* Corresponding author: Sun Lihua, professor. Major research area: pharmacoeconomics, medical investment performance and management, etc. Tel: 024-23986553, E-mail: slh-3632@163.com.

Abstract Objective To improve the quality of pharmacy service in private hospitals on the background of the fact that hospital pharmacy service is an important guarantee to promote rational drug use and the government encourages social capital to enter the field of pharmacy and healthcare, therefore, private hospitals are facing a new stage of development. Methods Questionnaire survey was used to sample and analyze 10 representative private hospitals in local area, and comparisons were made with the status of pharmacy service in level 3 public hospitals. Results and Conclusion It can be found that private hospitals have many problems in pharmacy services, such as the low level of professional skills of pharmaceutical personnel, low recognition and trust from patients, and the imperfect pharmaceutical management system. Some countermeasures and suggestions are put forward to promote the level of pharmacy services in private hospitals on the basis of this study.

Keywords: hospital pharmacy service; private hospital; questionnaire survey method

Pharmacy service is one of the ways for pharmacists to seek development under the new situation. Meanwhile, it is also a new mode to adapt to the development of modern technology and an important guarantee to promote rational drug use.With the deepening of the reform of pharmaceutical management in China in recent years, hospital pharmacy service has gradually become an important part of hospital service for patients. Besides, it is the development direction of pharmacy in all major hospitals, and it becomes popular in these hospitals.What is more, the government encourages more social capital to enter the field of medicine and health.The “Opinions on Promoting the Development of Health Service Industry” published in 2013 and the“Opinions on Accelerating the Development of Social Medical” in 2014 further promoted the development of private hospitals. According to the plan, China’s health service industry should reach 8 trillion RMB by 2020, accounting for about 10% of GDP, and become a supporting industry. The policy “Spring Wind” has attracted a large amount of private capital to invest in the medical industry. More urban and rural hospitals, including the second class and first class hospitals, develop fast because they get social capital integration. Under this new situation, it is particularly important to ensure the quality of pharmacy service in private hospitals.

Questionnaire method is applied to make sampling investigation on 10 representative private hospitals in the writer’s city, and the present situation of pharmacy service in these hospitals is analyzed.Then contrast analysis method is adopted to compare the survey results and the current status of pharmacy service in the tertiary hospitals, the problems and deficiencies of pharmacy service in the private hospitals are found. And then the causes of them are analyzed so that the countermeasures and suggestions for improving pharmacy services level in private hospitals can be put forward.

1 The formation of questionnaire

1.1 Subjects and methods of questionnaire

This survey is based on Shen Yalan’s questionnaire “Investigation and Research on Outpatient Pharmacy Service of Nanjing Tertiary Hospitals”[1]. A total of 10 representative private hospitals in the author’s city were selected and sampling investigation on the outpatients of these hospitals was conducted. Finally, the results of the investigation were compared with the questionnaire collected, and some problems in the pharmacy service of the private hospitals were found and analyzed.

1.2 The contents of the questionnaire

The questionnaire mainly includes the following items:

(1) Basic information, such as gender, age,degree and residence;

(2) Patients’ recognition of pharmacy services;

(3) Patients’ demand for pharmacy services;

(4) Patients’ satisfaction with pharmacy services.

The Cronbach’s α coefficient is 0.813 and the reliability of the questionnaire meets the requirements of the study. The questionnaire should be filled out by the respondents on the spot under the principle of voluntary agreement and on the premise of their consent. What is more, the questionnaire should be confident. With the assistance of the staff from the private hospitals, these questionnaires were done. A total of 178 questionnaires were issued to the selected patients of 10 private hospitals, and 150 questionnaires were recovered, with a recovery rate of 84.26%.

1.3 Analysis of investigation results

After analyzing the survey results and comparing with the patients’ questionnaire in “Investigation and Research on Outpatient Pharmacy Service of Nanjing Tertiary Hospitals”, we got the following points.

1.3.1 Structural analysis of patient samples

Among 150 patients, the ratio of male to female was about 1:1. There were 5 categories of age and 4 categories of educational degree. Patients of different age groups and different educational degree were involved. For long-term residence, the ratio of town to rural area was about 1:1 (See Table 1).

Table 1 Patient sample configuration (N = 150)

1.3.2 Patients’ recognition of pharmacy services

48% of the respondents heard about pharmacy services while the other 52% did not. Among the 48%of the patients who knew pharmacy services, 23%thought that pharmacy service should be provided by doctors, 4% considered it should be provided by pharmacists, and 21% felt that it should be provided by nurses, as shown in Fig. 1. Therefore, it can be seen that patients have little understanding of pharmacists and pharmacy service and they do not trust in pharmacists.

Fig. 1 Patient’s opinions on pharmacy services

Fig. 2 Patients’ demands for pharmacy services

However, according to the “Investigation and Research on Outpatient Pharmacy Service of Nanjing Tertiary Hospitals”, 41% of patients believed that pharmacy services should be provided by doctors,50% considered they should be given by pharmacists,and 9% considered that they should be provided by nurses[2]. Through the investigation and comparison of the patients’ opinions on pharmacy services between the private hospitals and the tertiary hospitals, it is shown that the patients’ trust to pharmacists is better in the tertiary hospitals, while the patients lack trust in pharmacists in the private hospitals because they have little understanding of pharmacists and pharmacy services. It leads to the patients’ misunderstanding of medical staffs who provide pharmacy services.

1.3.3 Patients’ demands for pharmacy services

The top five drug information that the outpatients should know are: adverse drug reaction (29%), dosage(28%), dietary requirements and other precautions during medication period (25%), drug therapeutic range (7%), related drug price and validity period(6%), and the course of treatment (5%) (See Fig. 2).

In addition, the content and form of pharmacy services are as follows:

Table 2 Patients’ needs for content and form of pharmacy services

As for the content of pharmacy services, in addition to dispensing drugs according to the correct prescription, many patients hope that hospitals can provide relevant medication guidance and consultation as well as effective drug information. Meanwhile,adverse drug reaction monitoring is also a part of the patient’s needs. Other patients believe that appropriate medication education and medication tracking for special patients should also be included in the service.This is consistent with the findings in “Investigation and Research on Outpatient Pharmacy Service of Nanjing Tertiary Hospitals”. In tertiary hospitals,81.2% of the patients expect the hospital to provide medication guidance and consultation except for correct drug delivery. 58.5% of the patients want to get drug information, and 44.5% of the patients expect hospital to provide monitoring adverse reactions.Besides, in the form of service, most patients would like to have on-site consultation, getting a medication guidance booklet or a phone call, or network consultation as a supplementary form.

1.3.4 Analysis of patients’ satisfaction with pharmacy services

In terms of patients’ satisfaction with pharmacy services, the results are shown in Table 3.

Table 3 Overall patients’ satisfaction with pharmacy services (N = 150)

The survey results in “Investigation and Research on Outpatient Pharmacy Service of Nanjing Tertiary Hospitals” showed that among the tertiary hospitals, 45% of patients were very satisfied, 4%were very dissatisfied and 35% were satisfied. In terms of the accuracy of dispensing drugs, 35% of the patients were very satisfied with the tertiary hospitals,8% were very dissatisfied and 30% were satisfied. In terms of spiritual outlook, 38% were very satisfied.As to the process and order of drug collection,37% were very satisfied. As to the communication between pharmacists and patients, 35% were very satisfied. According to the comparison data of the two hospitals, although the private hospitals in our city carried out corresponding pharmacy services, patients’satisfaction with pharmacy services was not good.

1.3.5 Summary of the investigationAccording to the above investigation and analysis, the serious problems of pharmacy services in the investigated private hospitals were low professional level of pharmacy personnel, patient’s low cognition of the service, and the lack of understanding of pharmacists and pharmacy services.The pharmacist’s work at the private hospital is still only confined to the traditional drug guarantee, but they occasionally or never actively provide drug information service, which is related to the longestablished concept of taking drugs as the center. In the analysis of patients’ satisfaction with pharmacy services, working attitude, mental outlook and the correct delivery of drugs are all the indexes for the satisfaction evaluation of the patients. However, in general, patients are not satisfied with the overall pharmacy services, which needs to be improved by relevant personnel.

2 Cause analysis of the problem

2.1 Professional skills of pharmaceutical personnel need to be improved

Pharmacists are the key to the success of pharmacy services. As pharmacists, they should not only have good comprehensive quality, good language ability and rich practical experience, but also have solid medical professional knowledge.Pharmacy services are based on the communication between pharmacists and the patients. Whether the pharmacists actively communicate with the patients and provide the corresponding medication information can affect the patient’s satisfaction. The key to the pharmaceutical management in private hospitals is to improve the quality of pharmacy staff.

2.2 Poor patients’ recognition and distrust

The patients have little understanding of pharmacists and pharmacy services, and they are unwilling to trust pharmacists. It can be seen that the popularity of pharmacy services in private hospitals is still insufficient. Patients’ attitude towards clinical pharmacy services will influence their selection of hospitals. Most patients express that they are willing to visit hospitals with better pharmacy services.Therefore, it is important to perfect pharmacy services and improve the quality of pharmacy services.

2.3 The imperfect hospital pharmacy management system

The establishment and improvement of the hospital’s pharmacy management system has already had an impact on the development of clinical pharmacy services. The first reason is that the traditional idea of attaching importance to doctor over pharmacist is deeply rooted. Due to the insufficient attention to clinical pharmacy service, it is hard for hospitals to develop clinical pharmacy service.The second reason is that the hospitals support for clinical pharmacy service is not sufficient, and there is no platform for clinical pharmacy service,resulting in the poor communication between medical staff and clinical pharmacists, which hinders the implementation of pharmacy service[3].

3 Countermeasures and suggestions

3.1 Improving the quality of pharmacy staff in private hospitals

In order to improve the quality of pharmacy personnel in private hospitals, the following aspects shall be done well. First, the pharmacy knowledge training should be organized to improve the professional level of pharmacists for rational drug use. Secondly, the cultivation of pharmacy personnel should be strengthened and the clinical pharmacist system must be actively promoted. Meanwhile,pharmacists should update their knowledge and continue their education. Through systematic and targeted education, the knowledge structure of pharmacists can be adjusted to lay a solid foundation for the development of pharmacy services.

3.2 Strengthening publicity and education and improving public cognition

First of all, private hospitals should intensify propaganda and improve the acceptance of pharmacy services among patients. Patients trust in pharmacy service is the basis for pharmacists. Secondly, the drug publicity manual can be prepared regularly to inform the patients of rational drug use. It also can attract public interest through different platforms such as lectures, publicity columns and websites. Thirdly,pharmacists may also spread basic pharmaceutical knowledge, medication guidance for common diseases and chronic diseases and rational drug use to the public through the lectures, so as to improve the awareness and trust of patients.

3.3 Improving pharmacy management system and establishing development platform

Firstly, private hospitals should change the traditional idea of attaching importance to doctor over pharmacist, but to understand the necessity of developing pharmacy services. Relevant drug management system and assessment criteria should be established to regulate the content and job responsibilities of clinical pharmacists. Secondly, a good development platform should be built for the development of clinical pharmacy services. Besides,hospitals should improve the status of clinical pharmacists and issue relevant regulations to ensure the support and cooperation of medical staff. Finally,pharmacy management system shall be formulated according to the development of pharmacy services in hospitals and relevant regions, which shall be adjusted occasionally.