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Cross Sectional Study

Type 2 diabetes mellitus patients’ satisfaction with pharmacy services in Wollega University Referral Hospital, Western Ethiopia

Fekadu, Ginenus MSca,; Dereje, Saktu BPharma; Dugassa, Dinka BPharma; Bekele, Firomsa MScb; Simegnew, Dawit MPHc; Turi, Ebisa MPHd; Tolossa, Tadesse MPHd; Fetensa, Getahun MSce; Alemu, Tamirat MSca; Gamachu, Busha MSca

Author Information
International Journal of Surgery: Global Health: November 2020 - Volume 3 - Issue 6 - p e28
doi: 10.1097/GH9.0000000000000028
  • Open

Abstract

Diabetes is a chronic metabolic disorder characterized by persistent hyperglycemia due to a deficiency in insulin secretion, insulin action or both1–3. The prevalence of type 2 diabetes is increasing over time. Likewise, the prevalence of people living with diabetes in Ethiopia is substantially increased from time to time. About 1.7 million adults between 20 and 79 had diabetes mellitus (DM) in Ethiopia. Thus, increased from 3.8% in 2014 to 5.2% in 2017. The number of undiagnosed is also high3–5.

Glycemic control is the ultimate goal of the management of diabetes2,6. Adequate glycemic control helps to reduce or delay the burden of diabetes complications7. According to the International Diabetes Federation (IDF) and the American Diabetes Association (ADA) guidelines, glycated hemoglobin (HgA1c) value is the most recommended monitoring parameter for appropriate glycemic control status. Thus, the value of HgA1c within the last 3 months is indicators of patients’ glycemic control2,8. Many studies reveal that there an association between HgA1c values and diabetes complications. Reducing HgA1c values significantly decreases diabetes complications and the overall death from diabetes9–11. Thus, early and adequate glycemic control improves macrovascular outcomes12 and diabetes complications13–15. Achieving optimal glycemic levels may not be an easy task. It depends on the type of treatment received patients’ adherence and comorbidities2,3. Likewise, risk factors, obesity, biological, and psychosocial factors are responsible for differences in glycemic control16.

The development of new and innovative technological methods and the increased need for specialized health care services have brought about a distinct transformation in pharmacy services17–19. In 2011, the International Pharmaceutical Federation (FIP) and the World Health Organization (WHO) jointly recommended good pharmacy practice guidelines20. Consequently, pharmacists have been increasingly involved in marketing their services with a focus on patient satisfaction. Furthermore, pharmacists have been persuaded to become mutually accountable for health care consequences and the enhancement of the patient’s quality of life21–23. However, the clinical training of pharmacists is not advanced, and the activities that represent the usual practice of pharmacists are still executed, in most cases, without direct interaction with the patient24,25.

Pharmacy staff in a position to clearly define how the patient should use the medication have been prescribed. Several studies have indicated that these factors are associated with patient satisfaction26–28. The pharmacy is an important physical service within a hospital, where patients get information about medication28. Ensuring the quality of pharmaceutical services in hospitals is an integral aspect of ensuring the quality of health care. In this regard, it has long been proven that adoption of the concept of pharmaceutical care is essential to improve the quality of pharmaceutical services29.

Patient satisfaction has many different facets, reflecting the type and quality of service provided by health care providers. It includes how well service is delivered, and the extent to which the expectations and needs of patients are met30. Patient satisfaction is an important humanistic outcome as a patient’s subjective assessment of health care services. The growing interest in patient satisfaction initially arose as a result of consumerism31. Studies have shown that rightful medication counseling by pharmacists identify and correct potential drug therapy problems, side effects, and adverse drug reactions. This was providing patient satisfaction with the pharmaceutical services and consequently optimize the patient quality of care. But the level of patient satisfaction in developing countries is poor. Hence it directly or indirectly affects the treatment outcome and glycemic control among diabatic patients30.

Pharmaceutical care is key in pharmacy practice globally. This is designed at providing a better outcome for the patients. Patient satisfaction is likely to affect the image of the Pharmacist and pharmacy profession32. Medication counseling is one area that enhanced rational use of medicines by the patients and health professionals33. Currently, the management of many diseases requires a multidisciplinary approach, which according to evidence-based medicine, has improved treatment outcomes of many patients. However, the role of a pharmacist has not been adequately explored and is often regarded as passive by many medical personnel33. It is a well-known fact that patient compliance to medication is an important factor in the prediction of numerous diseases. Poor patient compliance is a problem worldwide. Seeking advice from a pharmacist before purchasing drugs may be cost effective as well as promote compliance34.

Ethiopia is undergoing a major transition as far as the health sector is concerned (the health sector reforms) and hence the services and education availed to patients by the pharmacists are increasingly becoming important. Investigation on the contribution of pharmacists in a different disease treatment found that patients who were suffering from their disease showed significant improvement when given “directive guidance” by a pharmacist regarding their treatment35. Patient satisfaction is an important and commonly used indicator for measuring the quality in health care. Patient satisfaction affects clinical outcomes, patient retention, and medical malpractice claims. It affects the timely, efficient, and patient-centered delivery of quality health care. Hence, the current study is intended to assess type 2 DM patients’ satisfaction with pharmacy services in Wollega University Referral Hospital (WURH).

Methods

Study area, design and period

A descriptive cross-sectional study was conducted from May to June 2019 at WURH which is one of the youngest public hospitals in Western Ethiopia. The work has been reported in line with the strengthening the reporting of cohort studies in surgery (STROCSS) criteria36.

Populations

Source populations

  • All type 2 DM patients in WURH.

Study population

  • The study populations are all type 2 DM patients who were fulfilling the inclusion criteria and attending WURH during the study period.

Eligibility criteria

Inclusion criteria

  • Patients who were diagnosed to have type 2 DM and having at least 1 year follow-up at the DM clinic.
  • Willingness to participate in the study.

Exclusion criteria

  • Critically ill patients.
  • Newly diagnosed patients.
  • Pregnant women.
  • Patient with mental disorders.

Study variables

Dependent variable

  • Patient satisfaction.

Independent variables

  • Accessibility of health services.
  • Availability of medications.
  • Pharmacy staff attitude.
  • Provision of drug information.

Sampling design and procedure

Sample size

To collect necessary data through a questionnaire, the target populations of the study were the patients who were visiting WURH during the study period. The total population for this study was 400 as per WURH Record office of 2019. The sample size was determined based on the following simplified formula proposed by Yamane37.n=N1+N(e)2,Where n is the sample size, N is the population size and e is the level of precision. A 95% confidence level and e=0.05, are assumed for the purpose of determining sample size for this study. Accordingly, the sample size for the study was calculated as follows.=4001+400(0.05)2,n=200.

After the sample was determined using the above formula, convenient sampling was be used to collect data from the element in the sample. This sampling method involves collecting information from members of the population who were conveniently available (all eligible) during the study period. Hence, nonprobability, convenience (haphazard) sampling method was employed.

Data collection process

The self-administered questionnaire with both open and close-ended questions was distributed to sample respondents in the hospital. Two Bachelor nurses participated in data collection process. Orientation was given to them regarding the data collection processes. The data was collected from diabetic type 2 patients at the hospital level while they come for follow-up (during receiving the medications). Hence, both qualitative and quantitative data were gathered and subjected to descriptive analysis. Pretesting was done before the actual study, and also the data was cleared and checked every day for completeness and consistency before data processing and analysis. Both in-house and field editing was employed to detect errors that may be committed by respondents during filling up the questionnaires.

Data processing and analysis

Data were analyzed with the Statistical Program for Social Sciences (SPSS) version 20.0 Descriptive data were explained by frequency and percentage. Statistical tools such as tabulation and bar-graphs were used to present data. In addition, findings were presented in terms of the statement. After data has been presented and analyzed, the findings were used to draw the necessary conclusions and recommendations.

Ethics approval and consent-to-participate

This study was approved by the ethical review committee of the Institute of Health Science, Wollega University. Besides, permission was secured from the hospital and the pharmacy administrators to proceed with the study. Each of the clients was provided with explanations on the purpose of the study and asked for their consent to participate in the study. Only when they were willing to proceed with the interview were, they involved in the study. In addition, patient identifiers were not used in the study and the data collected was used by the investigators only for the study. The study was registered at researchregistry.com with a unique reference number of “researchregistry5846”38.

Operational definitions

  • Medication counseling: refers to “providing medication information orally or in written form to the patients or their caregivers on directions of use, advice on side effects, precautions, storage, diet and lifestyle modifications33.”
  • Availability is defined as the presence in a country of products that meet the population’s health needs.
  • Accessibility refers to physical access to the products, or where the products can be delivered to patients.
  • Affordability refers to a product’s cost versus the ability and willingness of people (patients) to pay for it.
  • Patient satisfaction is viewed as his/her “personal evaluation of health care services and providers.”
  • Negative attitude: if the patient lacks appropriate respect from the health care provider/pharmacist during the provision of treatment or medication.

Results

Out of 200 questionnaires distributed to the respondents, with 195 (97.5%) response rate. From a total of 195 type 2 DM patients, 136 (69.7%) were females and 59 (30.3%) were males. About two-thirds (64.1%) respondents were in the age range between 41 and 50 years (Table 1).

Table 1 - Socio-demographic characteristics of type 2 diabetes mellitus patients treated at Wollega University referral hospital, 2019.
Characteristics Frequency Percent
Age (y)
 31–40 24 12.3
 41–50 125 64.1
 >50 46 23.6
Sex
 Male 59 30.3
 Female 136 69.7
Educational level
 Elementary school 94 48.2
 High school 57 29.2
 College or above 44 22.6
Marital status
 Married 84 43.1
 Unmarried 23 11.8
 Widowed 51 26.2
 Divorced 37 19
Religious
 Orthodox 83 42.6
 Protestant 60 30.8
 Muslim 43 22.1
 Wakefata 7 4.6
Monthly income (Ethiopian birr)
 <1000 45 23.1
 1001–2000 100 51.3
 2001–3000 22 11.3
 >3000 28 14.3
Occupation
 Self-employed 116 59.5
 Government employed 79 40.5

The study reflected the majority of the respondents 124 (63.6) were happy and satisfied with Wollega University Referral Hospital Pharmacy service; while 71 (36.4) were dissatisfied. About two thirds (67.8%) patients agreed with the availability of prescribed medicines. None of the patients had negative attitude toward the pharmacists. About 43.1% of the patients strongly disagree regarding unclear instruction of taking medicines (Table 2).

Table 2 - Factors related to type 2 diabetes mellitus patients’ satisfaction with pharmacy services at Wollega University referral hospital, 2019.
Factors Influencing Patient Satisfaction Strongly Agree Agree Neutral Disagree Strongly Disagree
Prescribed medicines are available 0 (0%) 132 (67.8) 27 (13.8) 36 (18.5) 0 (0)
Cost of medicines is high 0 (0%) 0 (0%) 27 (13.8%) 62 (31.8%) 106 (54.4%)
Unclear instruction of taking medicine 0 (0%) 22 (11.3%) 27 (13.8%) 62 (31.8%) 84 (43.1%)
Poor facilities while waiting 0 (0%) 0 (0%) 0 (0%) 106 (54.4%) 89 (45.6%)
Negative attitude of the pharmacist 23 (11.8%) 126 (64.6%) 0 (0%) 46 (23.6%) 0 (0%)
Side effects noticed 144 (73.8%) 0 (0%) 0 (0%) 27 (13.8%) 24 (12.3%)
Good patient follow-up is there 0 (0%) 22 (11.3%) 52 (26.7%) 121 (62.1%) 0 (0%)
Food not to be taken with drugs noticed 23 (11.8%) 131 (67.2%) 28 (14.4%) 0 (0%) 13 (6.7%)
There is change of drugs if any side effects occur 0 (0%) 52 (26.7%) 27 (13.8%) 92 (47.2%) 24 (12.3%)
Frequently clean the waiting area 0 (0%) 146 (74.9%) 26 (14.8%) 23 (12.3%) 0 (0%)
Enough bench is there 64 (32.8%) 131 (67.2%) 0 (0%) 0 (0%) 0 (0%)

Discussion

About two-thirds (64.1%) respondents were in the age range between 41 and 50 years which was similar to the study done in Pakistan39. The highest proportion of respondents (48.2%) had elementary school educational levels, which was different from the study conducted in Gondar University Referral Hospital where secondary school was the highest percentage33. A person’s level of education affects one’s perspective on the use of health services. A high level of education allows a person to process the received information into a certain attitude. A person who has a low education has a low stance also in the maintenance of health. This indicates that the need for training and development is there and worth considering in order processing the received health information for maintaining one’s health.

As far as the marital status of the respondents concerned, from the total sample respondents, 84 (43.1%) were married. The majority of the respondents, 84 (43.1%) were orthodox which was similar to a study conducted in Gondar University Referral Hospital33. Moreover, the majority of the respondents’ monthly income ranges between 1000 and 2000 birr per month which was less than the study conducted in Pakistan39.

The majority of the respondents 124(63.6%) were happy and satisfied with Wollega University Referral Hospital Pharmacy service. This finding was comparable to other community pharmacy reports in some developed countries including Spain and Portugal40,41.

Regarding drug information provided at the pharmacy in the study area, most of the respondents reported that they were satisfied with the information on adverse effects of drugs/side effects that were provided to them, food not to be taken with drugs. This finding was in line with several studies conducted in different parts of the world39–42.

Patients were willing to receive pharmaceutical information. The satisfaction is likely associated with the provision of service promptness, pharmacist attitude/communication skills, medication counseling, and availability of enough waiting area43. However, most of the respondents have reported that they did not receive information on what to do when adverse effects of drugs/side effects occur, importance/need for loyalty to medication and no change of drugs if any side effects or adverse effects occur.

Moreover, majority of the respondents also reported that pharmacist did not provide voluntary detail advice about medications, screening prescriptions, and any other management work related to the stocking of medications and rather they have reflected negative attitude and sometimes irritated and even attempted insulting the patients which has negative effect on their satisfaction level with pharmacy service which was similar the study conducted in Nigeria44.

Regarding availability and affordability, majority of the respondents have reported that most of prescribed drugs were available and affordable compared with the private pharmacy service. The availability and affordability of prescribed drugs might have its own influence on patients’ level of satisfaction with pharmaceutical services. The majority of the respondents 132 (67.8%) are agreed on the availability of the required medicine. On the other hand, satisfaction rates in Baghdad was much higher45.

Clarity of instruction of taking medicine where 84 (43.1%) of the respondents have strongly disagreed on unclear instruction of taking prescribed medicine which was higher than the study conducted in North Ethiopia33. As far as the facility concerned majority of the respondents 106 (54.4%) have disagreed followed by those who have strongly disagree with 89 (45.6%) on poor facility of the hospital regarding pharmacy service, whereas none of the respondents have agreed on this issue. This indicated that almost all the respondents have satisfied with the facility of the hospital.

The pharmacist’s attitude toward treating patients and the majority of the respondents 126 (64.6%) have agreed that reflects negative attitude because of the working environment, while a few of them 23 (11.8%) have strongly agreed. The result indicates that the respondents have dissatisfied with the negative attitude of the pharmacists in the study area which has its influence on the satisfaction level of the patient.

The majority of the respondents 144 (73.8%) strongly agree on informing the patient side effect of the drugs while a few of them 24 (12.3%) have strongly disagreed that they received information on the adverse effect of the drugs from the pharmacists in the study area. Regarding the availability of good patient follow-up the majority of the respondents 121 (62.1%) disagreed followed by neutral 52 (26.7%), whereas a few respondents 22 (11.3%) agreed. Concerning the food information not to be taken with prescribed drugs majority of the respondents 131 (67.2%) agreed that the received information while a few of them 13 (6.7%) have strongly disagreed. On the change of drugs in case of occurrence of adverse drug effect majority of the respondents, 92(47.2%) have disagreed while a few of them 24 (12.3%) have strongly refused. Since the majority of the respondents did not get the opportunity of drug change in case of adverse effect reflection it has negatively affect patient satisfaction level of pharmacy service in the study area.

Conclusion

The study revealed that pharmaceutical services were provided and patient-reported that the services provided were beneficial to them in maintaining their health. Moreover, the respondents have reported that their satisfaction level with pharmacy service was affected by different pharmacy service-related factors. In the current situation of our country, this is very less to purchase the required drugs from different drug stores because it is expensive from there. Since the price of the prescribed drugs from this referral hospital is fair compared with the price of nonpublic drug stores the respondents were satisfied. Among other factors, the patient satisfaction level of pharmacy service was information provided on what to do when adverse effect of drug occurs, not voluntarily to change drugs in case of the adverse drug effect and negative attitude of pharmacists toward patients.

Improving service delivery for the customer using better procedures and techniques for service rendering institutions plays a crucial role in their survival and success. Therefore, to improve the problem with a shortage of information provisions on what to do during the occurrence of drug side effects, WURH management has to establish medication information center and activate it properly so that the patients have to be cultivated with different detailed information about the prescribed drugs. Moreover, creating a conducive working environment for the pharmacist’s employees, motivating them morally and financially, through better compensation package, and giving them extra vacation can alleviate the problem of demotivation and reflection of negative attitude to the customers.

Ethical approval

Ethical review committee of the Institute of Health Science, Wollega University.

Sources of funding

None.

Author contribution

G.F., S.D., D.D., and F.B. contributed in the proposal preparation, study design and analysis and write up of the manuscript. D.S., E.T., T.T., G.F., T.A., and B.G. contributed to conception, analysis, and write up of the manuscript. All authors read and approved the final version of the manuscript.

Conflict of interest disclosure

The authors declare that they have no financial conflict of interest with regard to the content of this report.

Research registration unique identifying number (UIN)

Researchregistry5846.

Guarantor

Ginenus Fekadu.

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Keywords:

Patient satisfaction; Diabetes mellitus; Pharmacy service; Ethiopia

Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of IJS Publishing Group Ltd.