Patient satisfaction and associated factor at red cross pharmacies in Addis Ababa, Ethiopia

Patient satisfaction is the degree of positive feeling that patients experience having used a service. It is one of important aspect of health care. It indicates the gap between expected service and the actual experience from the patient point of view [1]. Routine measuring patient satisfaction level for improvement is the recommended approach for health care provider at all level. Also, measurement of patient satisfaction has shown to be an increasingly important determination of overall health outcomes [2]. It has been observed in many studies that patients who are satisfied with health service are adherent to their treatment, enjoy better health, and there was more efficient use of health care resource [3].

Recently pharmacy service has been increasingly expanded beyond simple medication supply to become a more patient-centered and caring service. Pharmacists work in harmony with other health professionals to achieve the best clinical outcome and to improve patients' quality of life. The pharmacist is also expected to have an appropriate caring attitude and to apply his/her pharmacotherapy knowledge and skill for the improvement of patients' health and well-being [4, 5].

Patient-centered approach of pharmacy service is expected to increase patient satisfaction. In Ethiopia patient centered clinical pharmacy service is mostly implemented in public hospitals. However, such approached are not implemented adequately in community pharmacies. Still community pharmacy is considered as medication selling area only, without due emphasis on patient care. Despite this, development of Good Dispensing Practice (GDP) manual by Ethiopian Food and Drug Authority (EFDA) may have core value for pharmaceutical care service, ultimately increasing patient satisfaction. The issue is there is no clear monitoring whether GDP manual is adequately implemented or not [6].

Worldwide, various studies have been performed to assess patient satisfaction with community Pharmacies service [7‐11].While this measure becomes a key marker in developed countries, interest in the evaluation of patient satisfaction is growing in developing countries to evaluate community pharmaceutical service [12‐15].

In Ethiopia, some studies had been conducted on the satisfaction of client with pharmacy service in public hospitals [18‐25]. However, there is scarce documentation of opinion of patient satisfaction towards community pharmacy service. Red Cross pharmacies are the only chain pharmacies serving the patients throughout Ethiopia, serving larger segment of the population. Red cross pharmacy are known for lower price of medicines compared to private community pharmacy because of this many patients want to use such type of pharmacies, however in Addis Ababa there are only three Red Cross Pharmacies for more than five million population in the city [16]. Medicines availability, price, patients waiting times, accessibilities of the pharmacies, and services provided by the pharmacists may affect patient satisfaction [7, 17, 18].

Despite the vital role of patient satisfaction in shaping the quality of healthcare services, there is a paucity of research focusing on patient satisfaction towards community pharmacy services in Ethiopia, particularly at Red Cross pharmacies. Patient satisfaction is a significant indicator of healthcare service delivery and has been associated with improved treatment adherence, better health outcomes, and efficient utilization of healthcare resources. However, the factors affecting patient satisfaction at Red Cross pharmacies in Addis Ababa remain largely unexplored, leading to a gap in understanding the quality of pharmacy services provided to the population. The aim of this study was therefore, to assess patient satisfaction and identify factor associated with patient satisfaction toward Red Cross Pharmacies in Addis Ababa.

Patient satisfaction with Red Cross pharmacy services being found to be 60.4% suggests that a significant portion of the patients who utilized Red Cross pharmacies in the study expressed satisfaction with the services they received. This finding is an essential indicator of the quality of healthcare services delivered by Red Cross pharmacies and reflects how well they meet the needs and expectations of their patient population. The study reveals that the majority of patients had a positive experience with Red Cross pharmacy services, indicating that the pharmacies are successful in delivering satisfactory healthcare experiences. While 60.4% is a considerable proportion of satisfied patients, it also indicates that there is room for improvement. The satisfaction level was better than most pharmacy service of hospitals in Ethiopian [23‐26]. It was also better than some other African countries pharmacies, Tanzania (46%) [20]. But lower than developed countries satisfaction level, which was 65% in United Arab Emirates [7],85.1% in USA [3] and 77%in Qatar [27].

This study showed that patient satisfaction in Red Cross Community Pharmacy was higher than patient satisfaction in most hospitals’ pharmacy in Ethiopia. Possible reasons contributing to a better satisfaction rate at Red Cross pharmacies compared to other pharmacies include their reputation as a humanitarian organization, affordable medication prices, caring and empathetic staff, patient-centered approach, community trust, ethical practices, adherence to GDP, collaboration with public hospitals, and active participation in healthcare initiatives. These factors may collectively contribute to a positive patient experience, fostering higher satisfaction levels among patients visiting Red Cross pharmacies in Addis Ababa.

In this study, patients’ satisfaction with the pharmacy setup was 83.8%. This is higher than patient satisfaction in most public hospital in Ethiopia [19, 21‐23] and other countries [15]^. The pharmacy's working area setup plays a crucial role in achieving a patient satisfaction rate. An organized and efficient working area design enables streamlined medication dispensing, reduces waiting times, and ensures clear communication between patients and pharmacy staff. The pharmacy's layout, with easy access to medication shelves, consultation areas, and prescription counters, enhances the patient experience, making it convenient and comfortable for patients to access healthcare services. A well-arranged working area also fosters a patient-centered environment, where staff can offer personalized care and address patient needs promptly. The implication of this high satisfaction rate is a positive reputation for the pharmacy, increased patient loyalty, and improved health outcomes as satisfied patients are more likely to adhere to medications and follow treatment plans.

EFDA takes strict follow-up and measures on community pharmacy setup more than public hospitals pharmacies, that could be also the reason for the decreased patient satisfaction with public hospital pharmacy building. Also, there is no clear criterion on the number of pharmacies that should be available in public hospitals that depends on number of patients served. Many patients are served in a single outpatient pharmacy without having enough waiting area. This also could be reason for dissatisfaction in public hospital pharmacy [23, 24, 26]. It is tire some when a diseased man is required to stand for long period of time without adequate waiting area.

Patient satisfaction with interaction with the pharmacist in this study was, 62.8%. This is also better than patient satisfaction in some public hospital pharmacies in Ethiopia [21, 26].But it was lower than other public hospital in Ethiopia [21, 23, 25]. The reason could be patients may rate differently on different days about their interaction with the pharmacist. Relatively patients in public hospitals pharmacies in Ethiopia had better satisfaction on interaction with the patient than patients in Red Cross pharmacy. This could be because patients using public hospitals are relatively poor and easily satisfied with minor things relatively to patients in community pharmacy.

Main reason for decreased patient satisfaction in Red Cross community pharmacy is related with counseling. Only 45% of patients were satisfied with counseling service. Pharmacists in community pharmacy focus on telling the patient about the dosage regimen of the medication, they give little attention on counseling about the side effect, drug interaction, precautions and storage of the medication. Most community pharmacies are private owned and majorly focus on selling the medication in a shortest time possible without letting adequate time on detail counseling. Also, there is no additional payment for counseling service that could be the reason pharmacists give little attention on counseling in community pharmacies. Public hospitals in Ethiopia had comparable or better counseling than community pharmacy [19, 21, 22].There was some difference in satisfaction with the specific counseling point.

Additionally, clinical pharmacy service and pharmaceutical care programs are initiated in only in public hospitals. This program should be implemented in every day counseling activities in community pharmacies. Since this program may help to optimize medication use in patients. But until now there is no strict rule to initiate such programs in community pharmacies. Until now EFDA doesn’t have any strict follow-up about counseling sessions. Furthermore, patients do not inquire information about medications they take about its side effect, interactions and precautions. Patients focus on the dosage regimen of the medicine only. That could be the possible reason for decreased patient satisfaction in Red Cross pharmacy compared to public hospital pharmacies in Ethiopia. Counseling on possible side effect, drug interaction and storage of medication is main reason for dissatisfaction in public hospital also [19, 21, 23, 24]. This indicate there should be reminder for major counseling points in every dispensing area.

Different factors were associated with clients’ satisfaction in this study. Disorganized flow of work in the pharmacy, unavailability of all prescribed medicines, and higher medication cost were negatively associated with patient satisfaction. In public hospital pharmacy there is program called Auditable Pharmaceutical Transaction System (APTS). In APTS there is clear steps for patient flow starting from entering the pharmacy and evaluation of the prescription until the patient leave the pharmacy [28]. But APTS is not practiced in Red Cross community pharmacy. This could be reason decreased patient satisfaction in Red Cross pharmacy. It will be easier for patient if there is clear step that patients should follow when entering Red Cross pharmacies.

Availability of only some medications from the all prescribed medication was also negatively associated with clients’ satisfaction. Mostly patients want to purchase all of their prescribed medication at one place, but due to unavailability only some medication may be available in one pharmacy, this is commonly seen in community pharmacies. It is common to see patients worried about where to find the unavailable medication. This is also the case with other studies [13, 15].

Recently due to COVID-19 and political instability in Ethiopia cost of medication has raised alarmingly. Many patients purchase medications from out of pocket, health insurance system is initiated recently for health expenses. This is also the main reason for dissatisfaction for patients in Ethiopia. On the other hand, unlike public hospital pharmacies, Red Cross pharmacy purchase medications from private medication suppliers. That could be also the reason for patient dissatisfaction with the price of medication. This is also the case with other studies done in Pakistan where free or lower cost medication increased patient satisfaction [15].Unlike the present study, different studies showed that age, gender, marital status, level of education were associated with clients’ satisfaction [15, 29, 30]. The difference might be in part due to difference in studied facilities.

Measuring the level of patient satisfaction using various dimensions of services helps to predict the gap between patient needs and patient satisfaction regarding pharmaceutical care services. This study provides valuable insights into patient satisfaction with Red Cross pharmacy services in Addis Ababa, Ethiopia. The overall patient satisfaction rate of 60.4% highlights that a more than half of patients had positive experiences with the pharmacy services. However, there is room for improvement as nearly half of the dissatisfied patients attributed their dissatisfaction to inadequate counseling. Factors negatively associated with patient satisfaction include unavailability of some medications, unfair medication cost, and a lack of organized pharmacy workflow. These findings emphasize the need for targeted interventions to address these issues and enhance patient experiences in Red Cross pharmacies.

Based on the study findings, we recommend implementing targeted interventions to enhance patient satisfaction and pharmaceutical care services at Red Cross pharmacies in Addis Ababa, Ethiopia. Efforts should focus on improving counseling services to address patient dissatisfaction, ensuring the availability of medications, and reviewing medication pricing practices for fairness and transparency. Additionally, optimizing the pharmacy workflow and fostering a patient-centered approach will help create a more organized and patient-friendly environment. Continuous monitoring and evaluation of patient satisfaction levels will be crucial to gauge the impact of these interventions and drive ongoing improvements in pharmacy services, ultimately enhancing patient experiences and meeting their healthcare needs effectively.