SYNOPSIS

Title: Quality of Pharmacy Services in POF Hospital, Wah Cantt

Dr. Mahfishan Kiran Syed

MS.c Healthcare Administration

(Registration No. NUMS/AFPG/20/MSC/030)

Academic Supervisor

MAJ. GEN WASIM ALAMGIR, HI (M)

Department of -Health care Administration

Institute -AFPGMI

National University of Medical Sciences,

Rawalpindi
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Title of Research Project: Quality of Pharmacy Services in POF Hospital, Wah Cantt

Synopsis submitted for: Discipline:

þMaster □M.Phil. □ Ph.D. Healthcare Administration
Name of the Applicant: Qualifications (list all; with date)
Dr.Mahfishan Kiran Syed MBBS in 1994

Date of Enrollment: Registration No.

NUMS/AFPG/20/MSC/030
Supervisor
Signature:
Name: Maj. Gen Wasim Alamgir, HI
(M) Qualification: FCPS, FRCPL, MRCP(UK &
IRE), DIP CARD (LONDON)
Designation: Advisor Neurology Pak Army, Professor of Medicine AM College,
Consultant Neurologist, PEMH Rawalpindi
Address:
AFPGMI Rawalpindi.
Phone No: 0321-9836934 Email: dr.mehfishan123@gmail.com
Head of Department
Signature:
Name:

RESTRICTED
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TABLE OF CONTENTS

List of abbreviations……………………………………………………………….…1

Project summary…………………………………………………………………….2

Key words ……………………………………………………………………………3

Introduction........................................................................................................4

Aims and Objectives ………………………………………………………………...7

Review of Literature...........................................................................................8

Materials and Methods....................................................................................11

References.......................................................................................................14

Institutional review board …………………………………………………………16

Annexures...........................................................................................……17-23

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LIST OF ABBREVIATIONS

AFPGMI Armed Forces Post Graduate Medical Institute

Asst Assistant
GPP Good pharmacy practice
ASHP American Society of Health System Pharmacists
POF Pakistan Ordnance Factories
WHO World Health Organization
LMIC Low- and Middle-Income Country
CPPQ Community Pharmacy Patient Questionnaire
OTC Over the counter
FIP International Pharmacy Forum
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Project summary

Pharmacy deals with purchasing, preparation and delivery of medicines not only to
the admitted patients but also to the outdoor patients according to the prescription of
physicians, ensuring the safety and health of patients in effective manners. Now
hospital pharmacy includes modern services related to health care, like clinical
advices, reviewing medication for safety and efficacy and providing drug information.
Hospitals that fail to understand the importance of delivering quality services and
customer satisfaction may be inviting a possible loss of patients. Patient satisfaction
is widely used to measure quality of healthcare by identifying potential areas for
improvement, to increase the effectiveness of healthcare system. An evaluation of
hospital pharmacy practices is essential to assure that they meet the global standards
and to prioritize practice advancements. POF hospital is responsible to provide health
care facilities to serving/ retired POF’s employees and families / parents of the
employees, army personnel posted to POF (including their families/ parents). The
health of the POF employees and their families is fundamental to the welfare of the
organization. The medical store functioning in POF hospital is the backbone of the
setup. It plays an important role in improving access to health care and in closing the
gap between the potential benefits of medicines and the actual value realized. Patient
satisfaction depends on the patients’ experience within different departments in the
hospital as well as patients’ expectations during their visit to the pharmacy. The
objectives of the study are to identify the existing practices of the pharmacy along
with satisfaction level of patients and suggest recommendations for improvement. It
will be an observational cross-sectional quantitative study. Study setting will be POF
hospital Wah Cantt with a time duration of one year. The data collection tool will be
structured questionnaire and it will be analyzed by SPSS version 25. The anticipated
findings about pharmacy services and patient satisfaction level will be presented. The
study will give an insight of the existing gaps in the performance of pharmacy
services and patient satisfaction level and will show a way forward to bring
improvement in the system.
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Key words

Customer satisfaction; Hospital pharmacy; Patient satisfaction; Quality services;

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INTRODUCTION

1. Pharmacy is an establishment which deals with purchasing, preparation and

delivery of medicines not only to the admitted patients but also to the outdoor patients
according to the prescription of physicians, ensuring the safety and health of patients
in effective manners. Pharmacy is the back bone of any good hospital and health
care delivery system. Different hospitals adopt different health services. The hospital
pharmacy practice includes not only conventional roles like compounding and
dispensing medication but also helps patients regarding actions and reactions of the
drugs prescribed to them.

2. Now hospital pharmacy includes modern services related to health care, like
clinical advices, reviewing medication for safety and efficacy and providing drug
information. In recent years, as standards of living have improved, there is an
increasing demand for better health care as well. With improved lifestyles, improving
the quality of medical care services became a primary concern for patients and health
providers. For provision of better services to patients, quality has become
increasingly important for hospitals in respect of sustaining and retaining patients.
Hospitals that fail to understand the importance of delivering quality services and
customer satisfaction may be inviting a possible loss of patients whereas hospitals
that value patients and their demands and needs experience loyalty from patients to
their hospital.

3. Patient satisfaction is widely used to measure quality of healthcare by identifying

potential areas for improvement, to increase the effectiveness of healthcare system.
A local study conducted among patients visiting public health clinics showed that the
more satisfied groups were less educated and elderly. (Ismail et al., 2020)

4. There is growing pressure to demonstrate and improve the quality of health

care delivered in community pharmacies. This demand is partly driven by the need to
determine and evidence how the extended role of community pharmacy teams
contributes towards health service delivery and the reduction of pressure on other
health sectors. (Alhusein & Watson, 2019)
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5. An evaluation of hospital pharmacy practices is essential to assure that they

meet the global standards and to prioritize practice advancements. An evaluation of
hospital pharmacy practice was first conducted in 1998 by the American Society of
Health-System Pharmacists (ASHP) using a national survey. The survey examined
the role of the pharmacist in distinct stages: prescribing, transcribing, dispensing,
administrating, monitoring, and educating patient.(Almaghaslah et al., 2021)

6. POF Hospital was established in 1962 with an initial capacity of 103 beds.
Existing bed strength is 676 due to introduction of new departments over successive
years. It is now a modern tertiary care hospital providing teaching facilities to Wah
Medical College. The hospital is responsible to provide health care facilities to
serving/ retired POF’s employees and families / parents of the employees, army
personnel posted to POF (including their families/ parents) and employees of allied
departments (CMA, IDA etc.) The hospital also extends diagnostic and treatment
facilities to general public residing in the area on payment.

7. The medical store functioning in POF hospital is the backbone of the setup. It
provides all types of indoor as well as outdoor treatment facilities. The health of the
POF employees and their families is fundamental to the welfare of the organization.
Barriers to good health include poor access to quality medical products, lack of
access to trained health professionals and care, an inadequate health workforce,
unaffordable cost of care and poor standards of education of health-care
professionals. So, to overcome all these parameters a good internal and external
audit of the entire pharmacy setup is required. This study will give us an opportunity
to develop the strategies to meet the patient’s expectations and improve the quality of
care and services being offered by the medical store.

Rationale
8. Pharmacy plays an important role in improving access to health care and in
closing the gap between the potential benefits of medicines and the actual value
realized and should be part of any comprehensive health system. In addition, the
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increasingly complex and diverse nature of pharmacy roles in the health-care system
and public health demands a continuous maintenance of the competence of
pharmacy to develop up-to-date skills and expertise. “GPP” is the practice of
pharmacy that responds to the needs of the people who use the pharmacy services
to provide optimal, evidence-based care. To support this practice, it is essential to
establish national framework of quality standards and guidelines.

9. Pharmacy services include not only just provision of drugs to the patients but
also educating and counselling them about their drug dosage, therapies and
medication related problems. Patient satisfaction depends on the patients’
experience with in different departments in the hospital as well as patients’
expectations during their visit. The purpose of this study is to review the existing
pharmacy services in POF Hospital and identifying the day-to-day problems
faced by not only the patients but also the staff working in the pharmacy and
capture high value quality actions to improve the services.
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Aim
10. The aim is to improve the pharmacy services in POF Hospital, Wah.

Objectives
11.The objectives of the study are: -
a. To determine the satisfaction level in patients reporting to the hospital
pharmacy.
b. To suggest recommendations to improve the pharmacy services for
improved health care.
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LITERATURE REVIEW

12. Hospitals vary from one another in terms of their specialty, services offered,
and resource availability. Their services are widely measured with scales that gauge
patients’ perspective. Across the globe, economic conditions shape people’s
expectations of service quality and their lifestyle. Patients’ perceptions play a vital role
in the failure of any product or service. Consequently, organizations develop tactics to
provide greater service quality to customers to thrive in the current economic climate.
The concept of quality originated in manufacturing organizations, but it is equally
important for service organizations. It is now well recognized that the provision of
quality services is closely associated with organizations’ incremental customer
satisfaction, consumer maintenance, consumer allegiance, budgets and productivity,
facility assurance, and economic presentation.(Shafiq et al., 2017)

13. Patient satisfaction is defined as a subjective emotional opinion based mainly

on patient expectation and their previous experiences compared to the currently
received service. In the services sector, special attention is paid to the fact that
patient satisfaction is connected not only with what the patient receives but also
largely with how the entire process proceeds. For this reason, getting to know patient
needs and expectations, such as their satisfaction with the services provided, seems
essential for the development of patient-centered care. (Bratkowska et al., 2020)
It is an important humanistic testimony to determine the outcome, services and
sustainability of any health care system. The evidences promulgate that satisfied
patients uphold good relations with their health care providers and adhere to
treatment that ultimately led to better health outcomes. More satisfied patients are
persistent in using health care services and values.(Aziz et al., 2018)

14. Pharmacy services have been increasingly expanded beyond simple

medication supply to become a more patient-centered and caring service. (Ayalew et
al., 2017). A patient’s perception of the service provided by a health care provider is
essential for the successful delivery of health care. Including the patient’s perspective
as a humanistic outcome can improve service provision, increase help-seeking
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behavior, lead to higher adherence, or increase the customers’ commitment toward

the service provider. Moreover, as some health care systems aim to provide special
reimbursements for certain service elements provided in the pharmacy, such as
consultation, analyzing variations in service quality is also important from a health
system and a policy perspective. (Guhl et al., 2019)

15. Enhanced pharmacy services have been identified as a mechanism to address

medicines and drug-related problems. Over recent decades, there has been
considerable worldwide increase in the morbidity and mortality associated with
chronic diseases. This has been linked with lack of individualized patient care and
consequent medication-related issues. World Health Organization (WHO) and the
International Pharmaceutical Federation (FIP) have recognized the need to develop
pharmacy services as a way to meet the fast-growing demand for safe and quality
uses of medicines, alongside affordable healthcare service provision.
Pakistan is a low- and middle-income country (LMIC) that has been recently ranked
lower than all other South Asian countries at 152th out of 189 countries. Pakistan is
struggling with a number of threats to the optimal use of medicines, including high
prevalence of medication errors and adverse drug reactions, misuse of controlled,
and excessive self-medication. There is also a growing list of medicine-related issues
that demand immediate participation of pharmacies in the patient’s welfare, including
over-the-counter (OTC) availability of prescription medicines, inappropriate use of
medicines, formulation issues, unsafe storage and disposal of medicines, and poor
availability of medicines. Additionally, poor health in the female population, elderly,
and medically underserved rural populations in Pakistan need scalable and affordable
community pharmacy services, such as health screening (e.g., diabetes., cholesterol,
osteoporosis), timely immunizations, pain control, and home-based care delivery and
family planning services.(Atif et al., 2020)

16. Patient satisfaction can also determine the degree of competitiveness among
healthcare organizations. Patients perceive their satisfaction to be based on the
hospital’s responsiveness to their views and needs, the quality of the healthcare
services delivered by the hospital, and the overall doctor-patient relationship.
Therefore, it is very important for hospitals to understand the determining factors of
patient satisfaction. Hospitals need to assess what patients’ value and how they
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perceive the quality of care. Hospitals can use patient satisfaction information to
determine how to improve service quality, the appropriate methods to use, and the
timing for using these methods.(Lim et al., 2018)

17. Communication skills on pharmaceutical services are necessary for effective

interactions. Pharmacies are required to positively interact with patients and
contribute to the appropriate use of the medicine while simultaneously building mutual
trust. They also give advices and offer guidance on the side effects of the medication
and warn them about the things that can be harmful when using that drug. Hence,
communication and understanding between the patient and healthcare workers
significantly contribute to the patient’s views and feelings toward the services of the
health professional.(Ragma, 2018)

18. In developing countries, the health-care system is largely controlled by

government and often struggles with the lack of quality. In these settings, there has
been an initiative that encourages health administrators to identify health- care quality
as one of the key drivers for strengthening health systems. Although there has been
considerable increase in attention paid to improve the quality of health care, the
measurement of quality of health care or its component is in infant stage. Hospital
pharmacy service is one aspect of health care that needs to be delivered to the
standard in order to improve overall quality of health care. The service delivered by
the hospital pharmacy unit is a vital component of an institutional health-care system.
Medication dispensing and drug distribution, compounding, medication utilization
review, adverse drug reaction monitoring, and drug information service are the main
services delivered through this unit.(Ayele et al., 2020)
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MATERIALS & METHODS

The methodology to be adopted is described below:

a. Study Design.

Descriptive observational cross sectional study involving response of

patients visiting the pharmacy.

b. Study Type

It will be a quantitative study.

c. Study Setting.

POF Hospital Wah Cantt.

d. Time Duration.

1 Year after approval of synopsis.

e. Study Population.

The study population for this study shall consist of:

Patients reporting to P.O.F Hospital pharmacy.

f. Sampling Technique. Following procedure will be adopted for

sampling.

Non probability Convenience Sampling

Structured Questionnaires

g. Sample Size.

Sample size is 340. It was calculated as suggested by (Shafiq et al.,

2017) .

h. Sample Selection.

Sample selection criteria are laid out as under.

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(1) Inclusion Criteria.

All adult male / female entitled patients reporting in Pharmacy.

(2) Exclusion Criteria.

Children and non-willing patients and staff.

i. Data Collection Tools.

The data collection tool is a pretested, structured, self-administered

questionnaire adapted from a study, carried out by “Pharmaceutical
Services Negotiating Committee” in UK with the title of community
pharmacy patient questionnaire (CPPQ). Attached as annexure B.

j. Data Collection Procedure.

Purpose and details of study will be communicated to the respondent in

detail by the researcher. Questionnaires for the patients reporting to the
pharmacy will be distributed and self-administered. Any further inquiry
about questionnaire will be resolved through telephonic conversation
with the respondents. All statements were measured on a 5-point Likert
scale showing very poor and fairly poor will be taken as low satisfaction
and quality level whereas fairly good and very good will be taken as
high satisfaction and quality levels. Don’t know will be taken as neutral.

k. Plan of Data Analysis.

Data will be analyzed by using SPSS version 25 and mean,

percentage and standard deviation will be calculated. Graphical
representation will be made by using line and bar charts. The
existing practices of the pharmacy will be checked through
document review
of SOPs.
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l. Ethical Considerations.

Ethical approval will be obtained from Institutional Review Board (IRB)

of Armed Forces Post Graduate Medical Institute (AFPGMI) Rawalpindi.
Informed consent will be taken from all the participants of the survey
with assured confidentiality regarding identity of participants and their
responses to the questions.
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REFERENCES

1. Ismail, A., Gan, Y. N., & Ahmad, N. (2020). Factors associated with patient
satisfaction towards pharmacy services among outpatients attending public
health clinics: Questionnaire development and its application. PLoS ONE,
15(11 November), 1–12. https://doi.org/10.1371/journal.pone.0241082

2. Alhusein, N., & Watson, M. C. (2019). Quality indicators and community

pharmacy services: a scoping review. International Journal of Pharmacy
Practice, 27(6), 490–500. https://doi.org/10.1111/ijpp.12561

3. Almaghaslah, D., Alsayari, A., Alyahya, S. A., Alshehri, R., Alqadi, K., &
Alasmari, S. (2021). Using Design Thinking Principles to Improve Outpatients ’
Experiences in Hospital Pharmacies : A Case Study of Two Hospitals in Asir
Region , Saudi Arabia.

4. Shafiq, M., Naeem, M. A., Munawar, Z., & Fatima, I. (2017). Service quality
assessment of hospitals in Asian context: An empirical evidence from Pakistan.
Inquiry (United States), 54. https://doi.org/10.1177/0046958017714664

5. Bratkowska, K., Religioni, U., Krysiński, J., & Merks, P. (2020). Quality of
pharmaceutical services in independent pharmacies and pharmacy chains in
poland from the patient perspective. Patient Preference and Adherence, 14,
2459–2467. https://doi.org/10.2147/PPA.S284014

6. Aziz, M. M., Ji, W., Masood, I., Farooq, M., Malik, M. Z., Chang, J., Jiang, M.,
Atif, N., & Fang, Y. (2018). Patient satisfaction with community pharmacies
services: A cross-sectional survey from Punjab; Pakistan. International Journal
of Environmental Research and Public Health, 15(12).
https://doi.org/10.3390/ijerph15122914

7. Ayalew, M., Taye, K., Asfaw, D., Lemma, B., Dadi, F., Solomon, H., Tazeze, H.,
& Tsega, B. (2017). Patients’/clients’ expectation toward and satisfaction from
pharmacy services. Journal of Research in Pharmacy Practice, 6(1), 21.
https://doi.org/10.4103/2279-042x.200995
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8. Guhl, D., Blankart, K. E., & Stargardt, T. (2019). Service quality and perceived
customer value in community pharmacies. Health Services Management
Research, 32(1), 36–48. https://doi.org/10.1177/0951484818761730

9. Atif, M., Razzaq, W., Mushtaq, I., Malik, I., Razzaq, M., Scahill, S., & Babar, Z.
U. D. (2020). Pharmacy services beyond the basics: A qualitative study to
explore perspectives of pharmacists towards basic and enhanced pharmacy
services in Pakistan. International Journal of Environmental Research and
Public Health, 17(7). https://doi.org/10.3390/ijerph17072379

10. Lim, J. S., Lim, K. S., Heinrichs, J. H., Al-Aali, K., Aamir, A., & Qureshi, M. I.
(2018). The role of hospital service quality in developing the satisfaction of the
patients and hospital performance. Management Science Letters, 8(12), 1353–
1362. https://doi.org/10.5267/j.msl.2018.9.004

11. Ragma, F. (2018). Quality of Pharmacy Services. August 2017.

https://doi.org/10.13140/RG.2.2.17242.85449

12. Ayele, Y., Hawulte, B., Feto, T., Basker, G. V., & Bacha, Y. D. (2020).
Assessment of patient satisfaction with pharmacy service and associated
factors in public hospitals, Eastern Ethiopia. SAGE Open Medicine, 8,
205031212092265. https://doi.org/10.1177/2050312120922659
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INSTITUTIONAL REVIEW BOARD (IRB) APPROVAL FORM

(It will be submitted after approval of the synopsis)

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Annexure ‘A’

INFORMED CONSENT FORM

QUALITY OF PHARMACY SERVICES IN P.O.F HOSPITAL

Introduction
1. You are requested to participate in a study about quality of pharmacy services
in P.O.F Hospital. Your contribution will require responding to the attached
questionnaire. You are likely to require 15-20 minutes to indicate your answers.
Purpose of the study
2. The purpose of this study is to review existing pharmacy services as well as
level of patient satisfaction and to improve the quality of services.

Confidentiality and Right of Refusal

3. Your responses to the questionnaire will remain confidential, and your name
will not be associated with the research findings. Your identity will not be disclosed.
The decision to participate in this study is entirely up to you. You may refuse to take
part or may withdraw from the study at any time.

Additional Information
4. Please do not hesitate to ask anything before participating or during the study.
I, Dr._____________, may be contacted by phone on ______________ and my email
address is __________________________.

Consent
1. Your signatures below confirm that you have read and understood the
information provided in this form and that you are willing to participate in the study.

Signature

_____________________

Date

Name (Optional)___________________________
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Annexure ‘B’

QUESTIONNAIRE FOR PATIENT’S REPORTING IN POF PHARMACY

Serial No.

INTRODUCTION
This questionnaire is designed specifically to assess the status of pharmacy
services in terms of patient’s satisfaction level.
DEMOGRAPHIC DETAILS

1. Please fill in your gender

O Male
O Female
2. Please choose your age group
O Below 26 years
O 26 - 35 years
O 36 - 45 years
O 46 - 55 years
O 56 - 65 years
O Over 65 years
3. Please indicate the highest education level you have achieved
O No formal education
O Secondary School
O Bachelor’s Degree
O Master’s Degree
O Higher Degree
4. Please indicate your form of employment. (You can choose more than 1 box
for example if you have a regular paid employment and are also self-employed)
O POF employee
O Dependent POF employee
O Retired POF employee
O Army personnel
O Other, please specify
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Community Pharmacy Patient Questionnaire

This section is about why you visited the pharmacy today

Q1 Why did you visit this pharmacy today?
To collect a prescription for: Yourself  Someone else  Both  OR
For some other reason (please write in the reason for your visit):

If you did not collect a prescription, please go to Q3.

Q2 If you collected a prescription today, were you able to collect it straight away,
did you have to wait in the pharmacy or did you come back later to collect it?

Straight away  Waited in pharmacy  Came back later 

Q3 How satisfied were you with the time it took to provide your prescription
and/or any other pharmacy services you required?

Not at all satisfied  Not very satisfied  Fairly satisfied  Very Satisfied 

This section is about the pharmacy and the staff who

work there more generally, not just for today's visit

Q4 Thinking about any previous visits as well as today's, how would you rate the
pharmacy on the following factors? Please tick one box for each aspect of the
pharmacy listed below, to show how good or poor you think it is:

ANSWERS: very fairly fairly very don’t

poor poor good good know
a) The cleanliness of the pharmacy ………………….     
b) The comfort and convenience of the
waiting areas (e.g., seating or standing room) …..     
c) Availability the medicines/appliances
you need ……………………………………………..     
d) Offering a clear and well-organized layout ……….     
e) Privacy/confidentiality available or not………     
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Q5 How would you rate the pharmacist and the other staff who work there? Please
tick one box for each aspect of the service listed below, to show how good or poor you
think it is:
ANSWERS:

Very fairly fairly very don’t

a) Being polite and taking the time to listen poor poor good good know
to what you want …………………………………….     
b) Answering any queries you may have…..…….. …     
c) The service you received from the
pharmacist …………………………………………..     
d) The service you received from the other
pharmacy staff ………………………………………     

e) Providing an efficient service ……………………...     

f) The staff overall attitude…………………………...     

Q6, How well do you think the pharmacy provides each of the following
services?
ANSWERS:
Not Not Fairly Very Never
at all very well well used
well well
a) Providing advice on a current health problem
or a longer-term health condition…………………..     
b) Providing general advice on leading a more
healthy lifestyle ……………………………………...     
c) Disposing of medicines you no longer need ……..     
d) Providing advice on health services or
information available elsewhere …………………...     

Q7 Have you ever been given advice about any of the following by the
pharmacist or pharmacy staff?
Stopping smoking……......  Yes  No
Healthy eating…………….  Yes  No
Physical exercise…………  Yes  No

Q8 Which of the following best describes your preference about this pharmacy?
This is the pharmacy that you choose to visit every time………………………… 
This is the only pharmacy available that you use when you need to………… 
This pharmacy was just convenient for you today ……………………………….. 
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Q9 Finally, taking everything into account - the staff, the shop and the service
provided - how would you rate the pharmacy where you received this
questionnaire?
Poor  Fair  Good  Very Good  Excellent 

[Insert here, if required, additional questions relating to healthcare service provision]

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Annexure ‘C’

TIMELINE OF RESEARCH
PROJECT

2021 2022
Activities
Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug

Approval
of Synopsis
Refining
Literature
Search
Data
Collection

Data Analysis

Report
Writing

Printing
Report

Thesis
Defense
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Annexure ‘D’

ESTIMATED BUDGET FOR RESEARCH PROJECT

Ser Budget Head Total (Rs.)

1. Transport 40,000

2. Stationary 20,000

3. Media / Internet / Telephone 10,000

4. Food and Refreshment 7000

5. Miscellaneous 10,000

6. Accommodation / Stay -
7.
Personnel 10,000

Total 97,000