Accepted Manuscript Patient Satisfaction With Community Pharmacy: Comparing Urban And Suburban ✰ Chain-Pharmacy Populations David F. Malewski , M.S., Pharm.D. Aimrie Ream , Pharm.D. candidate Caroline A. Gaither , Ph.D. PII:
S1551-7411(14)00065-5
DOI:
10.1016/j.sapharm.2014.05.001
Reference:
RSAP 518
To appear in:
Research in Social & Administrative Therapy
Received Date: 25 September 2013 Revised Date:
7 May 2014
Accepted Date: 8 May 2014
Please cite this article as: Malewski DF, Ream A, Gaither CA, Patient Satisfaction With Community ✰ Pharmacy: Comparing Urban And Suburban Chain-Pharmacy Populations , Research in Social & Administrative Therapy (2014), doi: 10.1016/j.sapharm.2014.05.001. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
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PATIENT SATISFACTION WITH COMMUNITY PHARMACY: COMPARING URBAN AND SUBURBAN CHAIN-PHARMACY POPULATIONS
M AN U
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David F Malewski M.S. Pharm.D. a,* Aimrie Ream, Pharm.D. candidate a Caroline A Gaither Ph.D. b a University of Michigan College of Pharmacy, Ann Arbor, MI 48109, USA b University of Minnesota College of Pharmacy, Minneapolis, MN 55455, USA
*Corresponding Author:
TE D
Portions of this study were presented at the 2013 Annual Meeting of the American Pharmacists Association, Los Angeles, CA and the 2012 Midwest Social and Administrative Pharmacy Meeting, Madison, WI
EP
David F Malewski M.S. Pharm.D. University of Michigan - College of Pharmacy Department of Clinical, Social and Administrative Science 3571 C.C. Little Building 428 Church Street Ann Arbor, MI 48109 Phone: +1-314-482-5695 Fax: +1-734-763-4480 E-Mail: [email protected] (D. Malewski)
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Keywords: Patient Satisfaction, Community Pharmacy, Pharmacy Location
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PATIENT SATISFACTION WITH COMMUNITY PHARMACY: COMPARING URBAN AND SUBURBAN CHAIN-PHARMACY POPULATIONS
_ _ _ _
M AN U
SC
_
_ _ _ _ _ _ _ _ _
EP
*Corresponding Author:
TE D
Portions of this study were presented at the 2013 Annual Meeting of the American Pharmacists Association, Los Angeles, CA and the 2012 Midwest Social and Administrative Pharmacy Meeting, Madison, WI
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42
Keywords: Patient Satisfaction, Community Pharmacy, Pharmacy Location
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ABSTRACT
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Background. Patient satisfaction with pharmaceutical care can be a strong predictor of medication and other health-related outcomes. Less understood is the role that location of pharmacies in urban or suburban environments plays in patient satisfaction with pharmacy and pharmacist services. Objectives. The purpose of this study was to serve as a pilot examining urban and suburban community pharmacy populations for similarities and differences in patient satisfaction. Methods. Community pharmacy patients were asked to self-administer a 30-question patient satisfaction survey. Fifteen questions addressed their relationship with the pharmacist, 10 questions addressed satisfaction and accessibility of the pharmacy, and five questions addressed financial concerns. Five urban and five suburban pharmacies agreed to participate. Data analysis included descriptive statistics and chi-square analysis. Results. Most patients reported high levels of satisfaction. Satisfaction with pharmacist relationship and service was 70% or higher with no significant differences between locations. There were significant differences between the urban and suburban patients regarding accessibility of pharmacy services, customer service and some patient/pharmacist trust issues. Conclusions. The significant differences between patient satisfaction in the suburban and urban populations warrant a larger study with more community pharmacies in other urban, suburban and rural locations to better understand and validate study findings.
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INTRODUCTION
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Patient satisfaction has become a driver of quality as affordable care organizations expand and healthcare market competition grows.1-9 Organizations such as the U.S. Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare and Medicaid Services (CMS) recognize the importance of patient satisfaction as a quality metric through the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey program.10 Patient satisfaction is vital for continuous monitoring and quality improvement of healthcare delivery systems.11 From the patient perspective, research suggests that satisfied patients are more likely to continue a relationship with one healthcare practitioner, participate in their own healthcare, adhere to their treatment regimens and have better health outcomes.6-7,12
M AN U
Pharmacists are one of the most accessible healthcare professionals in terms of location and play an increasing role in maintaining patient health and driving quality.13 Early pharmacy satisfaction research focused primarily on patients’ satisfaction with services and facilities2-5, more recent studies focus on satisfaction with the pharmacistpatient relationship and cognitive/pharmaceutical care services.6-9 Patients tend to be highly satisfied with these services, but satisfaction might differ across a number of phenomena including geographic location of pharmacy.
TE D
Research outside of pharmacy indicates that location of residence influences patient satisfaction with health services,14-16 but there are few studies that explicitly compare the results of two or more locations to each other.9 Haven et al. demonstrated differences in patient confidence in available healthcare in suburban locations when compared to rural and urban.17 Geographic access to pharmacies differs across the US and living in well-served areas often predicts healthcare services use.18,19 Examining population-based differences may help to reveal factors leading to targeted interventions.
EP
Access to health services and building trust are important components in addressing health disparities among racial/ethnic minorities.20,21 Investigating patient satisfaction by location (urban versus suburban) may reveal gaps in satisfaction, providing target areas for interventions.
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A study was undertaken investigating whether location-based factors influence various aspects of patient satisfaction. The objectives of this study were to: (1) assess patient satisfaction in 10 (5 urban, 5 suburban) chain pharmacies, (2) examine multiple aspects of patient pharmacy-related experiences: relationship with pharmacist and service provided, ease of access to pharmacy services, and financial concerns and (3) compare and contrast urban and suburban patient satisfaction. METHODS Design, Population and Sample
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The University of Michigan IRB approved the project involving a chain (multi-unit) pharmacy operating in two American cities: Detroit (urban) and Ann Arbor (suburban) Michigan. In the United States, urban areas consist of approximately 3,000+ people per square mile, and suburban areas between 1,000 to 3,000.22 Population estimates for Ann Arbor and Detroit are 116,121 and 701,475, respectively.23 Corporate management provided addresses of five pharmacies operating in Detroit and Ann Arbor. Questionnaire Development
M AN U
SC
Composition. The questionnaire addressed 4 areas of patient satisfaction as well as demographic and pharmacy use information. Fifteen questions covered satisfaction with the relationship and service received from the pharmacist, 4 questions addressed pharmacy facility satisfaction, 6 questions assessed pharmacy accessibility and 5 questions assessed financial concerns. Eleven questions each came directly from either Horvat’s Patient Satisfaction with Pharmacy Performance Questionnaire,6 or MacKeigan and Larson’s Satisfaction With Pharmacy Services.1 Eight questions were developed to examine pharmacist/pharmacy/patient interactions based on more recent satisfaction questionnaires.8,24 As recommended by CAPHAS,25 items were measured on two 10-point Likert-type scales (either strongly agree to strongly disagree or very little to very much). Demographic and pharmacy use information is listed in Table 1. Data Collection
Data Analysis
EP
TE D
Data were collected via a self-administered questionnaire over a 1 to 2 day period from October to December. Investigators approached pharmacy patrons 18 years or older and inquired if they were a regular patient of the pharmacy. If so, they were asked to complete the questionnaire. At a 90% confidence interval, 5% margin of error and 50% response distribution, at least 267 responses were needed. The goal was 30 or more completed questionnaires at each of the10 pharmacies.
Each questionnaire received a unique identifier before being coded into an Excel database. Responses were included in the overall dataset contingent upon completing at least 25 items. Satisfaction items were recoded from the 10-point response-format into a simplified 3-point format. Chi-square analyses comparing locations were conducted using SPSSV20.
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RESULTS
Recruitment Of the 558 pharmacy customers approached, 79 were not patients, 153 declined, and 326 completed questionnaires; 163 each in Detroit and Ann Arbor. An overall response rate of 58% was achieved.
ACCEPTED MANUSCRIPT 5
Demographics (See Table 1) All demographic comparisons are statistically significant except for gender and pharmacy visits during the last month. (See Table 1)
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Pharmacist/Pharmacy Interactions (Table 2)
SC
Counseling. Four items addressed pharmacists’ counseling skills. There were no significant differences between urban and suburban locations with 74% or more of respondents agreeing with these statements. Patients in Detroit were less likely to feel that the pharmacist knew how to help them with expert advice (p=0.066).
M AN U
Perceptions of Relationship. Four items addressed patient relational perceptions of their interactions with the pharmacist. There was a significant difference between urban and suburban locations concerning correct dispensing of prescriptions (p=0.035), with 11% of Detroit versus 4% of Ann Arbor patients indicating disagreement with this statement. Patient/Pharmacy Interaction. Four items asked patients about their interactions with the pharmacy. Concerning convenience of pharmacy location, 17% of Detroit versus 6% of Ann Arbor patients indicated neutral or disagreement with the statement (p=0.012). Pharmacist: Services Provided (Table 3)
EP
TE D
Advice. Three items questioned patients about their comfort and frequency of talking to their pharmacist and trust in information accuracy. The frequency which patients sought advice from the pharmacist differed significantly between urban and suburban locations (p
S1551-7411(14)00065-5
DOI:
10.1016/j.sapharm.2014.05.001
Reference:
RSAP 518
To appear in:
Research in Social & Administrative Therapy
Received Date: 25 September 2013 Revised Date:
7 May 2014
Accepted Date: 8 May 2014
Please cite this article as: Malewski DF, Ream A, Gaither CA, Patient Satisfaction With Community ✰ Pharmacy: Comparing Urban And Suburban Chain-Pharmacy Populations , Research in Social & Administrative Therapy (2014), doi: 10.1016/j.sapharm.2014.05.001. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
RI PT
PATIENT SATISFACTION WITH COMMUNITY PHARMACY: COMPARING URBAN AND SUBURBAN CHAIN-PHARMACY POPULATIONS
M AN U
SC
David F Malewski M.S. Pharm.D. a,* Aimrie Ream, Pharm.D. candidate a Caroline A Gaither Ph.D. b a University of Michigan College of Pharmacy, Ann Arbor, MI 48109, USA b University of Minnesota College of Pharmacy, Minneapolis, MN 55455, USA
*Corresponding Author:
TE D
Portions of this study were presented at the 2013 Annual Meeting of the American Pharmacists Association, Los Angeles, CA and the 2012 Midwest Social and Administrative Pharmacy Meeting, Madison, WI
EP
David F Malewski M.S. Pharm.D. University of Michigan - College of Pharmacy Department of Clinical, Social and Administrative Science 3571 C.C. Little Building 428 Church Street Ann Arbor, MI 48109 Phone: +1-314-482-5695 Fax: +1-734-763-4480 E-Mail: [email protected] (D. Malewski)
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42
Keywords: Patient Satisfaction, Community Pharmacy, Pharmacy Location
ACCEPTED MANUSCRIPT
RI PT
PATIENT SATISFACTION WITH COMMUNITY PHARMACY: COMPARING URBAN AND SUBURBAN CHAIN-PHARMACY POPULATIONS
_ _ _ _
M AN U
SC
_
_ _ _ _ _ _ _ _ _
EP
*Corresponding Author:
TE D
Portions of this study were presented at the 2013 Annual Meeting of the American Pharmacists Association, Los Angeles, CA and the 2012 Midwest Social and Administrative Pharmacy Meeting, Madison, WI
AC C
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42
Keywords: Patient Satisfaction, Community Pharmacy, Pharmacy Location
ACCEPTED MANUSCRIPT 2
ABSTRACT
EP
TE D
M AN U
SC
RI PT
Background. Patient satisfaction with pharmaceutical care can be a strong predictor of medication and other health-related outcomes. Less understood is the role that location of pharmacies in urban or suburban environments plays in patient satisfaction with pharmacy and pharmacist services. Objectives. The purpose of this study was to serve as a pilot examining urban and suburban community pharmacy populations for similarities and differences in patient satisfaction. Methods. Community pharmacy patients were asked to self-administer a 30-question patient satisfaction survey. Fifteen questions addressed their relationship with the pharmacist, 10 questions addressed satisfaction and accessibility of the pharmacy, and five questions addressed financial concerns. Five urban and five suburban pharmacies agreed to participate. Data analysis included descriptive statistics and chi-square analysis. Results. Most patients reported high levels of satisfaction. Satisfaction with pharmacist relationship and service was 70% or higher with no significant differences between locations. There were significant differences between the urban and suburban patients regarding accessibility of pharmacy services, customer service and some patient/pharmacist trust issues. Conclusions. The significant differences between patient satisfaction in the suburban and urban populations warrant a larger study with more community pharmacies in other urban, suburban and rural locations to better understand and validate study findings.
AC C
43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66
ACCEPTED MANUSCRIPT 3
INTRODUCTION
SC
RI PT
Patient satisfaction has become a driver of quality as affordable care organizations expand and healthcare market competition grows.1-9 Organizations such as the U.S. Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare and Medicaid Services (CMS) recognize the importance of patient satisfaction as a quality metric through the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey program.10 Patient satisfaction is vital for continuous monitoring and quality improvement of healthcare delivery systems.11 From the patient perspective, research suggests that satisfied patients are more likely to continue a relationship with one healthcare practitioner, participate in their own healthcare, adhere to their treatment regimens and have better health outcomes.6-7,12
M AN U
Pharmacists are one of the most accessible healthcare professionals in terms of location and play an increasing role in maintaining patient health and driving quality.13 Early pharmacy satisfaction research focused primarily on patients’ satisfaction with services and facilities2-5, more recent studies focus on satisfaction with the pharmacistpatient relationship and cognitive/pharmaceutical care services.6-9 Patients tend to be highly satisfied with these services, but satisfaction might differ across a number of phenomena including geographic location of pharmacy.
TE D
Research outside of pharmacy indicates that location of residence influences patient satisfaction with health services,14-16 but there are few studies that explicitly compare the results of two or more locations to each other.9 Haven et al. demonstrated differences in patient confidence in available healthcare in suburban locations when compared to rural and urban.17 Geographic access to pharmacies differs across the US and living in well-served areas often predicts healthcare services use.18,19 Examining population-based differences may help to reveal factors leading to targeted interventions.
EP
Access to health services and building trust are important components in addressing health disparities among racial/ethnic minorities.20,21 Investigating patient satisfaction by location (urban versus suburban) may reveal gaps in satisfaction, providing target areas for interventions.
AC C
67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112
A study was undertaken investigating whether location-based factors influence various aspects of patient satisfaction. The objectives of this study were to: (1) assess patient satisfaction in 10 (5 urban, 5 suburban) chain pharmacies, (2) examine multiple aspects of patient pharmacy-related experiences: relationship with pharmacist and service provided, ease of access to pharmacy services, and financial concerns and (3) compare and contrast urban and suburban patient satisfaction. METHODS Design, Population and Sample
ACCEPTED MANUSCRIPT 4
RI PT
The University of Michigan IRB approved the project involving a chain (multi-unit) pharmacy operating in two American cities: Detroit (urban) and Ann Arbor (suburban) Michigan. In the United States, urban areas consist of approximately 3,000+ people per square mile, and suburban areas between 1,000 to 3,000.22 Population estimates for Ann Arbor and Detroit are 116,121 and 701,475, respectively.23 Corporate management provided addresses of five pharmacies operating in Detroit and Ann Arbor. Questionnaire Development
M AN U
SC
Composition. The questionnaire addressed 4 areas of patient satisfaction as well as demographic and pharmacy use information. Fifteen questions covered satisfaction with the relationship and service received from the pharmacist, 4 questions addressed pharmacy facility satisfaction, 6 questions assessed pharmacy accessibility and 5 questions assessed financial concerns. Eleven questions each came directly from either Horvat’s Patient Satisfaction with Pharmacy Performance Questionnaire,6 or MacKeigan and Larson’s Satisfaction With Pharmacy Services.1 Eight questions were developed to examine pharmacist/pharmacy/patient interactions based on more recent satisfaction questionnaires.8,24 As recommended by CAPHAS,25 items were measured on two 10-point Likert-type scales (either strongly agree to strongly disagree or very little to very much). Demographic and pharmacy use information is listed in Table 1. Data Collection
Data Analysis
EP
TE D
Data were collected via a self-administered questionnaire over a 1 to 2 day period from October to December. Investigators approached pharmacy patrons 18 years or older and inquired if they were a regular patient of the pharmacy. If so, they were asked to complete the questionnaire. At a 90% confidence interval, 5% margin of error and 50% response distribution, at least 267 responses were needed. The goal was 30 or more completed questionnaires at each of the10 pharmacies.
Each questionnaire received a unique identifier before being coded into an Excel database. Responses were included in the overall dataset contingent upon completing at least 25 items. Satisfaction items were recoded from the 10-point response-format into a simplified 3-point format. Chi-square analyses comparing locations were conducted using SPSSV20.
AC C
113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158
RESULTS
Recruitment Of the 558 pharmacy customers approached, 79 were not patients, 153 declined, and 326 completed questionnaires; 163 each in Detroit and Ann Arbor. An overall response rate of 58% was achieved.
ACCEPTED MANUSCRIPT 5
Demographics (See Table 1) All demographic comparisons are statistically significant except for gender and pharmacy visits during the last month. (See Table 1)
RI PT
Pharmacist/Pharmacy Interactions (Table 2)
SC
Counseling. Four items addressed pharmacists’ counseling skills. There were no significant differences between urban and suburban locations with 74% or more of respondents agreeing with these statements. Patients in Detroit were less likely to feel that the pharmacist knew how to help them with expert advice (p=0.066).
M AN U
Perceptions of Relationship. Four items addressed patient relational perceptions of their interactions with the pharmacist. There was a significant difference between urban and suburban locations concerning correct dispensing of prescriptions (p=0.035), with 11% of Detroit versus 4% of Ann Arbor patients indicating disagreement with this statement. Patient/Pharmacy Interaction. Four items asked patients about their interactions with the pharmacy. Concerning convenience of pharmacy location, 17% of Detroit versus 6% of Ann Arbor patients indicated neutral or disagreement with the statement (p=0.012). Pharmacist: Services Provided (Table 3)
EP
TE D
Advice. Three items questioned patients about their comfort and frequency of talking to their pharmacist and trust in information accuracy. The frequency which patients sought advice from the pharmacist differed significantly between urban and suburban locations (p
