A comparison of patients’ and pharmacists’ satisfaction with medication counseling provided by community pharmacies: a cross-sectional survey

Medication counseling has become a key priority for modern community pharmacists. Modern pharmacy practices display an evolving paradigm from traditional drug dispensing to more active and expanded clinical roles, including patient-oriented medication counseling activities [1, 2]. Medication counseling refers to “providing medication information orally or in written form to the patients or their representatives on directions of use, advice on side effects, precautions, storage, diet, and lifstyle modifications”[3]. Preliminary studies showed that through medication counseling, pharmacists may identify and correct drug-related problems, improve the patient’s knowledge about the proper use of medicines, increase patient satisfaction with the pharmacy service, and consequently optimize the patient quality of care [4‐6].

Satisfaction assessment is considered an important indicator of the quality of the pharmacy service as it reflects whether the service is meeting one’s expectations or values. There is an increasing trend to assess satisfaction level when the pharmacy service has started to expand its scope of practice [7‐10]. So far, previous studies have focused on the patients’ or pharmacists’ satisfaction with pharmacy services or with specific disease management services in developed countries, which is often difficult to generalize to other countries, such as South Korea, where the pharmacy service is still more likely to use the traditional role. Medication counseling practice by community pharmacists has been studied by performing surveys and evaluating patients’ or pharmacists’ satisfaction [9, 10]. Evaluating the level of satisfaction with medication counseling has become one of the pivotal components for predicting the quality of pharmacy services [10].

In South Korea, much attention has recently been focused on the issue of medication counseling practice by community pharmacists. Although it has been legally mandated that pharmacists are required to provide medication counseling to every patient [11], pharmacists have often failed to offer drug information to patients or only provide brief counseling upon patient request. As a result, more-stringent regulations were recently announced imposing monetary penalties on pharmacists who do not provide medication information to patients with each prescription filled [12]. However, this mandate has not necessarily worked as intended, and the quality and content of information provided varies among pharmacists [13]. Although this clearly calls for the quality assessment of medication counseling at this point, no studies have been conducted to evaluate the satisfaction with medication counseling by community pharmacists. To date, no studies have compared pharmacists’ and patients’ view or satisfaction with the medication counseling practice. The feedback from a survey could help to identify differences in levels of satisfaction with medication counseling between pharmacists and patients, and could assist in pinpointing areas for future improvement.

This study represents the first attempt to measure and compare patients’ and pharmacists’ satisfaction with medication counseling services provided by community pharmacists in South Korea. To evaluate the quality of current medication counseling practice by community pharmacists, questionnaires are an effective means for obtaining feedback on patients’ or pharmacists’ counseling experiences. In addition, the findings of this study will provide baseline data and strong evidence for improving the quality of medication counseling by community pharmacists.

One aim of this study was to assess and compare the levels of satisfaction of patients and community pharmacists with current medication counseling. We also aimed to examine the expectations of both patients and pharmacists regarding the implementation of medication counseling standards as a strategy to improve the quality of medication counseling.

A descriptive, cross-sectional survey was designed to explore pharmacists’ and patients’ levels of satisfaction with the current provision of medication counseling services provided by community pharmacists in South Korea from June 13, 2014 to July 15, 2014. The research was approved by the Yonsei University Institutional Review Board (IRB no. 1040917-201405-SB-170-02) and conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants before the administration of the survey. Participation in this survey was voluntary, and confidentiality was maintained throughout the study.

This is the first study, to our knowledge, that has assessed and compared patients’ and pharmacists’ levels of satisfaction with medication counseling services performed by community pharmacists in South Korea. The results of this study showed that the current medication counseling service was associated with low levels of both patient and pharmacist satisfactions. More than half of the respondents in both the patient and pharmacist groups were not satisfied with the medication counseling service and patients appeared to have less favorable views of the counseling service received from community pharmacists.

The results of this study are slightly inconsistent with a previous study that evaluated the quality of current medication counseling in community pharmacies. Shin et al. [13] reported that the pharmacists’ satisfaction with their own medication counseling was relatively less favorable (31.1 %) compared to the present study (47.3 %) [13]. The higher degree of pharmacists’ satisfaction in the present study may be due to the use of a different method and the different survey content to the previous study. Another previous study, by Van Geffen et al. [15], evaluated patient satisfaction with counseling by pharmacists [15]. The level of patient satisfaction with counseling was inconsistent with that found in the present study: patient satisfaction was slightly higher in the previous study compared to the present study (42.0 % vs. 31.1 %). This inconsistency could be due to the different study setting and the selection of the patient population. The patients’ or pharmacists’ satisfaction has a practical implication for evaluating the quality of pharmacy service [16]. An overall low level of satisfaction with the medication counseling service in both groups indicates that the quality of medication counseling does not meet the patients’ needs and expectations. Counseling should be more tailored to the patients’ needs. Pharmacists need to expand their roles in supporting patients with their medications.

The present study investigated the reasons why patients were not satisfied with medication counseling received from community pharmacists. The patients pinpointed the length of counseling time as a main reason for dissatisfaction with the medication counseling service. Interestingly, pharmacists also perceived time constraints as a major barrier to delivering effective medication counseling practice, which was similar to previous studies [13, 17, 18]. The role of pharmacists is dominated by dispensing and checking the high volume of prescriptions in South Korea. With the emphasis on the pharmacist’s responsibility for medication counseling, pharmacists have an increased workload and increased job stress levels, which may contribute to the poor performance of pharmacists as well as the poor quality of the pharmacy service [19]. Effective solutions for alleviating the pharmacists’ time constraint issue include the improvement of pharmacy staffing levels and optimal time management [19, 20]. The pharmacy staffing levels can be improved by adequately reimbursing pharmacists for the time spent on medication counseling [21]. Additionally, it is important for pharmacists to plan strategies for time management to overcome job stress and to aid the accomplishment of their responsibilities more efficiently. Optimal time management will allow pharmacists to spend more time interacting and communicating with the patient, thereby improving the quality of the pharmacy service. The majority of pharmacists perceived that they spent 1–5 min counseling patients, whereas the majority of patients reported that the length of time taken for medication counseling was less than 1 min. As the length of time taken for counseling increased, the levels of patient and pharmacist satisfaction significantly increased, which may be related to an increased amount of relevant information imparted to patients with increased counseling time. The provision of better levels of information has been associated with an increased satisfaction level [22, 23]. Thus, pharmacists should attempt to allocate sufficient time to deliver effective medication counseling to patients.

It is important for pharmacists to provide appropriate, clear, and relevant information to patients about their medications. Given the advertising of medications in the media and easy access to medical information on websites, patients were most likely to rely on portal sites first to search for medication information before they asked pharmacists, as shown in the present study. Even though the patients’ satisfaction with the pharmacists’ performance of medication counseling was low in the present study, the pharmacists were still considered a reliable source for patients when seeking medication information. Pharmacists are in a unique and readily available position to answer patients’ concerns and inquiries about their medications that they may read about or hear about from others.

The present study also suggested that national guidelines for medication counseling standards or protocols should be implemented and developed for effective medication counseling in addition to verbal counseling. Even though a new pharmaceutical affair law reinforces pharmacist counseling practices, the contents of medication information that pharmacists should provide to patients was lacking and often varied from pharmacist to pharmacist. This clearly calls for the contents of medication information to be standardized in a more patient-oriented direction or as user-tailored content. Based on the medication counseling standards, pharmacists could use their expertise in determining which information should be provided to each patient, with the expectation of improving the quality of medication counseling. The U.S. Food and Drug Administration has already published Medication Guides, which are paper handouts that contain information for patients on how to use a medication safely [24]. The guides are distributed with many prescription drugs that pharmacists dispense to patients. As shown in previous studies, providing structured and standardized written information in addition to verbal counseling can help patients or their caregivers to better understand their medications [25, 26].

The findings of this study should be interpreted with some limitations. There is potential bias associated with the convenience sampling method, which may reduce the generalizability of this study. However, convenience sampling was employed in the present study in order to recruit as many respondents as possible from a wide geographical area. Another limitation is the questionnaire distribution method used in this study. As this survey was carried out via the Internet, the access to the survey may have been limited for elderly people who may have a different experience and expectation of the service. Patients older than 50 years were under-represented in this study, which may have been due to selection bias. Moreover, the responses of patients and pharmacists relied on their ability to recall information and experiences of medication counseling practices, which may have resulted in recall bias.

Despite these limitations, this survey has provided useful insight into the current state of medication counseling practices and satisfaction levels of both patients and pharmacists. The low satisfaction levels of patients and pharmacists may reflect the low quality of medication counseling currently provided in community pharmacies in South Korea. Both the patient and pharmacist groups greatly supported the implementation of a national level of medication counseling standards as one of the strategies to improve the quality of pharmacy services. Consequently, this study provides baseline data for the construction of strategies to improve pharmacist medication counseling services in South Korea.