Hospital pharmacists’ perspectives on diabetes treatment barriers and solutions: A qualitative study from Indonesia
Abstract
Background: Despite available treatment options, diabetes mellitus (DM) management faces significant barriers affecting patient outcomes. While most research focuses on patient factors, limited attention has been given to healthcare provider perspectives, particularly hospital pharmacists who are key stakeholders in diabetes care.
Objective: This study explored treatment barriers and solutions from hospital pharmacists’ perspectives in Indonesia.
Methods: This qualitative phenomenological study involved 18 hospital pharmacists at Cilacap Regional General Hospital, Central Java, Indonesia. Participants were selected through purposive sampling and had minimum one-year experience in diabetes patient care. Semi-structured interviews were conducted from January to February 2025, audio-recorded, transcribed verbatim in Bahasa Indonesia, and analyzed using thematic analysis. All interviews were conducted in Bahasa Indonesia and participant quotes were translated to English while preserving original meaning and cultural context.
Results: Analysis of three predetermined barrier themes revealed: adverse drug reactions (ADRs) (particularly metformin-related gastrointestinal effects and insulin-associated hypoglycemia), medication non-adherence (influenced by feeling healed, treatment boredom, age-related denial, and therapy burden), and monthly follow-up challenges (geographic barriers, transportation difficulties, physical limitations, and insufficient family support). Pharmacists proposed comprehensive solutions including patient and family education, interprofessional collaboration, technology integration through WhatsApp support, and flexible monitoring approaches.
Conclusion: Pharmacist-identified barriers operate as interconnected system components requiring multi-level interventions. Evidence-based solutions emphasizing education, collaboration, family engagement, and technological support can enhance diabetes management outcomes while respecting cultural contexts and resource constraints.
References
1. CNBC Indonesia. Indonesia Masuk 5 Besar Kasus Diabetes Tertinggi di Dunia. Jakarta: CNBC Indonesia; 2022. Available from: https://www.cnbcindonesia.com/lifestyle/20250630152234-33-644974/indonesia-masuk-5-besar-kasus-diabetes-tertinggi-di-dunia
2. Putri IH, Jati SP, Martini M. Faktor Penghambat Pelaksanaan SPM Kesehatan pada Penderita Diabetes Mellitus: Literatur Review. Malahayati Nurs J. 2023;5(8):2804-2816. https://doi.org/10.33024/mnj.v5i8.10974
3. Della A, Subiyanto P, Maria A. Faktor-Faktor Yang Berhubungan Dengan Kepatuhan Pengobatan Pasien Diabetes Melitus Tipe 2. J Keperawatan Klin dan Komunitas (Clinical Community Nurs Journal). 2023;7(2):124. https://doi.org/10.22146/jkkk.83090
4. Hutasuhut RF, Siregar PP. Kemudahan Akses Pelayanan Kesehatan Dapat Meningkatkan Kepatuhan Minum Obat Pasien Diabetes Melitus Tipe 2 di Puskesmas Medan Area Selatan. Pandu Husada. 2024;5(2):42-50.
5. Anshari AF, Ichsan B, Cholisoh Z. Hubungan Kepatuhan Minum Obat terhadap HbA1C dan Kualitas Hidup Pasien Diabetes di RSI Purwodadi. JPSCR J Pharm Sci Clin Res. 2023;8(3):317. https://doi.org/10.20961/jpscr.v8i3.73753
6. Soelistijo S. Pedoman Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 Dewasa di Indonesia 2021. Glob Initiat Asthma. 2021:46. Available from: www.ginasthma.org
7. Khairunnisa, Rawitri K, Wiryanto, Wahyuni S. Pengaruh Asuhan Kefarmasian Terhadap Outcome Klinis Dan Kualitas Hidup Pada Pasien Diabetes Melitus Tipe 2. JFIOnline. 2021;13(2):118-128. https://doi.org/10.35617/jfionline.v13i2.18
8. Wahyuningrum R, Wahyono D, Mustofa M, Prabandari YS. Pengelolaan Diabetes Melitus Tipe 2 Oleh Apoteker. JFIOnline. 2019;9(1). https://doi.org/10.35617/jfi.v9i1.550
9. Kamba V. Peran Apoteker dalam Meningkatkan Kepatuhan Berobat pada Pasien Diabetes Melitus. J Noncommunicable Dis. 2021;1(1):45. https://doi.org/10.52365/jond.v1i1.225
10. Putri MA, Sukandar EY. Pengaruh konseling apoteker terhadap kepatuhan terapi pasien diabetes melitus di beberapa puskesmas dan rumah sakit. 2024;4(3):275-286. https://doi.org/10.36805/jbf.v4i3.1130
11. Syafitri IW, Yasin NM, Sari IP. Pengaruh Edukasi oleh Apoteker dengan Metode Brief Counseling terhadap Pengetahuan, Kepatuhan dan Glukosa Darah Pasien DM Tipe 2 di Puskesmas Kabupaten Pemalang. J Manaj dan Pelayanan Farm (Journal Manag Pharm Pract). 2023;13(1):12. https://doi.org/10.22146/jmpf.74821
12. Rahmawaty A, Anggraeni NW. Pengaruh Konseling Apoteker Terhadap Tingkat Kepatuhan Minum Obat Dan Kadar Gula Darah Pasien Diabetes Mellitus. J Ris Kefarmasian Indones. 2023;5(1):181-193. https://doi.org/10.33759/jrki.v5i1.349
13. Wahyuningrum R, Wahyono D, Prabandari YS. Wawancara Motivasi Apoteker Untuk Kepatuhan Terhadap Pengobatan Diabetes Melitus Tipe 2. Pharmacon. 2016;5(2):191-195.
14. Fifi FF, Fitrisia A, Ofianto. Implementasi Thematic Analysis Melalui Langkah Coding Dalam Penelitian Kualitatif Pada Ilmu Sosial. FisiPublik: Jurnal Ilmu Sosial dan Plitik. 2023;8(1):443-453
15. Putra RJS, Achmad A, Pramestutie HR. Kejadian Efek Samping Potensial Terapi Obat Anti Diabetes Pada Pasien Diabetes Melitus Berdasarkan Algoritme Naranjo. Pharm J Indones. 2017;2(2):45-50. https://doi.org/10.21776/ub.pji.2017.002.02.3
16. Faria HTG, Rodrigues FFL, Zanetti ML, Araujo MFM, Damasceno MMC. Adherence to diabetes mellitus treatments in family health strategy units. Rev da Esc Enferm. 2014;48(2):254-260. https://doi.org/10.1590/S0080-623420140000200009
17. McCreight LJ, Bailey CJ, Pearson ER. Metformin and the gastrointestinal tract. Diabetologia. 2016;59(3):426-435. https://doi.org/10.1007/s00125-015-3844-9
18. Setyawan FSF, Subagiyo A, Lakoan MR. The Role of Pharmacists In Pharmaceutical Services: A Literature Review. International Journal of Society Reviews. 2024;2(8):2263-2275.
19. Kurniasih DAA, Sinta I, Syania S, Andini H, Setiawati EP. Peran Apoteker dalam Kolaborasi Interprofesi: Studi Literatur. Maj Farm. 2022;18(1):72. https://doi.org/10.22146/farmaseutik.v18i1.71900
20. Helgesen AK, Nome CM, Stenbjerg JK, Arnesen MH, Aardalen TR, Dilles T, Pharmaceutical Care in Primary Healthcare-A Study of Nurses', Pharmacists', and Physicians' Experiences of Interprofessional Collaboration. Healthcare (Basel). 2024;12(11):1100. https://doi.org/10.3390/healthcare12111100
21. Mustaqimah M, Saputri R. Review: Faktor Tidak Patuh Minum Obat Pada Pasien Diabetes Melitus. J Farm Syifa. 2023;1(1):7-12. https://doi.org/10.63004/jfs.v1i1.111
22. Insani WN, Lestari K, Abdulah R, Ghassani SK. Pengaruh Pelayanan Informasi Obat terhadap Keberhasilan Terapi Pasien Diabetes Melitus Tipe 2. J Farm Klin Indones. 2013;2(4):127-135.
23. Goenarso R, Anastasya P. Peningkatan Pemahaman Pasien Diabetes Mellitus Tipe 2 Terhadap Obat Anti Diabetes Oral Di Klinik Penyakit Dalam Rumah Sakit Adi Husada Kapasari Surabaya. Adi Husada Nurs J. 2015;1(2):41. https://doi.org/10.37036/ahnj.v1i2.21
24. Prasetya SA, Irawan A, Rahman S. Hubungan Motivasi Terhadap Kepatuhan Pengobatan Pada Penderita Diabetes Melitus Tipe II. J Nurs Invent. 2023;4(1):15-24. https://doi.org/10.33859/jni.v4i1.294
25. Fatiha CN, Sabiti FB. Peningkatan Kepatuhan Minum Obat Melalui Konseling Apoteker pada Pasien Diabetes Mellitus Tipe 2 di Puskesmas Halmahera Kota Semarang. JPSCR J Pharm Sci Clin Res. 2021;6(1):41. https://doi.org/10.20961/jpscr.v6i1.39297
26. Liu Z, Sang X, Liu Y, Yu C, Wan H. Effect of psychological intervention on glycemic control in middle-aged and elderly patients with type 2 diabetes mellitus: A systematic review and meta-analysis. Prim Care Diabetes. 2024;18(6):574-581. https://doi.org/10.1016/j.pcd.2024.09.006
27. Mphasha MH, Mothiba TM, Skaal L. Family support in the management of diabetes patients' perspectives from Limpopo province in South Africa. BMC Public Health. 2022;22(1):1-8. https://doi.org/10.1186/s12889-022-14903-1
28. Baig AA, Benitez A, Quinn MT, Burnet DL. Family interventions to improve diabetes outcomes for adults. Ann N Y Acad Sci. 2016;1353(1):89-112. https://doi.org/10.1111/nyas.12844
29. Puspita IEA, Wibowo IMP, Kristianto FC. Implementasi Pelayanan Telefarmasi di Apotek Sesuai Standar Pelayanan Kefarmasian. MPI (Media Pharm Indones). 2022;4(2):105-113. https://doi.org/10.24123/mpi.v4i2.5278
30. Hirsch JD, Bounthavong M, Arjmand A, Hincapie AL, Ramjan S, Nisperos M, et al. Improved patient-reported medication adherence, patient satisfaction, and glycemic control in a collaborative care pharmacist-led diabetes 'tune-up' clinic. Int J Environ Res Public Health. 2021;18(17):1-10. https://doi.org/10.3390/ijerph18179242
31. Sinuraya RK, Oktrina A, Handayani NK, Destiani DP, Puspitasari IM. Pelayanan Farmasi Klinis Meningkatkan Kontrol Gula Darah Pasien Diabetes Melitus. Indones J Clin Pharm. 2019;8(4):271. https://doi.org/10.15416/ijcp.2019.8.4.271
32. Rofiq A, Boy E, Wilan R, Sari P, Ayu DD, Koto U. Edukasi Diabetes Mellitus pada Keluarga Binaan Keluarga Fakultas Kedokteran UMSU dimasa Pandemi COVID-19. J Implementa Husada. 2022;3(2):90-93. https://doi.org/10.30596/jih.v3i2.11274
33. Jordan OJ, Benitez A, Burnet DL, Quinn MT, Baig AA. The Role of Family in Diabetes Management for Mexican American Adults. Hisp Heal Care Int. 2024;22(2):109-118. https://doi.org/10.1177/15404153231206086
34. Bakhtiar HS. Dikotomi Eksistensi Telemedicine Bagi Masyarakat Terpencil: Perspektif Teori Kemanfaatan. J Paradigma. 2022;3(2):115-125. https://doi.org/10.22146/jpmmpi.v3i2.79461
35. Sarabi RE, Sadoughi F, Orak RJ, Bahaadinbeigy K. The effectiveness of mobile phone text messaging in improving medication adherence for patients with chronic diseases: A systematic review. Iran Red Crescent Med J. 2016;18(5). https://doi.org/10.5812/ircmj.25183
36. Trianggraini SA, Wahyuni S, Tuah UH, Artikel H. Kolaborasi Inovasi Pelayanan Kesehatan Melalui Mobile JKN. 2024;9:9-17. https://doi.org/10.71040/irpia.v9i9.251
37. Sagala RB, Hajad V. Inovasi Pelayanan Kesehatan Mobile JKN Di Kantor BPJS Kota Subulussalam. J Soc Polit Gov. 2022;4(1):14-23. https://doi.org/10.24076/JSPG.2022v4i1.775
2. Putri IH, Jati SP, Martini M. Faktor Penghambat Pelaksanaan SPM Kesehatan pada Penderita Diabetes Mellitus: Literatur Review. Malahayati Nurs J. 2023;5(8):2804-2816. https://doi.org/10.33024/mnj.v5i8.10974
3. Della A, Subiyanto P, Maria A. Faktor-Faktor Yang Berhubungan Dengan Kepatuhan Pengobatan Pasien Diabetes Melitus Tipe 2. J Keperawatan Klin dan Komunitas (Clinical Community Nurs Journal). 2023;7(2):124. https://doi.org/10.22146/jkkk.83090
4. Hutasuhut RF, Siregar PP. Kemudahan Akses Pelayanan Kesehatan Dapat Meningkatkan Kepatuhan Minum Obat Pasien Diabetes Melitus Tipe 2 di Puskesmas Medan Area Selatan. Pandu Husada. 2024;5(2):42-50.
5. Anshari AF, Ichsan B, Cholisoh Z. Hubungan Kepatuhan Minum Obat terhadap HbA1C dan Kualitas Hidup Pasien Diabetes di RSI Purwodadi. JPSCR J Pharm Sci Clin Res. 2023;8(3):317. https://doi.org/10.20961/jpscr.v8i3.73753
6. Soelistijo S. Pedoman Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 Dewasa di Indonesia 2021. Glob Initiat Asthma. 2021:46. Available from: www.ginasthma.org
7. Khairunnisa, Rawitri K, Wiryanto, Wahyuni S. Pengaruh Asuhan Kefarmasian Terhadap Outcome Klinis Dan Kualitas Hidup Pada Pasien Diabetes Melitus Tipe 2. JFIOnline. 2021;13(2):118-128. https://doi.org/10.35617/jfionline.v13i2.18
8. Wahyuningrum R, Wahyono D, Mustofa M, Prabandari YS. Pengelolaan Diabetes Melitus Tipe 2 Oleh Apoteker. JFIOnline. 2019;9(1). https://doi.org/10.35617/jfi.v9i1.550
9. Kamba V. Peran Apoteker dalam Meningkatkan Kepatuhan Berobat pada Pasien Diabetes Melitus. J Noncommunicable Dis. 2021;1(1):45. https://doi.org/10.52365/jond.v1i1.225
10. Putri MA, Sukandar EY. Pengaruh konseling apoteker terhadap kepatuhan terapi pasien diabetes melitus di beberapa puskesmas dan rumah sakit. 2024;4(3):275-286. https://doi.org/10.36805/jbf.v4i3.1130
11. Syafitri IW, Yasin NM, Sari IP. Pengaruh Edukasi oleh Apoteker dengan Metode Brief Counseling terhadap Pengetahuan, Kepatuhan dan Glukosa Darah Pasien DM Tipe 2 di Puskesmas Kabupaten Pemalang. J Manaj dan Pelayanan Farm (Journal Manag Pharm Pract). 2023;13(1):12. https://doi.org/10.22146/jmpf.74821
12. Rahmawaty A, Anggraeni NW. Pengaruh Konseling Apoteker Terhadap Tingkat Kepatuhan Minum Obat Dan Kadar Gula Darah Pasien Diabetes Mellitus. J Ris Kefarmasian Indones. 2023;5(1):181-193. https://doi.org/10.33759/jrki.v5i1.349
13. Wahyuningrum R, Wahyono D, Prabandari YS. Wawancara Motivasi Apoteker Untuk Kepatuhan Terhadap Pengobatan Diabetes Melitus Tipe 2. Pharmacon. 2016;5(2):191-195.
14. Fifi FF, Fitrisia A, Ofianto. Implementasi Thematic Analysis Melalui Langkah Coding Dalam Penelitian Kualitatif Pada Ilmu Sosial. FisiPublik: Jurnal Ilmu Sosial dan Plitik. 2023;8(1):443-453
15. Putra RJS, Achmad A, Pramestutie HR. Kejadian Efek Samping Potensial Terapi Obat Anti Diabetes Pada Pasien Diabetes Melitus Berdasarkan Algoritme Naranjo. Pharm J Indones. 2017;2(2):45-50. https://doi.org/10.21776/ub.pji.2017.002.02.3
16. Faria HTG, Rodrigues FFL, Zanetti ML, Araujo MFM, Damasceno MMC. Adherence to diabetes mellitus treatments in family health strategy units. Rev da Esc Enferm. 2014;48(2):254-260. https://doi.org/10.1590/S0080-623420140000200009
17. McCreight LJ, Bailey CJ, Pearson ER. Metformin and the gastrointestinal tract. Diabetologia. 2016;59(3):426-435. https://doi.org/10.1007/s00125-015-3844-9
18. Setyawan FSF, Subagiyo A, Lakoan MR. The Role of Pharmacists In Pharmaceutical Services: A Literature Review. International Journal of Society Reviews. 2024;2(8):2263-2275.
19. Kurniasih DAA, Sinta I, Syania S, Andini H, Setiawati EP. Peran Apoteker dalam Kolaborasi Interprofesi: Studi Literatur. Maj Farm. 2022;18(1):72. https://doi.org/10.22146/farmaseutik.v18i1.71900
20. Helgesen AK, Nome CM, Stenbjerg JK, Arnesen MH, Aardalen TR, Dilles T, Pharmaceutical Care in Primary Healthcare-A Study of Nurses', Pharmacists', and Physicians' Experiences of Interprofessional Collaboration. Healthcare (Basel). 2024;12(11):1100. https://doi.org/10.3390/healthcare12111100
21. Mustaqimah M, Saputri R. Review: Faktor Tidak Patuh Minum Obat Pada Pasien Diabetes Melitus. J Farm Syifa. 2023;1(1):7-12. https://doi.org/10.63004/jfs.v1i1.111
22. Insani WN, Lestari K, Abdulah R, Ghassani SK. Pengaruh Pelayanan Informasi Obat terhadap Keberhasilan Terapi Pasien Diabetes Melitus Tipe 2. J Farm Klin Indones. 2013;2(4):127-135.
23. Goenarso R, Anastasya P. Peningkatan Pemahaman Pasien Diabetes Mellitus Tipe 2 Terhadap Obat Anti Diabetes Oral Di Klinik Penyakit Dalam Rumah Sakit Adi Husada Kapasari Surabaya. Adi Husada Nurs J. 2015;1(2):41. https://doi.org/10.37036/ahnj.v1i2.21
24. Prasetya SA, Irawan A, Rahman S. Hubungan Motivasi Terhadap Kepatuhan Pengobatan Pada Penderita Diabetes Melitus Tipe II. J Nurs Invent. 2023;4(1):15-24. https://doi.org/10.33859/jni.v4i1.294
25. Fatiha CN, Sabiti FB. Peningkatan Kepatuhan Minum Obat Melalui Konseling Apoteker pada Pasien Diabetes Mellitus Tipe 2 di Puskesmas Halmahera Kota Semarang. JPSCR J Pharm Sci Clin Res. 2021;6(1):41. https://doi.org/10.20961/jpscr.v6i1.39297
26. Liu Z, Sang X, Liu Y, Yu C, Wan H. Effect of psychological intervention on glycemic control in middle-aged and elderly patients with type 2 diabetes mellitus: A systematic review and meta-analysis. Prim Care Diabetes. 2024;18(6):574-581. https://doi.org/10.1016/j.pcd.2024.09.006
27. Mphasha MH, Mothiba TM, Skaal L. Family support in the management of diabetes patients' perspectives from Limpopo province in South Africa. BMC Public Health. 2022;22(1):1-8. https://doi.org/10.1186/s12889-022-14903-1
28. Baig AA, Benitez A, Quinn MT, Burnet DL. Family interventions to improve diabetes outcomes for adults. Ann N Y Acad Sci. 2016;1353(1):89-112. https://doi.org/10.1111/nyas.12844
29. Puspita IEA, Wibowo IMP, Kristianto FC. Implementasi Pelayanan Telefarmasi di Apotek Sesuai Standar Pelayanan Kefarmasian. MPI (Media Pharm Indones). 2022;4(2):105-113. https://doi.org/10.24123/mpi.v4i2.5278
30. Hirsch JD, Bounthavong M, Arjmand A, Hincapie AL, Ramjan S, Nisperos M, et al. Improved patient-reported medication adherence, patient satisfaction, and glycemic control in a collaborative care pharmacist-led diabetes 'tune-up' clinic. Int J Environ Res Public Health. 2021;18(17):1-10. https://doi.org/10.3390/ijerph18179242
31. Sinuraya RK, Oktrina A, Handayani NK, Destiani DP, Puspitasari IM. Pelayanan Farmasi Klinis Meningkatkan Kontrol Gula Darah Pasien Diabetes Melitus. Indones J Clin Pharm. 2019;8(4):271. https://doi.org/10.15416/ijcp.2019.8.4.271
32. Rofiq A, Boy E, Wilan R, Sari P, Ayu DD, Koto U. Edukasi Diabetes Mellitus pada Keluarga Binaan Keluarga Fakultas Kedokteran UMSU dimasa Pandemi COVID-19. J Implementa Husada. 2022;3(2):90-93. https://doi.org/10.30596/jih.v3i2.11274
33. Jordan OJ, Benitez A, Burnet DL, Quinn MT, Baig AA. The Role of Family in Diabetes Management for Mexican American Adults. Hisp Heal Care Int. 2024;22(2):109-118. https://doi.org/10.1177/15404153231206086
34. Bakhtiar HS. Dikotomi Eksistensi Telemedicine Bagi Masyarakat Terpencil: Perspektif Teori Kemanfaatan. J Paradigma. 2022;3(2):115-125. https://doi.org/10.22146/jpmmpi.v3i2.79461
35. Sarabi RE, Sadoughi F, Orak RJ, Bahaadinbeigy K. The effectiveness of mobile phone text messaging in improving medication adherence for patients with chronic diseases: A systematic review. Iran Red Crescent Med J. 2016;18(5). https://doi.org/10.5812/ircmj.25183
36. Trianggraini SA, Wahyuni S, Tuah UH, Artikel H. Kolaborasi Inovasi Pelayanan Kesehatan Melalui Mobile JKN. 2024;9:9-17. https://doi.org/10.71040/irpia.v9i9.251
37. Sagala RB, Hajad V. Inovasi Pelayanan Kesehatan Mobile JKN Di Kantor BPJS Kota Subulussalam. J Soc Polit Gov. 2022;4(1):14-23. https://doi.org/10.24076/JSPG.2022v4i1.775
Published
2025-08-28
How to Cite
SWANDARI, Mika Tri Kumala; CHOLISOH, Zakky; KARUNIAWATI, Hidayah.
Hospital pharmacists’ perspectives on diabetes treatment barriers and solutions: A qualitative study from Indonesia.
Acta Pharmaciae Indonesia : Acta Pharm Indo, [S.l.], v. 13, n. 1, p. 15716, aug. 2025.
ISSN 2621-4520.
Available at: <https://jos.unsoed.ac.id/index.php/api/article/view/15716>. Date accessed: 06 sep. 2025.
doi: https://doi.org/10.20884/1.api.2025.13.1.15716.
Section
Articles
This work is licensed under a Creative Commons Attribution 4.0 International License.
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