Pharmacist counseling intervention to improve patient antibiotic compliance

I Gusti Ayu Rai Widowati , I Made Ady Wirawan, Ni Made Sri Nopiyani, Komang Ayu Kartika Sari

I Gusti Ayu Rai Widowati
Indonesian Pharmacy Association, Bali Province. Email:

I Made Ady Wirawan
Udayana University

Ni Made Sri Nopiyani
Udayana University

Komang Ayu Kartika Sari
Udayana University
Online First: December 01, 2018 | Cite this Article
Widowati, I., Wirawan, I., Nopiyani, N., Sari, K. 2018. Pharmacist counseling intervention to improve patient antibiotic compliance. Public Health and Preventive Medicine Archive 6(2): 128-134. DOI:10.15562/phpma.v6i2.158

Background and objectives: Reported microbial resistance to antibiotics is increasing. One of the main factors is patient non-compliance in use of antibiotics. Pharmacist counseling has been shown to be effective in increasing compliance with the use of several types of medications, but its effectiveness of on compliance with antibiotic use has not been widely published. The purpose of this study was to determine the effectiveness of pharmaceutical counseling in a pharmacy setting to increase compliance with antibiotic use.

Method: A randomized controlled trial was conducted on 104 adult patients aged 18 years and over who purchased antibiotics by prescription at a pharmacy in Denpasar City, Bali Province. The number of subjects was determined with a confidence level of 95% and a power of 90% with the effect size of 20%. Subjects were divided into two groups using the block randomization method, namely 52 subjects in the intervention group and 52 subjects in the control group. The intervention group was provided with pharmaceutical counseling by a pharmacist at the time of delivery of the drug at the pharmacy, while the control group was provided drug information according to the pharmacy service standard. Subject compliance was measured by telephone interview using the Morisky Medication Adherence Scale-8 questionnaire within 3-5 days after purchasing the medication. Statistical analysis with the Mann Whitney U Test was performed to determine the difference in mean rank of compliance scores between the intervention group and the control group. The proportion of compliance among the intervention group was divided by proportion of compliance in the control group to get the compliance ratio. Logistic regression analysis was conducted to determine the adjusted compliance ratio.

Results: The number of subjects analyzed was 98, as 5 subjects could not be contacted by telephone and 1 subject was hospitalized. The mean rank of compliance scores in the intervention group (61.05) was significantly higher (p<0.001) than the comparison group (37.95). The proportion of compliance in the intervention group was 65.3% and the control group was 18.4%, with the proportion ratio (PR) of 3.56 (95%CI=1.90-6.64). Logistic regression analysis showed that variables which significantly increased compliance with antibiotic use were pharmacist counseling (APR=9.33; 95%CI: 3.24-26.87), frequency of taking medication (APR=6.94; 95%CI: 2.01-23.92) and method of payment (APR=4.30; 95%CI: 1.18-15.66).

Conclusion: Pharmaceutical counseling at a pharmacy setting was found to increase compliance of antibiotic use. Compliance of antibiotic use is also influenced by the frequency of taking medication and the method of payment. Pharmacist counseling when accessing medication at a pharmacy is crucial for improving patient compliance of antibiotic use.


WHO. Situational analysis on antimicrobial resistance in the South-East Asia Region. 2016.

Al-Eidan F, Mcelnay J, Scott M, McConnel J. Management of Helicobacter pylori eradication – the influence of structured counselling and follow up. Clinical Pharmacology. 2002; 53: 163-71.

Muras M, Krajewski J, Nocun M, Godycki-cwirko M. A survey of patient behaviours and beliefs regarding antibiotic self-medication for respiratory tract infections in Poland. Archives of Medical Science. 2013; 9(5): 854-7.

Shah SJ, Ahmad H, Rehan RB, Najeeb S, Mumtaz, Jilani MH, Self-medication with antibiotics among non-medical university students of Karachi; a cross-sectional study. BMC Pharmacology and Toxicology. 2015;15(74):1-7.

Widayati A. Self medication with antibiotics in Yogyakarta City Indonesia. The University of Adelaide (dissertation); Adelaide; 2013.

Fernandes M, Leite A, Basto M, Nobre MA, Vieira N, Fernandes R, Nogueira, P, Jorge P, Non adherence to antibiotics therapy in patients visiting community pharmacy. International Journal of Clinical Pharmacy. 2014; 36(1): 86-91.

Wibowo R, Soedibyo S. Kepatuhan berobat dengan antibiotik jangka pendek di Poliklinik Umum Departemen Kesehatan Anak Rumah Sakit Dr. Cipto Mangunkusumo, Jakarta [Compliance in short term antibiotic use at General Polylinic, Department of Pediatrics Dr. Cipto Mangunkusumo Hospital]. Sari Pediatri. 2016;10(3):171-6.

Department of Health of Indonesia. Pedoman Konseling Pelayanan Kefarmasian di Sarana Kesehatan [Guidelines for counseling by pharmacist at health care services]. 2007.

Dewanti SW, Andrajati R, Supardi S. Pengaruh konseling dan leaflet terhadap efikasi diri, kepatuhan minum obat dan tekanan darah pasien hipertensi di dua puskesmas Kota Depok [The influence of counseling and leaflets on self-efficacy, compliance of medication and blood pressure of patients with hypertension at two public health centers in Depok City]. Jurnal Kefarmasian Indonesia. 2015; 5(1): 33-40.

Harijanto W, Rudijanto A, Alamsyah A. Pengaruh konseling motivational interviewing terhadap kepatuhan minum obat penderita hipertensi [The influence of counseling with motivational interviewing to compliance on anti-hypertension medication]. Jurnal Kedokteran Brawijaya. 2015; 28(4): 345-53.

Hynes Rb. Yao X, Degani A, Kripalani S, Garg AX, McDonal HP. Interventions to enhance medication adherence. The Cochrane Collaboration. 2008; Apr 16; (2).

Kripalani S, Yao X, Haynes B. Intervention to enhance medication adherence in chronic medical conditions. Archive of Internal Medicine. 2007; 167 (6): 540-50.

McDonald HP, Garg AX. Clinician’s corner intreventions to enhance patient adherence. Scientific Review and Clinical Applications. 2016; 288(22): 2868-70.

Okumura LM, Rotta I, Correr CJ. Assesment of pharmacist-led patient councelling in randomized controlled trials: a systematic review. International Journal of Clinical Pharmacy. 2014; 36 (5):882-91.

Purwanti A, Supardi S. Gambaran pelaksanaan standar pelayanan farmasi di apotek DKI Jakarta tahun 2003 [The implementation of pharmacy service standard at a pharmacy in Jakarta]. Majalah Ilmu Kefarmasian. 2004; 1(2): 102-15

Culig J, Leppee M. From Morisky to Hill-bone: Self-reports scales for measuring adherence to medication. Collegium Antropologicum. 2014; 38(1): 55-62.

Cals JWL, Hopstaken RM, Le Doux PHA, Driessen GA, Neleman PJ, Dinant G, Dose timing and patient compliance with two antibiotic treatment regimen for lower respiratory tract infections in primary care. International Journal of Antimicrobial Agents. 2008; 31: 531–536.

Llor C, Herna´ndez S, Bayona C, Moragas A, Sierra N, Herna´ndez N, Miravitles M, A study of adherence to antibiotic treatment in ambulatory respiratory. International Journal of Infectious Diseases. 2013; 17: 168-172.

No Supplementary Material available for this article.
Article Views      : 261
PDF Downloads : 111