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The Assessment of Patient Satisfaction and Attendance of Community Pharmacies in Slovakia

The Assessment of Patient Satisfaction and Attendance of Community Pharmacies in Slovakia Keywords Kúcové slová: INTRODUCTION Pharmacists are the most accessible health care professionals and play a key role in the delivery of health care services, particularly in ensuring effective and safe treatment. In the era of rapidly accelerating changes in health care delivery, the * E-mail: minarikova@fpharm.uniba.sk © European Pharmaceutical Journal roles of pharmacists are constantly being redefined (European Community Pharmacy Blueprint, 2012). During the past years, the pharmacist´s role has grown and changed to encompass areas beyond the function of dispensing medications. The new role is based on the concept of changing the pharmacist´s focus from drug providing and distributing services to more patient-oriented approaches (Hepler & Strand, 1990) with positive impact on patient outcomes (Armour et al, 2007, Nkansah et al, 2010). Despite the fact that the concept of new pharmaceutical care is now widely accepted by pharmacists, there are serious barriers in implementation of this concept in real pharmaceutical practice (Van Mil, 2001). The transition to a market-oriented economy in Slovakia, like other Eastern European countries, caused changes in the healthcare system and affected all its aspects, including pharmacy care, pharmacy services, pharmacist´s role and expectations and patient´s behaviour (Volmer et al. 2009). While the total number of pharmacists in the year 1999 was 2 175 (Health Statistics Yearbook of the Slovak Republic, 1999), today this is higher than twice that number. According to the Slovak Chamber of Pharmacists, 4 419 pharmacists and 1 972 pharmacies are currently in Slovakia (Slovak Chamber of Pharmacists, 2015). With density of 822 pharmacists and 366 pharmacies per 10 000 inhabitants, Slovakia is comparable with other European countries (International Pharmaceutical Federation Global Pharmacy Workforce Report, 2012). The distribution of pharmacies in Slovakia shows regional disparities. The number of pharmacies and pharmacists is not regulated and it dramatically increased as a result of legislative changes and liberalisation of ownership regulation, which enables non-pharmacists to own pharmacies. It is estimated that about 70% of all pharmacies in Slovakia are part of some or the other pharmacy chains (Szalayová et al. 2014). Community pharmacies are privately owned in Slovakia, they run on a profit basis and are not subsidised by the state. All prescription (Rx) and non-prescription (over-the-counter = OTC) medicines can be purchased only from community pharmacy (Szalay et al. 2011). The significant market competition together with regulatory arrangements, represent indirect factors that affect the financial­economic situation of pharmacies as business entities (Malovecka et al. 2015, Vogler et al. 2012,). There is no doubt that community pharmacies must now try to create new image by overcoming the perception of pharmacist as medicine dispenser to professional provider of healthcare goods and services oriented to patient needs with the aim of fully satisfying them. Pharmacists who can demonstrate greater patient satisfaction may be at a competitive advantage. Patient satisfaction becomes an important indicator of availability and quality of provided care (Cleary & McNeil, 1988, Kucukarslan & Schommer, 2002). Sitzia and Wood emphasise that effectiveness of medical care should not be expressed only by clinical and economic parameters, but as well by patient opinions in assessment of this care (Sitzia & Wood, 1997). There are strong evidences that patient satisfaction is linked with better medication compliance, clinical outcomes (Kane et al. 1997, Ware & Davies, 1983), patient loyalty with care providers (Garman et al. 2004, Oparah & Kikanme, 2006) and with continuously using health care service (Zastowny et al. 1989). Collecting data by using available instruments to measure patient satisfaction is valuable for continuous quality improvement to identify variations, trends and patterns. Published studies from developed countries concentrate on patient satisfaction with pharmaceutical care (Naik Panvelkar et al. 2009) or with specific disease management (Armour et al. 2007). There are also data that show positive correlation between patient choice of pharmacy, provided pharmaceutical care and loyalty of patients (Merks et al. 2014). It seems that consistently applied pharmaceutical care can influence the patient's choice of pharmacy and also patient satisfaction. Similar data from Slovakia are still inadequate. This study presents the first Slovak nationwide patientreported outcomes about patient satisfaction with pharmaceutical care provided in community pharmacies. An additional objective was to identify reasons of pharmacy attendance and determine factors that influence patient's choice of community pharmacy in Slovakia. METHODS This is a cross-sectional study utilising self-administered questionnaire. The survey questionnaire was developed from published studies (Larson et al. 2002, Traverso et al. 2007). All items were translated to Slovak language using a forward backward method and randomly assigned. Three dimensions were proposed: managing therapy (16 items), interpersonal relationship (9 items) and general satisfaction (4 items). A 5-point Likert-type scale (1 = very satisfied, 2 = satisfied, 3 = neither satisfied nor dissatisfied, 4 = dissatisfied, 5 = very dissatisfied) was used to measure the extent of patient satisfaction with the pharmaceutical care provided in community pharmacies. To evaluate patient attendance in community pharmacy, the respondents were inquired about their reasons for visiting a community pharmacy and the factors that make them choose a particular pharmacy. Respondents could indicate more than one given options. Finally, sociodemographic and health characteristics were included into the questionnaire. The questionnaire was first applied in a pilot test (10 patients) for clarity, relevance, acceptability and time to completion. Refinements were made to the survey accordingly. The results from pilot testing were not included in the main study. The participants of the survey were asked by the specially educated students from Faculty of Pharmacy of the Comenius University in Bratislava to give oral permission for participation in the survey and answer the self-administered questionnaire, explaining to them that it was voluntary and confidential. No inclusion or exclusion criteria were predetermined. Data collection took place over an 8-week period between October and December 2013 in a total of 33 community pharmacies in 23 different Slovak cities. The selection of pharmacies was random and reflected the actual possibilities of research organiser and the agreement of pharmacy. Daniela Minarikova Table 1. Characteristics of study respondents (n = 2 844) Characteristics Gender (N = 2 841)a Age (years) (N = 2 844)a Male Female 30 31­60 61 Primary school Level of education (N = 2 799)a Secondary school High school Number of Rx or OTC drugs during the last month (N = 2 832)a Number of prescriptions during the last 3 months (N = 2 829)a Number of pharmacies visited during the last 3 months (N = 2 812)a Long-term use of medicines (N = 2 835)a Average monthly expenditure for medicines and other goods from the pharmacy (euro) (N = 2 833)a 0 1­2 3 0 1­ 2 3 1 2 3 Yes No < 10 10­30 > 30 > 100 000 City (number of inhabitants) (2 844)a < 100 000 < 50 000 < 20 000 Frequency (%) 944 (33.2) 1 897 (66.8) 801 (28.2) 1 531 (53.8) 512 (18.0) 187 (6.7) 1 649 (58.9) 963 (34.4) 474 (16.7) 1 198 (42.3) 1 160 (41.0) 830 (29.3) 1 215 (42.9) 784 (27.7) 1 269 (45.1) 1 054 (37.5) 490 (17.4) 1 279 (45.1) 1 556 (54.9) 1 237 (43.7) 1 149 (40.6) 447 (15.8) 326 (11.5) 557 (19.6) 957 (33.6) 1 004 (35.3) score and standard deviations according to original 5-point Likert scale. Calculated scores were collapsed into three satisfaction levels (high satisfaction = range of score 1.00­ 2.50, moderate satisfaction = range of score 2.51­3.50, low satisfaction = range of score 3.51­5.00). RESULTS General characterisation of survey During the 8-week study period, 2 844 respondents answered the survey. Their characteristics are summarised in Table 1. The mean age was 44.0 years with a standard deviation of 17.1 years. A total of 53.8% participants were in the 31­60 years age group. The majority of the participants (66.8%) were females, 58.9% had completed a secondary education. From the total number of study respondents, 11.5% were from cities with more than 100 000 inhabitants (only two cities in Slovakia), 19.6% were from cities with up to 100 000 inhabitants, 33.6% were from cities with up to 50 000 inhabitants and 35.3% were from cities with up to 20 000 inhabitants. From the total number, 42.3% of participants had one or two medicines and 41.0% had three or more medicines during last month (either Rx or OTC drugs). As physicians can prescribe medicines for longer time, the number of prescriptions can be lower. Only 27.2% of the participants had three or more prescriptions during the last 3 months, 42.9% had one or two prescriptions and 29.3% had no prescriptions during the last 3 months. Long-term use of medicines (for example, drugs for chronic diseases, such as diabetes, hypertension and others) were used by 45.1% of respondents. Our data show that respondents usually do not attend many pharmacies. Only 17.4% of the respondents visited three or more pharmacies during the last 3 months, the rest of respondents visited only one or two. With the wide availability of the pharmacies, this finding can be an indirect indicator of the patient´s satisfaction - satisfied patient does not need to visit more pharmacies to fulfil his/ her requirements. 43.7% of our respondents stated that their average monthly expenditures for pharmaceutical products (it means co-payment on Rx products, OTC drugs, other goods in pharmacy) are less than 10 euro, 40.6% spent from 10­30 euro, but 15.8% spent more than 30 euro in average per month. Not all respondents completed every item. N = number of respondents completing the item. All questionnaires were analysed regardless of the completeness of questionnaire; therefore, the actual evaluated numbers are different from the total number of respondents (n = 2 844). After coding and checking the questionnaires for accuracy, they were statistically analysed using the Statistical Package for Social Sciences (SPSS) version 19.0 for Windows. Frequency and percentage statistics were used to represent results. In order to present patient satisfaction in a measurable way, scoring of responses was done for all items as the mean Patient attendance of community pharmacies The main reasons for visiting pharmacy are shown in Table 2. The two main stated reasons for visiting community pharmacy were to obtain prescription medication (70.4%) and over-thecounter medications (70.4%). Due to counselling and using pharmaceutical services, only 12.0% and 4.5% of respondents separately reported visiting community pharmacy. The main factors influencing the choice of any particular pharmacy are in Table 3. The primary factor was the pharmacy location (74.1% of respondents) followed by good experience with the pharmacy (49.3% of respondents). The less Table 2. Main reasons for visiting a community pharmacy (n = 2 844) Main factors for visiting community pharmacy To obtain prescription medications Frequency (%) 2 001 (70.4) To obtain over-the-counter medications and 2 001 (70.4) food supplements To obtain other products (cosmetics, baby care products ...) Counselling Pharmacy services (measure blood pressure, cholesterol ...) Other 786 (27.6) 342 (12.0) 127 (4.5) 39 (1.4) Table 3. Factors influencing the choice of any particular pharmacy (n = 2 844) Factors influencing the choice of any particular pharmacy Pharmacy location Good experience with the pharmacy Qualified and friendly staff Convenient working hours Pharmacy services (measure blood pressure, cholesterol ...) Self-service area Other reasons Frequency (%) 2 106 (74.1) 1 401 (49.3) 913 (32.1) 579 (20.4) 197 (6.9) 76 (2.7) 66 (2.3) mean score more than 2.00 (one item in general satisfaction, two items in interpersonal relationship and five items in managing therapy). All other items achieved mean score under 2.00. The most positively evaluated item was `The availability of the pharmacist to answer your questions' from managing therapy (1.26 ± 0.704; 88.2% highly satisfied respondents), then `The way how pharmacist answers your questions', from interpersonal relationship (1.63 ± 0.733; 90.1% highly satisfied respondents) and `The professional appearance of the pharmacy', from general satisfaction (1.63 ± 0.765; 88.8% highly satisfied respondents). The following items recorded the lowest scores: `The privacy of your conversations with the pharmacist' from general satisfaction (2.45 ± 1.110; 53.6% highly satisfied respondents), `How frequently the pharmacist checks with you about how well your medications are working' (2.31 ± 1.118; 40.2% highly satisfied respondents) and `How your pharmacist uses information about your previous conditions/drugs when assessing your drug therapy' (2.28 ± 1.181; 44.0% highly satisfied respondents), both from managing therapy. DISCUSSION To the best of our knowledge, ours was the first effort to evaluate the patient satisfaction with pharmaceutical care provided in community pharmacies in Slovak republic. Our previous pilot study presented a high patients´ satisfaction and the professional and human approach of pharmacists was identified as the key factors of patients´ satisfaction (Minarikova et al. 2015). For this assessment, we used validated questionnaires (Larson et al. 2002, Traverso et al. 2007). Their instruments contained two main dimensions of pharmaceutical care that relate to satisfaction (friendly explanation and managing therapy). They evaluated cumulative experience of patients with comprehensive pharmaceutical care practice in community pharmacies and they could be applied in community pharmacies offering pharmaceutical care as well as traditional pharmacy services, which are dominant in Slovak conditions. Our survey results generally showed a high patient satisfaction with pharmaceutical care provided in the Slovak community pharmacies, particularly in the term of interpersonal relationship. This finding is consistent with other published studies. Alturki et al. (Alturki et al. 2013) showed a `good consumer satisfaction' with the pharmacy encounters in Kingdom of Saudi Arabia. The items that received high satisfaction scores were pharmacist was always available, pharmacist provides thorough explanations/clear labelling of drugs, pharmacist politeness and prompt. Other studies also demonstrated that a pharmacist's personality, competence and ability to reach to a patient could positively influence a patient's decision to choose a particular pharmacy and her/ his satisfaction (Hasan et al. 2013). According to our results, managing therapy was rated with the lowest score. The respondents were more dissatisfied nearly with all items from this dimension. This finding was not surprising because specific important factor was qualified and friendly staff of pharmacy (32.1% of respondents) and convenient working hours (20.4% of respondents). Self-service area was a considerable factor influencing the choice of pharmacy only for 2.7% of respondents. Patient satisfaction with pharmaceutical care provided in community pharmacies This section consisted of a total 29 items that reflected patient's satisfaction with three dimensions of pharmaceutical care. Table 4 shows these results. The mean calculated score ranged from 1.26 to 2.45. High satisfaction level was achieved in all dimensions: the highest with interpersonal relationship (1.85 ± 0.598; 86.7% highly satisfied respondents), the lowest with managing therapy (2.24 ± 0.704; 65.4% highly satisfied respondents). Only 3.5% respondents indicated low satisfaction and 31.1% moderate satisfaction with managing therapy. From the total items, only eight of them had the Daniela Minarikova Table 4. Survey items and patients satisfaction % respondents rating as HS 65.4 88.2 58.7 40.2 60.4 68.9 68.4 57.3 65.2 55.5 44.0 48.6 58.4 47.3 45.6 65.8 66.7 86.7 66.2 83.6 83.8 81.1 59.9 83.4 83.5 80.4 90.1 71.3 53.6 83.7 88.8 88.7 MS 31.1 9.2 35.1 48.3 33.6 23.8 27.4 35.2 27.8 38.7 40.3 43.8 34.8 42.3 44.9 24.4 25.6 12.3 27.9 14.0 13.7 15.9 32.7 13.8 13.3 17.7 7.8 26.5 29.2 13.6 9.1 9.6 LS 3.5 2.6 6.2 11.5 6.0 7.3 4.2 7.5 7.0 5.8 15.7 7.5 6.8 10.4 9.5 9.8 7.7 1.0 5.9 2.4 2.5 3.0 7.4 2.8 3.2 1.9 2.1 2.2 17.2 2.7 2.1 1.7 Mean score ± SD 2.24 ± 0.704 1.26 ± 0.730 1.89 ± 1.083 2.31 ± 1.118 1.85 ± 1.076 1.69 ± 1.061 1.67 ± 1.009 1.93 ± 1.104 1.77 ± 1.075 1.95 ± 1.082 2.28 ± 1.181 2.10 ± 1.103 1.90 ± 1.095 2.16 ± 1.135 2.18 ± 1.118 1.78 ± 1.117 1.74 ± 1.080 1.85 ± 0.598 2.11 ± 0.947 1.75 ± 0.805 1.76 ± 0.798 1.77 ± 0.844 2.22 ± 0.975 1.82 ± 0.789 1.75 ± 0.829 1.82 ± 0.796 1.63 ± 0.733 2.02 ± 0.643 2.45 ± 1.110 1.83 ± 0.781 1.63 ± 0.765 1.68 ± 0.735 Item/Dimension of pharmaceutical care Managing therapy The availability of the pharmacist to answer your questions. The way the pharmacist helps you to manage your medications. How frequently the pharmacist checks with you about how well your medications are working. The pharmacist´s efforts to help you improve your health or stay healthy. The information the pharmacist gives you about the proper storage of your medication. The pharmacist´s efforts to solve problems that you have with your medication. The written information the pharmacist provides you about drug therapy and/or diseases. The information the pharmacist gives you about the results you can expect from your drug. The pharmacist´s help when a medication does not have the expected effect. How your pharmacist uses information about your previous conditions/ drugs when assessing your drug therapy. The help you get from the pharmacy staff with the administrative arrangements necessary to obtain your medicines. The way your pharmacist works together with you to plan what should be done to get good results from your medications. The way your pharmacist works together with your doctor to make sure your medications are the best for you. The responsibility that the pharmacist assumes for your drug therapy. How well the pharmacist explains possible side effects. How well the pharmacist explains what your medications do Interpersonal relationship The pharmacist´s interest in your health. The pharmacist´s professional relationship with you. The courtesy and respect shown to you by the pharmacy staff. The help you get from the pharmacist when you have a health problem related to your medication. The help you get from the pharmacist to avoid unnecessary costs related to your prescriptions. The amount of time the pharmacist offers to spend with you. The pharmacist´s instructions about how to take your medication. The professionalism of all the pharmacy staff. The way the pharmacist answers your questions. General satisfaction The privacy of your conversations with the pharmacist. The amount of time it takes to get a prescription filled at your pharmacy. The professional appearance of the pharmacy. Your pharmacy services overall HS - high satisfaction, MS - moderate satisfaction, LS - low satisfaction counselling concerning disease treatment or drug-related management of patients is not routine in Slovak community pharmacies. Although according to the actual legislation (Act no. 362/2011), provision expert information and advice on medicines, medical devices and dietetics is an integral part of dispensing process, it does not involve a real continuous longterm and patient-oriented pharmaceutical care. Similarly, different satisfaction was found by Larson (Larson et al. 2002) and Traverso (Traverso et al. 2007), respondents scored items on the managing therapy lower than they did items on the friendly explanation or interpersonal relationship and general satisfaction. These results suggest that better understanding of patient's needs and expectations about his/her treatment management is necessary and should be considered as a key factor in future development and advancing pharmacy practice, leading to higher patient satisfaction. Different dimensions of the pharmacies have been observed that can contribute uniquely to customer satisfaction, with consumer gender contributing greatly toward satisfaction, with type/ location of pharmacy, consumer age and educational degree also playing a part (Petrova et al. 2009). Community pharmacies are easy available healthcare facilities providing a highly qualified healthcare without any limitations for patients. Pharmacists are usually ranked as one of the most trusted professionals with high level of honesty and ethical principles (European Community Pharmacy Blueprint, 2012). According to our results, community pharmacies in Slovakia are not frequently visited by patients (82.6% visited one or two pharmacies per 3 months), but 70.6% of them had more than one prescription during the last 3 months. On the other hand, 83.3% of respondents indicated that they needed more than one prescription or OTC medicines during last month. The consumption of drugs in Slovakia is among the highest in Europe. In Slovakia, all prescription and OTC medicines are dispensed only in pharmacies; additional goods (cosmetics, herbal products) people can buy also in the facilities that do not provide health care (e.g. supermarkets). It can explain that the main reason for pharmacy visit was the obtaining of Rx or OTC medications, similarly as in other published studies (El Hajj et al. 2011, Govo et al. 2008). Counselling or special services were the important reasons for pharmacy visit only http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Acta Facultatis Pharmaceuticae Universitatis Comenianae de Gruyter

The Assessment of Patient Satisfaction and Attendance of Community Pharmacies in Slovakia

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Abstract

Keywords Kúcové slová: INTRODUCTION Pharmacists are the most accessible health care professionals and play a key role in the delivery of health care services, particularly in ensuring effective and safe treatment. In the era of rapidly accelerating changes in health care delivery, the * E-mail: minarikova@fpharm.uniba.sk © European Pharmaceutical Journal roles of pharmacists are constantly being redefined (European Community Pharmacy Blueprint, 2012). During the past years, the pharmacist´s role has grown and changed to encompass areas beyond the function of dispensing medications. The new role is based on the concept of changing the pharmacist´s focus from drug providing and distributing services to more patient-oriented approaches (Hepler & Strand, 1990) with positive impact on patient outcomes (Armour et al, 2007, Nkansah et al, 2010). Despite the fact that the concept of new pharmaceutical care is now widely accepted by pharmacists, there are serious barriers in implementation of this concept in real pharmaceutical practice (Van Mil, 2001). The transition to a market-oriented economy in Slovakia, like other Eastern European countries, caused changes in the healthcare system and affected all its aspects, including pharmacy care, pharmacy services, pharmacist´s role and expectations and patient´s behaviour (Volmer et al. 2009). While the total number of pharmacists in the year 1999 was 2 175 (Health Statistics Yearbook of the Slovak Republic, 1999), today this is higher than twice that number. According to the Slovak Chamber of Pharmacists, 4 419 pharmacists and 1 972 pharmacies are currently in Slovakia (Slovak Chamber of Pharmacists, 2015). With density of 822 pharmacists and 366 pharmacies per 10 000 inhabitants, Slovakia is comparable with other European countries (International Pharmaceutical Federation Global Pharmacy Workforce Report, 2012). The distribution of pharmacies in Slovakia shows regional disparities. The number of pharmacies and pharmacists is not regulated and it dramatically increased as a result of legislative changes and liberalisation of ownership regulation, which enables non-pharmacists to own pharmacies. It is estimated that about 70% of all pharmacies in Slovakia are part of some or the other pharmacy chains (Szalayová et al. 2014). Community pharmacies are privately owned in Slovakia, they run on a profit basis and are not subsidised by the state. All prescription (Rx) and non-prescription (over-the-counter = OTC) medicines can be purchased only from community pharmacy (Szalay et al. 2011). The significant market competition together with regulatory arrangements, represent indirect factors that affect the financial­economic situation of pharmacies as business entities (Malovecka et al. 2015, Vogler et al. 2012,). There is no doubt that community pharmacies must now try to create new image by overcoming the perception of pharmacist as medicine dispenser to professional provider of healthcare goods and services oriented to patient needs with the aim of fully satisfying them. Pharmacists who can demonstrate greater patient satisfaction may be at a competitive advantage. Patient satisfaction becomes an important indicator of availability and quality of provided care (Cleary & McNeil, 1988, Kucukarslan & Schommer, 2002). Sitzia and Wood emphasise that effectiveness of medical care should not be expressed only by clinical and economic parameters, but as well by patient opinions in assessment of this care (Sitzia & Wood, 1997). There are strong evidences that patient satisfaction is linked with better medication compliance, clinical outcomes (Kane et al. 1997, Ware & Davies, 1983), patient loyalty with care providers (Garman et al. 2004, Oparah & Kikanme, 2006) and with continuously using health care service (Zastowny et al. 1989). Collecting data by using available instruments to measure patient satisfaction is valuable for continuous quality improvement to identify variations, trends and patterns. Published studies from developed countries concentrate on patient satisfaction with pharmaceutical care (Naik Panvelkar et al. 2009) or with specific disease management (Armour et al. 2007). There are also data that show positive correlation between patient choice of pharmacy, provided pharmaceutical care and loyalty of patients (Merks et al. 2014). It seems that consistently applied pharmaceutical care can influence the patient's choice of pharmacy and also patient satisfaction. Similar data from Slovakia are still inadequate. This study presents the first Slovak nationwide patientreported outcomes about patient satisfaction with pharmaceutical care provided in community pharmacies. An additional objective was to identify reasons of pharmacy attendance and determine factors that influence patient's choice of community pharmacy in Slovakia. METHODS This is a cross-sectional study utilising self-administered questionnaire. The survey questionnaire was developed from published studies (Larson et al. 2002, Traverso et al. 2007). All items were translated to Slovak language using a forward backward method and randomly assigned. Three dimensions were proposed: managing therapy (16 items), interpersonal relationship (9 items) and general satisfaction (4 items). A 5-point Likert-type scale (1 = very satisfied, 2 = satisfied, 3 = neither satisfied nor dissatisfied, 4 = dissatisfied, 5 = very dissatisfied) was used to measure the extent of patient satisfaction with the pharmaceutical care provided in community pharmacies. To evaluate patient attendance in community pharmacy, the respondents were inquired about their reasons for visiting a community pharmacy and the factors that make them choose a particular pharmacy. Respondents could indicate more than one given options. Finally, sociodemographic and health characteristics were included into the questionnaire. The questionnaire was first applied in a pilot test (10 patients) for clarity, relevance, acceptability and time to completion. Refinements were made to the survey accordingly. The results from pilot testing were not included in the main study. The participants of the survey were asked by the specially educated students from Faculty of Pharmacy of the Comenius University in Bratislava to give oral permission for participation in the survey and answer the self-administered questionnaire, explaining to them that it was voluntary and confidential. No inclusion or exclusion criteria were predetermined. Data collection took place over an 8-week period between October and December 2013 in a total of 33 community pharmacies in 23 different Slovak cities. The selection of pharmacies was random and reflected the actual possibilities of research organiser and the agreement of pharmacy. Daniela Minarikova Table 1. Characteristics of study respondents (n = 2 844) Characteristics Gender (N = 2 841)a Age (years) (N = 2 844)a Male Female 30 31­60 61 Primary school Level of education (N = 2 799)a Secondary school High school Number of Rx or OTC drugs during the last month (N = 2 832)a Number of prescriptions during the last 3 months (N = 2 829)a Number of pharmacies visited during the last 3 months (N = 2 812)a Long-term use of medicines (N = 2 835)a Average monthly expenditure for medicines and other goods from the pharmacy (euro) (N = 2 833)a 0 1­2 3 0 1­ 2 3 1 2 3 Yes No < 10 10­30 > 30 > 100 000 City (number of inhabitants) (2 844)a < 100 000 < 50 000 < 20 000 Frequency (%) 944 (33.2) 1 897 (66.8) 801 (28.2) 1 531 (53.8) 512 (18.0) 187 (6.7) 1 649 (58.9) 963 (34.4) 474 (16.7) 1 198 (42.3) 1 160 (41.0) 830 (29.3) 1 215 (42.9) 784 (27.7) 1 269 (45.1) 1 054 (37.5) 490 (17.4) 1 279 (45.1) 1 556 (54.9) 1 237 (43.7) 1 149 (40.6) 447 (15.8) 326 (11.5) 557 (19.6) 957 (33.6) 1 004 (35.3) score and standard deviations according to original 5-point Likert scale. Calculated scores were collapsed into three satisfaction levels (high satisfaction = range of score 1.00­ 2.50, moderate satisfaction = range of score 2.51­3.50, low satisfaction = range of score 3.51­5.00). RESULTS General characterisation of survey During the 8-week study period, 2 844 respondents answered the survey. Their characteristics are summarised in Table 1. The mean age was 44.0 years with a standard deviation of 17.1 years. A total of 53.8% participants were in the 31­60 years age group. The majority of the participants (66.8%) were females, 58.9% had completed a secondary education. From the total number of study respondents, 11.5% were from cities with more than 100 000 inhabitants (only two cities in Slovakia), 19.6% were from cities with up to 100 000 inhabitants, 33.6% were from cities with up to 50 000 inhabitants and 35.3% were from cities with up to 20 000 inhabitants. From the total number, 42.3% of participants had one or two medicines and 41.0% had three or more medicines during last month (either Rx or OTC drugs). As physicians can prescribe medicines for longer time, the number of prescriptions can be lower. Only 27.2% of the participants had three or more prescriptions during the last 3 months, 42.9% had one or two prescriptions and 29.3% had no prescriptions during the last 3 months. Long-term use of medicines (for example, drugs for chronic diseases, such as diabetes, hypertension and others) were used by 45.1% of respondents. Our data show that respondents usually do not attend many pharmacies. Only 17.4% of the respondents visited three or more pharmacies during the last 3 months, the rest of respondents visited only one or two. With the wide availability of the pharmacies, this finding can be an indirect indicator of the patient´s satisfaction - satisfied patient does not need to visit more pharmacies to fulfil his/ her requirements. 43.7% of our respondents stated that their average monthly expenditures for pharmaceutical products (it means co-payment on Rx products, OTC drugs, other goods in pharmacy) are less than 10 euro, 40.6% spent from 10­30 euro, but 15.8% spent more than 30 euro in average per month. Not all respondents completed every item. N = number of respondents completing the item. All questionnaires were analysed regardless of the completeness of questionnaire; therefore, the actual evaluated numbers are different from the total number of respondents (n = 2 844). After coding and checking the questionnaires for accuracy, they were statistically analysed using the Statistical Package for Social Sciences (SPSS) version 19.0 for Windows. Frequency and percentage statistics were used to represent results. In order to present patient satisfaction in a measurable way, scoring of responses was done for all items as the mean Patient attendance of community pharmacies The main reasons for visiting pharmacy are shown in Table 2. The two main stated reasons for visiting community pharmacy were to obtain prescription medication (70.4%) and over-thecounter medications (70.4%). Due to counselling and using pharmaceutical services, only 12.0% and 4.5% of respondents separately reported visiting community pharmacy. The main factors influencing the choice of any particular pharmacy are in Table 3. The primary factor was the pharmacy location (74.1% of respondents) followed by good experience with the pharmacy (49.3% of respondents). The less Table 2. Main reasons for visiting a community pharmacy (n = 2 844) Main factors for visiting community pharmacy To obtain prescription medications Frequency (%) 2 001 (70.4) To obtain over-the-counter medications and 2 001 (70.4) food supplements To obtain other products (cosmetics, baby care products ...) Counselling Pharmacy services (measure blood pressure, cholesterol ...) Other 786 (27.6) 342 (12.0) 127 (4.5) 39 (1.4) Table 3. Factors influencing the choice of any particular pharmacy (n = 2 844) Factors influencing the choice of any particular pharmacy Pharmacy location Good experience with the pharmacy Qualified and friendly staff Convenient working hours Pharmacy services (measure blood pressure, cholesterol ...) Self-service area Other reasons Frequency (%) 2 106 (74.1) 1 401 (49.3) 913 (32.1) 579 (20.4) 197 (6.9) 76 (2.7) 66 (2.3) mean score more than 2.00 (one item in general satisfaction, two items in interpersonal relationship and five items in managing therapy). All other items achieved mean score under 2.00. The most positively evaluated item was `The availability of the pharmacist to answer your questions' from managing therapy (1.26 ± 0.704; 88.2% highly satisfied respondents), then `The way how pharmacist answers your questions', from interpersonal relationship (1.63 ± 0.733; 90.1% highly satisfied respondents) and `The professional appearance of the pharmacy', from general satisfaction (1.63 ± 0.765; 88.8% highly satisfied respondents). The following items recorded the lowest scores: `The privacy of your conversations with the pharmacist' from general satisfaction (2.45 ± 1.110; 53.6% highly satisfied respondents), `How frequently the pharmacist checks with you about how well your medications are working' (2.31 ± 1.118; 40.2% highly satisfied respondents) and `How your pharmacist uses information about your previous conditions/drugs when assessing your drug therapy' (2.28 ± 1.181; 44.0% highly satisfied respondents), both from managing therapy. DISCUSSION To the best of our knowledge, ours was the first effort to evaluate the patient satisfaction with pharmaceutical care provided in community pharmacies in Slovak republic. Our previous pilot study presented a high patients´ satisfaction and the professional and human approach of pharmacists was identified as the key factors of patients´ satisfaction (Minarikova et al. 2015). For this assessment, we used validated questionnaires (Larson et al. 2002, Traverso et al. 2007). Their instruments contained two main dimensions of pharmaceutical care that relate to satisfaction (friendly explanation and managing therapy). They evaluated cumulative experience of patients with comprehensive pharmaceutical care practice in community pharmacies and they could be applied in community pharmacies offering pharmaceutical care as well as traditional pharmacy services, which are dominant in Slovak conditions. Our survey results generally showed a high patient satisfaction with pharmaceutical care provided in the Slovak community pharmacies, particularly in the term of interpersonal relationship. This finding is consistent with other published studies. Alturki et al. (Alturki et al. 2013) showed a `good consumer satisfaction' with the pharmacy encounters in Kingdom of Saudi Arabia. The items that received high satisfaction scores were pharmacist was always available, pharmacist provides thorough explanations/clear labelling of drugs, pharmacist politeness and prompt. Other studies also demonstrated that a pharmacist's personality, competence and ability to reach to a patient could positively influence a patient's decision to choose a particular pharmacy and her/ his satisfaction (Hasan et al. 2013). According to our results, managing therapy was rated with the lowest score. The respondents were more dissatisfied nearly with all items from this dimension. This finding was not surprising because specific important factor was qualified and friendly staff of pharmacy (32.1% of respondents) and convenient working hours (20.4% of respondents). Self-service area was a considerable factor influencing the choice of pharmacy only for 2.7% of respondents. Patient satisfaction with pharmaceutical care provided in community pharmacies This section consisted of a total 29 items that reflected patient's satisfaction with three dimensions of pharmaceutical care. Table 4 shows these results. The mean calculated score ranged from 1.26 to 2.45. High satisfaction level was achieved in all dimensions: the highest with interpersonal relationship (1.85 ± 0.598; 86.7% highly satisfied respondents), the lowest with managing therapy (2.24 ± 0.704; 65.4% highly satisfied respondents). Only 3.5% respondents indicated low satisfaction and 31.1% moderate satisfaction with managing therapy. From the total items, only eight of them had the Daniela Minarikova Table 4. Survey items and patients satisfaction % respondents rating as HS 65.4 88.2 58.7 40.2 60.4 68.9 68.4 57.3 65.2 55.5 44.0 48.6 58.4 47.3 45.6 65.8 66.7 86.7 66.2 83.6 83.8 81.1 59.9 83.4 83.5 80.4 90.1 71.3 53.6 83.7 88.8 88.7 MS 31.1 9.2 35.1 48.3 33.6 23.8 27.4 35.2 27.8 38.7 40.3 43.8 34.8 42.3 44.9 24.4 25.6 12.3 27.9 14.0 13.7 15.9 32.7 13.8 13.3 17.7 7.8 26.5 29.2 13.6 9.1 9.6 LS 3.5 2.6 6.2 11.5 6.0 7.3 4.2 7.5 7.0 5.8 15.7 7.5 6.8 10.4 9.5 9.8 7.7 1.0 5.9 2.4 2.5 3.0 7.4 2.8 3.2 1.9 2.1 2.2 17.2 2.7 2.1 1.7 Mean score ± SD 2.24 ± 0.704 1.26 ± 0.730 1.89 ± 1.083 2.31 ± 1.118 1.85 ± 1.076 1.69 ± 1.061 1.67 ± 1.009 1.93 ± 1.104 1.77 ± 1.075 1.95 ± 1.082 2.28 ± 1.181 2.10 ± 1.103 1.90 ± 1.095 2.16 ± 1.135 2.18 ± 1.118 1.78 ± 1.117 1.74 ± 1.080 1.85 ± 0.598 2.11 ± 0.947 1.75 ± 0.805 1.76 ± 0.798 1.77 ± 0.844 2.22 ± 0.975 1.82 ± 0.789 1.75 ± 0.829 1.82 ± 0.796 1.63 ± 0.733 2.02 ± 0.643 2.45 ± 1.110 1.83 ± 0.781 1.63 ± 0.765 1.68 ± 0.735 Item/Dimension of pharmaceutical care Managing therapy The availability of the pharmacist to answer your questions. The way the pharmacist helps you to manage your medications. How frequently the pharmacist checks with you about how well your medications are working. The pharmacist´s efforts to help you improve your health or stay healthy. The information the pharmacist gives you about the proper storage of your medication. The pharmacist´s efforts to solve problems that you have with your medication. The written information the pharmacist provides you about drug therapy and/or diseases. The information the pharmacist gives you about the results you can expect from your drug. The pharmacist´s help when a medication does not have the expected effect. How your pharmacist uses information about your previous conditions/ drugs when assessing your drug therapy. The help you get from the pharmacy staff with the administrative arrangements necessary to obtain your medicines. The way your pharmacist works together with you to plan what should be done to get good results from your medications. The way your pharmacist works together with your doctor to make sure your medications are the best for you. The responsibility that the pharmacist assumes for your drug therapy. How well the pharmacist explains possible side effects. How well the pharmacist explains what your medications do Interpersonal relationship The pharmacist´s interest in your health. The pharmacist´s professional relationship with you. The courtesy and respect shown to you by the pharmacy staff. The help you get from the pharmacist when you have a health problem related to your medication. The help you get from the pharmacist to avoid unnecessary costs related to your prescriptions. The amount of time the pharmacist offers to spend with you. The pharmacist´s instructions about how to take your medication. The professionalism of all the pharmacy staff. The way the pharmacist answers your questions. General satisfaction The privacy of your conversations with the pharmacist. The amount of time it takes to get a prescription filled at your pharmacy. The professional appearance of the pharmacy. Your pharmacy services overall HS - high satisfaction, MS - moderate satisfaction, LS - low satisfaction counselling concerning disease treatment or drug-related management of patients is not routine in Slovak community pharmacies. Although according to the actual legislation (Act no. 362/2011), provision expert information and advice on medicines, medical devices and dietetics is an integral part of dispensing process, it does not involve a real continuous longterm and patient-oriented pharmaceutical care. Similarly, different satisfaction was found by Larson (Larson et al. 2002) and Traverso (Traverso et al. 2007), respondents scored items on the managing therapy lower than they did items on the friendly explanation or interpersonal relationship and general satisfaction. These results suggest that better understanding of patient's needs and expectations about his/her treatment management is necessary and should be considered as a key factor in future development and advancing pharmacy practice, leading to higher patient satisfaction. Different dimensions of the pharmacies have been observed that can contribute uniquely to customer satisfaction, with consumer gender contributing greatly toward satisfaction, with type/ location of pharmacy, consumer age and educational degree also playing a part (Petrova et al. 2009). Community pharmacies are easy available healthcare facilities providing a highly qualified healthcare without any limitations for patients. Pharmacists are usually ranked as one of the most trusted professionals with high level of honesty and ethical principles (European Community Pharmacy Blueprint, 2012). According to our results, community pharmacies in Slovakia are not frequently visited by patients (82.6% visited one or two pharmacies per 3 months), but 70.6% of them had more than one prescription during the last 3 months. On the other hand, 83.3% of respondents indicated that they needed more than one prescription or OTC medicines during last month. The consumption of drugs in Slovakia is among the highest in Europe. In Slovakia, all prescription and OTC medicines are dispensed only in pharmacies; additional goods (cosmetics, herbal products) people can buy also in the facilities that do not provide health care (e.g. supermarkets). It can explain that the main reason for pharmacy visit was the obtaining of Rx or OTC medications, similarly as in other published studies (El Hajj et al. 2011, Govo et al. 2008). Counselling or special services were the important reasons for pharmacy visit only

Journal

Acta Facultatis Pharmaceuticae Universitatis Comenianaede Gruyter

Published: Dec 1, 2016

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