Interaction Exchange in Dispensaries: An Observation
on the Chronic Disease Management Program
Setiyo Budi Santoso
1
, Muhammad Hafid Naufal Majid
2
, Annis Azhar Suryaningtyas
3
,
Rayinda Faizah
4
, Ika Mulyono Putri Wibowo
5
{[email protected]
1
}

Department of Community and Clinical Pharmacy, Universitas Muhammadiyah Magelang
1
Pharmacy Undergraduate Program, Universitas Muhammadiyah Magelang
2

Department of Communication Science, Universitas Muhammadiyah Magelang
3

Department of Clinical Psychology, Universitas Muhammadiyah Magelang
4

Department of Center Medication Information and Pharmaceutical Care, Universitas Surabaya
5

Abstract. The number of chronic diseases in Indonesia has increased from year to year.
One of the essential elements in managing chronic disease is the provision of adequate
drug information. So pharmacists need to have excellent and practical communication
skills when delivering drugs to chronic disease patients. This paper presents a process of
exchange of interactions between pharmacists and patients in dispensaries. Researchers
have collected data by cross-sectional observation in two primary health care. A total of
48 patients were involved in this study. The process of coding the interaction exchange has
used the Roter Interaction Analysis System (RIAS). An interesting finding in the study
was that most patients only took time from one minute when interacting with staff
dispensaries. The mean number of interactions representing the task-focused function did
not differ significantly between the two dispensaries during that duration. In contrast to
social-emotional communication, the amount of information exchanged has a gap. Based
on these findings, we recommend that future studies formulate specific guidelines for
pharmacists for treating patients with chronic disease with a short duration.
Keywords: Primary Health Care, Roter Interaction Analysis System, Task focused, Socio-
emotional
1 Introduction
The prevalence of hypertension and type 2 diabetes mellitus (T2DM) has increased in
Indonesia. The hypertension population was 25.8% (2013), rising to 34.1% (2018). Likewise,
the T2DM population was rising from 6.9% (2013) to 8.5% (2018) [1]. Through the chronic
disease management program (Prolanis), they obtain health services proactively from health
facilities that were integrated with the national health insurance as called by BPJS [2].
Prolanis participant adherence in taking medication is the key to successful therapy
management [3]; [4]. Their adherence to therapy is closely related to drug counselling services
by pharmacist [5]-[8].
Sari, Putra, & Masran state that patients with good knowledge have a high need for drug
information. Some patients tend to hesitate to ask questions to pharmaceutical personnel [10].
One reason is the lack of perceptions of patients towards health workers due to poor
communication [11].
BIS-HSS 2020, November 18, Indonesia
Copyright © 2021 EAI
DOI 10.4108/eai.18-11-2020.2311623

Prolanis participants have increased from year to year. Some researchers have concluded
the relationship between drug information services on the quality of therapy management output
of prolanis participants. However, many prolanis participants are still constrained in obtaining
optimal drug information services. The author considers it necessary to formulate a good
communication model in therapy management. To initiate the development roadmap. Through
this paper, the authors identify the interaction process in dispensaries that involves pharmacist
and prolanis participants.
2 Method
This research took place at two primary health care (PHC), Unit Tempuran and Unit
Muntilan 2. Both are first-level health facilities in Magelang Regency-Indonesia, integrated into
the national health insurance service (BPJS).
The cross-sectional observations have taken place while participants were visiting each
PHC on their monthly schedule (February 2020). Through an audio recording device, we
recorded all interactions that took place in a pharmaceutical service expressly provided for
prolanis participants. Forty-eight participants (26 members of Unit Muntilan and 22 members
of unit Tempuran) were involved in the study. All steps in the series of methods have received
approval from the head of the Magelang district health office, pharmaceutical personnel and
prolanist participants involved in the research.
All recordings are then transcribed in text. Furthermore, we analyzed it according to the
Roter Interaction Analysis System (RIAS) instrument [12]. The procedure is carried out under
the fifth author's direction, as an experienced and verified researcher who has successfully
carried out this method in previous research [13], [14]. The coding results were descriptively
presented in two types to the communication functions: task-focused and socio-emotional.
3 Results and Discussion
3.1 Result

Based on our observations, we reported that most prolanis participants only took a short
time when interacting with staff dispensaries. The average interaction time in PHC Tempuran
was only 35 seconds, along with in PHC Muntilan 2 for 40 seconds (figure 1). During the
duration, the mean number of interactions representing the task-focused function was balanced
in both of PHC, amounting to 5.7 utterances. In contrast to socio-emotional communication, the
amount of information exchanged has a gap. The mean interaction in the PHC Tempuran was
less with 4.12 utterances, whereas, in PHC Muntilan 2, the mean was 6.64 utterances which
were moreover (figure 1).

Fig. 1. Mean duration and utterances of interactions exchange (IE) between patient and pharmacist in
dispensaries
Table 1 showed the utterances domains involved in exchange interactions. We are
interested in writing down the number of interactions that are predominantly interchangeable.
What is at the top is precisely biomedical information that is not related to the therapeutic
regimens. This statement is confirmed by giving information with 159 utterances and
pharmacists' efforts in gathering data with 39 closed questions and 33 open questions. The
domains are evenly distributed in the two dispensaries.
The most frequent interaction with therapeutic regimens was the provision of information
with a total of 17 utterances. Moreover, therapeutic domains are rarely explored with either
closed-ended questions (6 utterances), or open-ended questions (3 utterances).
Table 1. The frequency of utterances representing a task-focused interaction
No Variables of Interaction Exchange PHC
Muntilan 2
(n=22)
PHC
Tempuran
(n=26)
Total
(n=48)
1. Give information on other
therapeutic regimen
79 utterances 80 utterances 159 utterances
2. Ask closed-ended question on other
therapeutic regimen
20 utterances 19 utterances 39 utterances
3. Give information on therapeutic
regimen
13 utterances 20 utterances 33 utterances
4. Ask open-ended question on other
therapeutic regimen
7 utterances 10 utterances 17 utterances
5. Ask closed-ended question on
therapeutic regimen
3 utterances 3 utterances 6 utterances
6. Ask open-ended question on
therapeutic regimen
2 utterances 1 utterance 3 utterances
7. Give Orientation/Instruction 1 utterance 4 utterances 5 utterances
8. Ask for understanding No utterance 5 utterances 5 utterances
9. Ask for permission No utterance 2 utterances 2 utterances
10. Bid for repetition 1 utterances 1 utterance 2 utterances
11. Back Channel No utterance 1 utterance 1 utterance
40
5.73 6.64
35
5.77 4.12
Duration of IE
(Second)
Task Focused IE
(Utterances)
Socio-Emotional IE
(Utterances)
Muntilan 2 (n=22)Tempuran (n=26)

Other domains (table 1) that are slightly discussed are those related to orientation (5
utterances), ask for understanding (5 utterances), ask for permission (2 utterances), bid for
repetition (2 utterances) and only one utterance on the backchannel.
A report on interactions that represent socio-emotional functions is presented in Table 2.
We are amazed to see that this interaction is dominated by a show of agreement (understanding)
with 94 utterances and approval direct with 84 utterances. Efforts to ensure patients' identity in
pharmaceutical services are indicated by the number of personal remarks, as many as 66
utterances, which is evenly distributed in both dispensaries.
Among the three dominant domains, what appears to be a gap in the two dispensaries is the
approval performance. Prolanis members in PHC Tempuran are more expressive in the making
than the members in PHC Muntilan 2.
Table 2. The frequency of utterances representing a socio-emotional interaction
No Variables of Interaction Exchange PHC
Muntilan 2
(n=22)
PHC
Tempuran
(n=26)
Total
(n=48)
1. Show agreement or understanding 44 utterances 50 utterances 94 utterances
2. Show approval-direct 27 utterances 57 utterances 84 utterances
3. Personal remarks 33 utterances 33 utterances 66 utterances
4. Laughs, tells jokes 1 utterance 5 utterances 6 utterances
5. Shows disapproval-direct 1 utterance No utterance 1 utterance
6. Back channel responses 1 utterance 1 utterance 2 utterances

There are not many attempts at cracking the situation through talks of jokes or laughs (6
utterances). Among patients and staff, there were also almost no statements of denial (1
utterance). Backchannel expression was responded to only once in each dispensary.

3.2 Discussion

In previous publications, we have described pharmacists' readiness and responsiveness in
providing excellent service in dispensaries[15], [16]. This paper presents the facts of the
interactions exchange at PHC. This data is notable for three reasons. First, this is the roadmap
opening gate for developing a communication model in Indonesia pharmaceutical services that
we are currently doing. Second, identifying communication using RIAS instruments in a
pharmaceutical context has never been done in a PHC setting. Third, we studied populations
with chronic diseases who regularly attend health system services, including pharmaceutical
services.
Publications on drug information services, particularly in the setting of PHC in Indonesia,
evaluate drug administration, which includes services regarding name, dose, time, frequency
and similar matters regarding the procedure for taking drugs [17]–[19]. Although they have
proven that aspects of drug information services are beneficial for patients in terms of
compliance, achieving therapeutic results, improving knowledge, to satisfaction [4], [20]–[25].
However, we consider that a more detailed stage is needed to reconstruct what has happened in
dispensaries' interactions so far. For this reason, we use the RIAS instrument in completing this
research design.
Our findings confirm that both dispensaries have a balanced number of interaction
exchanges on the task-focused aspect. It is an effort to ensure that the patient's steps in taking
drugs are safe. Moreover, the pharmacy staff is responsible for helping patients solve problems

related to drugs. In the Indonesian context, this is the case in pharmacy and medical services.
Sure, the minimum standard for providing health services information is information about
biomedicine [26]. Regarding the pharmacy, task-focused. In our findings, we highlighted that
much interaction spent demanding complete insurance administration. So we think it is evident
to explain the many frequencies of interactions exchange in another therapeutic regimen.
However, the mean of frequencies to the socio-emotional interaction has gaps between the
two dispensaries. Even so, Table 3 confirms that a high gap occurs in the approval performance.
The author considers this is not worthwhile. What should be appreciated is the high dealing
expression between patients and pharmacists. It shows that they are in the form of agreement,
understanding or approval. Almost no disapproval performances between them also supported
this. Even so, the socio-emotional has improved engagement between patients and pharmacy
staff [27]. In other findings, the socio-emotional interaction is even more practised by patients
[14]
Beyond our expectations, it turns out that prolanis members spend less than 1 minute
interacting in dispensaries. It is surprising. In another setting, They take 20-30 minutes to
maximize counselling in each meeting [28]. Other opinions express that the setting can be the
cause of less than optimal communication [29]. The researchers' observations show that the
PHC has met the waiting room standards according to the regulations [30]. Even so, patients
encounter several challenges in accessing services at PHC. Patients need to spend plenty of time
queuing before facing a doctor. Then queue while waiting for a call from the pharmacy service.
Many of them thought about going home immediately after receiving the medicine. As for the
prolanis members we observed, they were already familiar with the drugs they routinely took
for a long duration.
Our experience shows that patients with chronic disease who have been taking medication
for a long duration need a touch of socio-emotional communication as motivation in undergoing
therapy [31]. Research on pharmaceutical communication should be developed further to
intervene in the dimensions of patient quality of life or the problem of drug therapy intervention
as we have partly investigated [32], [33]. The result of this research is the incomplete puzzle
pieces. We will immediately submit research data on another setting as drugstores and hospitals.
Our steps have strong analytical materials to develop a suitable communication model to be a
reference for pharmacists in Indonesia.
4 Conclusion
Our findings confirm that prolanis members spend less time interacting with pharmacists.
The prolanis participants were familiar with the issues related to the drugs they were taking. We
recommend that future studies formulate specific guidelines for pharmacists for treating patients
with chronic disease with a short duration.
Acknowledgement
We would like thanks to the Research Division of Universitas Muhammadiyah Magelang
through the funding research grant scheme of institutional vision revitalization in 2019.

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