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Adult HIV/AIDS Patients’ Level of Satisfaction on Pharmaceutical Service: Institutional Prospective Cross Sectional Study

Objective : Patients are essential sources of information to assess the accessibility and effectiveness of pharmaceutical care. Patients’ perception and satisfaction on the care they received has direct influence on treatment adherence. This study was thus aimed to assess HIV/AIDS patients’ level of satisfaction on the pharmaceutical services provided in Zewditu Memorial Hospital, Addis Ababa, Ethiopia. An institution based cross sectional study was conducted from April 16, 2018 to May 16, 2018 in Zewditu Memorial Hospital. Result: Among the total 285 participants enrolled in the study, 172(60.4%) of them were females and the mean age of the participants was 42.5±9.8. The participants of this study received ART service for a mean duration of 7.3±3.5 years. In this study, 26.7%, 13.7%, 38.6%, 13% and 8.1% of the study participants rated the overall satisfaction to the ART pharmaceutical service as excellent, very good, good, fair, and poor, respectively. Participants who were provided information about drug-drug and drug-food interaction were 2.72 times more likely to be satisfied than those who weren’t provided (AOR=2.72, 95%CI : 1.13-6.54).

Patient satisfaction on pharmaceutical care can be conceptualized as patient's evaluation of the pharmacist's performance in a variety of patient care activities [8]. It is one of the imperative components for the great success of any healthcare services, especially in the ART units [9]. Patient satisfaction has direct effect on adherence to HAART [10].
Patient's satisfaction is essentially an important issue in Africa particularly for countries like Ethiopia, where there is a dearth of adequate resources and skilled human capital to provide efficient health care services to the HIV/AIDS patients [9,11]. Hence, assessing the HIV/AIDS patients' level of satisfaction towards the pharmaceutical service in ART clinic is crucial for improving treatment outcome. This study is hence designed to identify the level of satisfaction of HIV/AIDS patients towards the pharmaceutical service provided at the ART clinic of Zewditu Memorial Hospital (ZMH), Addis Ababa, Ethiopia.

Methods
An institution-based prospective cross sectional study, using a quantitative data collection and key informant interview method, was conducted in ZMH, Addis Ababa, Ethiopia. The study setting is the leading medical center in Ethiopia, for the treatment of HIV/AIDS. Currently, it provides ART pharmaceutical care for more than 7,000 PLWH. This study was carried out from April 16, 2018 to May 16, 2018. In selecting the study participants, patients who were ART care beneficiaries for more than 1 year and above the age of 18 were included. The number of patients to be involved in the study was determined using the single proportion formula [12] considering the prevalence data (78.5%) taken from previous similar study by Michael [13]. Margin of error was set to be 5% (95% confidence interval). Accordingly, the sample size was: Assuming 10% non -response rate, the total sample size was 285.
For obtaining a representative of the population who has been visiting the ART pharmacy, a systemic random sampling technique was used.
Questionnaire was designed and modified appropriately after it was pretested on 25 clients prior to the actual data collection. In collecting data on the patients' satisfaction towards the ART pharmaceutical service, study participants were asked to respond to a number of assessment questions classified on a Likert scale of 1-5, with"1" stood for rating of the item as "poor", while "2", "3", "4", and "5" stood for "fair", "good", "very good", and "excellent", respectively. These satisfaction assessment questions are regrouped in 8 themes.
Following checking its completeness and consistency, the data collected were entered to and analyzed using SPSS Statistics for Windows, version 20.0. Frequencies, percentages, t-test, and ANOVA with post hoc test were used to analyze different variables. P-value less than 0.05 were used as cut off points for determining statistical significance of associations among different variables.

Socio-demographics Characteristics of Participants
Of the total 285 participants enrolled in the study, majority (172; 60.4%) of them were females. More than half (53.3%) of the respondents were married. The mean age (±SD) of the participants was 42.5±9.8 and the highest proportion was found between the age group of 31 and 40 years. More than one-third (34.4%) of them had attended secondary level education. Occupationally, 28.8% of them were self-employed. The participants had received the ART service for a mean duration of 7.3±3.5 years ( Table 1).

Patients' Satisfaction towards the Service
More than half of the patients rated the time given by the pharmacist to listen what they are in need of as excellent (123; 43.2%) and very good (27; 9.5%). Moreover, majority (70.2%) of them claimed that there is excellent use of easy and understandable language by pharmacist for communication.
Most participants (55.1%), however, rated the provision of written information by pharmacists as poor ( Table 2).
As it is indicated in table 2 below, 156 (54.7%) of the participants rated the service provided about medication precaution and side effect by the pharmacist as poor. Similarly, more than half of the participants indicated that they are not satisfied with pharmacist effort to give information about drug-drug and drug-food interactions.
The arrangement of medication and the cleanliness of the environment was rated as excellent by 192 (67.4%) and 189(66.3%) participants, respectively. Of the total participants, 138(48.4%) of them rated the availability of medication as excellent and the overall appearance of the pharmacy was rated as excellent by 68.4% of the participants. As the overall satisfaction of the patients is indicated in table 2, more than a quarter (26.7%) of them rated the overall satisfaction as excellent; whereas, 13.7% , 38.6% ,13% and 8.1% of them rated their satisfaction as very good, good, fair and poor, respectively.

Factors Affecting Patient Satisfaction towards the Pharmaceutical service
Binary logistic regression analysis showed that there is significant (p<0.05) association between provision of information about drug-drug/drug-food interaction and overall satisfaction of participants.
Participants' who were provided information related to drug-drug and drug-food interaction were 2.72 times more likely to be satisfied than those who didn't receive information (AOR=2.72, 95% CI: 1.13-6.54). Participants who reported shorter time to receive service were 4.06 times more likely to be satisfied than those who did not (AOR=4.06, 95% CI: 1.69-9.74). However, no association was found between patients' socio-demographics variable and overall satisfaction (Table 3).

Discussion
In recent decades, determining patients' level of satisfaction is found to be the most useful tool for getting their views on how to provide them a care [14]. This is due to its ability to reflect the quality of health care delivery and provider's ability in successful delivery of care that meets patients' expectations and needs [15,16]. A satisfied patient is more likely to develop a longer lasting rapport with their health care provider. An individual who fails to take the ART due to dissatisfaction will end up in developing resistant strains to the drugs in a matter of few minutes [17].
Present study showed that the overall mean satisfaction of the participants on ART pharmaceutical services provided at ZMH was 3.38±1.23. This finding is in line with a similar study done in Gondar on expectation and satisfaction of ART clients towards the pharmaceutical service [18]. This indicates the similarity of pharmacy practice in the settings.
In our study, 43.1% of participants rated the time taken by the pharmacist to listen to what they need as excellent; this was higher when compared with another study done in ART special unit in Addis Ababa [19]. This might be due to the effort exerted by the hospital to modernize the pharmacy service in recent years. The easy and understandable language utilization by the pharmacists was rated excellent (4.29). This was slightly higher compared to the report of the study in Gondar (3.90) by Abebe et al., [18].
The effort of pharmacists to solve patients' medication related problem was rated poor by majority of the participants. This finding is supported by a study done in Nigeria, where perception of patients regarding the pharmacists' efforts to solve patients' medication related problems were negative [20].
This could be because of lack of knowleadge or willingness by the pharmacists side.
Several factors including patient's age, educational level, health status and the severity of illness influence satisfaction on care ART services [21]. However, in this study no association was found between patients' socio-demographics variable and overall satisfaction. This study rather revealed that provision of information about ARV drug-drug and drug-food interaction, and shorter time to receive service influenced participants overall satisfaction towards the pharmaceutical service provided in the hospital.

Conclusions
The adult HIV/AIDS patients' satisfaction with the overall ART pharmaceutical service was rated positively by participants with a mean value of 3.38. Patients claimed that they were better satisfied with infrastructure and the appearance of the pharmacy. In addition, the participants were better satisfied with the pharmacists' availability, commitment, confidentiality and for using easy and understandable language in the service. However, majority of the participants were not satisfied with the provision of medication related information and on the pharmacists' efforts to solve medications related problems.

Limitations
As the respondents were interviewed in the compound of the hospital, study bias could have occurred. Moreover, the study was conducted in a governmental hospital that provides care to the certain group of the population in the city and the sample size used is not that large enough. As such, the result may not be a reflective of the situation in the general population. The finding of this study is interpreted in light of several limitations. The cross-sectional design gives only a snap shot of events. Hospital to get permission for conducting the study. The data collectors clearly explained the aims of the study for the study participants. Information was collected after obtaining written consent from each participant. To ensure confidentiality, participants' data were linked to a code number and registered. The right was given to the study participants to refuse or discontinue participation at any time they want and the chance to ask any thing about the study.

Availability of data and material
The data sets generated during the current study are available from corresponding author on a reasonable request.

Funding
The study was not funded Acknowledgments global, regional, and national incidence, prevalence, and mortality of HIV, 1980-