Research Article
Clinical Medicine
Medical Communications
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Pharmacists are required to positively interact with patients and contribute to the “appropriate use of the medicine” while simultaneously building mutual trust. Thus, communications skills are necessary and indispensable as a pharmacist. At the pharmacies, we conducted an investigation on the available patient services. The investigation included users from two community pharmacies and was conducted over 10 days. The survey was comprised of 22 items concerning user services. A total of 315 responses were obtained. We looked at the following four areas: user characteristics; overall pharmacy; attitude of reception staff; attitude of pharmacists; and general level of satisfaction. User needs mainly involved insufficient privacy considerations; improving the management of waiting times; consultations on health and self-medication; and treating users as individuals. Unlike previous work, this investigation that was conducted performed not only a choice but the tool for exploring a user's true opinions. By this method, the users were allowed to have comment space, which gave us information about the users’ attitudes towards their community pharmacies. This can be said to be a very important technique when considering “patient-centered medical services”. We suggest using the results of this investigation for improving user services at pharmacies to build better mutual trust with users.
Keywordspatient satisfaction, communications, pharmacist, community pharmacy, questionnaire survey.
Author info
1 Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
2 Kinjo Gakuin University College of Pharmacy
3 Mie Prefecture Pharmaceutical Association
4 Graduate School of Nanzan University
RecievedDec 3 2013 AcceptedJan 11 2014 PublishedJan 22 2014
CitationChika Nakayama,Taeyuki Oshima,Ayako Kato,Masahiko Nishii,Takeshi Kamimura,Atsumi Nitta1,Mahito Yamaguchi (2014) Questionnaire Survey on Patient Satisfaction at Community Pharmacies. Science Postprint 1(1): e00012. doi:10.14340/spp.2014.01A0001
Copyright©2014 The Authors. Science Postprint published by General Healthcare Inc. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 2.1 Japan (CC BY-NC-ND 2.1 JP) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
FundingThis work was supported by JSPS KAKENHI Grant Number 23590627.
Competing interestNo relevant competing interests were disclosed.
Ethics StatementThe survey was conducted by first orally explaining the goal of the study to the patients at the pharmacies (patients, their families, or attendants) and obtaining their consent, after which they were requested to complete the questionnaire. The participant details were kept anonymous. They cooperated with this survey for nothing. This study was approved by the Nanzan University Ethics Committee.
Corresponding authorChika Nakayama
Address Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama-shi 930-0194, Japan
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Currently, because “patient-centered medical services” are being demanded, better medical services are provided by proactively interacting with patients, thereby building trusting relationships with them 1,2. However, the reality is that almost pharmacists have received few opportunities to undergo sufficient communication training, which can be the reason for one-sided explanations and insensitive attitudes. The 1997 revision of the Pharmacists Law heralded a shift in the role of pharmacists from the specialized task of dispensing medications to a job that demands active engagement with patients, including the provision of information on drugs for their appropriate use. In addition, this new role brought about a change in pharmaceutical education. To educate pharmacists with excellent qualifications, the course duration was changed to a 6-year program, which included a focus shift from drug development to training practitioners who can succeed in clinical settings （http://www.mext.go.jp/a_menu/01_d/08091815.htm, Accessed May 2013）. Furthermore, this 6-year curriculum （http://www.pharm.or.jp/rijikai/cur2005/A.pdf, Accessed October 2012） includes training in patient services and communication skills, with the goal that students completing the program possess appropriate skills required at the workplace.
Because good patient communication leads to patient loyalty and is associated with obtaining new patients, an increasing number of medical institutions are focusing on improving communication skills. Similarly, because of the separation of medical practice and drug dispensing, concern is turned to the approach for a patient to use a pharmacy comfortably. Thus, pharmacists are required to accurately grasp patient needs and provide services that respond to such needs. In relation to improving services, the Japanese government established an “Information Provision System for Pharmacy Faculties” (http://www.mhlw.go.jp/seisakunitsuite/bunya/kenkou_iryou/iyakuhin/kinoujouhou/index.html, Accessed June 2013) to help people select the most appropriate pharmacy. Listening to patient views has become increasingly important for pharmacies; this information system provides greater transparency for patients by detailing which pharmacies are conducting patient satisfaction surveys, stating which pharmacies are conducting research and implementing programs related to achieving patient satisfaction, and classifying establishments under useful headings 3-6.
In this study, we conducted an investigation of patient services at pharmacies with the goal of improving communication skills and raising overall levels of patient services in pharmacies. The results of this survey were subsequently incorporated into measures to improve the overall levels of patient services in pharmacies that were surveyed.
The subjects of this study were the users of two pharmacies (store A and B) that were operated by the Mie Pharmacists Association. The reason these pharmacies were chosen for this survey was they met the criteria for a standard pharmacy (http://www.mhlw.go.jp/topics/medias/c-med/2010/10/19.html, Accessed January 2013). The survey was conducted over 10 days, and printed questionnaires were used. The survey was conducted by first orally explaining the goal of the study to the users at the pharmacies (patients, their families, or attendants) and obtaining their consent, after which they were requested to complete the questionnaire. The participant details were kept anonymous. The survey forms were collected in a box placed near the pharmacy exit.
The questions were based on previous studies 3-6 and were formulated to ascertain how the services provided through the facilities and whether pharmacy staff were meeting user needs. The 22 items in the questionnaire covered user characteristics (gender, age and visit frequency), followed by atmosphere in a hard and soft side of the pharmacy (7 items), attitudes of the reception staff (4 items), attitudes of the pharmacists (7 items) and general level of satisfaction with the overall pharmacy．The answers to be provided were “yes” or “no.” Participants were asked to provide detailed reasons if they answered “unsatisfied” or “inappropriate” (space was provided for comments). The general level of satisfaction was expressed in the form of a visual analog scale. Users recorded their rating by making a mark above a 10-cm line with the left end denoting “satisfied” and the right end, “unsatisfied”. This study was approved by the Nanzan University Ethics Committee.
We carried out this study in a fund of the Grants in Aid for Scientific Research (Grant Number 23590627).
We obtained answers of the questionnaires from 315 users (response rate: 100%). Valid responses were obtained from 315 users in each items (atmosphere in a hard and soft side of the pharmacy, attitudes of the reception staff, attitudes of the pharmacists) (valid response rate: 100%) and 253 users in the general level of satisfaction (valid response rate: 80%).
A total of 315 participants (men: 45%; women: 55%) returned the questionnaire, 212 from store A and 103 from store B. Answers were obtained from a wide range of ages, from teenagers to people over 80 years of age.
The answers for usage frequency indicated that most respondents were repeat users, with 83% responding “always”, 15% “sometimes”, and 0.7% “first time.”
As shown in Figure 1, the items “greeted pleasantly,” “personal appearance of staff,” and “approachability” received excellent ratings of approximately 100% (Figure 1, items 1, 2 and 6). Regarding the “differentiation of pharmacists and reception staff,” some respondents answered that it was difficult to visually differentiate solely by assessing the different colored laboratory coats (Figure 1, item 3). Furthermore, users expressed specific functional desires regarding the waiting room, including “too few magazines” and “bothered by long waiting times and too many people (Figure 1, item 4)”. Although “privacy considerations” received good ratings (Figure 1, item 5) , several users expressed concern over the open-floor plans by saying “the person next to me could overhear my information” (Figure 2, item 2) and “there was too little space between people” (Figure 2, item 1). With regard to “consideration and care,” users expressed dissatisfaction about the management of waiting times (Figure 1, item 7).
Question items
1. Were you greeted pleasantly?
2. Was the pharmacy staff’s personal appearance clean and appropriate?
3. Could you tell the difference between the pharmacists and the reception staff?
4. Was the waiting room comfortable?
5. Was your privacy given sufficient consideration?
6. Was the pharmacy staff easy to approach?
7．Did you feel you did not receive enough care and consideration? (Opposite item)
1．The space between people was too small
2．The person next to me could hear my personal information
3．Personal information such as that on my prescription or insurance card was not treated with proper care
4．The chairs and counters were poorly arranged
5．Other
Store A and B （n＝41）
These 41 users answered with "No" in Fig.1, item5
As shown in Figure 3, several users gave extremely high ratings (approximately 100%) for “wording” and “understandability of explanations” at the reception desk (Figure 3, items 1 and 3). However, some expressed dissatisfaction regarding “indifferent and businesslike” attitudes and “chatting when it was crowded” under “tone of voice, facial expression, and behavior” (Figure 3, item 2). “Waiting time” was the cause of dissatisfaction in most participants, and a difference was observed between the two stores. At store A, which had more users, less than 30% expressed dissatisfaction with the waiting times. The reasons specified in the questionnaires included “having to wait for tens of minutes without any notification” and “wanted to know how long I would have to wait.” Therefore, responses showed that enough information on waiting times was not conveyed (Figure 3, item 4).
Quetion items
1. Did the reception staff speak to you politely and appropriately?
2. Did their tone of voice, facial expression, or behavior cause you any discomfort? (Opposite item)
3. Was it easy to understand their explanations and information provided?
4. Were you given appropriate information about the waiting time?
Question items
As shown in Figure 4, Users gave high evaluations for almost all items in this category. However, complaints in the space for comments regarding the “tone of voice, facial expression, and behavior” included that the pharmacists were “not smiling” and “not energetic” (Figure 4, item 2). The open-floor plan was also mentioned, with some users “worried about the volume of the pharmacist’s voice” (Figure 4, item 2). Responses regarding “consultations on matters other than prescriptions, such as health issues and non-prescription drugs” revealed that users “did not know the services that were available” or “held back because the staff looked busy,” which suggested that despite a desire by users to use these services, the pharmacies were not sufficiently prepared to meet their needs (Figure 4, item 6) .
Question items
1. Did the pharmacists speak to you politely and appropriately?
2. Did their tone of voice, facial expression, or behavior cause you any discomfort? (Opposite item)
3. Did they use easy-to-understand language in their explanations?
4. Could you understand the prescription name, effects, side effects, administration method, drug interactions, and other important points from the pharmacist’s explanation?
5. Did the explanation help resolve any anxieties or doubts?
6. Did you feel you could not ask about things other than your prescription, such as about over-the-counter drugs or health issues? (Opposite item)
7. Did the drug explanation last for an appropriate duration?
At store A, 65% of users expressed a level of general satisfaction of more than 81%; at store B, the proportion was 73% (Figure 5).
The results of this survey indicated that user needs mainly involved the following: insufficient privacy considerations; improving the management of waiting times; consultations on health and self-medication; and treating users as individuals. Users expressed concern over the pharmacies’ open-floor plans under “insufficient privacy considerations” because they felt people nearby could easily overhear personal information. Some users asked for privacy considerations such as speaking in a low voice and providing private rooms. Because the largest number of complaints involved “improving the management of waiting times” and waiting time was mentioned under “consideration and care,” addressing this issue will have a significant and broad effect on improving user services. Therefore, conducting specific improvements, such as providing appropriate notification about waiting times and furnishing a comfortable waiting room, should be considered. With regard to “consultations on health and self-medication,” several users said they were not aware of the availability of such services. Users said that they would use these services now that they were aware of their availability; therefore, pharmacies need to actively provide consultations on health aspects and non-prescription drugs. Pharmacists always must consider that users have the right to ask about anything including over-the-counter drugs or health issues. However, from the side of users, they do not know their rights in the community pharmacy. The appeal has to be made as to which service pharmacists can do for the users in the community pharmacies. Users expressed varying desires at both ends of the scale regarding “attending to users as individuals,” with some users wanting short explanations and others desiring detailed ones. This shows that pharmacy staff must be equipped to understand user needs and adapt to the situation by providing services that fit individual needs. Part of these results is similar to some previous reports 3-5.
Although users gave relatively high ratings on each item in the two-grade assessments, it would be difficult to understand their specific needs solely based on such evaluations. Therefore, we provided space for comments, which allowed the users to write specific and frank desires and dissatisfactions. This comment space provided an insight if users wrote “unsatisfied” under the heading of “waiting time.”, did the users merely want to leave quickly? Did they want to be told how long they would have to wait? Was there a problem with the waiting area? This survey is significant because pharmacies were shown the manner in which users expected attention by clarifying the reasons behind the answers marked as “unsatisfied.” Previous studies reported that patients do not feel satisfaction when they have to wait a long time to take medicine in the community pharmacy 4,5. However, the real reason for frustration of patients was not clear in these previous studies. In this study, the comment space given revealed that correspondence of pharmacists without consideration is an important point for their unsatisfactory ratings. The pharmacy side should prepare the service for users according the results of this study. Thus, in order to get real requests from users, the comment section is necessary when we survey users’ requests.
Furthermore, by separating questions concerning reception staff from those regarding pharmacists, the survey can be used to ascertain communication-related issues for each worker. In this study, we also clarified that the users feel satisfaction based on the response from all staff in the community pharmacy. Then, it is important that not only pharmacists, but also the reception staff have to improve their communication skills. We have proposed some important points 1) Reception staff kindly inform the users the how long wait is for taking his/her medicine. 2) Community pharmacies should provide a comfortable waiting space for users, for example, many interesting magazines, good furniture, etc.
Finally, the pharmacies undertook specific measures to improve user services based on the results of this survey. At the pharmacy level, the pharmacies improved the toilets and waiting-room facilities. At the user level, the pharmacies created scenarios based on learning targets that focused on “privacy considerations” and “improving the management of waiting times” and held training sessions on user-pharmacist communication for pharmacy staff.
Unlike previous work, the investigation we conducted performed not only a choice but the device to explore a user's real feelings and concerns which includes a free comment space for every item. This can be said to be a very important technique when aiming for “patient-centered medical services”. We believe that conducting satisfaction surveys will become an important tool for pharmacies to not only understand the current situation but to also see whether the actions they have considered for responding to user needs have been implemented. Through a continuous cycle of survey and improvement, we hope to contribute to the creation of pharmacies that support users who in turn appreciate the enhanced services provided.
We are thankful to the staff members of the pharmacies of Mie Prefecture Pharmaceutical Association who cooperated in the questionnaire.
Chika Nakayama: Main researcher and Coordinator
Taeyuki Oshima: Co-researcher, Adviser and Organizer
Ayako Kato: Co-researcher
Masahiko Nishii: Co-researcher
Takeshi Kamimura: Co-researcher
Atsumi Nitta: Co-researcher and Adviser
Mahito Yamaguchi: Co-researcher
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