Patient Satisfaction with Pharmacist-Provided Health-Related Services in a Primary Care Clinic

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Abstract

(1) Background: Patient satisfaction plays an important role in the perceived value, sustained utilization, and coverage of healthcare services by payers and clinics. (2) Methods: A 33-question survey was designed to assess patient satisfaction and perceived value for healthcare services provided by a clinical pharmacist in a single primary care facility. It included general items from validated patient satisfaction surveys (i.e., PROMIS ® , CAHPS) and pharmacist-specific items identified in selected literature. It was offered to all patients who were presenting for a new, unique visit with the clinical pharmacist at the medical clinic between May 2019 and April 2020. (3) Results: A total of 66 patients agreed to take the survey (RR = 100%), and the responses were overwhelmingly positive. However, men were more likely than women to report higher satisfaction (X2(1, n = 920) = 0.67, p = 0.027), and new patients reported higher satisfaction than existing patients (X2(1, n = 1211) = 1.698, p = 0.037). (4) Conclusions: The findings of this study indicate a high degree of patient satisfaction with pharmacist-provided healthcare services in the primary care setting.

Keywords: patient satisfaction, pharmacist, primary care, chronic disease, collaborations, medically underserved areas

1. Introduction

In the past 15 years, there has been an increased focus on the patient care experience and the involvement of patients in the evaluation and assessment of the healthcare provided through the use of patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs) [1,2]. Patient satisfaction, a key global indicator of healthcare quality, plays an important role in measuring the value patients place on healthcare services, service utilization by patients, and coverage of services by payers [3]. Satisfied patients tend to continue using a valued service and better adhere to prescribed treatments, both of which ultimately lead to better health outcomes [4]. Other studies have explored the interaction between multiple dimensions of patient satisfaction on quality of healthcare services, including satisfaction with providers, interactions with clinicians, the medical facility, and leadership style [5,6,7].

Pharmacist-provided clinical health services address an often unmet primary care need, especially in rural and medically underserved communities [8,9,10,11]. Particularly in those settings, many pharmacists increasingly provide a variety of non-dispensing, clinical health services (e.g., medication management, chronic disease management, transitions of care, and preventative care services) improving healthcare access, service utilization, health outcomes, and quality of life [12,13]. Especially for rural patients, pharmacists are often the nearest and most accessible healthcare provider. However, the extent to which patients are satisfied with pharmacist-provided healthcare services in the primary care setting has been minimally studied for few conditions [14,15,16]. While the literature is robust supporting the strength of pharmacists’ contribution to the clinical care of patients, it is lacking when supporting the connection between patient satisfaction and pharmacist-provided healthcare services in the primary care setting, particularly in rural areas. It is therefore essential to critically evaluate this relationship, especially in light of shifts in healthcare reimbursement models towards quality. Consequently, the authors sought to contribute additional data related specifically to rural patient satisfaction in the primary care space. The objective of this study is to determine patient satisfaction with non-dispensing, general healthcare services rendered by a pharmacist in a primary care setting.

2. Materials and Methods

A survey was designed to assess patient satisfaction and perceived value for healthcare services provided by a clinical pharmacist embedded in a single primary care facility as a core healthcare provider between May 2019 and April 2020. The clinical pharmacist was established with the clinic three-years prior to the study period, has a number of trainings and certifications (post-graduate residency, Board Certified in Ambulatory Care Pharmacy (BCACP), Certified Diabetes Educator). Additionally, the pharmacist is enrolled and credentialed as a rendering provider with state and commercial insurance plans. The clinic practiced a Patient-Centered Medical Home model with care teams including physicians, nurse practitioners, physician assistants, pharmacists, nurses, and behavioral health professionals. The clinical pharmacist conducted scheduled visits with patients who were referred by other clinic providers for a specific purpose, including collaborative disease management of a variety of chronic conditions (i.e., diabetes, hyperlipidemia, anticoagulation, preventative health, osteoporosis); prescribing and adjusting medications; medication therapy management, administration, and medication counseling; and the administration of preventative healthcare services, such as smoking cessation and vaccinations. The survey was offered only to patients who were meeting with the pharmacist for the first time to establish care; this convenience-based sampling technique was determined to be appropriate given the resources available for the study and constraints specific to the practice setting. Patients were excluded from survey participation if they also had a same-day appointment with another clinic provider or were repeat visits with the same clinical pharmacist. Patients were also excluded if they were younger than 18 years of age or non-English speaking. All visits were documented, coded, and billed in the clinic’s electronic health record in the same fashion as other core healthcare providers.

Investigators reviewed literature and institution-specific documents for existing patient satisfaction or perception surveys to inform survey design. The final survey design included general items from validated patient satisfaction surveys (i.e., PROMIS ® , CAHPS) and pharmacist-specific items identified in selected literature [2,17]. The result was a 33-item survey consisting of 15 questions related to demographics and service utilization, and 18 questions focused on patient satisfaction. The patient satisfaction questions were divided into four key domains: (1) Patient Experience, (2) Self-Efficacy for Managing Medications and Treatment, (3) Perceived Value of Pharmacist-Provided Health Services, and (4) Willingness to Pay for those services.

The survey items selected to capture Self-Efficacy for Managing Medications were specifically adapted from PROMIS Self-Efficacy for Managing Medications and Treatment [2,17]. All other survey components were selected and revised based on relevance to pharmacist healthcare services, suggestions received from the clinic pharmacist, and face validity from patients and colleagues. A five-point Likert scale was used to assess respondent perceptions, ranging from the negative “Strongly disagree” to the positive “Strongly agree”.

The researchers selected the following 18-survey items to express the four domains of patient satisfaction for analysis (see Table 1 ):

Table 1

Domains and factors of patient satisfaction.