INTRODUCTION:

The role of pharmacists in the healthcare system has evolved significantly over the past few decades. Beyond their traditional duties of preparing and dispensing medications, pharmacists now play a crucial role in patient therapy management through the pharmaceutical care model¹.

Pharmaceutical care aims to ensure that patients' medication use is safe and effective, thereby improving clinical outcomes and patients' quality of life^2,3.

Diabetes mellitus is one of the most common chronic diseases encountered in healthcare practice. This condition requires complex and continuous therapy management to control blood glucose levels and prevent complications⁴. Pharmacists play a vital role in the pharmaceutical care of diabetes mellitus patients, including providing education, monitoring drug therapy, and collaborating with other healthcare professionals to optimize treatment outcomes^5,6.

However, the implementation of pharmaceutical care in diabetes mellitus patients often faces various challenges. These challenges include a lack of clear standards, generic practice guidelines, and systemic barriers such as limited resources and time constraints^7-9. Therefore, there is an urgent need to develop a pharmaceutical care implementation model that can address these challenges and be widely applied in various healthcare settings.

In the current digital era, information technology, particularly social media, has become an integral part of daily life¹⁰. Its widespread use and high accessibility offer new opportunities in various fields, including pharmaceutical care. Social media, with its ability to reach a broad audience and provide real-time information, presents significant potential for enhancing the implementation of pharmaceutical care^11-13.

This study aims to develop a hybrid pharmaceutical care implementation model that combines conventional face-to-face approaches with the use of social media. Focus groups are conducted as the primary method to identify the acceptability, suggestions, and barriers in implementing this model for diabetes mellitus patients. Through a systematic and participatory approach, it is hoped that this hybrid implementation model will not only improve the quality of pharmaceutical care for diabetes mellitus patients but also be adaptable and applicable to various local contexts.

MATERIALS AND METHODS:

Design:

This study was a qualitative using a focus group discussion (FGD) approach. The participants in this study include three pharmacists from primary healthcare centers, three academics, two members of a pharmacist association, and one representative of a local policymaker. Participant selection was conducted using purposive sampling. The study was carried out in February 2024. This study utilized semi-structured group discussions where discussion questions followed a guide, but the researcher could still explore topics that might diverge from the guide. Participants were provided with a draft of the Hybrid Pharmaceutical Care model one week before the FGD for review. Member checking was performed at the end of the FGD by presenting the researcher’s notes to each participant for correction and confirmation. Audio recordings were transcribed verbatim. Participant identities and other identifying information were removed during the transcription process before data analysis. Themes, sub-themes, and categories were identified from thematic content analysis of the transcripts. A shared coding tree was developed after coding the transcripts. The transcripts were analyzed by three researchers and then discussed collectively to identify themes, sub-themes, and categories.

Ethical Approval:

Before the discussion, the researcher provides participants with information about the aim, benefits, and process of the study. Participants who agree to participate sign a research consent form. The study was approved by The Ethical Committee of Medical Research, Medical Faculty, University of Lambung Mangkurat Banjarmasin, Indonesia (No.119/KEPK-FK ULM/EC/IV/2022).

RESULT:

Participant Demographic:

The total number of participants in this study was nine. The participants consist of pharmacist from primary healthcare centers, Academics, Members of Pharmacist Association, and Local Policymaker. The demographic characteristics of the participants are presented in Table 1.

Development of a Hybrid Pharmaceutical Care Implementation Model:

The focus group discussion (FGD) played a critical role in the development of the hybrid pharmaceutical care implementation model. Through in-depth discussions, participants shared their insights and experiences, leading to the identification of key themes, sub-themes, and categories that are central to the hybrid pharmaceutical care implementation model design. These thematic elements emerged from a systematic analysis of the dialogue, revealing the multifaceted nature of pharmaceutical care and the diverse perspectives of stakeholders involved. The thematic analysis results, which capture the core ideas and patterns from the FGD, are comprehensively summarized and organized in Table 2.

Table 2. Classification of themes and sub-themes

Theme	Sub-theme	Category	Keywords	Informant
Acceptability of the Hybrid Model Implementation	Support for the implementation of the hybrid model	Support from pharmacy associations	Once successfully implemented in the community health center, the model should also be applied in community pharmacies.	PA1
		Support from the Health Department (local policymaker)	The implementation of the hybrid model aligns with the Information System Program for Monitoring and Guidance of Pharmaceutical Facilities (Simona) from the Department of Health.	LP
		Support from practicing pharmacists	The hybrid model simplifies pharmaceutical care for patients with diabetes mellitus.	P1, P2
		Support from academics	The hybrid model and module are sufficiently comprehensive and can support the implementation of pharmaceutical care.	A3
	Simplicity of implementing the hybrid model	Experience with telepharmacy during the COVID-19 pandemic	During the COVID-19 pandemic, patients were afraid to access healthcare and had difficulty accessing information. This hybrid model allows patients to consult with pharmacists without needing to meet in person.	LP
		Pharmacists have the competency to implement the hybrid pharmaceutical care model	The module is adequately detailed and supports pharmaceutical care. Using WhatsApp for pharmaceutical care can simplify pharmacists' practices	A3, P1
		The hybrid model is considered sufficiently applicable or easy to implement	The hybrid model is highly applicable. This model can be implemented for patients at community health centers.	P2, P3
		Pharmaceutical care using WhatsApp has already been used	Pharmaceutical care with social media has been applied to patients with diarrhea, but it has not yet been used for patients with diabetes mellitus.	P1

Notes: Pharmacist = P, Academics = A, Pharmacist association = PA, Local policymaker = LP

Table 2. Classification of themes and sub-themes (Continued)

Theme	Sub-theme	Category	Keywords	Informant
Barriers to Implementing the Hybrid Model	Patient Perspective Barriers	Patients who lack technological proficiency	Most patients are still not very familiar with information technology such as WhatsApp.	PA1
		Patients are often in a hurry to leave when provided with education	Patients want to leave quickly after receiving their medication.	P3
		The narrative sent via WhatsApp is monotonous and too lengthy	Long sentences make patients bored with reading them. Written information of this nature is monotonous. The narrative is too lengthy.	LP, A3, A2
	Pharmacist Perspective Barriers	Additional workload	The use of this hybrid model has the potential to increase workload and working hours. It may add tasks beyond regular working hours.	A2, A3
	Pharmacist Perspective Barriers	The community health center has just one pharmacist, who already has a significant workload	There is only one pharmacist at the community health center, and their workload is already heavy.	PA2
Recommendations for Developing the Hybrid Model	Module Content and Structure	The module is made more concise by including images as an alternative to lengthy text	The module is made more concise or includes images. Pictures are added to the module. The opening and closing sentences are too lengthy; get straight to the point for the key information. The algorithm is presented in a flowchart format, so pharmacists can use it directly.	LP, P2, A3, A1
		Providing motivation to patients to prevent boredom with diabetes mellitus medication	Many patients understand and are aware of the side effects and proper use of medication, but they are non-adherent because they are bored.	PA2
		A systematic approach to assessment, care planning, evaluation, and follow-up in the module	The columns in the patient medication record should be comprehensive, including patient demographics, drug aspects, clinical aspects, and pharmaceutical care (assessment, care plan, evaluation, and follow-up).	A1
	Implementation of the Hybrid Model	Educational tools in the form of flip charts	Including flip charts, such as calendars, containing educational information to help patients focus better on the information. Providing a flowchart for the implementation stages. Adding supporting images.	P1, A2, A1
	Implementation of the Hybrid Model	The hybrid model is implemented within a short timeframe.	The implementation of this hybrid model is expected to require minimal time.	PA2
	Implementers of the Hybrid Model	The implementation of the hybrid model must be conducted by a pharmacist	This hybrid model is specifically within the domain of pharmacists; only pharmacists are authorized to use this model. This hybrid model is intended for pharmacists, and it is expected that they will practice correctly.	PA1, A1

Notes: Pharmacist = P, Academics = A, Pharmacist association = PA, Local policymaker = LP

DISCUSSION:

Theme 1: Acceptability of the Hybrid Model Implementation

1. Support for the implementation of the hybrid model:

The focus group discussion results show that all participants support the implementation of the hybrid pharmaceutical care model for patients with diabetes mellitus. Practicing pharmacists at community health centers believe that the model is easy to apply. Additionally, representatives from the Department of Health also stated that this hybrid pharmaceutical care model aligns with the pharmaceutical care program promoted by the Department through the telepharmacy concept. Academics and members of pharmacy organizations indicated that the hybrid pharmaceutical care model meets the standards of pharmaceutical care and thus has the potential for implementation. The pharmaceutical care standards set by the Indonesian Ministry of Health are currently only implemented in person when patients and pharmacists meet at healthcare facilities¹⁴. As technology and communication evolve, social media has become a valuable resource for aiding the implementation of pharmaceutical care^15,16. The use of social media enables pharmacists to provide more intensive education and conduct follow-up evaluations of diabetes medication outcomes without the need for in-person meetings or while patients are receiving medication at home. Social media applications in supporting healthcare have been widely adopted and have shown positive results in the health outcomes of diabetes patients^12,17.

2. Simplicity of implementing the hybrid model:

The module developed for the implementation of the hybrid pharmaceutical care model includes a guide and systematic steps for pharmaceutical care. Practicing pharmacists at community health centers have stated that the module’s content is easy to understand and implement because it aligns with their competencies. Pharmacists have foundational competencies related to pharmaceutical care acquired during their education, so this hybrid pharmaceutical care model can strengthen and develop the skills they already possess^18,19. Telepharmacy has been increasingly implemented for patients since the COVID-19 pandemic. Pharmacists' experience with telepharmacy during the pandemic can facilitate adaptation to the implementation of this hybrid model, minimizing the need for significant adjustments^20,21. The study conducted on 378 Indonesian pharmacists found that most study participants had sufficient knowledge, positive perceptions, and readiness to implement telepharmacy services in their future pharmaceutical practice²². A hybrid pharmaceutical care model can be integrated into pharmaceutical care standards to improve health outcomes for patients with diabetes mellitus.

Theme 2: Barriers to Implementing the Hybrid Model

1. Patient Perspective Barriers:

The implementation of the hybrid pharmaceutical care model still encounters various challenges, especially from the patients' side. Patients with diabetes mellitus are typically elderly, which can lead to several limitations, particularly in using social media and mobile phone technology²³. Elderly is often associated with a decline in physical and cognitive abilities. This decline can affect patients' ability to learn and use new technologies, including digital applications or platforms that may be utilized in the hybrid pharmaceutical care model²⁴. These limitations can become obstacles for patients in accessing health information, communicating with healthcare professionals, and managing their medication independently. It is important to develop content in the hybrid pharmaceutical care model that is engaging, concise, effective, and easily understandable for patients. The content should be designed to convey the necessary information in a clear and straightforward manner²⁵. The use of easily understandable language and appealing visuals can help improve patients' comprehension of the information provided. Additionally, technical support and training for elderly patients in using technology can be solutions to overcome these challenges²⁴.

2. Pharmacist Perspective Barriers:

Besides the challenges faced by patients, the implementation of the hybrid pharmaceutical care model also encounters several issues on the pharmacists' side. A major challenge is the extra workload that pharmacists need to handle^26,27. In many community health centers, there is often only one pharmacist available, leading to a limited number of pharmacists. This adds to the challenge, as the pharmacist must manage numerous responsibilities and routine tasks. A national survey in Indonesia indicates that a key barrier to implementing pharmaceutical care is the shortage of pharmacists in healthcare facilities²⁸.

The addition of tasks in implementing the hybrid pharmaceutical care model, such as monitoring patients' use of technology, providing health education digitally, and ensuring medication adherence through online platforms, can increase pharmacists' workload. This situation has the potential to cause fatigue and a decrease in pharmacists' productivity, which could ultimately affect the quality of pharmaceutical care provided to patients. Therefore, good and adequate workload management will help pharmacists in community health centers to be more effective in implementing the hybrid pharmaceutical care model²⁷.

Theme 3: Recommendations for Developing the Hybrid Model

1. Module Content and Structure:

To overcome various challenges in implementing the hybrid pharmaceutical care model, especially those related to patient limitations and pharmacists' workload, a carefully and efficiently designed module is needed. The module should be structured with content that is concise yet thorough, clear, and comprehensive. This will make it easier for both pharmacists and patients to understand and use the module without being overwhelmed by excessive information. Additionally, step-by-step guides or algorithms for each procedure or activity that needs to be performed by pharmacists or patients are necessary. These guides should be supplemented with relevant illustrations. Using images and visuals as alternatives to lengthy text can be particularly helpful for elderly patients, making the information easier to comprehend²⁹. Visualizing the medication process, using diagrams for medication usage, and incorporating simple icons can enhance the understanding of information. Other research indicates that engaging content is more likely to be accepted and comprehended by patients³⁰. Including motivational content for diabetes mellitus patients to adhere to their treatment regimen is also crucial. Existing research shows that providing motivation can improve medication adherence among diabetes mellitus patients³¹.

2. Implementation of the Hybrid Model:

The implementation of the hybrid pharmaceutical care model involves both face-to-face interactions when pharmacists meet with patients and social media communication when patients are undergoing treatment at home. In the face-to-face component of the hybrid model, using aids such as educational flipcharts can help pharmacists deliver educational material more effectively. These aids will capture the patients' attention and help them focus more on the presented educational content, thus enhancing their understanding of the material³².

The use of flipcharts that provide guidance and content about the hybrid pharmaceutical care model also helps pharmacists utilize the implementation time more efficiently and effectively, without compromising the quality of education provided to diabetes mellitus patients. Additionally, in the hybrid model implemented through social media, educational videos enable patients to absorb information more effectively. Other research indicates that flipcharts are understood with an ease level of 76-100% and followed up with an ease level of 80-100%, while videos are understood with an ease level of 90-100% and followed up with an ease level of 100%³³.

3. Implementers of the Hybrid Model:

The implementation of the hybrid pharmaceutical care model requires the presence of pharmacists as the primary executors, given their competencies and legal authority. Pharmacists are the only professionals with specialized expertise and training in pharmacy, as well as the legal authority to provide pharmaceutical care in accordance with established standards³⁴. Pharmacists are professionals with in-depth training in pharmacy, encompassing knowledge of medications, drug interactions, and appropriate therapies for various medical conditions. This expertise is crucial for ensuring that the hybrid pharmaceutical care model is implemented correctly and effectively. Pharmacists are not only capable of assessing patients' medication needs but also providing evidence-based consultations, monitoring side effects, and adjusting therapies as necessary. Numerous studies have demonstrated that pharmaceutical care provided by pharmacists is effective in improving health outcomes for diabetes mellitus patients^35,36.

CONCLUSION:

These findings strongly endorse the broader adoption of the hybrid pharmaceutical care model, which leverages both face-to-face interactions and social media platforms for implementation by pharmacists. This model is particularly beneficial for managing chronic conditions such as diabetes mellitus, as it improves the accessibility and efficiency of care. By integrating traditional in-person consultations with modern digital communication tools such as social media, the hybrid approach not only extends the reach of pharmaceutical care but also provides continuous support and education for diabetes management. This comprehensive coverage can lead to improved patient outcomes, better glycemic control, and increased satisfaction among patients living with diabetes mellitus.

CONFLICT OF INTEREST:

The authors have no conflicts of interest regarding this study.

ACKNOWLEDGMENTS:

The authors would like to thank the academics, pharmacists practicing at the Banjarmasin City Health Center, the Indonesian Pharmacists Association, and the Banjarmasin City Health Policy Makers for their contributions in providing experience and ideas for this research.

REFERENCES:

1. Raiche T, Pammett R, Dattani S, Dolovich L, Hamilton K, Kennie-Kaulbach N, et al. Community pharmacists' evolving role in Canadian primary health care: a vision of harmonization in a patchwork system. Pharm Pract (Granada). 2020; 18(4): 2171.

2. Stewart D, Anthony B, Morrison C, MacRae Y, Dixon L, Friel E, et al. Evaluating pharmacist input into the pharmaceutical care of patients in dispensing medical practices in remote and rural areas of Scotland. Fam Pract. 2017; 34(4): 491-9.

3. Mossialos E, Courtin E, Naci H, Benrimoj S, Bouvy M, Farris K, et al. From "retailers" to health care providers: Transforming the role of community pharmacists in chronic disease management. Health Policy. 2015; 119(5): 628-39.

4. Pertiwi MV, Alfian R, Nita Y, Athiyah U. Medication adherence of diabetes mellitus patients in Indonesia: A systematic review. Pharmacy Education. 2022: 188-93.

5. Brewster S, Holt R, Portlock J, Price H. The role of community pharmacists and their position in the delivery of diabetes care: an update for medical professionals. Postgrad Med J. 2020; 96(1138): 473-9.

6. Mishra V, Nayak P, Sharma M, Albutti A, Alwashmi ASS, Aljasir MA, et al. Emerging Treatment Strategies for Diabetes Mellitus and Associated Complications: An Update. Pharmaceutics. 2021; 13(10).

7. Koster ES, Philbert D, Bouvy ML. Impact of the COVID-19 epidemic on the provision of pharmaceutical care in community pharmacies. Res Social Adm Pharm. 2021; 17(1): 2002-4.

8. Silva BB, Fegadolli C. Implementation of pharmaceutical care for older adults in the brazilian public health system: a case study and realistic evaluation. BMC Health Serv Res. 2020; 20(1): 37.

9. Foo KM, Sundram M, Legido-Quigley H. Facilitators and barriers of managing patients with multiple chronic conditions in the community: a qualitative study. BMC Public Health. 2020; 20(1): 273.

10. Farsi D. Social Media and Health Care, Part I: Literature Review of Social Media Use by Health Care Providers. J Med Internet Res. 2021; 23(4): 23205.

11. Car J, Tan WS, Huang Z, Sloot P, Franklin BD. eHealth in the future of medications management: personalisation, monitoring and adherence. BMC Med. 2017; 15(1): 73.

12. Alfian R, Athiyah U, Nita Y. Social media health interventions to improve diabetes mellitus patient outcome: a systematic review. J Basic Clin Physiol Pharmacol. 2021; 32(4): 297-304.

13. Lin Y-H, Chen R-R, Guo SH-M, Chang H-Y, Chang H-K. Developing a web 2.0 diabetes care support system with evaluation from care provider perspectives. Journal Of Medical Systems. 2012; 36(4): 2085-95.

14. Kemenkes. Regulation of The Minister of Health of The Republic of Indonesia Number 74 of 2016 on Standards of Pharmaceutical Services In Community Health Centers. In: Department H, editor. Jakarta: Ministry of Health of the Republic of Indonesia; 2016.

15. Chen J, Wang Y. Social Media Use for Health Purposes: Systematic Review. J Med Internet Res. 2021; 23(5): 17917.

16. Ghahramani A, de Courten M, Prokofieva M. The potential of social media in health promotion beyond creating awareness: an integrative review. BMC Public Health. 2022; 22(1): 2402.

17. Gabarron E, Årsand E, Wynn R. Social Media Use in Interventions for Diabetes: Rapid Evidence-Based Review. Journal Of Medical Internet Research. 2018; 20(8): e10303-e.

18. Fukawa T, Mohri J, Kobayashi M, Atsuda K. Training needs of community pharmacists for advanced pharmaceutical care management. Pharmacy Education. 2022; 22(1): 416-23.

19. Marjadi B, Alfian R, Susanto Y, Tjandra L, Pratama ANW, Schneider C. Pharmacists' continuing professional development for non-communicable diseases management: A consensus study. Res Social Adm Pharm. 2022; 18(11): 3964-73.

20. Sarasmita MA, Sudarma IW, Adi Jaya MK, Irham LM, Susanty S. Telepharmacy Implementation to Support Pharmaceutical Care Services during the COVID-19 Pandemic: A Scoping Review. Canadian Journal of Hospital Pharmacy. 2024; 77(1).

21. Rabbani SA, Sharma S, Mahtab A, Pottoo FH, Sridhar SB. A systematic scoping review of implementation of telepharmacy during COVID-19. Journal of Applied Pharmaceutical Science. 2022.

22. Wathoni N, Lestari K, Iftinan G, Rahayu S, Nurlatifah A, Khairinisa M, et al. Knowledge, Perception, and Readiness of Indonesian Pharmacists for the Implementation of Telepharmacy-Based Pharmaceutical Services in Indonesia. Integrated Pharmacy Research and Practice. 2023; 12: 213-25.

23. Toschi E, Munshi MN. Benefits and Challenges of Diabetes Technology Use in Older Adults. Endocrinol Metab Clin North Am. 2020; 49(1): 57-67.

24. Zhang Y, Li X, Luo S, Liu C, Xie Y, Guo J, et al. Use, Perspectives, and Attitudes Regarding Diabetes Management Mobile Apps Among Diabetes Patients and Diabetologists in China: National Web-Based Survey. JMIR mHealth and uHealth. [Article]. 2019; 7(2).

25. Brown WI, Cernusca D, Roehrich L. Evaluation of a Hybrid Training Module for Community Pharmacy Staff Providing Hypertension Medication Therapy Management. J Pharm Pract. 2018; 31(2): 183-9.

26. Puspitasari HP, Aslani P, Krass I. Challenges in the management of chronic noncommunicable diseases by Indonesian community pharmacists. Pharm Pract (Granada). 2015; 13(3): 578.

27. Shao SC, Chan YY, Lin SJ, Li CY, Kao Yang YH, Chen YH, et al. Workload of pharmacists and the performance of pharmacy services. PLoS One. 2020; 15(4): e0231482.

28. Rendrayani F, Alfian SD, Wahyudin W, Puspitasari IM. Knowledge, attitude, and practice of medication therapy management: a national survey among pharmacists in Indonesia. Front Public Health. 2023; 11: 1213520.

29. Schubbe D, Scalia P, Yen RW, Saunders CH, Cohen S, Elwyn G, et al. Using pictures to convey health information: A systematic review and meta-analysis of the effects on patient and consumer health behaviors and outcomes. Patient Educ Couns. 2020; 103(10): 1935-60.

30. Monkman H, Kushniruk AW, Borycki EM, Sheets DJ, Barnett J. Differences in Memory, Perceptions, and Preferences of Multimedia Consumer Medication Information: Experimental Performance and Self-Report Study. JMIR Hum Factors. 2020; 7(4): 15913.

31. Dehghan-Nayeri N, Ghaffari F, Sadeghi T, Mozaffari N. Effects of Motivational Interviewing on Adherence to Treatment Regimens Among Patients With Type 1 Diabetes: A Systematic Review. Diabetes spectrum: a publication of the American Diabetes Association. 2019; 32(2): 112-7.

32. Manaf ZA, Rosli MHM, Noor NM, Jamil NA, Mazri FH, Shahar S. Exploring dietitians' views on digital nutrition educational tools in Malaysia: a qualitative study. Nutr Res Pract. 2024; 18(2): 294-307.

33. Jamil NA, Chau SH, Abdul Razak NI, Shamsul K, II, Mohd-Said S, Rani H, et al. Development and evaluation of an integrated diabetes-periodontitis nutrition and health education module. BMC Med Educ. 2021; 21(1): 278.

34. Bader LR, Bates I, Galbraith K. Trends in advanced practice and specialisation in the global pharmacy workforce: a synthesis of country case studies. Int J Pharm Pract. 2020; 28(2): 182-90.

35. Abdulrhim S, Sankaralingam S, Ibrahim MIM, Awaisu A. The impact of pharmacist care on diabetes outcomes in primary care settings: An umbrella review of published systematic reviews. Prim Care Diabetes. 2020; 14(5): 393-400.

36. Shrestha S, Shrestha R, Ahmed A, Sapkota B, Khatiwada AP, Christopher CM, et al. Impact of pharmacist services on economic, clinical, and humanistic outcome (ECHO) of South Asian patients: a systematic review. J Pharm Policy Pract. 2022; 15(1): 37.

Received on 26.08.2024 Revised on 20.05.2025

Accepted on 16.11.2025 Published on 13.01.2026

Available online from January 17, 2026

Research J. Pharmacy and Technology. 2026;19(1):313-318.

DOI: 10.52711/0974-360X.2026.00045

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.

Characteristics	Pharmacist	Academics	Pharmacist association	Local policymaker
Age
30 – 40 years	1	1
>40 years	2	2	2	1
Education
Pharmacist	3		1
Master		1		1
Doctor		2	1
Length of service
<10 years	1	1
>10 years	2	2	2	1