Evaluation of the Quality of Pharmaceutical Services in Private Hospitals in Sukoharjo in 2023

ABSTRACT


INTRODUCTION
Minimum Service Standards are provisions regarding the type and quality of basic services which are mandatory regional affairs that every citizen has the right to obtain at a minimum and are also technical specifications regarding minimum service benchmarks provided by public service agencies to the community (Menkes RI, 2008).Based on (Menkes RI, 2019) Study Sabarudin et al., (2015) shows that the aspect that meets the SPM based on the Menkes 2008 is the waiting time for prescription services finished medicine 3.07 minutes and concocting prescriptions 6.59 minutes, and the level of customer satisfaction with pharmaceutical services (81.08%) while the conformity of prescription writing with the formulary does not meet the standard (98.7%).
Achievement of pharmaceutical service quality targets is influenced by several factors, namely human resources, availability of SOPs, patient characteristics, and visit period (Ismail et al., 2020;WR Pratiwi et al., 2017;Puspita et al., 2018).
Research conducted by Tuloli et al (2022) about The statements in the questionnaire were quoted and modified from the customer satisfaction questionnaire in (Puspitasari et al., 2021) and questionnaires from (S. Pratiwi, 2011).The questionnaire was tested for validity and reliability using 30 respondents.

Material
The

Sample
The number of samples taken in this research for each indicator is as follows: Willing to be a respondent

Operational definition
Table2.Operational definition

Variable Definition Category
Waiting time for medication services

Mixed medicine
The time period from when the patient submits the prescription until receiving the prescribed medication.

Data analysis
Analysis of indicators in research are: 1.
Waiting time for prescription services Calculation of waiting time using the average formula (mean) (Puspita et al., 2018)namely as follows: Information :   are listed in the hospital formulary, so the prescribed drugs are not available at pharmaceutical service outlets.(Yunarti, 2022).
According toNarulita and Aprianti, (2020)Doctors' failure to write prescriptions according to the hospital formulary will result in vacancies, shortages and excess drugs, thereby affecting drug supplies.Then there is a need for greater investment to fulfill more types of drugs.The quality of service will also be affected due to empty drug stocks, long service times, drug replacement, and this will affect drug prices so that the quality of treatment will be low.
The solution that can be done is for the pharmacy officer to confirm to the doctor that the drug is not available in the pharmacy, and suggest replacing it with a type of drug that has the same use that is available in the pharmacy.The doctor will replace it with a drug available at the pharmacy.If the drug cannot be replaced with a drug available in the pharmacy, the doctor will suggest that a copy of the prescription be made so that the patient can get the drug outside the hospital's pharmacy installation and will note it down and make efforts to procure the drug and prepare it.The next formulary will list the drug so that doctors can prescribe it to patients (Narulita and Aprianti, 2020).

Pharmaceutical Services
According , 2022).The purpose of quality evaluation is to realizing safe and quality health services and used to assess and evaluate to maintain and improve the quality of health services.Even though the achievement of these indicator targets has shown a positive trend, it has not yet met the expected targets.Based on (Permenkes RI, 2022) Quality indicators in hospitals related to pharmaceutical services are outpatient waiting times, compliance with the use of the national formulary and patient satisfaction.
to measure the level of patient satisfaction using scoring techniques with a Likert scale.The scoring technique used in this research is a minimum of 1 and a maximum of 5(Sugiyono, 2018in Arjil, 2019)that is .Very dissatisfied was given a weight of 1, dissatisfied was given a weight of 2, quite satisfied was given a weight of 3, satisfied was given a weight of 4 and very satisfied was given a weight of 5 .So the respondent's answers are calculated using the following formula(Puspitasari et al., 2021): is calculated from the time the patient submits the prescription until the patient receives the medicine.ObThe items examined were prescriptions for compounded drugs and prescriptions for non-concocted drugs.The number and average time of recipes studied can be seen in for a particular case, other drugs can be used on a limited basis according to hospital policy with the following conditions: first, the use of drugs outside the Hospital Formulary is only possible after receivingrecommendation from the chairman of the Pharmacy and Therapy Committee/Team with the approval of the director/head of the hospital.Second, submitting requests for drug use outside the Hospital Formulary is done by filling in a non-formulary special drug request form.Third, drugs administered outside the hospital formulary are given in limited quantities according to need(RI Ministry of Health, 2020).According toNi'matunnisa and Nurwahyuni, (2021) Doctors' noncompliance in writing prescriptions can be influenced by several supporting factors, one of which is that the doctor's knowledge of the hospital formulary is obtained from books or from other people, not directly from hospital management, so this will influence the doctor's decision in writing prescriptions.The factor that causes discrepancies in the availability and prescription of drugs that are not in accordance with the hospital formulary is because the old formulary has not been revised and updated so that the prescribing guidelines still use the old hospital formulary.Apart from that, the drug planning method used is based on the period or use of the previous year, however, because the doctor's prescribing pattern changes according to the trend of the patient's disease, the prescribing pattern also changes.Another factor is that sometimes some doctors forget what drugs comfortable and at home in the medicine waiting room.If the patient is satisfied, the patient will be loyal to the services provided by the hospital.Based on data from the table for the reliability dimension of 5 items pertaMrsAan item number 1 has the lowest percentage value (79.6%) services at the Outpatient Pharmacy Installation is one of the important aspects that influences patient satisfaction(Faramita et al., 2016).Therefore, the waiting time for services in pharmaceutical installations is very important for a hospital to pay attention to.The results of research on the responsiveness dimension show that item number 3 has the lowest percentage value of 81.6%, namely that the service was carried out quickly, but has reached the target, namely 76.61%.In the assurance dimension, item number 1 has the lowest percentage value, namely 89.6%, because IFRS still does not provide complete medicines so it is not uncommon for patients to have to redeem prescriptions at pharmacies outside the hospital, this is one of the factors which indirectly slows down the patient's ability to obtain the required prescription.The results of the empathy dimension questionnaire show that item number 5 has the lowest percentage value, namely 88.5%.Even though item number 5 is the item with the lowest score, in its classification respondents or patients feel very satisfied with the way staff communicate with patients.According to Yanti et al., (2023)The role of health workers in providing services to patients greatly determines the quality of health services, so cooperation between health professions is really needed in providing services to patients.The results of the recapitulation of patient satisfaction for each dimension showed that the lowest value was in the tangible dimension, namely 86.2% and the highest dimension value was in the empathy dimension with a value of 91.the target that has been set, namely 76.61.The weakness of this research is that patient data collection for customer satisfaction indicators was only carried out within 1 month.Then for the benefits of this researchFrom the results obtained, it is known that all aspects have met the target achievement, however, the research results for the formulary target are still close to the minimum target, so improvements must be made to the formulary by updating the formulary regularly..The lowest indicator of customer satisfaction is in the tangible dimension, namely related to infrastructure facilities so that facility development must be increased CONCLUSIONS AND SUGGESTIONS The results of the research show that in the implementation of the evaluation of the quality of pharmaceutical services in the Hospital Pharmacy InstallationPrivate in Sukoharjowhich include: The average waiting time for service providers for finished medicine is ≤ 30 minutes and for compounded medicine an average of ≤ 60, the level of patient satisfaction has reached the target of 88.8%, the conformity of prescription writing with the formulary has reached the target of 83.1%.
Evaluation of the Quality of that they met the SPM based on the Menkes 2008, namely the waiting time for prescription services finished medicine 18.42 minutes and concocting prescriptions 40.37 minutes, and the level of customer

Validity and Reliability Test Results of the Patient Satisfaction Questionnaire with Pharmaceutical Services in HospitalsPrivate in Sukoharjo Validity test Reliability Test No R count R table Information Cronbach's alpha Information A.
Table1.

Table 3 below Table3. Research Results related to Waiting Times for Compound and Non-Concocted Medicine Prescription Services for the Period October -December 2023 in HospitalsPrivate in Sukoharjo
In table 3shows the results that the service for non-concocted drug prescriptions is adequate, these results provide an illustration of the waiting time for non-gastrointestinal drug therapy class, the largest number of drug items was repimid, totaling 7 drug items (0.60%).For the