To the best of our knowledge, this is the first study reporting the satisfaction levels of patients and caregivers using the pharmacy VAS during the Covid-19 pandemic. The respondents demonstrated a high level of overall satisfaction towards the four types of VAS. Majority of them suggested extended hours of operation, more courteous staff, better communication system, and a smoother registration process when using VAS. While the previous studies evaluated a maximum of three types of VAS [13, 21–23], this study evaluated four different type VAS for satisfaction level among the users. This study describes the key factors affecting patients and caregivers’ need with regards to pharmacy VAS, informing stakeholders on the possible gaps for improvement.
We also translated the questionnaire into Mandarin, providing a wider choice of language options for participants. The study was designed as a self-administering online questionnaire without the presence of interviewers that allows the respondent to freely provide their responses, and a semi-structured question at the end of questionnaire that allowed respondents to give their expectations on VAS in free text.
At least 77.2% of the respondents rated their satisfaction with mean scores of more than 4.0 out of a maximum of 5.0 irrespective of service types. Similar to the findings of previous studies, a range of 74.5 to 100% of respondents rated high level of satisfactions to pharmacy VAS [10, 13, 21, 23]. In contrast, patients satisfaction level with the outpatient pharmacy services varied between 1.5 and 87.5% [12, 24–31]. In the comparison of VAS against traditional counter service (TCS), a significant higher proportion of VAS users (77.8 to 96.2%) rated higher satisfaction scores than TCS users (63.1 to 89.4%) [13, 21, 22]. This implied that VAS users are satisfied with this innovative method of medication dispensing that offer them more flexibilities to get their prescription refills when compared to the conventional dispensing service that requires them to come to the counter and wait to get their medication prepared by pharmacy staff.
Being a retiree, more than 60 years of age, residing near to the hospital and utilisation of drive-through service were significant predictors for higher score of satisfaction to VAS. In contrast, a previous study showed that satisfaction level of older adults and female users were negatively correlated with VAS while users with higher income had their satisfaction level positively correlated with VAS [13]. Types of VAS selected by users were recognized as one of the factors affecting users’ satisfaction level [21]. Another study showed that users of mail pharmacy services demonstrated a lower satisfaction level than drive-through and call-and-collect service as users are required to pay for the mail service [13]. On the other hand, other studies study show that users of mail pharmacy demonstrated a better satisfaction compared to TCS [22] or other types of VAS such as integrated drug dispensing system [21]. It is postulated that the factors affecting the satisfaction level of VAS users could have been unique for geographical location, health institutions and types of VAS selected.
It is noteworthy that types of VAS evaluated in each study were limited by the availabilities of VAS offered by the respective health institution. In addition, as discussed by the previous study [21], patients could only select the VAS based on the availability of VAS, and the selection of VAS is also limited by the pharmaceutical dosage form of the medication. For instance, currently, mail pharmacy is not an option for patients prescribed with medications requiring storage at low temperatures, dangerous drugs or psychotropic medications. This has render difficulties for researchers to compare the satisfaction level among different types of VAS in the presence of such limitations. There is no single standard measure of patient satisfaction applicable to all pharmacy situations.
Users who selected pharmacy drive-through service had positive correlation with the satisfaction levels of VAS after adjusting other factors. High satisfaction levels were seen in users of pharmacy drive-through services evaluated in a previous study, which indicated that as high as 69.2% of the users rating this service ‘very satisfied’ and 30.8% rated ‘satisfied’, mainly due to convenience, short waiting time and problem rectification in a timely manner [23]. Insufficient parking lots, congested patients waiting area and long waiting time have been the major issues encountered by most of the tertiary hospitals globally. The introduction of drive-through pharmacy is able to ease these problems among the elderly, working adults and parents with young children who require to refill their medication on long-term basis [32]. In line with the WHO guidelines during the outbreak of COVID-19 pandemic in 2020 [33], elderly patients, who are associated with higher risks of mortality with coronavirus infection [34], are encouraged to select drive-through services in order to avoid the crowds and limit the contact with others [35]. Drive-through pharmacy also has been encouraged locally and in Australia during the on-going pandemic of COVID-19 as a safety measure for the public especially the elderly to get their medication because the nature of this service enables the practice of physical distancing and it has been a proven efficient and safe method of medication dispensing [35, 36]. In spite of many advantages of drive-through services, it is important to note that this service would be of maximum benefit for citizens who own a vehicle and when the hospital is faced with inadequate carparks [37–40].
Respondents expect pharmacy staff to be more polite and courteous. Evidence showed that pharmacist attitude is positively correlated with patients’ satisfaction visiting pharmacy department of public hospitals [41–43]. The patients receiving pharmaceutical care service would expect the pharmacy personnel to be pleasant and courteous [42], and show good attitude to them [44]. Previous study proposed that satisfactions of VAS users might be affected by the attitudes of pharmacists and questions assessing this context can be explored in future surveys [13]. Meanwhile, researchers could consider exploring factors affecting the attitude of pharmacy personnel when delivering VAS to the users.
The need to upgrade communication systems was suggested by respondents to improvise VAS. Effective communication was identified as one of the important elements to improve customer satisfaction in out-patient pharmacy service [21, 45]. Establishing a single point of contact for all incoming queries can be adapted such that it serves as a centralised system to streamline the registration process, real-time communication between pharmacy personnel should any issue arise and alert the users to collect their medication based on the types of VAS they selected. The communication can be leveraged including creating service desk automation software [46], such as mobile application, that are equipped with the capabilities of voice calling, video conferencing, text, e-mail, and social media, suited to the preference of the customers [47].
The limitations of this study include findings of a single-centre study may not be generalizable to other centres as the types of VAS services may vary between health institutions. In addition, our study did not compare the satisfaction level between VAS and TCS users, the satisfaction of existing TCS users especially among the elderly is therefore unknown. The timing of data collection would affect the satisfaction of the users [41], this survey was conducted during the pandemic in which the use of VAS could be a preferred option as it allowed the users to practice physical distancing and this factor could have contributed to high satisfaction levels. Future research should consider assessing the satisfaction level of TCS users and the reasons of not selecting VAS in which the findings could be used as a reference for VAS improvement as well as the overall flow of out-patient dispensing activities. Other limitations are recall-bias among the users of VAS and the use of convenient sampling may lead to selection bias of the study population.