The Satisfaction of Covid-19 patients Self-home Care with Telepharmacy Services

 

Hilda Muliana¹, Suharjono²*, Yulistiani², Budi Suprapti²

¹Doctoral Program in Pharmaceutical Sciences, Faculty of Pharmacy, University of Airlangga,

Surabaya 60115, East Java, Indonesia.

²Department of Pharmacy Practice, Faculty of Pharmacy, University of Airlangga,

Surabaya 60115, East Java, Indonesia.

 

ABSTRACT:

Background: The impact of Covid-19 pandemic makes the hospital innovate using technology services, one of which was telepharmacy. Telepharmacy has the potential to improve Covid-19 outpatient through the use of telecommunications with self-home care patient. In July 2021, 120 patients received telepharmacy services with teleconsultation with pulmonologist, pediatrist, internist, otorhinolaryngologist, neurologist, psychiatrist and general practioners. In August 2021, telepharmacy patients were reduced to 39 patients, and in September 2021, telepharmacy patients were reduced to 11 patients. Objectives: Evaluating outpatients with telepharmacy services by measuring satisfaction patients. Methods: This program integrated with interprofessional doctor, pharmacy, nurse, driver and customer care unit. The satisfaction of patient depends on the multiprofessional services. This research to evaluate the satisfaction Covid-19 outpatients with received telepharmacy services. Desain study were descriptive, non-experimental and study cross-sectional. Data collected 3 months dan the samples were 170 patients with patient surveys to evaluate patient satisfaction. Results: 170 patients received telepharmacy ranged in age from 5-70 years, consisting of  93 women (54.7%) and 77 men (45.3%) with 76,5% satisfaction with telepharmacy services. Patients reported telepharmacy services from pulmonologist by 61.7%, internist 8.2%, otorhinolaryngologist 1.2%, pediatrist 23.5%, neurologist 0.5%, psychiatrist 0.5% and general practitioner from medical check-up by 4.1%. Conclusions: The satisfaction of self-home care telepharmacy patients overall reached 76.5%, and the patient felt dissatisfied were 23.5%. The decrease of patients in August and September 2021 because the telepharmacy services has not been maximized services and needs improvement. The hospital can improve the quality of telepharmacy services to increase patient satisfaction and visit telepharmacy patients.

 

 

INTRODUCTION:

The world of health related with digital technology and the internet. Rapid technological advances have an impact on the health sector. Technological developments play a role in helping doctors and health workers build better quality health services. Teledigital health was a form of telehealth service that uses digital technology and the internet.

 

Telemedicine was a health service that was carried out remotely, a technology that allows patients to consult doctors privately, without having to meet face-to-face.

 

The Covid-19 pandemic has changed healthcare services around the world, patients can still get treatment from doctors using technology digital. Teleconsultation can be carried out between patients and doctors working in health facilities using telemedicine.¹

 

Telepharmacy uses electronic information and communication technologies to support and provide pharmaceutical care and drug distribution when distance separates pharmacists from hospitals. After a doctor writes a drug order, the order was scanned and stored in the hospital network, the pharmacist accesses the network via the internet to review orders and check patient profiles with computerized drugs. Pharmacists intervene regarding drug orders, clarify unclear or illegible orders, make compliance recommendations in the hospital formulary, check drug interactions, inform drug instructions and warnings, drug monitoring, therapy management, patient counseling, prepare drug orders according to doctor's instructions, and ensure patients get their drugs and comply treatment instructions.^2,3

 

Telepharmacy services have several advantages, it can be accessed by people in rural and remote areas, many elderly patients get the treatment without leave their homes, the Covid-19 pandemic provides safety and comfort for patients when seeking treatment at doctors, it can overcome the shortage of pharmacists in health facilities, telepharmacy provides an effective time for patients and it can increase patient satisfaction­.⁴

 

Covid-19 patients who were self-isolating (“isoman patients” or self-home care patients) at home were asked to take advantage of the telemedicine services provided by the hospital. The patient does not need to come to the hospital, they can do teleconsultation with the intended doctor as a new patient, control to the doctor periodically and get home-delivered medicine.

 

Telepharmacy services in Awal Bros Batam Hospital start in June 2021 for all outpatients, Covid-19 and non Covid-19. The Covid-19 self-home care patient with telepharmacy services in July 2021  were 120 patients, August 2021 were 39 patients and September 2021 were 11 patients. Totally of the Covid-19 self-home care patient with telepharmacy services between July 2021 – September 2021 were 170 patients. The decrease of telepharmacy patients can be measured by patient satisfaction with the telepharmacy services obtained.

 

METHODS :

Study Design and Population :

This study was conducted in the private hospitals that use electronic medical records and have provided telemedicine services in Batam. This study was a descriptive, non-experimental and cross-sectional study conducted at Awal Bros Batam Hospital. Inclusion criteria was Covid-19 outpatients self-home care with received telepharmacy services in July 2021 to September 2021. Exclusion criteria were non-Covid-19 outpatients, Covid-19 outpatients telemedicine without bought the drugs in Pharmacy, and Covid-19 inpatients.

 

Study Protocol :

 

Figure 1. The protocol of telemedicine outpatients

 

Patients register to become telemedicine outpatients at least a day before. At the time of scheduling an appointment, the patient was contacted by customer care for outpatient registration, and the patient pays for the registration. Customer care provides video and audio cellphones to the doctor, to carry out telemedicine. Doctor write the diagnosis in the Electronic Medical Record and write the electronic prescription. Pharmacists tell about the drug cost information. The patient pays the drug by transfer. The medicine was prepared by the pharmacist, and the medicine was delivered by the driver. Two days after the patient got the drugs, the pharmacist call the patient for ask the satisfaction services.

Data collected 3 months  (July 2021-September 2021) dan the samples were 170 patients with patient surveys to evaluate patient satisfaction and the quality services. This study integrated with interprofessional doctor, pharmacy, nurse, driver and customer care unit. The satisfaction of patient depends on the multiprofessional services.

 

STATISTICAL ANALYSIS :

Descriptive statistic were used to describe and evaluate (mean) and categorical variables (frequency and percent).

 

 

RESULTS:

The study was the first study to evaluate the satisfaction patients with received telepharmacy services in Awal Bros Batam Hospital. Telepharmacy services in this hospital start in June 2021 for all outpatients, Covid-19 and non Covid-19. This study collected data from July to September 2021 for the self-care Covid-19 outpatients who received telepharmacy services. The self-home care outpatients with telepharmacy services were 170 patients. The patients got the telemedicine services, which went to pulmonologist, internist, otorhinolaryngologist, pediatrist, neurologist, psychiatrist and medical check-ups with general practitioners. The patients got the electronic prescription from the doctor and bought the drugs, and received telepharmacy services.

 

Table 1. The Sociodemopgraphic and Characterictic of Telepharmacy patients

 

Telepharmacy patients in July - September 2021 were women 54.7% and men 45.3%. There were telepharmacy patients from companies (85.3%) and general patients (14.7%), and there were no BPJS insurance patients. Most of the patients were self-home care patients with Covid-19 control to the doctor by 67% and the new patients by 33%. Telepharmacy patients ranged in age from 5-70 years with a mean of 28.1 and a median of 45.

 

Table 2. The spesialization doctor for patient with with receive telepharmacy services

 

Self-home care of Covid-19 patients with receiving telepharmacy services from pulmonologist were 61.7%, internist 8.2%, otorhinolaryngologist 1.2%, pediatrist 23.5%, neurologist 0.5%, psychiatrist 0.5% and general practitioner from medical check-up by 4.1%.

In September 2021 there was 1 patient from a psychiatrist, and received the control substance drugs, where the patient took the drug to the hospital, because it could not be sent home by the driver officer.

 

Pulmonology patients were adult the Covid-19 control patients and adult new the Covid-19 patients who were self-isolating at home. Meanwhile, 40 pediatric patients were the Covid-19 self-isolation patients (self-home care), they were control patients and new patients. Patients from otorhinolaryngologist, neurologist, psychiatrist and internist were adult patients with additional symptoms requiring further consultation with the doctors. Specifically, general practitioner patients were self-isolating patients who perform medical check-ups for treatment control during self-isolation.

 

Table 3. The satisfaction patient with receive telepharmacy services

 

The satisfaction with Covid-19 self-care patients who received telepharmacy services was 76.5% and those who felt dissatisfied were 23.5%. Dissatisfied telepharmacy patients were described by the patient, dissatisfied with the long-term home delivery service, no explanation on the use of drugs from the pharmacist, and the cost of home delivery of drugs.

 

Table 4. The satisfaction of telepharmacy patients with gender

 

Based on the data in table 4, the self-home care satisfaction of patients who receive telepharmacy services were female patients feel satisfied were 48.8% and  27.6% male patients.

 

Table 5. The satisfaction of telepharmacy patients with insurance patient

 

 

 

Based on the data in table 5, it was explained that the satisfaction of self-home care for patients who receive telepharmacy services from company insurance were 63.5% satisfied and 12.9% for general patients.

 

Table 6. The satisfaction of telepharmacy patients with type patient

 

In self-control home care, patients felt satisfaction with telepharmacy services were 49.3% and new patients were 27%.

 

DISCUSSION:

Telemedicine was a treatment service for patients using technology remotely.­⁵ In the ancient times, the best communication between doctors and patients was with handwritten prescriptions. Technological developments and the use of the internet have turned into electronic prescribing.⁶ Electronic prescriptions can reduce medication errors caused by illegible prescriptions. Electronic prescribing has the benefit of greater patient convenience, increased adherence to prescription writing based on the hospital formularies, pharmacists contacting doctors less to clarify illegible, unclear and incomplete prescriptions, faster drug preparation process, pharmacists more time to give patient counseling and pharmaceutical care.⁷ 

 

According to the Center for Connected Health Policy (CCHP), telemedicine was traditional physician diagnosis and clinical monitoring delivered through technology, while telehealth was physician diagnosis, health education, and other relevant health care fields. Telemedicine was concerned with providing services by doctors only, while telehealth was concerned with providing services by health practitioners such as doctors, dentists, surgeons, nurses, therapists, phychologists, pharmacists and other professionals in the field of medicine. Telenursing in India emerged due to the increasing number of elderly and sick population, longer distances between patients and health care centres, concern for cutting healthcare costs and less populated areas.⁸  With telenursing, health care services to patients were not limited by time and distance, can overcome the limited of nurses spread over a wide geographical area. Tele-nursing assists patients and families in the management of care for chronic disease patients. Tele-nursing can also reduce the length of stay of patients in the hospital.⁹

 

Patients in rural areas who experience emergency conditions or in postoperative patients who must be monitored 24 hours in rural areas have great challenges in saving patients' lives. This problem in India can be solved with the help of a health monitoring system using IoT, which monitors diagnostic parameters such as heart rate, pressure, activity and temperature using appropriate sensors such as heart rate sensor, pressure sensor, and temperature sensor. This telemedicine system can assist patients in dealing with sudden cardiac arrest, changes in pressure, changes in temperature and death.¹⁰

 

Telemedicine services to patients provide the benefits, the patients did not meet many people, time efficient, cost-effective, practical by using digital technology, and symptoms of illness can be treated.¹¹ The use of the internet in medical practice was beneficial for patients who have limited mobility or accessibility needs.⁶ Telemedicine services were a safe option for vulnerable patients with a greater risk of Covid-19-related morbidity or mortality.⁵ In the pandemic of Covid-19, telemedicine services were the right solution in providing health services to patients, especially for Covid-19 self-home care patients.

 

Quality services were the main attraction of patients to hospitals which depend on the factors of skilled staff, pleasant work environment, hospital policies, salary structure, employee job satisfaction.¹² The quality of good hospital services can provide satisfaction to patients¹³ and the patient satisfaction will help to improve the quality of care.¹⁴ Providing satisfying and meaningful health services to patients was not an easy thing. Every patient was different, and has a different situation. The things that are done and the needs that were met vary in each situation. Patient satisfaction indicates the extent to which the patient's health care needs were met with their needs. Patients have certain expectations before visiting the hospital and the resulting satisfaction or dissatisfaction was the result of the patient's experience in getting health services. Hospitals can use patient satisfaction as a measure of the quality of telemedicine and telepharmacy services in the hospitals.¹⁵ Telemedicine services provide satisfaction to patients by getting solutions for disease symptoms, saving time and money, and getting treatment.¹⁶  

 

Telepharmacy was a part of telemedicine services for patients, who get electronic prescription from a doctor, buy medicine at the hospital, and the medicine will deliver to the patient's home.¹⁶  Telepharmacy can be used to manage patients living in remote areas, by sending electronic videos to patients, for example instructional videos on the proper use of corticosteroid inhalers to asthma patients.⁷  Telepharmacy services that were part of telemedicine services need a study to determine patient satisfaction with telepharmacy services.

 

Patient satisfaction was a patient's psychological state resulting from the confirmation or disconfirmation of expectations with reality. Patient satisfaction was the perception of treatment outcomes that meet patient expectations.¹³  Patient satisfaction was a measure that can be used to evaluate health services in the hospitals.¹⁷ Patient satisfaction in telepharmacy services was an evaluation of the performance of hospital pharmacists in providing telepharmacy services to patients.

 

The satisfaction of patients receiving telepharmacy services was high than dissatisfaction patient. This study shows that telepharmacy services were preferred by patients and get solutions to their problems. 170 patients were satisfied by 76.5% who came from pulmologist, pediatrist, internist, otorhinolaryngologist, neurologist, psychiatrist, and general practitioners. The telemedicine services from neurosurgery and orthopedic department, there did not register, while in America the visit of telemedicine patients seeking treatment for neurosurgery and orthopedics was large and the patient satisfaction rate was high.^5,18 The development of telemedicine services to all department of medicine needs to be developed, to increase the visits of telepharmacy patients.

 

The development of telemedicine in all department of medicine can be supported by the history of telemedicine services, which were first teleradiology services in the radiology departement, tele-electrocardiogram in the cardiology departement, tele-ultrasonography services in the obstetric gynecology departement, telestroke services in the neurology department and tele-psychiatry in the psychiatry department.¹⁹ Various fields of medical science can be developed towards telemedicine services.

 

In July and August 2021 there were no telepharmacy patients from psychiatrist, in September 2021 there was 1 telepharmacy patient from psychiatrist and received control substance drugs which could only be given to patients by pharmacists. This patient after telemedicine service with a psychiatrist, received telepharmacy services and took medication to the hospital. Control substance drugs cannot be delivered to the patient's house with a driver, because it requires special monitoring and delivery of the drug directly to the patient. Psychiatric patients require regular control to a psychiatrist and require continuous, safer and more effective treatment with telemedicine services.²⁰ The Covid-19 self-home care patients who experience long covid also need a teleconsultation to a psychiatrist. Telemedicine services for psychiatric cases can be developed with telepharmacy services which were also ready to serve patients to deliver medicines to patients' homes. Telepharmacy services require pharmacists who come to patients' homes to deliver drugs directly to patients and provide educational counseling to patients.

 

The decrease visits of telepharmacy patient in August and September 2021 could be related to the patient dissatisfaction at 23.5%. The patient's dissatisfaction was informed because of the long delivery of the drug, the pharmacist did not call the patient to explain the use of the drug, and the cost of sending the drug home. Based on the results of interviews with pharmacists in the hospital, the limited of pharmacists staff makes it take a long time to prepare drugs and pharmacists do not call the patients to explain the drug of use. Telepharmacy services should be repair for the preparation drugs, delivery drugs, cost of delivery drugs, and the pharmacist will deliver the drugs to patients home with give the information about the drug of use.

 

The telepharmacy services will continue to develop and improve in the future, even though the Covid-19 cases has decreased, telepharmacy services will continue to be needed by the community, because it was cost and time efficient, more practical with digital technology, safe from Covid-19 transmission and make the patient comfortable and satisfied.²¹

 

This study has the limitation that this study were descriptive and qualitative study. For the next study can combine quantitative study and qualitative study to get the satisfaction patient complete study.

 

CONCLUSION:

The satisfaction of self-home care telepharmacy patients overall reached 76.5%, and the patient felt dissatisfied were 23.5%. The decrease of patients in August and September 2021 because the telepharmacy services has not been maximized services and needs improvement. The high telepharmacy satisfaction patient can improve the quality of telepharmacy services. The hospital can improve the quality of telepharmacy services to increase patient satisfaction and visiting telepharmacy patients.

 

CONFLICT OF INTEREST:

We have no conflicts of interest regarding this investigation.

 

ACKNOWLEDGMENTS:

We would like to thank Awal Bros Batam Hospital for granting permission to use the data provided in this study.

 

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Accepted on 05.06.2022           © RJPT All right reserved

Research J. Pharm. and Tech 2022; 15(12):5583-5588.