Embed Size (px)
Citation preview
1 23
International Journal of ClinicalPharmacyInternational Journal of ClinicalPharmacy and Pharmaceutical Care ISSN 2210-7703Volume 36Number 4 Int J Clin Pharm (2014) 36:707-715DOI 10.1007/s11096-014-9928-7
Client priorities and satisfaction withcommunity pharmacies: the situation inTehran
Gholamhossein Mehralian, MaryamRangchian & Hamid Reza Rasekh
1 23
Your article is protected by copyright and
all rights are held exclusively by Koninklijke
Nederlandse Maatschappij ter bevordering
der Pharmacie. This e-offprint is for personal
use only and shall not be self-archived
in electronic repositories. If you wish to
self-archive your article, please use the
accepted manuscript version for posting on
your own website. You may further deposit
the accepted manuscript version in any
repository, provided it is only made publicly
available 12 months after official publication
or later and provided acknowledgement is
given to the original source of publication
and a link is inserted to the published article
on Springer's website. The link must be
accompanied by the following text: "The final
publication is available at link.springer.com”.
RESEARCH ARTICLE
Client priorities and satisfaction with community pharmacies:the situation in Tehran
Gholamhossein Mehralian • Maryam Rangchian •
Hamid Reza Rasekh
Received: 19 August 2013 / Accepted: 21 February 2014 / Published online: 22 July 2014
� Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014
Abstract Background Client satisfaction is an important
criterion to evaluate pharmacy services. In addition,
knowledge about client satisfaction can be helpful to
identify strengths and weaknesses which can be used to
improve health services. Objective The aim of this study
was to assess clients’ priorities and satisfaction with
community pharmacy services in Tehran. Setting This
study was conducted on clients visiting community phar-
macies settled in Tehran, the capital city of Iran. Method A
cross-sectional descriptive study involving clients of
community pharmacies was undertaken using a self-
administrated anonymous questionnaire. Data were col-
lected from 800 clients of 200 community pharmacies
settled in 22 districts of Tehran. Main outcomes measure
Clients’ satisfaction with four areas including community
pharmacies physical space, relationship quality, consulta-
tion quality and other dimensions of service delivery, and
clients’ priorities about different issues related to commu-
nity pharmacies. Results The study showed that client
satisfaction regarding the four mentioned areas (relation-
ship quality, physical space, consultation quality and other
dimensions of service delivery) was more than the average
of Likert scale (cut point = 3). However, satisfaction with
consultations is not much higher than the mentioned cut
point. Moreover, ‘‘observing courtesy and respect’’ and
‘‘computerized dispensing’’ showed the most and the least
priority to respondents, respectively. Conclusion Accord-
ing to the findings, it seems that a wide range of corrective
actions can be performed to promote the level of client
satisfaction especially in case of consultations. More
importantly, clients’ needs and priorities should be taken
into account to select and prioritize these actions.
Keywords Community pharmacy � Client priorities �Client satisfaction � Iran
Impact of findings on practice
• Community pharmacists in Tehran, Iran, should give
more attention to counselling, especially about herbal
medicines and complementary products, and about
health services.
• Pharmacists in Tehran are considered to be courteous
and reliable by their clients.
Introduction
The aim of an efficient health system is to provide good
quality public health services. Nowadays, client (client
defined as either the patient of their carer) satisfaction is
considered as a major determinant factor of quality, to the
extent that in the United States, the reimbursement of phy-
sicians’ services is linked to this factor [1]. Moreover, public
dissatisfaction with services leads to poor morale amongst
staff which ultimately leads to lower standards of service
Electronic supplementary material The online version of thisarticle (doi:10.1007/s11096-014-9928-7) contains supplementarymaterial, which is available to authorized users.
G. Mehralian (&) � M. Rangchian � H. R. Rasekh
Department of Pharmacoeconomics and Pharma Management,
School of Pharmacy, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
e-mail: [email protected]
123
Int J Clin Pharm (2014) 36:707–715
DOI 10.1007/s11096-014-9928-7
Author's personal copy
provision. Evaluation of services provided by pharmacists is
vital when considering their role as advisors to clients on
matters such as drug side effects, interactions, and the pur-
chase and use of over the counter medication. Making
improvements in the quality of health care is a policy shared
internationally, and numerous studies have shown the posi-
tive effects of pharmacists’ intervention and cooperation
with physicians, on clinical and health economic outputs
(efficiency of health care) [2–7]. Client satisfaction is one of
the most important criteria for evaluating the quality of
services, providing valuable information for design of ser-
vices that meet clients’ needs, values and expectations [8–
11]. In addition, lack of satisfaction with health care has
adverse consequences such as patient disconnection, or non-
compliance with the treatment processes, leading to
decreased efficiency of the health care system and waste [12,
13]. On the other hand, positive influences of high levels of
client satisfaction on the hospital profitability have been
reported, and the same effect is probable in the case of
pharmacies [14]. Measuring client satisfaction with various
aspects of pharmacy activities helps the pharmacist to
identify any weaknesses and take steps to improvement.
[15]. The diversity of factors influencing perceived satis-
faction of clients in the health care systems has been high-
lighted in several studies [16–19].
Aim of the study
The present study aimed to evaluate clients’ priorities and
satisfaction with community pharmacies in Tehran. For this
purpose, we should answer to the following questions:
• How satisfied are clients with each aspect of pharmacy
practice?
• How do clients prioritise the various aspects of
pharmacy practices?
Study design
This study was a cross sectional, survey-based, descriptive
research using a validated questionnaire. Due to criticisms of
assessing satisfaction exclusively based on experts’ opinions
[20, 21], a two-phase design was selected to conduct the
research. The first phase was to investigate the target popu-
lation’s views in order to discover important issues not
included by reviewed literature. In the second phase, levels
of perceived priorities and satisfaction were investigated.
Population and sample
Target population of the study was clients receiving ser-
vices from community pharmacies situated in Tehran. In
the study 20 clients participated in the preliminary phase.
In the second phase, 800 clients from 200 different phar-
macies located in 22 districts of Tehran were invited to
respond the main questionnaire. Clients under the age of 16
were excluded from the study, since their referral to
pharmacies is unusual in Iran.
Questionnaire development
The development of the main questionnaire of the study
was based on the previous literature and views of 20 clients
of community pharmacies. Views of this sample were
gathered via a preliminary questionnaire.
The final questionnaire, which was anonymous and self-
administered, consisted of three main parts. The first part
contained questions related to the clients’ satisfaction with
pharmacies practices. The second part of the questionnaire
was used to assess the clients’ rating of relative priorities
and importance of various issues related to the pharmacy
practice. The third part included questions about the
respondents’ demographic characteristics. The first and the
second parts of the questionnaire were developed on five
point Likert scale. (1 = Very low, 2 = Low, 3 = Medium,
4 = High, 5 = Very high). To assess the validity of the
questionnaire, the opinions of 10 experts in the field of
pharmacy (pharmacists working as a pharmacy managers
or a pharmacy technical officers) were collected. In addi-
tion, factor analysis was performed on the data gathered
from the main sample (800 subjects) using software SPSS
16. 0.0 For example, the average variance extraction was
used to analyse the unidimensionality of the satisfaction
components.
Questionnaire validity and reliability
The validity of the questionnaire was evaluated according
to the review of the questionnaire by ten experts. Based on
their suggestions, some changes were made to the ques-
tionnaire such as rearrangement, elimination and augmen-
tation of some questions. According to the results of the
factor analysis, the first part of the questionnaire (satis-
faction assessment) was divided into four components
instead of three. These four components included: physical
space of pharmacy, communication, consultation, and other
aspects of service delivery. The result of average variance
extraction showed that all components fell into acceptable
levels. Next, the reliability of the questionnaire was
appraised by calculating the Chronbach’s alpha value
based on questionnaires completed by 30 users of com-
munity pharmacies. The Cronbach’s alpha values obtained
for questions related to satisfaction and priorities were
equal to 0.917 and 0.924, respectively, which showed a
high level of reliability for both sections. According to the
708 Int J Clin Pharm (2014) 36:707–715
123
Author's personal copy
literature, the minimum acceptable value of Chronbach’s
alpha to confirm reliability of the questionnaire is 0.5 [22,
23], and the calculated values for four components of the
satisfaction showed acceptable reliability. Finally, the
questionnaire, in the finished form, was used to collect
data. Results of factor analysis and reliability test are
presented in Table 1.
Data collection and data analysis
In both phases, the questionnaires were distributed by
researchers and were completed in the pharmacies by
invited respondents. Data were analysed using SPSS
16.0.0. software. Descriptive statistics on the sample
characteristics were computed. At first, we used factor
analysis for data reduction and to assess the unidimen-
sionality of components. Moreover, Kolmogorov–Smirnov
testing showed that the distribution of data was normal;
consequently for data analysis the Student t test, the
Kruskal–Wallis test, and the linear regression test were
performed. For the Student t test, p \ 0.05 was set as the
level of significance. The factor analysis was performed
using principal component extraction without rotation.
Factors with Eigen values greater than one were selected
for factor analysis. Items with factor loadings greater than
or equal to 0.40 were considered significant. For data
related to clients’ priorities (the second part of the main
questionnaire), the Friedman test was used.
Results
Out of 800 questionnaires distributed, 797 questionnaires
were completed, of which 46.8 % were answered by
female subjects. There are further demographic data in
Table 2. The first age category was defined as 16–19 to
separate teenage respondents from next category. Other age
categories were defined with intervals equal to 10 years.
Clients’ satisfaction with present status
T test was used to examine the level of satisfaction reported
for each question. As seen in Table 3, levels of satisfaction
with all four components were more than the cut point, but
satisfaction with services was less than satisfaction with
relationship. The detailed evaluation of the items showed
that among 17 questions about satisfaction, the highest
level of satisfaction was related to the ‘‘reliability of
pharmacists’ information’’. ‘‘Observe courtesy and
respect’’ was placed in the next highest ranked. The lowest
level of satisfaction was expressed in the case of ‘‘con-
sultation about herbal medicines and complementary pro-
ducts’’. It should be noted that standard deviation values for
these two items and ‘‘answering to questions related to
health services’’ are relatively high. Therefore, interpreta-
tion of these results should be made with caution.
The relationship between nominal (categorical) vari-
ables and satisfaction was checked using the Kruskal–
Wallis test (Table 4). In the case of demographic param-
eters, four variables namely age, gender, education level
and occupation in a health care profession, were investi-
gated. The results showed significantly different levels of
satisfaction for different categories of education level and
occupation in a health care profession (p \ 0.01). In
addition, some other variables, including method of pay-
ment and average waiting time were studied. Interestingly,
in the case of waiting time, the highest satisfaction was not
associated with the least waiting time, and the group with
the average waiting time more than 30 min showed one of
the highest levels of satisfaction.
Table 1 Results of factor analysis and reliability test
Item Factor
loading
Cronbach’s
alpha
AVEa
Items on relationship quality 0.56 0.54
Observing courtesy and respect 0.49
Allocating time to answer client’s
questions
0.53
Reliability of information received
from pharmacists
0.41
Items on pharmacy physical space 0.79 0.71
Order and cleanliness 0.53
Comfortable waiting area 0.75
Appropriate physical space to
communicate with client
0.76
Items on consultation quality 0.86 0.65
Pharmacists’ counselling on disease 0.67
Recommendations about non-
medicinal treatment
0.70
Counselling about herbal medicines 0.83
Counselling about supplements 0.84
Answering to questions about health
services
0.64
Other dimensions of the service
delivery
0.84 0.56
Availability of required items 0.60
Fairness in the distribution of scarce
medicines
0.75
Arrangement of service delivery
process
0.81
Duration of waiting time 0.70
Conformity of received items with
prescript items
0.71
Proper dispensing and labeling 0.67
a Average variance extraction
Int J Clin Pharm (2014) 36:707–715 709
123
Author's personal copy
The linear regression analysis showed a significant
relationship between clients’ satisfaction with public and
private pharmacies and four evaluated aspects of practice
(p value\0.01). Details of regression analysis are shown in
Table 5. As shown, the four evaluated factors have more
effect on the satisfaction of clients of private pharmacies
compared to public pharmacies.
Clients’ priorities
The second part of the questionnaire was devoted to
investigating the importance of various pharmacy issues
from the clients’ point of view. The Friedman test was used
for data analysis. Observing courtesy and respect by the
Table 2 Participants’ characteristics
Item N Valid percent
Gender
Male 422 53.2
Female 371 46.8
Total 793
Age categories (years)
16–19 27 3.4
20–30 188 23.7
31–40 299 37.6
41–50 222 27.9
Above 50 59 7.4
Total 795
Education level
Illiterate 23 2.9
Under diploma 116 14.7
Diploma 272 34.2
Bachelor 306 38.6
Above bachelor 76 9.6
Total 793
Occupation
Un-related to health care 698 88.6
Related to health care 90 11.4
Total 788
Frequency of visiting pharmacy in the last 3 months
One time 219 27.5
Twice 245 30.9
3 times or more 330 41.6
Total 794
Identifying pharmacist amongst pharmacy staff
Never 2 3
Rarely 29 3.8
Some time 244 30.6
Often 325 40.9
Always 195 24.5
Total 795
Payment method
OOPa 76 9.5
OOP and insurance 623 78.4
Only insurance 92 11.5
Total 791
Waiting time
Less than 5 min 107 13.4
5–10 min 483 60.7
11–30 min 197 24.8
More than 30 min 7 1.0
Total 794
a Out of pocket
Table 3 Descriptive and one sample t test analysis
Item Mean SDa t-statistics
Items on relationship quality 3.75 0.62 33.81
Observing courtesy and respect 4.06 0.77 38.82**
Allocating time to answer client’s
questions
3.24 0.93 7.27**
Reliability of information received
from pharmacists
4.08 0.85 31.24**
Items on pharmacy physical space 3.46 0.70 18.31
Order and cleanliness 3.84 0.74 31.74**
Comfortable waiting area 3.22 0.84 10.50**
Appropriate physical space to
communicate with client
3.32 0.91 6.81**
Items on consultation quality 3.11 0.78 3.99
Pharmacists’ counselling on disease 3.39 0.87 12.64**
Recommendations about non-medicinal
treatment
3.09 0.95 2.70**
Counselling about herbal medicines 2.96 1.00 -1.20
Counselling about supplements 2.99 1.00 -0.31
Answering to questions about health
services
3.13 1.00 3.54**
Other dimensions of the service delivery 3.42 0.63 18.85
Availability of required items 3.61 0.86 19.86**
Fairness in the distribution of scarce
medicines
3.43 0.78 15.36**
Arrangement of service delivery process 3.33 0.82 11.32**
Duration of waiting time 3.17 0.87 5.62**
Conformity of received items with
prescript items
3.36 0.87 11.73**
Proper dispensing and labeling 3.62 0.83 20.88**
a Standard Deviation
* Significant at 0.05
** Significant at 0.01
710 Int J Clin Pharm (2014) 36:707–715
123
Author's personal copy
staff was shown to be the highest priority for clients.
Table 6 shows more information in this regard. As seen
from the table, some items have standard deviation
exceeding one.
Figure 1 shows the measured satisfaction and priorities
of six main subjects simultaneously. This manner of rep-
resentation seems to be useful to identify priority areas that
require intervention.
According to the chart, the expressed importance and
satisfaction of all items is greater than the midpoint of the
of Likert scale (the cut point equal to three).
Discussion
Satisfaction is an important indicator of the quality of a
health care system. Paying no attention to this is not con-
ducive to achieving the aim of high quality health care.
Considering clients’ opinions and demands leads to inno-
vation and improvement of the quality of health services,
and in this way, determination of the priorities of clients is
a key issue. The primary aim of this project was to
investigate client satisfaction with pharmacies practices in
a variety of areas. Among four investigated areas (physical
Table 4 Participants’
characteristics and satisfaction
mean rank
a Out of pocket
Grouping variable Test variables mean rank
Physical space Communication Consultation Other dimensions of
service delivery
Gender
Male 383.31 391.43 388.45 376.44
Female 410.91 403.78 404.52 416.96
Sig. (2-tailed) 0.087 0.443 0.323 0.013
Age categories (years)
16–19 444.41 425.89 394.48 382.96
20–30 456.33 418.81 424.77 403.76
31–40 385.68 384.66 396.67 409.90
41–50 353.65 396.35 386.66 381.50
Over 50 432.95 406.10 363.73 401.47
Sig. (2-tailed) 0.000 0.541 0.347 0.701
Education level
Illiterate 428.30 395.83 364.67 361.13
Under diploma 336.41 336.00 322.25 332.72
Diploma 362.97 363.86 361.13 359.91
Bachelor 423.31 422.78 434.54 437.56
Higher than bachelor 506.79 516.20 498.09 486.18
Sig. (2-tailed) 0.000 0.000 0.000 0.000
Occupation
Unrelated to health care 384.84 385.90 384.70 386.39
Related to health care 478.43 470.14 470.4 466.34
Sig. (2-tailed) 0.000 0.001 0.001 0.002
Payment method
OOPa 491.45 491.75 510.22 502.88
OOP and insurance 393.54 396.98 388.91 390.58
Only insurance 342.49 318.86 349.67 353.12
Sig. (2-tailed) 0.000 0.000 0.000 0.000
Waiting time
Less than 5 min 353.57 366.77 340.48 375.93
5–10 min 417.12 414.04 407.08 411.76
11–30 min 375.58 378.79 400.81 379.01
More than 30 min 442.50 372.88 515.00 382.38
Sig. (2-tailed) 0.021 0.114 0.024 0.248
Int J Clin Pharm (2014) 36:707–715 711
123
Author's personal copy
space of pharmacy, quality of relationship, quality of
consultation, and other aspects of service delivery) the
lowest level of satisfaction was related to the consultation
(3.11 ± 0.78), which is consistent with findings of a recent
study designed according to discrepancy theories con-
ducted by Dadfar and Brege [24]. The highest level was
related to the quality of relationship (3.75 ± 0.63). Supe-
riority of satisfaction with relationship in comparison to
service delivery was similar to the results of the study
conducted in 2002 in USA [25]. It is worth noting that in
the field of relationship quality, high satisfaction was
mainly related to two items; ‘‘observe courtesy and
respect’’, and ‘‘reliability of pharmacists comments’’, and
satisfaction with ‘‘allocation of sufficient time to respond to
clients’ questions’’ was a little more than cut point, so that
42 % of respondents expressed satisfaction equal to the
midpoint of Likert scale in regard with this item, and only
37.4 % reported high or very high satisfaction. In a study
conducted in 2003 in Saudi Arabia, 44.8 % of participants
in the study expressed the opinion that pharmacists allocate
enough time to talk or listen to them [26]. Levels of sat-
isfaction with various issues related to the physical space,
the quality of consultation and other aspects of service
delivery were fairly close to each other. However, it seems
that interventions which create more convenient waiting
areas and more appropriate environments for communi-
cating with clients can be helpful. Regarding consultation,
considering the importance of this matter from clients’
point of view as well as its influence on health promotion
and reduction of health costs, efforts to improve these
services seem essential. In order to address these short-
comings, paying more attention to the following issues are
suggested: appropriate staff training, appropriate
performance management, development of an appropriate
method or tool to evaluate pharmacy services, modification
of pharmacy services remuneration, increasing the number
of pharmacists per clients, improved staff development
processes, improvement of pharmacy students’ education
particularly in the field of herbal products and supplements
along with the enhancement of continuing education for
qualified pharmacists. It is obvious that the importance of
these to clients and their effectiveness in enhancing health
outcomes should be considered when deriving priorities.
The Friedman test showed that ‘‘observe courtesy and
respect’’ was the most important issue to clients. This
finding is consistent with findings of the study conducted
by Patterson et al. [27] and the study performed by Pascoe
and Attkisson in 1983 on outpatients of an urban health
Table 5 Result of the linear regression test for satisfaction with
public and private pharmacies
Independent
variable
Dependent variables
Satisfaction with public
pharmacies
Satisfaction with private
pharmacies
Coefficients t-statistics Coefficients t-statistics
Constant 2.45** 11.47 1.25** 6.22
PS 0.11 1.88 0.12* 2.18
RQ 0.09 1.20 0.24** 3.32
Consultation 0.09 1.62 0.17** 3.31
Other services
quality
0.02 0.31 0.20** 2.97
Adjusted R2 0.03 0.18
F value 8.05** 46.42**
PS Physical space, RQ Relationship quality
* Significant at 0.05
** Significant at 0.01
Table 6 Result of Friedman test
Evaluated item Mean Standard
deviation
Mean
rank
Observe courtesy and respect 4.66 0.67 16.79
Continual attendance of pharmacist in
pharmacy
4.58 0.68 16.11
Providing appropriate and updated
consultation
4.49 0.77 15.52
Using books and the internet to answer
clients’ questions
4.10 1.01 12.74
Work speed 4.12 0.92 12.59
Advice about healthy lifestyles 3.96 1.04 11.50
Filing for constant patients 3.77 1.20 10.62
Availability of requested items 4.34 0.94 14.28
Tranquil pharmacy environment 3.84 1.03 10.54
Comfortable and clean environment 3.86 1.02 10.68
Observing turns in service delivery 4.12 0.94 12.48
Availability of card reader 3.80 1.05 10.36
Computerisation of dispensing process 3.73 1.10 10.11
Having contracts with all insurance
companies
4.02 1.00 11.96
Price of required items 4.39 0.88 14.86
Uniformity of prices between pharmacies 4.36 0.94 14.60
Providing private space for consultation 4.22 0.99 13.53
Advice on beauty-hygienic products 3.97 1.08 11.79
Availability of information brochure 3.77 1.09 10.43
Providing information to obtain scarce
medicines
4.09 0.98 12.46
Providing information about OTC
products
3.99 1.05 11.86
Possibility of online purchase 3.91 1.20 11.72
Pharmacy closeness to home 4.61 0.81 16.48
Pharmacy closeness to doctor’s office 4.37 0.95 14.68
Chi Square = 2.240, Sig. = 0.000
712 Int J Clin Pharm (2014) 36:707–715
123
Author's personal copy
centre [28]. ‘‘Pharmacy proximity to home’’, ‘‘continual
presence of a pharmacist in pharmacy’’, ‘‘provision of
updated instructions by pharmacists’’, and ‘‘price of
required items’’ placed after ‘‘observe courtesy and
respect’’, respectively. As mentioned earlier, there were
significant differences between levels of satisfaction for
different categories of ‘‘education level’’ and ‘‘occupation
in a health care profession’’ (p value\0.01). This finding is
consistent with some previous studies, which showed a
more significant effect of education level compared to
gender [16]. The higher level of the satisfaction associated
with working in roles related to health care can be attrib-
uted to higher levels of knowledge about medicines or
adjustment to their expectations as a result of being
familiar with problems associated with practicing in health
professions.
Education level can affect people’s confidence, com-
munication skills and health knowledge which can all
influence their satisfaction with health care. Participants
with education levels higher than Bachelor, equal to
Bachelor and the illiterate group showed higher levels of
satisfaction, respectively. This finding for the first two
groups can be addressed by better knowledge in the health
area, higher levels of confidence and better communication
skills. The illiterate group expressed a higher level of sat-
isfaction compared to the group with education less than or
equal to high school degree. This might be due to increased
expectations in the latter group without improvement in
their communication skills. However, considering higher
levels of expressed satisfaction by more educated partici-
pants even with ‘‘physical space’’ and ‘‘other dimensions of
service delivery’’, some other reasons come to mind, for
example, it is probable that this group has better psycho-
logical condition, so they generally present with a more
positive perception. Another reason may be that they select
pharmacies with better facilities and staff. Further research
should be conducted to clarify the reasons for these points.
The findings of this study were not consistent with the
results of Dadfar and Brege study which showed lower
levels of satisfaction for clients with higher levels of edu-
cation. Their study was based on discrepancy theories; they
compared clients’ perceptions with their expectations. In
addition, Dadfar and Brege mentioned that more educated
clients often compare the services with what they experi-
ence in developed countries [24]. In general, it seems that
in studies based on discrepancy theories, clients compare
the current status with an idealistic standard, whereas in
studies designed according to fulfillment theories, the
comparison is done between clients’ perceptions and the
level considered acceptable. In the case of waiting time,
our findings confirm the discussion professed by Irwin
et al. [29] that greater participation of pharmacists in
consultation offset client concerns about long waiting
times.
There are various probable reasons for lower levels of
satisfaction shown by participants using insurance pro-
grams. It could be due to deficiencies in these programs or
additional waiting time due to the need for more complex
and time consuming calculations to derive the amount of
clients’ co-payment and to check prescriptions for other
details important to insurance companies. These issues
increase the risk of client agitation, which can lead to
decreased satisfaction, especially if pharmacy staff react
negatively in this situation.
Considering the result of the regression analysis, it
can be concluded that overall client satisfaction is not
predictable based on a linear equation of evaluated
components. This finding indicates that client satisfac-
tion might be influenced by some other factors. It is
important to note that due to the lack of client’s
knowledge about professional services delivered by
pharmacies, evaluation of these services might be
influenced by the client’s perception of other factors.
Concerns about clients’ ability to assess the technical
aspects of health care has also been expressed in some
previous studies [30].
Strengths
• Due to the relatively large sample size, the selected
sample would be a good representative of the popula-
tion receiving community pharmacy services in Tehran.
So findings of this study can be a reliable basis for
pharmacists and pharmacy managers to review and
improve their performance and client satisfaction. In
Fig. 1 Measured satisfaction and importance for main factors. R;
observe courtesy and respect to the client, P; pharmacy space
convenience and cleanliness, A; availability of required medicines,
W; waiting time, C1; pharmacists’ consultation about medicines
(chemical or herbal), C2; pharmacists’ non-medical suggestions
Int J Clin Pharm (2014) 36:707–715 713
123
Author's personal copy
this study, clients’ priorities were investigated in
addition to their satisfaction levels which may be useful
to help prioritise corrective actions.
Limitations
• The study was limited to the capital city of Iran, so
other studies are needed to identify clients’ priorities
and satisfaction with pharmacies in other cities and
rural areas. Influences of some important characteristics
of respondents (such as their character and psycholog-
ical status) were not investigated in this study, so the
effect of such factors remained unspecified.
Recommendations
• To prioritise corrective actions, the difference between
present status and the desired situation and the impor-
tance of various aspects of practice from the clients’
perspective should all be taken into account. Due to the
wide range of pharmaceutical care activities, the opin-
ion of experts should be considered to support the
evaluation of the importance of different aspects of
practice and the setting of priorities.
• Further studies are needed to assess the effects of
client’s underlying factors on their satisfaction with
pharmacies services [29].
Conclusion
Satisfaction with health care services is considered as a
positive indicator and a good criterion to evaluate health
care efficiency. The importance of this matter encouraged
us to investigate clients’ satisfaction and priorities with
pharmacy practice in Tehran. Findings showed that
‘‘observing courtesy and respect’’ and ‘‘computerised pre-
scription dispensing’’ are the most and the least important
issues to the respondents, respectively. It was observed that
satisfaction levels with all four evaluated areas were a little
more than the average. The lowest level of satisfaction was
related to consultation. Therefore, it seems that some cor-
rective actions are required with particular attention to this
aspect of practice.
Acknowledgments The authors would like to thank Dr. Ali Ra-
jabzadeh for his supporting role in this study.
Funding No financial support was obtained for this study.
Conflicts of interest Authors have no conflict of interest.
References
1. Hudak PL, Hogg-Johnson S, Bombardier C, McKeever PD,
Wright JG. Testing a new theory of patient satisfaction with
treatment outcome. Med Care. 2004;42:726–39.
2. Giberson S, Yoder S, Lee M. Improving patient and health sys-
tem outcomes through advanced pharmacy practice. A Report to
the US Surgeon General Office of the Chief Pharmacist US
Public Health Service 2011. http://www.usphs.gov/corpslinks/
pharmacy/documents/2011AdvancedPharmacyPracticeReporttot
heUSSG.pdf. Accessed 28 Oct 2013.
3. Curtiss FR, Fry RN, Avey SG. Framework for pharmacy services
quality improvement—a bridge to cross the quality chasm.
J Manag Care Pharm. 2004;10(1):60–78.
4. Cranor CW, Christensen DB. The Asheville Project: short-term
outcomes of a community pharmacy diabetes care program. J Am
Pharm Assoc. 2003;43(2):149–59.
5. Cranor CW, Bunting BA, Christensen DB. The Asheville Project:
long-term clinical and economic outcomes of a community pharmacy
diabetes care program. J Am Pharm Assoc. 2003;43(2):173–84.
6. Isetts BJ, Brown LM, Schondelmeyer SW, Lenarz LA. Quality
assessment of a collaborative approach for decreasing drug-
related morbidity and achieving therapeutic goals. Arch Int Med.
2003;163(15):1813–20.
7. Rubin HR, Pronovost P, Diette GB. The advantages and disad-
vantages of process-based measures of health care quality. Int J
Qual Health Care. 2001;13(6):469–74.
8. Rubin HR, Gandek B, Rogers WH, Kosinski M, McHorney CA,
Ware JE Jr. Patients’ ratings of outpatient visits in different
practice settings. JAMA. 1993;270(7):835–40.
9. Bond S, Thomas LH. Measuring patients’ satisfaction with
nursing care. J Adv Nurs. 1992;17(1):52–63.
10. Williams B. Patient satisfaction: a valid concept? Soc Sci Med.
1994;38(4):509–16.
11. Schommer JC, Kucukarslan SN. Measuring patient satisfaction
with pharmaceutical services. Am J Health Syst Pharm.
1997;54(23):2721–32.
12. Ware JE, Davis AR. Behavioral consequences of consumer dissat-
isfaction with medical care. Eval Program Plann. 1983;6(3):291–7.
13. Zastowny TR, Roghmann KJ, Cafferata GL. Patient satisfaction
and the use of health services: explorations in causality. Med
Care. 1989;27(7):705–23.
14. Nelson EC, Rust RT, Zahorik A, Rose RL, Batalden P, Siemanski
BA. Do patient perceptions of quality relate to hospital financial
performance? J Health Care Mark. 1992;12(4):6–13.
15. Locker D, Dunt D. Theoretical and methodological issues in
sociological studies of consumer satisfaction with medical care.
Soc Sci Med Part A Med Psychol Med Sociol. 1978;12:283–92.
16. Sitzia J, Wood N. Patient satisfaction: a review of issues and
concepts. Soc Sci Med. 1997;45(12):1829–43.
17. Risser NL. Development of an instrument to measure patient
satisfaction with nurses and nursing care in primary care settings.
Nurs Res. 1975;24(1):45–51.
18. Ware JE Jr, Snyder MK, Wright WR, Davies AR. Defining and
measuring patient satisfaction with medical care. Eval Program
Plann. 1983;6(3):247–63.
19. Blalock SJ, Keller S, Nau D, Frentzel EM. Development of the
consumer assessment of pharmacy services survey. J Am Pharm
Assoc. 2012;52(3):324–32.
20. Calnan M. Towards a conceptual framework of lay evaluation of
health care. Soc Sci Med. 1988;27(9):927–33.
21. Wensing M, Grol R, Smits A. Quality judgements by patients on
general practice care: a literature analysis. Soc Sci Med.
1994;38(1):45–53.
714 Int J Clin Pharm (2014) 36:707–715
123
Author's personal copy
22. Helmstadter GC. Principles of psychological measurement. New
York: Appleton-Century-Crofts; 1964. ISBN 9780137096671.
23. Nunnally JC. Psychometric theory. New Yourk: McGraw-Hill;
1967. ISBN 9780070475625.
24. Dadfar H, Brege S. Differentiation by improving quality of ser-
vices at the last touch point: the case of Tehran pharmacies. Int J
Qual Serv Sci. 2012;4(4):345–63.
25. Larson LN, Rovers JP, MacKeigan LD. Patient satisfaction with
pharmaceutical care: update of a validated instrument. J Am
Pharm Assoc Wash. 2002;42(1):44–50.
26. Bawazir SA. Consumer attitudes towards community pharmacy
services in Saudi Arabia. Int J Pharm Pract. 2004;12(2):83–9.
27. Patterson BJ, Doucette WR, Urmie JM, McDonough RP.
Exploring relationships among pharmacy service use, patronage
motives, and patient satisfaction. J Am Pharm Assoc.
2013;53(4):382–9.
28. Pascoe GC, Attkisson CC. The evaluation ranking scale: a new
methodology for assessing satisfaction. Eval Program Plann.
1983;6(3):335–47.
29. Irwin A, Laing C, Mearns K. The impact of patient aggression on
community pharmacists: a critical incident study. Int J Pharm
Pract. 2013;21(1):20–7.
30. Ben-Sira Z. The function of the professional’s affective behavior
in client satisfaction: a revised approach to social interaction
theory. J Health Soc Behav. 1976;17(1):3–11.
Int J Clin Pharm (2014) 36:707–715 715
123
Author's personal copy
