What factors of drug distribution system affect the satisfaction of outpatient with health insurance at district 2 hospital

RESEARCH PROJECT (BMBR5103) WHAT FACTORS OF DRUG DISTRIBUTION SYSTEM AFFECT THE SATISFACTION OF OUTPATIENT WITH HEALTH INSURANCE AT DISTRICT HOSPITAL? STUDENT’S FULL NAME : BUI ANH VU STUDENT ID : CGS00064957 INTAKE : MARCH, 2016 ADVISOR’S NAME & TITLE : ASSOC PROF DR BUI PHI HUNG August, 2017 Advisor’s assessment Advisor’s signature EXECUTIVE SUMMARY Improving the quality of patient care is always the highest goal of the health sector Especially in recent years, the policy for socialization of health care has facilitated a wide range of medical services, the competition has contributed to boosting the demand for service quality improvement The drug distribution system has been considered the most important and the most costly component of any health system and therefore it affects significantly the overall quality of health care As a result, evaluating the quality of this system is a vital part of the process of improving both the quality and efficiency of health care Patient satisfaction is the "property" of hospital The patient satisfaction index is the criterion used to measure the response of health facilities to the expectations of patients In other words, patient satisfaction is the highest measure of the quality of the operation of health facilities, not other forms of honor Program 527/CTr-BYT (June 18, 2009) of the Ministry of Health on "Improving the quality of medical examination and treatment at medical facilities for the purpose of meeting the patient satisfaction with the health insurance" require: improve morale, patient service attitude; reform administrative procedures; reduce inconvenience in reception, medical examination, treatment and payment to patients; improve the quality of health services in hospitals and healthcare facilities; ensure the rights of patients with health insurance, avoid abusing medicine, technology and test in order to save health resources and costs (Ministry of Health, 2009) In addition, Ministry of Health Circular No 19/2013/TT-BYT dated July 12, 2013 guiding implementation of medical service quality management requires all hospitals to assess the effectiveness of criteria, standard and quality management model indicators by 2018 (Ministry of Heath, 2013) Medicine supply is one of the important tasks that affect the quality of hospital treatment and is also a significant factor in assessing the quality of pharmacy's department In fact, the distribution of drugs has many factors affecting to patient satisfaction such as: drug quality, drug delivery process, waiting time, medicine consultation Therefore, it is necessary to have sufficient research to find out what factors make the patient dissatisfied In Vietnam, the issue of drug supply in hospitals still exist many inadequacies and receive social attention This inadequacy can occur at all stages of the drug delivery process: from procurement to delivery, from prescription to instructional use Despite continuous efforts, the health sector has not yet met the needs and expectations of patients There is always a gap between the current response and demand In order to measure and narrow this gap, the quality of drug supply and quality improvement work needs to be concentrated on the basis of a highly relevant assessment of patients When the Health Insurance Law came into force on July 1, 2009, District Hospital in Ho Chi Minh City became the place of registration for primary healthcare for patients with health insurance As a result, the number of outpatient with health insurance has increased from 800 to 1000 patients per day, leading to overload in some departments, especially in drug distribution system Therefore, the topic "What factors of drug distribution system affect the satisfaction of outpatient with health insurance at District Hospital ? " be done Overall objective: Providing factors of medicine dilivery activities affecting patient satisfaction Specific objectives: Describe and explain how each factor influence patient satisfaction Find out which factors actually impact patient satisfaction Provide recommendation to improve the quality of drug distribution system CONTENTS CHAPTER - INTRODUCTION 1.1 Introduction 1.2 Research Aims 1.3 Research Question 1.4 Context and Relevance 1.5 Scope of research 1.6 Structure 1.7 Conclusion CHAPTER - LITERATURE REVIEW 2.1 Introduction 2.2 What is the drug distribution system? 2.3 What is patient satisfaction? 10 2.4 What factors may affect patient satisfaction? 12 2.5 How to measure patient satisfaction? 14 2.6 Gap in liturature 15 2.7 Conclusion 16 CHAPTER - METHODOLOGY 17 3.1 Introduction 17 3.2 Research approach 17 3.3 Research design 18 3.4 Data collection 19 3.5 Data analysis 20 3.6 Reliability 21 3.7 Validity 21 3.8 Ethical considerations 22 CHAPTER - FINDINGS - DISCUSSION 24 4.1 Introduction 24 4.2 Descripting and explaining each factor 24 4.2.1 Personal question 24 4.2.2 Reliability 25 4.2.3 Responsiveness 26 4.2.4 Assuarance 29 4.2.5 Empathy 31 4.2.6 Tangible 32 4.3 Reliability analysis 33 4.4 Correlation analysis 35 4.5 Regression analysis 37 4.6 Conclusion 38 CHAPTER - CONCLUSION 40 5.1 Introduction 40 5.2 The purpose of the research 40 5.3 Addressing the research question 41 5.4 Key findings 41 5.5 Limitation and Recommendation 42 5.6 Answering the Research question 43 REFERENCE 44 Apendices - Questionnaire 49 CHAPTER - INTRODUCTION 1.1 Introduction In this chapter, I will introduce the research, overview District Hospital, outline the aims and discuss why it is relevant to quality of healthcare in Vietnam It will briefly measure the circumstance of the research and present the structure for this dissertation Firstly, I will sketch some highight of public hospitals in Vietnam and overview of District Hospital Then we will discuss the study aims and this will help us to develop a focused research question to investigate It will then state how this research is important and the relevance to the quality of healthcare in Vietnam Following which it will highlight what this dissertation will examine and the confines of it Finally it will finish by outlining the structure for the rest of the research Public hospitals play a crucial role in the healthcare system in Vietnam because they are the dominant provider of hospital care compared with private hospitals Among 1,099 hospitals national wide, there are 962 public hospitals, accounting for 87.5 per cent of the whole hospital system (Vietnam General Statistics Office, 2012) As a result, evaluating the quality of drug distribution system would help to better understand the current supply capacity and quality of supply and significantly contribute to the aim of improving the health outcomes for people in Vietnam Figure 1.0 District Hospital District Hospital was built in 1998 with the initial size of only 60 beds, but with the support of the state, District Hospital has been raised to 150 beds since 2015 Besides upgrading advanced medical equipment and facilities, District Hospital may also pay much attention to improving the level of medical staff, working principles, behaviors for physicians, nurses, technicians through training With a better goal of serving, the board of directors, doctors and nurses have been constantly innovating and improving their capacity Since 2015, District Hospital has attracted from 1,000 to 1,100 outpatients to medical examination and treatment every day, 2.5 times higher than in 2014 The number of inpatients has also increased, beds were always filled with over 90% patients The rate of referral to upper levels in 2015 decreased by 72% compared to 2014 In the first six months of 2017, the hospital has reduced the rate of referral to higher levels up to 82% over the same period in 2016 due to technical advances, actually hospital currently owned about 650 complicatied techniques People now are gradually becoming more confident in the quality of medical examination and treatment of hospitals and this has contributed significantly to reducing the overload of such hospitals: Cho Ray, Binh Dan, Nhan Dan Gia Dinh, 1.2 Research Aims This research aims to define what factors of drug distribution system affect outpatient satisfaction at District Hospital Based on these factors, managers can find solutions to improve the efficiency of drug distribution system and enhance the quality of healthcare in their hospital 1.3 Research Question A research question is the core of a research, the overall purpose of the research is therefore to find an answer to the research question In this instance, the research question should be tightly focussed, that is, it should be extremely clear exactly what aspect of practice the researcher is investigating and with which population of patients or clients So the study was conducted to answer the following research questions: - What factors of drug distribution system affect the satisfaction of outpatient with health insurance at District Hospital? - Why/How these factors affect the quality of drug distribution system at District Hospital? 1.4 Context and Relevance The Vietnamese public hospital system is overloaded, especially at the provincial and national levels, both in general and specialty public hospitals Further, the current shortage of experienced medical doctors, pharmacist and other professional staff has put increasing burden on hospital capacity to meet healthcare needs of the population This situation therefore affects the quality of healthcare system (Le TP, 2014) Decision No 68/QD-TTg dated January 10, 2014 of the Prime Minister approving the National Strategy on Vietnam pharmaceutical industry’s development to 2020 and with the vision to 2030 The overal objectives is to supply medicines adequately, timely with quality and rational prices according to the disease structure respectively with each socio-economical development stage and ensure medicine usage to be safe and rational To attach special importance to medicine supply for subjects belonging to social The current drug distribution model illustrates a complicated process can influence the quality of drug distribution system that is expressed by patient satisfaction Over the past 20 years, patient satisfaction surveys have gained increasing attention as meaningful and essential sources of information for identifying gaps and developing an effective action plan for quality improvement in healthcare organizations However the application of these findings is not the same in each healthcare center Each hospital should conduct its own patient satisfaction studies in order to improve the quality of healthcare Why I choose District Hospital? District Hospital is a secondary hospital undercontrolled by Ho Chi Minh City Ministry of Health In the past, there was no systematic study to evaluate customer satisfaction about the quality of drug distribution system for outpatients at District Hospital A number of surveys have been conducted at other hospitals, however, those research could not apply to enhance the quality of healthcare for this hospital Therefore a systematic study is needed to discover and answer the research questions posed 1.5 Scope of research The research involves the concepts of service quality in general and quality of drug distribution system in particular Quality of drug distribution system perceived by of drug distribution system quality Only Responsiveness and Assurance factors have significant influence on the overall satisfaction with regression coefficients of 0.746 and 0.318 (p values are 0.000 and 0.001, respectively) Further, the standardized coefficients at Table 4.11 indicate that the most affected factor on overall satisfaction is Responsiveness and Assurance (0.422 and 0.231, respectively) Moreover, the VIFs (Variance Inflation Factors) value is less than so we can ignore the multicollinearity Therefore, at District Hospital, in order to improve the quality of drug distribution system, it is fundamental to focus on the factor Responsiveness of four items and Assurance of three items Coefficientsa Model Unstandardized Standardized t Sig Collinearity Coefficients Coefficients Statistics B Std Error Beta Tolerance VIF (Constant) -.017 469 REL -.004 081 RES 746 ASU -.037 971 -.003 -.045 964 775 1.291 131 422 5.701 000 700 1.430 318 097 231 3.282 001 772 1.296 EMP 027 077 026 351 726 711 1.406 TAN 052 076 051 689 492 708 1.413 a Dependent Variable: SAT Table 4.11 Anova result - Coefficients 4.6 Conclusion This chapter has presented the findings of the research and discussed these findings by using graphs and tables It has clearly shown the results of the questionnaires and explained how it related to current drug distribution system at District Hospital It also has analysed the results from the data collected to attempt to answer the question “What 38 factors of drug distribution system affect the satisfaction of outpatient with health insurance at District Hospital?” The next chapter will draw firm conclusions from the research and link the findings to the research question It will discuss the aims of the research and state whether these have been completed or not Finally, it will attempt to answer the research question by considering all parts of the research to draw conclusions from 39 CHAPTER - CONCLUSION 5.1 Introduction The previous chapter discussed findings derived from analysing data collected by using a correct research method to find answers to the research question “What factors of drug distribution system affect the satisfaction of outpatient with health insurance at District Hospital?” As there was sufficient existing literature, as discussed in chapter two, a deductive approach was perceived as the best method for this study Quantitative data was analysed using the IBM Statistical Package for Social Sciences (SPSS) 20 and Microsoft Excel 2013 Findings from the data and discussing the findings were presented in chapter four This chapter will draw together the whole research project and create a firm conclusion to the question research It will also discuss the limitations of this research and give recommendations for future research 5.2 The purpose of the research The research in general has identified the most concerns about quality of drug distribution system This aspect is becoming more important in Vietnam because of three reasons, (1) the domination of public hospitals over private ones; (2) Current overcrowded situation of majority of public hospitals that negatively affects quality of drug distribution system; and (3) the lack of science researchs for enhancing the quality of healthcare at District Hospital By finding the factors of drug distribution system that affect patient satisfaction, it may give hospital new point of views to increase the quality of healthcare Some facilities, equipment that support the drug dilivery may need more time to implement because of budgetary reasons, but some issues such as employee attitudes can be enhanced in short term Therefore, by exploring these issues, it will allow board of director to take steps to 40 change these factors meaning that they will enhance the quality of healthcare at District Hospital 5.3 Addressing the research question This research has developed an appropriate framework that may be applied in District Hospital by answering the research question “What factors of drug distribution system affect the satisfaction of outpatient with health insurance at District Hospital ?” A specific study with solid samples sizes and good response rates are considered one of the strengths of this research Quantitative approach was conducted in the form of a questionnaire A sample group was formed which containing 174 participants and the questionnaires were distributed using simple random method The questionnaires were kept secretly and each patient was asked for informed approval so that no ethical guidelines were broken The participants were asked to self evaluate their satisfaction levels when taking the medicines at District Hospital The data was then collected and kept in a secure location while it was being analysed The researcher was then able to draw conclusions from the data to attempt to answer the research question 5.4 Key findings This research has demonstrated that the perception-based scale of SERVQUAL, also called SERVPERF, is an appropriate instrument to measure satisfaction among Vietnamese patients However, some modifications have been made according to the result of patient focus group discussions to create a 14-item PSQ scale reflecting five dimensions of quality of drug distribution system perceived by patients: Assurance, Reliability, Tangibles, Responsiveness, and Empathy This scale has been proved to be valid and reliable In these five dimemsion, most patients were satisfied with the dimension of Tangible (mean score at 4.22) while less patients were happy with the dimension of 41 Responsiveness (mean score at 3.53) All five dimensions expressed a correlation with the overall satisfaction Two dimensions really affecting to patient satisfaction in this research are Responsiveness and Assurance In dimension of Responsiveness, patients expressed a huge disatisfaction with the medicine price (75.6%) as well as the drug category (67.9%) Moreover, there were nearly one third patients complained about the waiting time to receive medicine Nevertheless, it’s worth saying that patients has showed a grateful feeling when checking health at District Hospital, the overal satisfaction scored 4.18 5.5 Limitation and Recommendation The primary limitation of this dissertation was the minuscule sample size used; therefore meaning that it has poor external validity Due to limited time (10 days) and budget, only 200 participants accepted to join the survey, however there are 26 unsuitable response so the sample-scale was only 174 invalid patients This may point out that the results of this study cannot be generalised to the entire public hospital, it was just applied for only District Hospital In future, if this research was reconducted, a much larger sample size including many public and private hospitals should be considered so that the consequences are more accurate This would also help to rule out any outliers in the data In terms of analysis strategy, validity assessment has some limitations Although content validity has been confirmed, there is no current “gold standard” satisfaction scales in order to conduct and examine the criteria-related validity of the research’s scales Construct validity of the scales was examined by only convergent validation using a oneitem variable of overall satisfaction Another limitation of this research was that participants were asked to self evaluate their satisfaction levels meaning that it has poor construct validity Participants may have exaggerated their satisfaction levels or lied about them and this may have swayed the results This may have meant that the results that were recorded were not completely 42 accurate This was a major flaw in the research design and therefore if this was completed again, a more scientific method should be used This would allow researchers to analyse peoples satisfaction levels through a series of questions or observations, rather than letting participants it themselves As mentioned above, this study should be implemented again in the future, it would be an excellent suggestion to compare public hospitals and private hospital for a long-term The quality of drug distribution system at private hospital was supposed better more than public hospital however up to now there were not any scientific study prove that statement If conducting such a comparetive research, the government could immitate or convert private model into public hospital system flexibly so as to improve the quality of healthcare system In the framework of this research, the main purpose was to figuring out what factors impact to the quality of drug distribution system Therefore author recommend hospital to firstly improve items not relating to huge budget such as staff’s attitude, waiting time, drug category, drug counselling In the next step, board of director should spend budget for reducing drug price as well as broadening the pharmacy Finally, a drug distribution system relating to internet, big data, the fourth industrial revolution should be considered as a solution for all current problems 5.6 Answering the Research question This research showed that Resposiveness and Assurance are two factors of drug distribution system affecting the satisfaction of outpatient with health insurance at 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Pharmaceutical Sector - Implications for Equitable Access and Rational Drug Use Health Economics and Drugs, DAP Series WHO/DAP/97.12 Wilson, J (2010), Essentials of Business Research: A Guide to Doing Your Research Project, SAGE Publications, pg Wuensch, Karl L (2005), What is a Likert Scale? and How Do You Pronounce 'Likert?, East Carolina University Yogesh, P.P., Gaurav, R., Satyanarayana, C (2011), Factors affecting In-patient Satisfaction in Hospital - A Case Study, International Conference on Technology and Business Management 48 Apendices - Questionnaire I am Bui Anh Vu - MBA student at Open University Malaysia Now I am conducting research on the subject "What factors of the drug delivery process affect your satisfaction at the District Hospital" for my graduate thesis under the guidance of Dr.Hung In order to complete this study, I need your help as a physical examination at District Hospital by answering the questions in this questionnaire I declare that all of your information will be kept confidential, and that investigative information is for research purposes only and not for any other profit-making purpose If you have any inquiries about the research results please contact me at 0919322614 or anhvu.pharma@gmail.com Please answer the following questions by circling in the boxes corresponding to your level of agreement on the statements (the higher the degree of consent shown) Is this your first treatment?(Xl) a First time(x=l) b Follow-up (x=2) Do you usually check and take medicine at this hospital?(X2) a No (x=l) b Yes (x=2) a b c d e Are you satisfied with drug quality? (X3) Very disatisfied (x=l) Disatisfied (x=2) Neutral (x=3) Satisfied (x=4) Very satisfied (x=5) a b c d e Are you satisfied with Doctor’s diagnosis ? (X4) Very disatisfied (x=l) Disatisfied (x=2) Neutral (x=3) Satisfied (x=4) Very satisfied (x=5) 49 a b c d e Are you satisfied with drug adequacy of the pharmacy?(X5) Very disatisfied (x=l) Disatisfied (x=2) Neutral (x=3) Satisfied (x=4) Very satisfied (x=5) a b c d e Are you satisfied with drug expense?(X6) Very disatisfied (x=l) Disatisfied (x=2) Neutral (x=3) Satisfied (x=4) Very satisfied (x=5) a b c d e Are you satisfied with number of drug in your prescription ?(X7) Very disatisfied (x=l) Disatisfied (x=2) Neutral (x=3) Satisfied (x=4) Very satisfied (x=5) Are you satisfied with drug origin in your prescription (Domestic/Undomestic)? (X8) a b c d e Very disatisfied (x=l) Disatisfied (x=2) Neutral (x=3) Satisfied (x=4) Very satisfied (x=5) Are you satisfied with the Doctor’s prescription out of health insurance drug category? (X9) a Very disatisfied (x=l) b Disatisfied (x=2) c Neutral (x=3) d Satisfied (x=4) e Very satisfied (x=5) 50 10 Are you satisfied with the waiting time to take medicine? (X10) a Very disatisfied (x=l) b Disatisfied (x=2) c Neutral (x=3) d Satisfied (x=4) e Very satisfied (x=5) 11 Are you satisfied with pharmacy’s drug conselling? (XI1) a Very disatisfied (x=l) b Disatisfied (x=2) c Neutral (x=3) d Satisfied (x=4) e Very satisfied (x=5) 12 Are you sympathetic with the pharmacy for errors in drug dilivery? (X12) a Strongly diagree (x=l) b Disagree (x=2) c Neutral (x=3) d Agree (x=4) e Strongly agree (x=5) 13 Are you satisfied with the staff’s attitude in drug dilivery? (X13) a Very disatisfied (x=l) b Disatisfied (x=2) c Neutral (x=3) d Satisfied (x=4) e Very satisfied (x=5) 14 Are you satisfied with the procedure of drug distribution? a Very disatisfied (x=l) b Disatisfied (x=2) c Neutral (x=3) d Satisfied (x=4) e Very satisfied (x=5) 51 15 Are you satisfied with the facilities at the distribution area? (X14) a Very disatisfied (x=l) b Disatisfied (x=2) c Neutral (x=3) d Satisfied (x=4) e Very satisfied (x=5) 16 Are you satisfied with the facilities at the drug waiting area? a Very disatisfied (x=l) b Disatisfied (x=2) c Neutral (x=3) d Satisfied (x=4) e Very satisfied (x=5) 17 Are you satisfied with the drug dilivery at District 10 hospital? (Y) a Very disatisfied (x=l) b Disatisfied (x=2) c Neutral (x=3) d Satisfied (x=4) e Very satisfied (x=5) Ho Chi Minh City, Month Day Year 2017 Signature, 52 ... departments, especially in drug distribution system Therefore, the topic "What factors of drug distribution system affect the satisfaction of outpatient with health insurance at District Hospital ? " be... investigated The next chapter will present existing literature surrounding the question ? ?What factors of drug distribution system affect the satisfaction of outpatient with health insurance at District. .. Prescription file Static and report Chart 2. 1 Current drug distribution system at District Hospital 2. 3 What is patient satisfaction? Outpatient with health insurance Outpatients are patients who have