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A comparison of patients’ and pharmacists’ satisfaction with medication counseling provided by community pharmacies: a cross-sectional survey
© Yang et al. 2016
Received: 25 January 2016
Accepted: 5 April 2016
Published: 14 April 2016
Medication counseling is a critical component of pharmaceutical care to promote the safe and effective use of medications and to maximize therapeutic outcomes. The assessment of patients’ and pharmacists’ satisfaction with medication counseling services could be one of the vital parameters for predicting the quality of pharmacy services. No study has measured and compared both patients’ and pharmacists’ satisfaction with medication counseling. The objectives of this study were to describe and compare patients’ and pharmacists’ levels of satisfaction with medication counseling services offered by community pharmacists in South Korea.
This was a descriptive, cross-sectional survey. The online survey was distributed to patients and community pharmacists using a structured questionnaire. The questionnaires consisted of 4 main areas: (1) responders’ characteristics (2) current state of medication counseling methods provided by community pharmacies (3) overall satisfaction with medication counseling (4) demand for the development of medication counseling standards. A comparison between patients and pharmacists was made using either a chi-square test or a Fisher’s exact test.
Between June 13, 2014 and July 15, 2014, a total of 252 patients and 620 pharmacists completed the survey. It was found that 47.3 % of pharmacists and 34.0 % of patients were satisfied with the current medication counseling service. Pharmacists showed a higher degree of satisfaction with the medication counseling service compared to patients (p <0.05). A major reason for patients not being satisfied with the medication counseling from community pharmacists was the insufficient time spent on counseling (51.2 %). The pharmacists’ perception of a major barrier to providing appropriate medication counseling for patients was the lack of time (24.3 %). Moreover, a substantial number of patients (88 %) and pharmacists (73 %) supported the development of medication counseling standards to improve community pharmacist counseling services (p < 0.001).
This study showed that both patients and pharmacists have low levels of satisfaction with the current medication counseling service offered by community pharmacists. This study provides baseline data for the development of national guidelines for medication counseling by pharmacists.
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”. 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 .
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 , 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 . However, this mandate has not necessarily worked as intended, and the quality and content of information provided varies among pharmacists . 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.
The pharmacist survey was intended for pharmacists who were currently practicing in community pharmacies in South Korea at the time of the study. The patient survey was intended for adults who had received medication counseling from community pharmacists. A convenience sampling method was employed in this survey to facilitate the recruitment of a large sample and to attract respondents from large geographical areas.
Two instruments were developed to measure the satisfaction level of patients and community pharmacists with the medication counseling service. Each self-administered questionnaire was developed primarily from published literature on medication counseling and expert reviews. Prior to data collection, the contents of the questionnaires were reviewed by groups of pharmacy researchers and experts for relevance, appropriateness, and acceptability. The face validity of the questionnaire was assessed by groups of practicing community pharmacists and pharmacy-users for clarity and comprehension. Then, the questionnaire was pretested with 25 patients and 10 community pharmacists and adjusted accordingly (the pilot sample was not included in the study sample). Reliability assessment was computed for the satisfaction responses to ascertain the internal consistency of the questionnaires using Cronbach’s alpha, which yielded 0.86 for the pharmacist survey and 0.65 for the patient survey.
- (2)Current state of medication counseling methods provided by community pharmacies
Patient questionnaire: perceived time taken for medication counseling, counseling method, and source of drug information obtained
Pharmacist questionnaire: perceived time spent on counseling and counseling method
- (3)Overall satisfaction with medication counseling
Patient questionnaire: overall satisfaction and reasons for dissatisfaction with medication counseling
Pharmacist questionnaire: overall satisfaction, barriers to counseling patients, and reasons for dissatisfaction with medication counseling
Demand for the development of medication counseling standards
Both the patient and pharmacist questionnaires consisted of 5-point Likert scales with descriptive choices ranging from “very satisfied” to “very dissatisfied” to measure and compare the satisfaction level between patients and pharmacists, and choices ranging from “very necessary” to “very unnecessary” to assess the demand for the development of medication counseling standards. Moreover, a variety of open- and close-ended questions was included in the questionnaires with a section to write comments.
A web-based survey was undertaken by both community pharmacists and patients. Both questionnaires were distributed online using the Qualtrics software, which allows respondents to navigate easily through a series of questions . For the patient survey, an online questionnaire was posted on social network services, such as Facebook, Twitter, and so forth, using a hyperlink. For the pharmacist survey, the survey link was distributed through Pharm Manager 2000 (Korea Pharmaceutical Information Centre, Seoul, Korea), which is the pharmacy management software most widely utilized in community pharmacies in South Korea. On Qualtrics, a tool was enabled to preclude respondents from performing multiple entries using the same IP address and device while maintaining the anonymity of respondents.
Data handling and statistical analyses
Once the survey was closed, data were downloaded from the Qualtrics website and imported directly into SPSS version 18.0 (SPSS Inc., Chicago, IL, USA) for analysis. The accuracy of the gathered data was assessed by visual inspection by two researchers who were independent of the study. During the assessment, the researchers eliminated inconsistent and unreliable answers (e.g., contradictory answers or all the same answers for a series of questions) from the final analysis. Descriptive statistics were calculated to present the frequencies of the survey responses. A comparison between patients and pharmacists was made using either a Chi-square test or a Fisher’s exact test. Differences between the groups were considered statistically significant if the p-value was less than 0.05.
Characteristics of the patients and pharmacists
Number of patients (%) total = 252
Number of pharmacists (%) total = 620
60 or older
Years of practice
Less than 1 year
20 or more years
Current state of medication counseling methods
Current state of medication counseling methods provided by community pharmacies
Number of Patients (%) total = 252
Number of Pharmacists (%) total = 620
Medication information printed on the prescription bag
Additional printout or stickers
Visual and auditory materials
Sources of drug information obtained
Portal site search (e.g., Google)
Inquiry to pharmacists
Inquiry to doctors
Government website (e.g., Ministry of Food and Drug Safety)
When patients had any medication-related questions, they reported that portal sites (Naver, Daum, and Google, etc.) were the most frequent source of drug information (51.6 %), followed by pharmacists (27.4 %), physicians (10.7 %), medical websites (8.7 %), and government websites (0.8 %).
Overall satisfaction with medication counseling
Patients’ reasons for dissatisfaction with medication counseling
Number of patients (%)
Use of plain language
Content of medication information received
Insufficient counseling time
Use of supplementary counseling aids
Demand for the development of medication counseling standards
Patients’ and pharmacists’ demand for the development of medication counseling standards
Number of participants (%)
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.  reported that the pharmacists’ satisfaction with their own medication counseling was relatively less favorable (31.1 %) compared to the present study (47.3 %) . 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. , evaluated patient satisfaction with counseling by pharmacists . 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 . 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 . 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 . 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 . 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.
Ethics approval and consent to participate
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.
Availability of data and materials
The datasets supporting the conclusions of this article are presented and included in the results section of the main manuscript.
This research was supported by grants (14172MFDS177) from the Ministry of Food and Drug Safety in 2014. Sincere thanks to all the respondents who spent their valuable time and efforts to complete the survey.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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