Measuring patient satisfaction and trust across various dimensions poses a challenge in the economic dynamics and service business development. Therefore, this study aims to analyze determinant factors of patient satisfaction and their impact on pharmacy trust. The investigation was carried out using a cross-sectional survey method with purposive sampling, and the questionnaire was designed based on a scientific literature review. The valid data obtained from 301 respondents were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). The results showed that the greatest antecedent to patient satisfaction was drug efficacy, followed by drug education, personnel quality, and financial-health coverage (all significant at p < 0.05). Patient satisfaction positively influenced trust in the pharmacy (p < 0.05). However, the physical aspect, procedures-service promptness, medication supply, and social responsibility did not affect patient satisfaction. These results suggest that the process and outcome elements of pharmacy service are critical factors in relationships between patients and pharmacies.

pharmacy service, satisfaction, trust, structural equation modeling, hospital

In early 2014, the Indonesian Government established a National Health Insurance (NHI) to provide comprehensive health assurance for citizens (Kristina et al. 2018). The implementation of NHI has made it imperative for healthcare providers to prioritize patient care, with patient satisfaction and safety being the two primary concerns of the program. The provision of pharmaceutical services is an integral part of the healthcare system (Decree of the Minister of Health of the Republic of Indonesia No. 58 of 2014). To improve the professionalism of pharmacy services in hospitals, the Minister of Health of Indonesia issued a Standard of Pharmaceutical Services at the Hospital through a Decree of the Minister of Health No. 58 of 2014. However, most hospitals have not met the expected pharmaceutical service standards. This condition is because pharmaceutical services in the country are predominantly focused on the preparation and distribution of medicines.

The evaluation of patient satisfaction and perceived service quality is an important issue for healthcare providers (Decree of Minister of Health of the Republic of Indonesia 2014). Patient satisfaction has become an essential requirement to provide quality health care because it improves health behavior and leads to better healthcare outcomes (Lee et al. 2015). Several studies have developed instruments to measure patient satisfaction with pharmaceutical services (Larson et al. 2002; Horvat and Kos 2010). However, most of the measurements focused on specific aspects of pharmaceutical services. Therefore, measuring overall patient satisfaction with multidimensional service is a challenging task, especially amid the rapidly evolving economic dynamics and development of service businesses (Clerfeuille et al. 2008).

Several studies argued that assessing satisfaction is inadequate to fully explain the relationship between healthcare providers and patients. This is because satisfaction refers to experience, while trust is the expectations for future behavior. Previous investigations have also showed a correlation between patient satisfaction and trust. Thom et al. (1999) reported that satisfaction is a consequence of trust, while Castaldo et al. (2016) found that satisfaction is an antecedent of trust. These different results provide an opportunity to review the relationship between patient satisfaction and trust. Therefore, this study aims to identify and analyze the most significant antecedents of patient satisfaction and their impact on pharmacy trust. The results are expected to provide a complex model and a broader concept of pharmaceutical services.

This study collected data from 301 respondents in two hospitals in Sleman, namely one public and one private. Based on the results of the respondent characteristics in Table 1,66.4% of the respondents were female and 38.5% were between 25–44 years. Furthermore, 71.6% were married, 78.2% earned a senior high school or higher, and 34.5% had a monthly income <1.500.000, – IDR. As shown in Table 1, 51.8% of respondents visit the hospital pharmacy, with an average of ≥ four times, while 63.4% have BPJS-PBI.

The measurement model (outer model) aimed to test for convergent validity, discriminant validity, and construct reliability. Convergent validity can be accepted when the loading factor of items is greater than 0.5. Meanwhile, the average variance extracted (AVE) value greater than 0.5 indicated that the variance item extracted for loading items in the construct (Fornell and Larcker 1981). When the Cronbach’s alpha and composite reliability (CR) value is also more than 0.7, it indicated good consistency of the instrument in measuring the construct (Chin 1998). The values obtained in Table 2 showed that the convergent validity and construct reliability were eligible. The model also ascertained discriminant validity, as presented in Table 3, where the square root of the AVE for each construct was greater than the correlation between other constructs in the model. Therefore, it can be concluded that the measurement model is eligible.

The structural model (inner model) is used to predict causality relationships between latent variables. The percentage of variance is explained by the R square (R²) value for the dependent or endogen variable. Based on the results of the R² test in Table 4, the inner model has a value of R² 0.631 on patient satisfaction. This indicated that the proposed pharmaceutical service components can explain 63.1% of the patient satisfaction variance. The R² value of 0.374 for trust in pharmacy revealed that the construct of patient satisfaction can explain a 37.4% variance of the trust in pharmacy. Moreover, Fig. 1 provided a graphical of the SEM analysis.

Figure 1. 

Graphical structural model analysis.

Hypothesis testing was conducted by examining the result of the bootstrapping analysis with a 95% level of confidence, as presented in Table 5. Based on the path analysis coefficients obtained through PLS, it can be concluded that there were 5 supported hypotheses (P<0.05). These included financial-health coverage, efficacy, drug education, and personnel quality, which affected patient satisfaction. Patient satisfaction has an impact on trust in the pharmacy, while 4 variables including physical aspect, procedure-service promptness, medication supply, and social responsibility had no significant influence.

Financial-health coverage is the patient’s perception of the cost and drug coverage provided by medical insurance. In this study, financial and health coverage had a positive impact on patient satisfaction, as supported by (Mackeigan and Larson 1989). This variable is the second important factor that affected patient satisfaction in the proposed model. However, there is still a perceived disparity between healthcare providers and patients. Hospitals often assume that NHI participants still have to pay when medications prescribed by doctors are not covered by NHI. Meanwhile, patients usually interpret that all medications prescribed by the doctor are included in the NHI coverage, therefore, they should not have to pay again.

Efficacy refers to patients’ subjective perceptions of drugs’ potential to cure diseases or relieve symptoms (healing experience). It is the first important factor for patient satisfaction. The accuracy and effectiveness of treatment are the primary objectives for patients in the healthcare system. Moreover, the healing experience will affect satisfaction in accessing health services, thereby increasing motivation to reuse the hospital (Waber et al. 2008).

Drug education encompasses activities related to providing counseling and medication information. This study found that drug education is the third important factor for patient satisfaction. This indicated that the provision of clear and complete medication information and recommendations by the pharmacist can affect patient satisfaction (Satibi 2015). Patients are more appreciative of the health staff contribution to help understand their treatment (Khudair and Hanssens 2010). However, the NHI program has made an increase in patient visits, which affected the workload of health professionals and limited the interaction time with the patient. Most of the pharmacists’ practice in the hospital is still focused on the preparation and dispensing of pharmaceuticals (Kristina et al. 2018). Moreover, the lack of motivation among health professionals can be a barrier to patient education (Lelorain et al. 2017).

Personnel quality refers to the quality of all staff involved in pharmaceutical services such as pharmacists and pharmacy technicians. It is the fourth important factor for patient satisfaction. This is because a friendly and polite attitude toward patients significantly determines the patient’s perception of service. According to Padma et al., patients will adhere to the advice of the health workers when they feel valued and cared for. Therefore, personnel is expected to be more responsive, reliable, friendly, sincere, and competent (Padma et al. 2009).

The physical aspect, procedure-service promptness, medication supply, and social responsibility did not have an impact on patient satisfaction. The knowledge and intellectual abilities make it easier for patients to adapt to the situation and facilities of service providers (Azizan et al. 2013). Currently, patient preferences are shifting by searching for other important factors when visiting a hospital pharmacy (Khudair and Raza 2013). According to Sankar et al. (2003), patients generally do not have any expatiations regarding how service providers should maintain data confidentiality because they are not concerned about the information. (Sankar et al. 2003).

This study highlighted that patient satisfaction has an impact on trust in pharmacy. Similarly, Castaldo et al. stated that transparent communication and a friendly environment enhance trust. Moreover, trust plays an important role in shaping patients’ perceptions, with pharmacists acting as key drivers of trust and satisfaction directly and indirectly. To enhance trust in pharmacy, it is essential to focus on developing pharmacists’ competencies, skills, behavior towards customers, kindness, effective communication, and building relationships (Castaldo et al. 2016).

The improvement of pharmaceutical services plays an essential function in hospital services. This study showed that the process and outcome elements of pharmacy service are critical factors in relational exchanges between patients and pharmacy service providers. The service sector is not static, therefore, the hospital pharmacy should continuous improvement the quality of services based on the patient’s needs to increase patient satisfaction. Patients’ satisfaction and trust are basic elements to building relationships, increasing reuse intention, and improving adherence to medication advice and instructions. However, the limitations of this study include the involvement of only two hospitals in Sleman, Yogyakarta, which limited the generalization of the results to other regions in Indonesia. Therefore, future study is recommended to include other relevant variables such as trust in pharmacists and patient loyalty.

This study provides a multidimensional framework for understanding the antecedents of patient satisfaction and their relationship with trust in pharmacy. The results showed that patient satisfaction was positively influenced by drug education, personnel quality, and financial-health coverage, with efficacy being the most significant antecedent. Trust in pharmacy positively affected patient satisfaction, while physical aspect, procedures-service promptness, medication supply, and social responsibility had no significant influence. These results can assist hospitals, specifically pharmacy managers in evaluating pharmacy service performance.

The authors confirm contribution to the paper as follows: study conception and design: PP, SAK, SPS, S; data collection: PP, R; analysis and interpretation of results: PP, S; draft manuscript preparation: PP, SAK, SPS, S. All authors reviewed the results and approved the final version of the manuscript.