Implementation of pharmacists services provided in all pharmacies must meet the standard of pharmaceutical services guidelines, including the provision of drug information. The study aims to compare the patient's perception of drug counseling services by pharmacy staff based on the type of pharmacy ownership (franchise/non-franchise) in Semarang. This research is an observational study with a cross-sectional design. Samples were taken of 286 respondents with a quota sampling technique. Data were collected using an online google form questionnaire tested for validity and reliability. The statistical analysis results used the Mann-Whitney test with a p-value of 0.05. There is no significant difference between the patient's perception of the drug information counseling services by pharmacy staff at the franchise or non-franchise pharmacies in Semarang with a p-value of 0.264. This study also found that the standard information given by pharmacy staff is healthy eating and education about antibiotics used in the common cold. In addition, only 55 of respondents were sure that the pharmacy staff who gave them drug information in pharmacies was a pharmacist. Consequently, we humbly recommend that pharmacists consistently wear their pharmacist identification.

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

Thepharmaceutical services implementation in Semarang has been evaluated byresearch conducted in hospitals. The results show that there are stilldifferences in implementing pharmaceutical service standards in several publicand private hospitals in Semarang that can potentially prevent medicationerrors. The difference in the implementation of the service standard willundoubtedly affect the quality of pharmaceutical services provided to patients5. Likewise, the pharmaceutical services provided in pharmacies, theimplementation of pharmaceutical services provided in the network/franchise,and non-network pharmacies must meet the standards of pharmaceutical servicesin pharmacies, in the provision of medicine, medical devices, and consumablemedical materials, or the clinical pharmacy services, including the provisionof medical information6. A study of the pharmacist community in 2009 showed that pharmacists arenot quite ready, according to the Department of Health and the Association ofIndonesian Pharmacists (Ikatan Apoteker Indonesia; IAI). The pharmacistsin non-franchise pharmacies are even more unprepared than the franchisepharmacies. Franchise pharmacies' pharmacists in the metropolitan city arepreparing to face the patient-oriented paradigm and fulfilling the pharmacy servicestandard. In contrast, the pharmacists in the independent non-franchisepharmacies still emphasize fast service and the lower price of medicine7.

The governmenthas enforced a standard of pharmaceutical services in pharmacies through theMinister of Health Decree Number 73 of the Year 2016 concerning the standard ofpharmaceutical services in Pharmacies, which includes two aspects. The firstaspect is the provision management of pharmacy, medical devices, and consumablemedical materials; the second is the clinical pharmacy services. Implementingthese standards is a practice guide for pharmacists in carrying out theprofession in pharmacies, protecting the public from unprofessional services,and carrying out pharmaceutical practices8. Pharmacists must improve knowledge, skills, and behavior in interactingwith patients by providing complete information on medication usage, sideeffects, and monitoring. Therefore, pharmacists must comply with pharmaceuticalservice standards in pharmacies to ensure the quality of public pharmaceuticalservices9.

Druginformation services are an essential part of the clinical pharmacy service10. The quality of pharmaceutical services at networked/franchise andnon-networked/non-franchise pharmacies will affect the completeness of theinformation provided to patients, so it is necessary to pay attention to goodservice and meet the Pharmacy Service Standards at the Pharmacy (StandarPelayanan Kefarmasian di Apotek; SPKA)11. Research on the completeness of drug information to patients is a studythat can be carried out to assess and measure the quality of service providedby pharmacists and pharmaceutical personnel in pharmacies12. The pharmacy service provider acts as the health worker who providesmedicine preparation services and information and education services to improvethe health and quality of life13. Therefore, it is necessary to investigate the completeness of theinformation by pharmacy personnel in Semarang pharmacies, eithernetworked/franchise or non-network pharmacies. The purpose of this study is tocompare patients' perceptions of drug information services by pharmacy staffaccording to the type of pharmacy ownership (franchise/non-franchise) inSemarang. Through the research, pharmacies can be informed about the medicalinformation services provided by the pharmacy personnel at the respectivepharmacies and, at the same time, can be used as evaluation materials to play amore significant role in improving the quality of medication informationservices to patients.

A franchise pharmacyis an authorization or official permission or approval granted by a pharmacycompany to distributors, groups, or individual owners to establish a pharmacy,for example, Kimia Farma, K24, and Viva Generik. Non-franchise pharmacy is a pharmacyin the general community. Inclusion criteria for respondents in this study weresubjects who had redeemed drugs or purchased pharmaceutical products at apharmacy in Semarang within a maximum of the last three months, had receiveddirect 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 theirquestionnaire. The study design and protocol were approved by the Faculty ofMedicine Ethics Committee, Universitas Islam Sultan Agung, with the numberEC/244/VII/Komisi Bioetik. The tool used in the research was a modifiedquestionnaire Investigating Consumer Attitudes toward Community PharmacyServices14. The questionnaireobtained permission from the previous author and was translated“backward-forward” into the Indonesian version by the Center for InternationalLanguage Development (CILAD) Universitas Islam Sultan Agung with DOI https://doi.org/10.5281/zenodo.6777035. From calculationfrom the Slovin formula with a population assumed as 1000 people, the studyrequires 286 and 30 respondents for the validity and reliability test. Therespondents were recruited by quota sampling from May until October 2020. Datacollection was carried out with a Google Form questionnaire. The questionnairedistribution 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 wasconducted with the Mann-Whitney test.

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

TableI. Respondents based on types ofpharmacies

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

TableII. Demographic characteristic of respondents

Table III describes that of167 respondents who visited franchise pharmacies, 93 people (55.7%) believedthat those who served respondents in pharmacies was pharmacist, followed by 19people (11.4%) who answered that those who served respondents were notpharmacists or person staff, and 55 people (32.9%) chose to answer that theydid not know the person profession who served them, whether it was a pharmacistor person staff. In non-franchise pharmacy have similar results with 45.4%,20.2%, and 34.4 %, respectively. Table III analyzes the response toinformation about drug services for patients, indicating that only 55.7% ofpatients recognized pharmacists in franchise pharmacies and only 45.4% innon-franchised pharmacies. About 33.7% of patients, in general, did not knowwhom pharmacy staff in charge provided the services. This study shows thatpharmacist roles are still not well known by the community. Since pharmacistsare health workers obliged to provide drug counseling, they should not bereplaced by pharmaceutical technical personnel. In addition, identity as apharmacist in pharmacies is essential, so it is always advised to use/wear aspecial identity sign that shows a pharmacist's profession when performingservice in the pharmacy17.

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

Table IV explains that from167 respondents in franchise pharmacies, 98 people (58.7%) answered agreed withthe assessment that the pharmacy staff who served were experienced,trustworthy, and confident. However, 69 people (41.3%) answered neutrally inthat regard. In non-franchise pharmacies have similar results with 58% and41.2%, respectively.

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

Table V indicates that themajority of the respondent, 140 respondents (83.8%) in franchise pharmacies and91 (76.5%) in non-franchise pharmacies, admitted that they had been givenadvice or information by pharmacy staff at the time of service. However, 27respondents (16.2%) in franchise pharmacies and 28 (23.5%) in non-franchisepharmacies answered that they were not given advice or information duringservice. Table VI shows that 57respondents (34.1%) in franchise pharmacies and 31 (26.1%) in non-franchisepharmacies answered that they had been given information and advice abouthealthy eating. They were followed by 35 respondents (21%) in franchisepharmacies and 24 (20.2%) in non-franchise pharmacies receiving education aboutthe use of antibiotics for flu and the common cold. Table VII shows that mostrespondents were satisfied with pharmacy staff service regarding attitude,instruction, drug information about side effects, and asking about previoushealth history and counseling place. However, the majority of respondents inboth pharmacies disagree with a statement about proper drug storage methodsinformation, with 10.8% in franchise pharmacies and 17.6% in non-franchisepharmacies.

TableV. Distribution of respondents'answers to the question " Have youever 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 informationabout drug services for patients shows that most respondents agreed thatpharmacy staff is in charge, providing medicines politely, always giving aclear label, and explaining all possible medication side effects clearly18. The study showedthat pharmacy staff in Semarang already implemented technical guidelines forpharmaceutical service standards in pharmacies; these activities are includedin the dispensing process. In the technical guidelines, it is stated thatbefore handing over the medicine to the patient, a re-examination of thewriting of the patient's name on the label, usage instructions, and the typeand amount of medicine (the compatibility between the writing of the label andthe prescription) must be done19.

In addition, mostrespondents agree that pharmacy staff provides written/printed information ondrug therapy and patient diseases. The pharmacy staff also used informationabout the patient's previous condition/medication when administering medicinetherapy. When administering medicine to patients, pharmacist or pharmacypersonnel must be attentive to the patient's history of medication or disease,especially related to the medications consumed, to reduce the side effects. Theprocess described in the statement is part of the clinical pharmacy serviceactivity: medication information provision20. Based on technicalguidelines for the implementation of pharmaceutical service standards inPharmacies, it is stated that in the drug counseling process, Drug InformationServices include activities such as answering questions orally or in writing,making brochures/leaflets containing medication information, as well asproviding education and information to patients. In detail, it is necessary toask the patient questions and data/information in implementing servicestandards21. The counselingprocess standard also explains that pharmacists need to explore furtherinformation by exploring medicine use problems and explaining medicine useproblem-solving. The pharmacy services standard's technical guidelines alsoshow that pharmacies must have adequate space, including rooms/places forcounseling. At a minimum, there must be a set of tables and chairs forcounseling in the counseling space, a book cupboard, reference books, leaflets,posters, counseling supporting tools, and counseling book records and forms to recordthe patients' treatment22.

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

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

In general, not allpatients are informed and aware of what to do with the medicines that have beenobtained, so medication services are needed to prevent medicine abuse andunwanted medicine interactions. In this case, medicine information services arestill lacking compared to the need for speed in service and information aboutpatients' medicines. Pharmacy personnel must provide patient information.Besides, pharmacy personnel must proactively provide medication informationservices to patients. Some information that should be conveyed to patientsincludes the dosage of drugs, methods, the timing of use, the amount ofmedicine consumed in a day, how to store medicines, and how to deal withpossible side effects are possible23.

In many countries,the sustainability of pharmacy practice has been carried out; pharmacists haveintegrated regulations to support patients in selecting medications andproviding appropriate information advice24,25. For results,pharmaceutical practices' sustainability needs to be maintained for patientquality of service and life. Furthermore, patient's perceptions of the pharmacyprofession as a product rather than a service certainly influence satisfactionwith community pharmacy services. Interestingly, in some study26, patient satisfactionwas high despite the low counseling level rating. According to other studies27,28, the higher thefrequency of counseling and monitoring, as well as the more targeted theguidance, the higher the satisfaction rating29. It has also beenstated that patient counseling may not be as frequent or as comprehensive dueto a lack of demand for these services. These findings emphasize the importanceof educating the public about pharmacists' services.

Patients'perceptions about pharmaceutical services based on the type of pharmacyownership (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 aspharmacists as they do pharmacy services to the community.

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

Nisa Febrinasari: conceptualization, supervision, writing- review and editing. AbdurRosyid: supervision. Fadhilla Huswatunnida: investigator, writingoriginal draft.

None.

Theauthors declare no conflict of interest.

1. Bobbins AC, Burton S, Fogarty TL. Differentmodels of pharmaceutical services and care in primary healthcare clinics in theEastern Cape, South Africa: Challenges and opportunities for pharmacy practice.Afr J Prim Health Care Fam Med. 2020;12(1):e1-11. doi:10.4102/phcfm.v12i1.2323

2. Lopes H, Lopes AR, Farinha H, Martins AP. Definingclinical pharmacy and support activities indicators for hospital practice usinga combined nominal and focus group technique. Int J Clin Pharm.2021;43(6):1660-82. doi:10.1007/s11096-021-01298-z

3. Eiland LS, Benner K, Gumpper KF, Heigham MK,Meyers R, Pham K, et al. ASHP-PPAG Guidelines for Providing Pediatric PharmacyServices in Hospitals and Health Systems. J Pediatr Pharmacol Ther.2018;23(3):177-91. doi:10.5863/1551-6776-23.3.177

4. Jimmy B, Jose J. Patient medication adherence: measures in daily practice. Oman Med J.2011;26(3):155-9. doi:10.5001/omj.2011.38

5. Satibi, Marin VYW, Suwarni S, Kuswardhani. AnalisisPerbedaan Implemantasi Standar Pelayanan Kefarmasian dengan Potensi MedicationError di Beberapa Rumah Sakit Kota Semarang. J Manajemen Pelayanan Farmasi JManag Pharm Pract. 2017;7(3):125-31. doi:10.22146/jmpf.33251

6. Costa FA, Scullin C, Al-Taani G, Hawwa AF,Anderson C, Bezverhni Z, et al. Provision of pharmaceutical care by communitypharmacists across Europe: Is it developing and spreading? J Eval Clin Pract.2017;23(6):1336-47. doi:10.1111/jep.12783

7. Mulyagustina, Wiedyaningsih C, Kristina SA. Implementationof Pharmaceutical Care Standard in Jambi City's Pharmacies. J ManajemenPelayanan Farmasi J Manag Pharm Pract. 2017;7(2):83-96. doi:10.22146/jmpf.30284

8. Wiryanto, Tanjung H, Rumonda R. Implementationof Standards for Managing Pharmaceutical, Medical Devices and DisposableMedical Materials in Community Pharmacy in Medan City. Open Access Maced J MedSci. 2019;7(22):3769-73. doi:10.3889/oamjms.2019.532

9. Ilardo ML, Speciale A. The Community Pharmacist:Perceived Barriers and Patient-Centered Care Communication. Int J Environ ResPublic Health. 2020;17(2):536. doi:10.3390/ijerph17020536

10. Alamri SA, Al Jaizani RA, Naqvi AA, Al GhamdiMS. Assessment of Drug Information Service in Public and Private SectorTertiary Care Hospitals in the Eastern Province of Saudi Arabia. Pharmacy.2017;5(3):37. doi:10.3390/pharmacy5030037

11. Gobel N, Tuloli TS, Madania. Studi Penjaminan Mutu (Quality Assurance) DalamPelayanan Kefarmasian Di Apotek. J Syifa Sci Clin Res. 2022;4(2):237-46. doi:10.37311/jsscr.v4i2.13956

12. Athiyah U, Setiawan CD, Nugraheni G, Zairina E,Utami W, Hermansyah A. Assessment of pharmacists’ knowledge, attitude andpractice in chain community pharmacies towards their current function andperformance in Indonesia. Pharm Pract. 2019;17(3):1518. doi:10.18549/PharmPract.2019.3.1518

13. Hermansyah A, Wulandari L, Kristina SA,Meilianti S. Primary health care policy and vision for community pharmacy andpharmacists in Indonesia. Pharm Pract. 2020;18(3):2085. doi:10.18549/pharmpract.2020.3.2085

14. El-Sharif SI, Alrahman NA, Khaled N, Sayah N,Gamal E, Mohammed A. Assessment of Patient’s Satisfaction with PharmaceuticalCare Service in Community Pharmacies in the United Arab Emirates. Arch Pharma Pract. 2017;8:22-30.

15. Aljuffali LA, Alshabanah MO, Almalag HM. Cross-sectionalstudy to evaluate burnout among pharmacy staff in Saudi Arabia during COVID-19pandemic. Saudi Pharm J. 2022;30(4):440-53. doi:10.1016/j.jsps.2022.01.017

16. Osamor PE, Grady C. Women's autonomy in healthcare decision-making in developing countries: a synthesis of the literature.Int J Womens Health. 2016;8:191-202. doi:10.2147/ijwh.s105483

17. Tommasello AC. Substance abuse and pharmacypractice: what the community pharmacist needs to know about drug abuse anddependence. Harm Reduct J. 2004;1(1):3. doi:10.1186/1477-7517-1-3

18. Brown MT, Bussell JK. Medication Adherence: WHOCares? Mayo Clin Proc. 2011;86(4):304-14. doi:10.4065/mcp.2010.0575

19. Manchanayake MGCA, Bandara GRWSK, SamaranayakeNR. Patients' ability to read and understand dosing instructions of their ownmedicines - a cross sectional study in a hospital and community pharmacysetting. BMC Health Serv Res. 2018;18(1):425. doi:10.1186/s12913-018-3252-1

20. Fitzgerald RJ. Medication errors: the importanceof an accurate drug history. Br J Clin Pharmacol. 2009;67(6):671-5. doi:10.1111/j.1365-2125.2009.03424.x

21. Toklu HZ, Hussain A. The changing face ofpharmacy practice and the need for a new model of pharmacy education. J YoungPharm. 2013;5(2):38-40. doi:10.1016/j.jyp.2012.09.001

22. Ali S, Shimels T, Bilal AI. Assessment ofPatient Counseling on Dispensing of Medicines in Outpatient Pharmacy of Tikur-AnbessaSpecialized Hospital, Ethiopia. Ethiop J Health Sci. 2019;29(6):727-36. doi:10.4314/ejhs.v29i6.9

23. Saqib A, Atif M, Ikram R, Riaz F, Abubakar M,Scahill S. Factors affecting patients' knowledge about dispensed medicines: AQualitative study of healthcare professionals and patients in Pakistan. PLoSOne. 2018;13(6):e0197482. doi:10.1371/journal.pone.0197482

24. Bou-Saba AW, Kassak KM, Salameh PR. The currenttrends and challenges towards good community pharmacy practice and the wayforward. Explor Res Clin Soc Pharm. 2022;6:100152. doi:10.1016/j.rcsop.2022.100152

25. McConnell KJ, Delate T, Newlon CL. Thesustainability of improvements from continuing professional development inpharmacy practice and learning behaviors. Am J Pharm Educ. 2015;79(3):36. doi:10.5688/ajpe79336

26. Ali HS, Alhadab AS, Mohamed EB, Prajapati SK,Badulla WFS, Alshakka M, et al. Patients’ Perspectives on Services Provided byCommunity Pharmacies in Terms of Patients’ Perception and Satisfaction. J YoungPharm. 2019;11(3):279-84. doi:10.5530/jyp.2019.11.56

27. Al-Arifi MN. Patients’ perception, views and satisfaction withpharmacists’ role as health care provider in community pharmacy setting atRiyadh, Saudi Arabia. Saudi Pharm J. 2012;20(4):323–30. doi:10.1016/j.jsps.2012.05.007

28. Hasan S, Sulieman H, Stewart K, Chapman CB,Hasan MY, Kong DCM. Assessing patient satisfaction with community pharmacy inthe UAE using a newly-validated tool. Res Social Adm Pharm. 2013;9(6):841–50. doi:10.1016/j.sapharm.2012.10.002

29. Larasanty LPF, Cahyadi MF, Sudarni NMR, WirasutaIMAG. Patient satisfaction with pharmaceutical care services provided atprimary-level and secondary-level health facilities in Indonesia’s healthcoverage system. J Health Res. 2019;33(1):80–8. doi:10.1108/JHR-06-2018-0033