Patient reported experience measures: an assessment of the out-patient pharmacy in a tertiary care teaching hospital

INTRODUCTION

With the rise in the number of hospitals and healthcare facilities, patients come in with specific expectations before their visits. Their experiences during their stay, including the quality of care and services provided, ultimately determine whether they leave satisfied or dissatisfied. Analysing patient experience data plays a crucial role in identifying quality improvement opportunities and enhancing patient satisfaction. Patient experience data, including patient related experience measures, are often collected but underutilized in improving hospital care. It emphasizes the need for effective analysis of these data to make meaningful changes in patient-centred care. The authors suggest systematic frameworks for analysing patient related experience measures to identify care deficiencies.¹

Comprehensive analysis of patient related experience measures can lead to targeted improvements in healthcare services, particularly in understanding patient needs and expectations. Choosing valid and reliable tools for collecting data and discusses how well-designed instruments facilitate effective analysis, enabling hospitals to improve service quality.² Analysis of patient related experience measures is crucial for driving patient-centred improvements and benchmarking service quality. Studies have shown patient related experience measures and Patient Reported Outcome Measures (PROMs) can transform healthcare by providing direct feedback from patients about their care experiences. It stresses that analysing patient related experience measures in depth helps identify gaps in service delivery and patient satisfaction, allowing hospitals to focus on areas needing improvement.³

Patient experience measures may be sensitive to differences in quality care across different providers, institutions or time, and thus can be used to identify gaps or evaluate changes in quality resulting from interventions or policies.⁴ Patient experience is a process indicator and reflects the interpersonal aspects of quality of care received. This indicator is broadly composed of three domains: effective communication; respect and dignity; and emotional support.⁵

Patient reported experience measure’s analysis can uncover key factors influencing patient satisfaction with pharmacy services, leading to targeted quality improvements. A study underscores the value of analysing Patient reported experience measures to understand the quality of pharmacy services, such as wait times, pharmacist-patient interactions, and access to medications. Analysing these measures helps hospitals improve service quality and patient engagement.⁶ Systematic analysis of patient reported experience measures is vital for improving the quality and efficiency of pharmacy services, ensuring that patient needs are addressed. A study provided insights applicable to hospital pharmacies where in it discussed the role of Patient reported experience measures in evaluating patient satisfaction with medication dispensing, pharmacist consultations, and overall service quality. The analysis of these measures is highlighted as a tool for improving pharmacy operations, patient communication, and satisfaction in hospital settings.⁷ The objective of this study is to assess the different levels of patient experiences and also to determine the factors that are affecting the satisfaction level for the services provided in the out-patient pharmacy.

METHODS

Statement of the problem

Patient reported experience measures: An assessment of the out-patient pharmacy in a tertiary care teaching hospital.

Study design

Our study was conducted using a descriptive, cross-sectional research design. The data is collected through a structured questionnaire administered to patients who had availed medicines from the out- patient pharmacy of the selected hospital

Sampling and sampling techniques

The data was collected from the patients (49) who had availed services from the out-patient pharmacy of the selected tertiary care hospital.

Tools and techniques of data collection

The study was conducted using a structured, close-ended questionnaire to collect patient data.

Data collection method

A structured questionnaire was made and given to the patients after receiving Ethical clearance from the Ethics Board of the institute where in the study was conducted.

Study period

The study was conducted from 30^th August 2023 to 16^th September 2023.

Inclusion criteria

All in-patients who could communicate in English, Kannada and Malayalam were taken for the study. Patients who had availed services from the out-patient Pharmacy during the above mentioned study period were taken for the study.

Exclusion criteria

Patients who had availed pharmacy facility from other pharmacy in the hospital were excluded from the study

Content validity

The tool was given to experts for content validity. Based on their suggestions and recommendations, the tool was modified.

Statistical analysis

The collected data were analyzed by frequency, percentage, mean, and standard deviation based on the study's objectives. The data were presented graphically as well as in the form of tables.

RESULTS

This section looks at the information from structured questionnaires filled out by 49 patients and tries to determine experiences of the out-patient pharmacy services in the selected hospital. This cross-sectional study on patient reported experience measure in pharmacy, designed a 13-item questionnaire and gathered valuable insights from patients, which were rated on a 3-point Likert scale. The collected data were meticulously analyzed to assess patients' experiences and perceptions. The findings provide a comprehensive overview of patient satisfaction, highlighting areas of strength and areas that may require improvement in pharmacy services. The results of the analysis are shown in tables and graphs. The representation of results and their implications are enlisted below.

This study showed that significant portion, 46%, expressed their experience as "excellent," indicating a high level of satisfaction with medicine availability. Another 44% rated it as "satisfactory," suggesting that the majority of respondents found the store's medicine inventory to be adequate. However, it's worth noting that 8% of respondents rated it as "poor," signifying a small but notable percentage of individuals who encountered issues with medicine availability (Table 1).

With regards to the timeliness of the services provided, while 40% of respondents found it "excellent," suggesting a prompt service experience, 34% rated it as "satisfactory," indicating a moderate level of satisfaction with regards to time taken to collect prescription from the patient by a pharmacy staff. Similarly, the time taken for billing and payment lead varying responses. 40% of respondents considered it "excellent," reflecting a fast-billing process, but 30% rated it as "poor," suggesting room for improvement in expediting this aspect of service. The 28% who found it "satisfactory" indicates a moderate level of satisfaction. For the overall time taken to receive medicine, the results show that 24% of respondents rated it as "excellent," while 42% found it "satisfactory." However, a significant 32% expressed dissatisfaction, considering it "poor." The responses regarding the fast-tracking process for single medicine purchases reveal a similar trend. While 28% rated it as "excellent," indicating efficient service, 34% found it "satisfactory." However, a substantial 36% marked it as "poor" (Table 1).

It is evident that with regard to the knowledge of the pharmacy staff and with regards to the experience of the patient regarding the assistance by the staff regarding medicine dose explanation, majority of patients (55%) rated the staff's performance as "excellent," indicating a high level of satisfaction. An additional 36% found it "satisfactory," suggesting overall competence. However, 8% of respondents reported a "poor" experience (Table 1).

Regarding the friendliness and courtesy of the staff, the majority of patients (49%) rated the friendliness and courtesy of the staffs as "excellent," signifying a high level of satisfaction with their friendliness and courtesy. Another substantial portion (36%) found it to be "satisfactory," indicating that most patients had positive interactions with the staff. However, 14% of respondents reported a "poor" experience, emphasizing the need to maintain consistent efforts in ensuring that all patients receive friendly and courteous service (Table 1).

It was observed that majority of patients (59%) found the accessibility and cleanliness of the drinking water facility to be "satisfactory," while 22% rated it as "excellent," and 18% considered it "poor” (Table 1).

A positive perception of patient experience regarding availability of seating arrangements in the pharmacy was observed, with 59% rating it as "excellent" and 32% as "satisfactory." A small 8% found it "poor," reflecting an overall positive experience in this regard (Table 1).

The assessment of crowd management reveals that a significant 40% of respondents rated it as "excellent," indicating a well-organized and efficient system, there is room for improvement, as 36% found it "satisfactory," and 22% marked it as "poor" (Table 1).

The prioritization of senior citizens in the pharmacy received predominantly positive feedback, with 55% rating it as "excellent" and 30% as "satisfactory". However, it's worth noting that 14% of respondents reported it as "poor” (Table 1).

The study indicates the pharmacy staff's readiness to address concerns and questions, almost half of the respondents (49%) rated this aspect as "excellent," However, it's important to acknowledge that 30% of respondents found it "satisfactory," while 20% reported it as "poor." While a significant number of patients experienced outstanding support in addressing their concerns and queries, there remains a notable segment of respondents who may have encountered challenges in this regard (Table 1).

With regard to the overall satisfaction with the services of the Out Patient Pharmacy, nearly 40% of patients rated it as "excellent," matching 40% found it "satisfactory," and 18% regarded it as "poor." These results indicate a relatively balanced perception of the pharmacy's overall service quality, with potential for improvement in certain areas to enhance overall satisfaction levels (Table 1).

DISCUSSION

Analyzing patient experiences enhances the quality of pharmaceutical care, leading to better clinical outcomes and more efficient pharmacy services. A paper review showed that the role of pharmaceutical care in hospitals, emphasizing patient-centered services in pharmacy practice. It discusses the role of PREMs in assessing patient experience with pharmaceutical care, noting that systematic analysis can improve medication management, adherence, and patient-pharmacist communication.⁸ This study aims to assess the different levels of patient experiences and also to determine the factors that are affecting the satisfaction level for the services that the patients receive when they avail facilitates from the pharmacy. The study significant findings of the study were as follows

The data showed that 46% of the patients rated their experience as excellent with regards to the availability of the medicines in the pharmacy. However, it's worth noting that 8% of respondents rated it as "poor," signifying a small but notable percentage of individuals who encountered issues with medicine availability. This finding underscores the importance of maintaining a well-stocked pharmacy inventory to meet the diverse needs of patients, as even a relatively small percentage of dissatisfied customers can impact overall service quality and reputation.

With regards to the timeliness of the services provided, more than 40% of the patients ranked excellent for the time taken to collect the prescription by the pharmacy staff, for the process of billing and payment and for the overall time taken to receive the medicines. However notable 24% expressed dissatisfaction, marking it as "poor." For the time taken by the staff to collect the prescription from the patient. This suggests that there is room for improvement in expediting the prescription retrieval process to enhance overall customer satisfaction. 30% of the patients rated “poor” for the time taken in billing and payment. This indicates the room for improvement and process mapping in expediting this aspect of service. Furthermore 32% of the patients expressed their dissatisfaction with regards to the overall time taken to receive the medications which emphasis the need to streamline the process to reduce waiting times and enhance the overall experience for patients. The study also revealed that only 28% of the patients had rated excellent with regards to the process of fast tracking of the order in case of single medications. This suggests opportunities for improvement in expediting the purchase process for single medications. Lean Six Sigma techniques have been applied in pharmacies to streamline workflow processes, thereby reducing waste and improving efficiency. By redesigning the workflow using Lean Six Sigma, a study showed a 25% reduction in dispensing times without compromising the accuracy or safety of the process.⁹

The current study showed that although 55% of the patients rated “excellent” for the staff knowledge and their assistance, 8% reported as “poor”, signaling room for improvement in ensuring that all the patients receive accurate and comprehensive information about their medications. A study focusing on educating pharmacists in clinical decision-making and medication management, aimed at reducing both dispensing times and errors in community pharmacies. It was observed that the pharmacists who participated in clinical education programs were able to improve their dispensing efficiency by 17%, mainly due to better clinical decision-making and faster processing of prescriptions.¹⁰

Further the current study emphasizes the need to maintain consistent efforts in ensuring that all patients receive friendly and courteous service, as this aspect plays a crucial role in enhancing overall patient satisfaction. The study also suggests room for improvement in ensuring a consistently clean and accessible drinking water facility. The data also suggest that while the pharmacy has made commendable efforts in managing the flow of patients, there may be challenges in ensuring a consistently smooth and organized experience, particularly during peak hours or busy periods. To enhance crowd management, strategies such as optimizing staff allocation and implementing queue management systems. This study also indicates that a significant portion of respondents appreciates the special attention given to senior citizens, which is crucial for ensuring their comfort and well-being during their pharmacy visits. To further enhance senior citizen prioritization, the pharmacy can consider initiatives such as the dedicated service counters should only cater to senior citizens and shorter wait times, so that this vulnerable population receives the care and attention they deserve.

The study has few limitations. The study does not capture experiences of the patients who had availed services from the other pharmacy in the Hospital. Since the pharmacy staff are posted in various pharmacy outlets within the hospital, it is essential to study the experience level of the patients from all the pharmacies across the hospital. This will help in understanding the operational aspects as well as the individual aspects which contribute in the reduced patient satisfaction level.

CONCLUSION

Regular measurement of patient experiences and timely proactive intervention for increasing patient satisfaction plays a pivotal role in enhancing the patient experience and delight not only during their stay in the hospital but also for all the services that they avail. This cross-sectional study on patient reported experience measure in the pharmacy has provided valuable insights into the various facets of pharmacy services, as perceived by patients. The findings reveal both strengths and areas for improvement within the pharmacy setting. Notably, patients expressed a high level of satisfaction with staff knowledge, dose explanation, and senior citizen prioritization, which are crucial components of quality healthcare service. However, there are notable opportunities for enhancement in areas such as crowd management and addressing concerns and questions. The responses underscore the importance of optimizing timeliness, convenience, and communication to ensure a consistently positive patient experience. Overall, this study serves as a valuable resource for the pharmacy to identify areas for improvement, prioritize patient-centric initiatives, and ultimately, deliver more effective and satisfying healthcare services. By addressing the concerns raised by patients, the pharmacy can work toward achieving a higher level of patient satisfaction and further improve its quality of care.

ACKNOWLEDGEMENTS

We would like to thank the patients of the selected tertiary care teaching hospital for sharing their views and inputs for this study.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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