was to modify and to characterize the physical and chemical properties of native sago starch (<em>Metroxylon</em> sp) (NSS) and pregelatinized sago starch (PSS).&nbsp;NSS was evaluated to be confirmed with the requirement, including microscopic analyses, amylum identification, ash content, amylum acidity, loss on drying, solubility in water, solubility in ethanol, and chemical content of Pb, Cd, Hg. Physically evaluated for both types of sago starch were particle size, moisture content, flow rate, angle of repose, tapped density, compactibility, water absorption rate, and water absorption capacity. Fourier transform infrared spectroscopy (FT-IR) was used to characterize and evaluate PSS and NSS’s chemical properties. Chemical content (Pb, Cd, Hg) and microbial content (yeast mold figures, number of bacteria, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Salmonella sp., Shigella sp.) of PSS are also identified.&nbsp;The results of this study showed that PSS exhibited different values of those determined parameters compared to that of NSS on particle size, moisture content, flow rate, the angle of repose, tapped density, water absorption rate, and water absorption capacity. In conclusion, PSS has better flow properties because it has a larger particle size than the NSS. PSS also has a larger water absorption rate and water absorption capacity than the NSS because PSS can interact with water easier than NSS. There is no bacterial content in PSS which means PSS follows the regulatory requirement. PSS had a good effect on weight uniformity, hardness, and disintegration time of the tablets. It makes PSS can be potentially used as the excipient in solid dosage form formulation.</p> T.N. Saifullah Sulaiman, Wahyono Wahyuono, Angi Nadya Bestari, Farida Nur Aziza Copyright (c) 2022 Indonesian Journal of Pharmacy Wed, 06 Apr 2022 00:00:00 +0700 Formulation And Optimization Peel-Off Gel Mask with Polyvinyl Alcohol and Gelatin Based Using Factorial Design from Banana Peel Flour (Musa paradisiaca L) As Antioxidant <p>Banana peel (Musa paradisiaca L) contains flavonoid compounds that act as an antioxidant that has the potential to be developed into cosmetic preparations such as peel-off gel masks. This study aims to determine the effect of variations in the concentration of banana peel flour, PVA, and gelatin on the physical properties of peel-off gel masks and to determine their antioxidant activity. This study uses a factorial design of 2<sup>3</sup> where the factors used are the concentration of banana peel flour, PVA, and gelatin with 2 levels. Based on the results of data analysis, it was found that there was a significant effect of each factor and the interaction between factors on the spreadability and drying time of the preparation (p&lt;0.05). F5 with a concentration ratio of banana peel flour, PVA, and gelatin of 5:12:5 was chosen as the optimum formula and continued to antioxidant activity test compared to F4 which had a ratio of concentrations of banana peel flour, PVA, and gelatin of 10:14:3. The antioxidant activity produced by F5 was better than F4 with IC50 values ​​of 525.41 and 355.64 ppm, respectively. It can be concluded that the optimization of the dosage formula will affect the activity of the active substance.</p> Elsa Fitria Apriani, Miksusanti Miksusanti, Novela Fransiska Copyright (c) 2022 Indonesian Journal of Pharmacy Tue, 19 Apr 2022 00:00:00 +0700 Evaluation of Clinical Outcome of Antipsychotic Therapy in Schizophrenic Patients in Palu – Indonesia <p>Schizophrenia is a severe mental disorder characterized by psychotic episodes. The first line of treatment for schizophrenia is the use of antipsychotics that is still subjective. There is still a need for research related to the use of antipsychotics to achieve effective treatment. This study aimed to compare the effectiveness of the First-Generation Antipsychotic (FGA) haloperidol, trifluoperazine and risperidone antipsychotic therapies as Second-Generation Antipsychotic (SGA) based on symptom reduction using the<em> Positive and Negative Syndrome Scale-Excited Component (PANSS-EC)</em> method in patients with acute schizophrenia and relapse hospitalization. This research used a quantitative analysis with a prospective approach where the sampling was conducted using <em>total sampling</em> and the data obtained were analyzed using independent t-test and linear regression analysis. There were 40 out of 120 patients who met the inclusion criteria, consisting of patients in groups of haloperidol, trifluoperazine and risperidone therapies with a therapeutic duration of 3–10 days. The results showed that the average <em>PANSS-EC</em> score of haloperidol medication of 15.35 was greater than that of trifluoperazine medication of 14.42 and the <em>p</em>-value showed no significant difference between the use of FGA, haloperidol and trifluoperazine with <em>p</em> = 0.190 (<em>p</em>&gt; 0.05). The average PANSS-EC score of haloperidol medication (FGA) of 15.35 was greater than that of risperidone (SGA) of 13.6 and the <em>p</em>-value showed that there was a significant difference between haloperidol and risperidone with <em>p</em> = 0.027 (<em>p</em>&lt; 0.05). The multivariate analysis showed <em>p</em> = 0.022 (<em>p</em>&lt; 0.05) which means haloperidol showed the greatest symptom reduction among the three antipsychotic medications.</p> Amelia Rumi, Alwiyah Mukaddas, Astriana, Siti Radhiya Copyright (c) 2022 Indonesian Journal of Pharmacy Mon, 14 Mar 2022 00:00:00 +0700 Development of Warfarin Safety Monitoring System at Primary Health Care grounded on Chronic Care Model <p>Warfarin, an anticoagulant with high risk on the fatal adverse effects, the safety monitoring system in primary health care is needed for patients in the community.&nbsp; This study aimed to investigate problems of warfarin use, to discover factors related to the blood clotting, and to develop a safety monitoring system for warfarin. A mixed method was conducted in two phases. Phase one consisted of home visit for 104 patients with warfarin which aimed to investigate use problems. Phase two; the focus groups included all stakeholders were done which aimed to develop a community-based system grounded on the Chronic Care Model (CCM). The warfarin monitoring system was implemented for a month and briefly evaluated the stakeholders’ satisfaction on it. <strong>&nbsp;</strong>The results revealed that: Phase one, 38.5% patients with warfarin at home had missed their treatment appointments. Their warfarin compliance was 91.1<u>+</u>21.3%. 53.5% had unused warfarin at home; 37.4% had inappropriate warfarin storage; 13.1% suffered the side effect of minor bleeding; 17.3% potentially had warfarin-herb interactions; 61.3% experienced drug-warfarin interaction. Two factors significantly affecting on the International Normalized Ratio (INR) and %Time in Therapeutic Range (%TTR) were inappropriate warfarin dosages and taking other medications. %TTR was influenced by warfarin compliance. Stage two, the safety monitoring system and protocol were created using CCM. The developed system composed of six elements that were joint operation of primary health care personnel and inter-professional team of the hospital. This promoted the continuity of services from hospital to community.&nbsp; After one-month implementation by an inter-professional team, all three groups of stakeholders were satisfied with its results. We concluded that the main problem afflicting warfarin patients was missed treatment appointments. Receiving extra medicines from other services, inappropriate dosage, and non-compliance. The developed warfarin monitoring system covered patients in primary health care, and all stakeholders were satisfied on its outcomes.</p> Chanuttha Ploylearmsang, Peerapong Poobal, Pattarin Kittiboonyakun Copyright (c) 2022 Indonesian Journal of Pharmacy Tue, 01 Mar 2022 00:00:00 +0700 Medication Persistence to Lipid-lowering Agents As A Cost-saving Opportunities on Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention in Indonesia <p>Medication persistence is known to reduce acute coronary syndrome (ACS) disease mortality. As much as 13% of Indonesia's budget on national health insurance programs was used for cardiovascular disease. The number of population-based studies discussing the cost-saving opportunities of medication persistence in ACS patients undergoing percutaneous coronary syndrome (PCI) is still minimal. This study aimed to investigate the estimated cost saving of persistence to lipid-lowering agents in patients with ACS after their first PCI. Hospital-based, retrospective cohort study with 2 years of follow-up was conducted with 367 patients. Patients were deemed as having medication persistence if the gap between prescriptions was ≤ 30 days. Persistence assessment was done for lipid-modifying agents (WHO ATC Code: C10). The main outcome is cost-saving opportunities assessed by dividing the difference in total costs resulting from medication persistence with the difference in the proportion of major adverse cardiovascular events (MACE) and major adverse cardiovascular and cerebrovascular events (MACCE) prevented by medication persistence. The study found that direct medical costs incurred by persistent patients were significantly lower than non-persistent patients with lipid-lowering agents (IDR 9,535,209.76 versus IDR 15,933,959.28). Persistence to lipid-lowering therapy can prevent one MACE incident with cost-saving of IDR 996,192.41 when compared to non-persistence patients, while one MACCE incident can be prevented with cost-saving of IDR 733,103.02. Our study indicates that among ACS patients who underwent their first PCI, medication persistence with lipid-lowering agents can contribute to cost-saving in preventing one MACE or MACCE event. These data will be useful for policymakers to help budget allocation and reemphasize the important role of medication persistence with lipid-lowering therapy in the management of ACS after PCI.</p> Erna Kristin, Lucia Krisdinarti, Alfi Yasmina, Woro Rukmi Pratiwi, Ratih Puspita Febrinasari, Endang Mahati, Sudi Indra Jaya Copyright (c) 2022 Indonesian Journal of Pharmacy Mon, 11 Apr 2022 00:00:00 +0700 Pre-Hospital and In-Hospital Delay in Acute Ischemic Stroke Patients in Indonesia: A Multi-center Study <p>Introduction: Little is known regarding pre-hospital and in-hospital delays in acute ischemic stroke (AIS) patients in Indonesia. This study aimed to evaluate the nature of these delays and identify factors causing pre-hospital delays among AIS patients in Indonesia. <br>Methods: This was a prospective, observational study conducted among adult AIS patients in 3 hospitals in Surabaya during March–August 2019. Baseline characteristics along with time intervals both pre- and post-arrival of patients to the study sites were collected and analysed. Multiple logistic regression analyses with a stepwise forward model were performed to evaluate the factors contributing to the pre-hospital delay. <br>Results: A total of 126 patients were recruited in this study. Mean age ± S.D. was 58.56 ± 10.71 years old. The mean ± S.D. time of pre-hospital delay and mean ± S.D. time to computerized tomography scan were 1,004±1,116.09 and 189±166.44 minutes, respectively. Only 18 out of 126 patients (14.29%) presented to the hospitals within 4.5-hour of intravenous thrombolysis (IVT) time window. However, only 3 patients (2.38%) ultimately received IVT. Wake-up stroke (OR=17.865; p=0.019), unawareness of the gravity of symptoms (OR=11.025; p=0.007), unawareness of stroke symptoms (OR=7.880; p=0.003) and referral patient (OR=7.819; p=0.008) were significantly associated with pre-hospital delay. <br>Conclusion: Pre-hospital delay of AIS was very common and represented a challenging problem to improve stroke care in Indonesia. Wake-up stroke along with lack of patient understanding in recognizing stroke symptoms and ineffective referral system were the most prominent risk factors for pre-hospital delay in Indonesian AIS patients. </p> Surakit Nathisuwan, Rizqi Haqqum Minalloh, Abdulloh Machin, Wida Mardiana, Thanarat Suansanae, Suvatna Chulavatnatol Copyright (c) 2022 Indonesian Journal of Pharmacy Fri, 22 Apr 2022 00:00:00 +0700