Participants’ Baseline Characteristics
A total of 508 respondents agreed to participate in this study, of whom 492 (96.9%) were Saudi; 263 (51%) were males and 432 (83%) were below 46 years of age (Table 1). Age over sex distribution of the participants is illustrated in Figure 1. There were no statistical differences in the demographic characteristics of the respondents who attended either hospitals (Table 1).
The average scores of domains medication availability, patient counseling, pharmacist and patient relationship, medication reconciliation, medication adherence, pharmacy location and waiting area, pharmacy communications and waiting time, and overall patient satisfaction of pharmacy services, were 4.51, 4.11, 4.30, 3.70, 3.57, 3.82, 3.63, and 4.15, respectively (Table 2). The general evaluation of pharmacy services domain was reported excellent by 245 (48.2%) respondents and very good (143; 28%), with 380 (76.4%) respondents were willing to recommend the pharmacy to their family or friends.
The respondents’ satisfactions were compared in the two hospitals and there was no significant difference (p>0.05) between them concerning all the domains of outpatient services such as medication availability, patient counseling, pharmacist and patient relationship, medication reconciliation, medication aberrance, pharmacy location and waiting area, pharmacy communications, waiting time, and overall patient satisfaction of pharmacy services (Table 2).
Overall, more than one-half of respondents (265; 52.2%) were very satisfied with pharmacy services and 233 (45.8%) were satisfied, whereas very few respondents (10; 2%) were dissatisfied with pharmacy services. There were no statistically significant differences between the overall satisfaction among respondents attending the two hospitals (p>0.05) (Table 3). The results showed no statistical significant difference between the satisfactions of respondents scored on paper questionnaire and web-based questionnaires (Table 4).
DISCUSSION
In this study, we explored the satisfaction with outpatient pharmacy services among respondents attending two tertiary care hospitals with variant medical specialties in the city of Tabuk, KSA. The study assessed patients’ responses on eight domains of outpatient pharmacy services. There was no statistical difference in all demographic characteristics between the participants of the two hospitals. Most of the respondents were Saudi nationals, which was expected because healthcare services are provided through cooperative health insurance regulations and insurance packages and only a small proportion of non-Saudi residents are allowed to receive healthcare services from governmental sectors17 . Most of the respondents were young adults below 46 years old who agreed to participate in the study, whereas a few number of respondents was elderly. This may be due to the interest in participating the survey through internet by the young adult population18 . Moreover, the general health conditions of many elderly patients were sick and it was not convenient for them to respond to the face-to-face interview.
We used mixed-mode survey in our study to improve the response rate as the previous studies recommended to add paper-based questionnaire with web-based questionnaire to increase the response rate. Though we used mixed-mode survey in our study, it did not affect the self-reported satisfaction of the respondents as previous studies in this regard have already ruled out this phenomenon19-21 .
The respondents reported high satisfaction with medicines availability domain and medication labeling and written instructions provided by the hospital pharmacists. Our results were similar to that reported in a recent study conducted in public, pediatric and emergency hospitals in Riyadh city 12and to outpatient services of primary healthcare centers in Saudi Arabia11 . Since the availability of medicines in hospitals remains the focus of the government, and labeling of medicines is the traditional activity of pharmacists, it might be a possible reason that respondents had higher satisfaction scores in these domains. However, a recent study demonstrated frequent drug shortages in ten largest Ministry of Health-hospitals in Riyadh city, Saudi Arabia offers the potential interest to conduct larger studies in order to enlighten the patient satisfaction regarding the drug availability in the near future22 .
Respondents scored less but still very good in the level of satisfaction with pharmacist counseling about the purpose of medications, explaining the side effects and storage of the medications (3.93, 3.65 and 3.74) as compared to medication labeling and providing written instructions. This was also consistent with a recent study in Al-Jouf province in the Northern Saudi Arabia which reported lower scores (3.08 and 3.11) in medication counseling13 . Lack of counseling areas in outpatient pharmacies along with inappropriate location of such areas might be the cause of patients’ lower satisfaction in this domain13 . However, in the current study, the participants scored very good to the question of whether counseling area was appropriate and respect the privacy. Our results were higher than those scored to ambulatory service at tertiary care hospitals in Riyadh city (2.2, 1.96 and 2.23) [4]. Low satisfaction levels were also associated with poor counseling practices provided by outpatient hospital pharmacies to diabetic patients23 . Whereas, knowledge, skills and the quality of pharmaceutical care counseling were determinants of willingness to pay for the service in Saudi Arabia7 . Older age, high educated patients, comorbidities, illness type and longer duration of treatment, few number of pharmacy staff in the hospitals, increased workload, and lack of continuous education for pharmacy service providers were reported as contributors to the low patients’ satisfaction with pharmacy services in the literature