Pharmaceutical services are part of a healthcare system oriented toward patient care and quality medication provision1. Pharmacy practice in pharmacies has complied with the pharmacy service standard in pharmacies. The medicine information service is one critical aspect of clinical pharmacy service2. The process of providing information by pharmaceutical personnel to patients is obligatory. Pharmaceutical personnel must be proactive in providing medication information services provided to patients3. Some medication information that needs to be conveyed to patients includes dosage, method and time of use, amount of consumption in a day, storage method, and how to deal with possible side effects4.

The pharmaceutical services implementation in Semarang has been evaluated by research conducted in hospitals. The results show that there are still differences in implementing pharmaceutical service standards in several public and private hospitals in Semarang that can potentially prevent medication errors. The difference in the implementation of the service standard will undoubtedly affect the quality of pharmaceutical services provided to patients5. Likewise, the pharmaceutical services provided in pharmacies, the implementation of pharmaceutical services provided in the network/franchise, and non-network pharmacies must meet the standards of pharmaceutical services in pharmacies, in the provision of medicine, medical devices, and consumable medical materials, or the clinical pharmacy services, including the provision of medical information6. A study of the pharmacist community in 2009 showed that pharmacists are not quite ready, according to the Department of Health and the Association of Indonesian Pharmacists (Ikatan Apoteker Indonesia; IAI). The pharmacists in non-franchise pharmacies are even more unprepared than the franchise pharmacies. Franchise pharmacies' pharmacists in the metropolitan city are preparing to face the patient-oriented paradigm and fulfilling the pharmacy service standard. In contrast, the pharmacists in the independent non-franchise pharmacies still emphasize fast service and the lower price of medicine7.

The government has enforced a standard of pharmaceutical services in pharmacies through the Minister of Health Decree Number 73 of the Year 2016 concerning the standard of pharmaceutical services in Pharmacies, which includes two aspects. The first aspect is the provision management of pharmacy, medical devices, and consumable medical materials; the second is the clinical pharmacy services. Implementing these standards is a practice guide for pharmacists in carrying out the profession in pharmacies, protecting the public from unprofessional services, and carrying out pharmaceutical practices8. Pharmacists must improve knowledge, skills, and behavior in interacting with patients by providing complete information on medication usage, side effects, and monitoring. Therefore, pharmacists must comply with pharmaceutical service standards in pharmacies to ensure the quality of public pharmaceutical services9.

Drug information services are an essential part of the clinical pharmacy service10. The quality of pharmaceutical services at networked/franchise and non-networked/non-franchise pharmacies will affect the completeness of the information provided to patients, so it is necessary to pay attention to good service and meet the Pharmacy Service Standards at the Pharmacy (Standar Pelayanan Kefarmasian di Apotek; SPKA)11. Research on the completeness of drug information to patients is a study that can be carried out to assess and measure the quality of service provided by pharmacists and pharmaceutical personnel in pharmacies12. The pharmacy service provider acts as the health worker who provides medicine preparation services and information and education services to improve the health and quality of life13. Therefore, it is necessary to investigate the completeness of the information by pharmacy personnel in Semarang pharmacies, either networked/franchise or non-network pharmacies. The purpose of this study is to compare patients' perceptions of drug information services by pharmacy staff according to the type of pharmacy ownership (franchise/non-franchise) in Semarang. Through the research, pharmacies can be informed about the medical information services provided by the pharmacy personnel at the respective pharmacies and, at the same time, can be used as evaluation materials to play a more significant role in improving the quality of medication information services to patients.

A franchise pharmacy is an authorization or official permission or approval granted by a pharmacy company to distributors, groups, or individual owners to establish a pharmacy, for example, Kimia Farma, K24, and Viva Generik. Non-franchise pharmacy is a pharmacy in the general community. Inclusion criteria for respondents in this study were subjects who had redeemed drugs or purchased pharmaceutical products at a pharmacy in Semarang within a maximum of the last three months, had received direct pharmaceutical services from pharmacists and pharmacy technical staff, the minimum age was 17 years, and subjects who were willing to be respondents. The exclusion criteria were respondents who did not complete their questionnaire. The study design and protocol were approved by the Faculty of Medicine Ethics Committee, Universitas Islam Sultan Agung, with the number EC/244/VII/Komisi Bioetik. The tool used in the research was a modified questionnaire Investigating Consumer Attitudes toward Community Pharmacy Services14. The questionnaire obtained permission from the previous author and was translated “backward-forward” into the Indonesian version by the Center for International Language Development (CILAD) Universitas Islam Sultan Agung with DOI https://doi.org/10.5281/zenodo.6777035. From calculation from the Slovin formula with a population assumed as 1000 people, the study requires 286 and 30 respondents for the validity and reliability test. The respondents were recruited by quota sampling from May until October 2020. Data collection was carried out with a Google Form questionnaire. The questionnaire distribution was through Google Form link sharing as https://bit.ly/pelayananfarmasi by social media. The Questionnaire item was available in the Supplement file. Data analysis was conducted with the Mann-Whitney test.

The research was carried out on Google Form, in which all questions were valid and reliable with R >0.361 for 30 respondents with a significance level of 5%. The reliability test shows that Cronbach's α value was 0.832. Table I shows that from 286 respondents who met inclusion criteria, franchise pharmacies have more patients than non-franchise ones, with 167 respondents at franchise and 119 at non-franchise pharmacies.

TableI. Respondents based on types of pharmacies

Table II shows that in each pharmacy, the number of respondents with females was more dominant than males, with a relatively large ratio. The female respondents in franchised and non-franchised pharmacies were 130 people (77.8%) and 89 people (74.8%), respectively; the rest were males. Most respondents are between 17 and 25 years old with an education diploma or bachelor's degree. The same results were also shown in previous research15, which explains that women were more concerned about the health of each family member, which affected the frequency of female respondents visiting the pharmacy. In addition, another previous study16 also shows that women have an essential role as decision-makers in health services for themselves and their families.

TableII. Demographic characteristic of respondents

Table III describes that of 167 respondents who visited franchise pharmacies, 93 people (55.7%) believed that those who served respondents in pharmacies was pharmacist, followed by 19 people (11.4%) who answered that those who served respondents were not pharmacists or person staff, and 55 people (32.9%) chose to answer that they did not know the person profession who served them, whether it was a pharmacist or person staff. In non-franchise pharmacy have similar results with 45.4%, 20.2%, and 34.4 %, respectively. Table III analyzes the response to information about drug services for patients, indicating that only 55.7% of patients recognized pharmacists in franchise pharmacies and only 45.4% in non-franchised pharmacies. About 33.7% of patients, in general, did not know whom pharmacy staff in charge provided the services. This study shows that pharmacist roles are still not well known by the community. Since pharmacists are health workers obliged to provide drug counseling, they should not be replaced by pharmaceutical technical personnel. In addition, identity as a pharmacist in pharmacies is essential, so it is always advised to use/wear a special identity sign that shows a pharmacist's profession when performing service in the pharmacy17.

TableIII. Distribution of respondents answers to the question “Are you served by a pharmacist?”

Table IV explains that from 167 respondents in franchise pharmacies, 98 people (58.7%) answered agreed with the assessment that the pharmacy staff who served were experienced, trustworthy, and confident. However, 69 people (41.3%) answered neutrally in that regard. In non-franchise pharmacies have similar results with 58% and 41.2%, respectively.

TableIV. Distribution of respondents' answers to the question "How would you rate the pharmacy staff who served you? Are their experienced/trustworthy/confident/useful?”

Table V indicates that the majority of the respondent, 140 respondents (83.8%) in franchise pharmacies and 91 (76.5%) in non-franchise pharmacies, admitted that they had been given advice or information by pharmacy staff at the time of service. However, 27 respondents (16.2%) in franchise pharmacies and 28 (23.5%) in non-franchise pharmacies answered that they were not given advice or information during service. Table VI shows that 57 respondents (34.1%) in franchise pharmacies and 31 (26.1%) in non-franchise pharmacies answered that they had been given information and advice about healthy eating. They were followed by 35 respondents (21%) in franchise pharmacies and 24 (20.2%) in non-franchise pharmacies receiving education about the use of antibiotics for flu and the common cold. Table VII shows that most respondents were satisfied with pharmacy staff service regarding attitude, instruction, drug information about side effects, and asking about previous health history and counseling place. However, the majority of respondents in both pharmacies disagree with a statement about proper drug storage methods information, with 10.8% in franchise pharmacies and 17.6% in non-franchise pharmacies.

TableV. Distribution of respondents' answers to the question " Have you ever been given advice by a pharmacy staff?"

TableVI. Distribution of respondents' answers regarding suggestions/information ever given by pharmacy staff

TableVII. Analysis of responses to questions "Pharmacy staff services at franchise and non-franchise pharmacies" based on median and mean values

According to Table VII, the response to information about drug services for patients shows that most respondents agreed that pharmacy staff is in charge, providing medicines politely, always giving a clear label, and explaining all possible medication side effects clearly18. The study showed that pharmacy staff in Semarang already implemented technical guidelines for pharmaceutical service standards in pharmacies; these activities are included in the dispensing process. In the technical guidelines, it is stated that before handing over the medicine to the patient, a re-examination of the writing of the patient's name on the label, usage instructions, and the type and amount of medicine (the compatibility between the writing of the label and the prescription) must be done19.

In addition, most respondents agree that pharmacy staff provides written/printed information on drug therapy and patient diseases. The pharmacy staff also used information about the patient's previous condition/medication when administering medicine therapy. When administering medicine to patients, pharmacist or pharmacy personnel must be attentive to the patient's history of medication or disease, especially related to the medications consumed, to reduce the side effects. The process described in the statement is part of the clinical pharmacy service activity: medication information provision20. Based on technical guidelines for the implementation of pharmaceutical service standards in Pharmacies, it is stated that in the drug counseling process, Drug Information Services include activities such as answering questions orally or in writing, making brochures/leaflets containing medication information, as well as providing education and information to patients. In detail, it is necessary to ask the patient questions and data/information in implementing service standards21. The counseling process standard also explains that pharmacists need to explore further information by exploring medicine use problems and explaining medicine use problem-solving. The pharmacy services standard's technical guidelines also show that pharmacies must have adequate space, including rooms/places for counseling. At a minimum, there must be a set of tables and chairs for counseling in the counseling space, a book cupboard, reference books, leaflets, posters, counseling supporting tools, and counseling book records and forms to record the patients' treatment22.

The Mann-Whitney test result shows Asymp Sig. (2-tailed) value of 0.264, as shown in Table VIII. The significance of the acquisition result value was more than 0.05, which indicates that the completeness of the medication information by the pharmacy personnel between the franchise and nonfranchise pharmacies has no significant difference. The median value acquisition of franchise pharmacies' respondents is 19.00, while the nonfranchise pharmacies' respondents is 18.00. The median value obtained in the two ownership types of pharmacies shows the category of "very complete" in the pharmacy service, which is in the value range of 18-21. Therefore, it can be interpreted that the completeness of medicine information by pharmacy personnel between the franchise and non-franchise pharmacies has no significant difference.

TableVIII. Mann-Whitney test results, Median value of the franchise and non-franchise pharmacies

In general, not all patients are informed and aware of what to do with the medicines that have been obtained, so medication services are needed to prevent medicine abuse and unwanted medicine interactions. In this case, medicine information services are still lacking compared to the need for speed in service and information about patients' medicines. Pharmacy personnel must provide patient information. Besides, pharmacy personnel must proactively provide medication information services to patients. Some information that should be conveyed to patients includes the dosage of drugs, methods, the timing of use, the amount of medicine consumed in a day, how to store medicines, and how to deal with possible side effects are possible23.

In many countries, the sustainability of pharmacy practice has been carried out; pharmacists have integrated regulations to support patients in selecting medications and providing appropriate information advice24,25. For results, pharmaceutical practices' sustainability needs to be maintained for patient quality of service and life. Furthermore, patient's perceptions of the pharmacy profession as a product rather than a service certainly influence satisfaction with community pharmacy services. Interestingly, in some study26, patient satisfaction was high despite the low counseling level rating. According to other studies27,28, the higher the frequency of counseling and monitoring, as well as the more targeted the guidance, the higher the satisfaction rating29. It has also been stated that patient counseling may not be as frequent or as comprehensive due to a lack of demand for these services. These findings emphasize the importance of educating the public about pharmacists' services.

Patients' perceptions about pharmaceutical services based on the type of pharmacy ownership (franchise/non-franchise) in Semarang do not significantly differ. Unfortunately, many respondents are still unaware of the pharmacist profession. Therefore, We humbly recommend that pharmacists wear identification as pharmacists as they do pharmacy services to the community.

We would like to thank all the participants who contributed to this study for their time and efforts.

Nisa Febrinasari: conceptualization, supervision, writing- review and editing. Abdur Rosyid: supervision. Fadhilla Huswatunnida: investigator, writing original draft.

None.

The authors declare no conflict of interest.

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