Building Patient Loyalty in Pharmacy Service: a Comprehensive Model
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Indonesian Journal of Pharmacy VOL 32 (2) 2021: 241–250 | RESEARCH ARTICLE Building Patient Loyalty in Pharmacy Service: A Comprehensive Model Prasojo Pribadi1, Susi Ari Kristina2, Suci Paramitasari Syahlani3, Satibi2* 1. Department of Pharmacy Management, Faculty of Health Science, Universitas Muhammadiyah Magelang, Jl. Mayjend Bambang Soegeng 21, Magelang, Central Java, Indonesia. 2. Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Sekip Utara 55281 Yogyakarta, Indonesia. 3. Department of Livestock Sozio-Economics, Faculty of Animal Science, Universitas Gadjah Mada, Jl. Fauna No.03, Yogyakarta, Indonesia Info Article ABSTRACT Submitted: 14-02-2021 The function of pharmaceutical services has been broadened to Revised: 21-05-2021 become patient-centered care that emphasize building relationships Accepted: 16-06-2021 between patients and service providers. Furthermore, loyalty indicate a powerful and positive connection between customers and service provider. *Corresponding author This study aims to examine the mechanism of pharmacy services, patient Satibi emotions, satisfaction, and trust in influencing patient’s loyalty. A cross- Email: sectional survey was conducted in the outpatient department (OPD) from six [email protected] referral hospitals. The purposive sampling method was used in this study, with inclusion criteria: patients over 17 years old, volunteered to be a respondent, as well as using pharmacy service experience at least three times. A total 300 usable responses were obtained. Self-administered questionnaire method was utilized. The partial least square-structural equation modeling (PLS-SEM) approach was performed for data analysis. The results showed that pharmacy service has a significant effect on emotions, satisfaction, and trust (p<0.05). Patient satisfaction has a positive effect on trust and loyalty (p<0.05). While trust has a significant influence on patient loyalty (p<0.05). Positive emotions has a positive effect on patient loyalty. Furthermore, positive emotions, satisfaction, and trust has a fully mediating role. The association between pharmacy service and trust is partially mediated by satisfaction. Trust has a partial mediating effect on the relationship between satisfaction and patient loyalty. In addition, pharmacy services has an indirect effect on patient loyalty. Pharmacists have a professional and ethical obligation to assess the patient's requirements and condition holistically, taking into account emotional, psychological, social, and biological factors. Pharmacists can employ practical ways to promote patient-centered communication, engage patients in their treatment, and foster the formation of a pharmacist-patient relationship based on mutual respect, this leads to a common knowledge of all the issues, goals, and challenges to therapy management. Keywords: Patient Loyalty, Emotion, Satisfaction, Trust, Hospital, Pharmacy Service INTRODUCTION conventional function of pharmaceutical services The high volume of prescriptions shows an from drug supply to become patient-centered care. increase in demand for pharmaceutical services, it This service is an essential aspect of developing is reported that 80% of patients who visit patient-care provider relationships, which is a puskesmas get pharmaceutical services (Insani et popular indicator of healthcare quality (Insani et al., 2017; Kim and Ruger, 2008). The pharmacy al., 2017; Khudair and Raza, 2013). Currently, the department plays a crucial role in the final process management of healthcare services in Indonesia of healthcare, thereby shifting the paradigm of the does not give preferences in enhancing patient Indonesian J Pharm 32(2), 2021, 241-250 | indonesianjpharm.farmasi.ugm.ac.id 241 Copyright © 2020 THE AUTHOR(S). This article is distributed under a Creative Commons Attribution-ShareAlike 4.0 International (CC BY-SA 4.0) Building Patient Loyalty in Pharmacy Service satisfaction through the service function of the experiences on satisfaction and loyalty (Chebat and pharmacy (Ramli and Sjahruddin, 2015). Slusarczyk, 2005; DeWitt et al., 2008; Dubé et al., Moreover, the existing literature stated that 1996; Vinagre and Neves, 2010, 2008). However, customers' loyalty is a basic element in a service most of them are applicable in the general business, which indicates a strong and positive healthcare sector. Presently, the studies involving relationship between customers and service emotional factors in pharmaceutical services in providers (Chang et al., 2013; Mittal and Lassar, both developed and developing countries are still 1998). Since the implementation of the Universal very limited. This research propose a more complex Health Coverage (UHC) in Indonesia, there has conceptual framework by including negative and been an aggressive expansion of profit private positive emotions, simultaneously. The purpose of hospitals, compared to the non-profits (Health this research is to explore the mechanism of Policy Plus, 2018). Therefore, the healthcare sector pharmacy services, patient emotions, satisfaction, requires loyal customers to survive in a challenging and trust in influencing patient loyalty in a referral and competitive business environment (Ehigie, hospital setting. Furthermore, it determines the 2006; Tosyali et al., 2019). Many factors affected mediating role of emotions, satisfaction and trust. the company's success in maintaining customers' loyalty, which include: service quality, trust and MATERIAL AND METHODS satisfaction. Most of the empirical investigations Research design and subjects proved a positive relationship between service A cross-sectional survey was conducted in quality perceptions, satisfaction and loyalty (Arab the outpatient department (OPD) from six referral et al., 2012; Kim et al., 2017; Sumaedi et al., 2014). hospitals. The purposive sampling method was Meanwhile, the manner of delivering quality used in this study, with inclusion criteria: patients pharmacy access and services can strengthen over 17 years old, volunteered to be a respondent, patient loyalty to the hospital. as well as using pharmacy service experience at Previous loyalty literature in the context of least three times. Informed consents were also pharmaceutical service were conducted in several asked to patients before interviewing. The data was countries. Augusto & Bastos formulated an collected during September-December, 2018 in the conceptual framework to show that loyalty is the Special Region of Yogyakarta Province. outcome of service quality and satisfaction of A total of 500 questionnaires were pharmacies in Portugal (Augusto and Bastos, distributed and 300 usable responses were 2008). Athavale et al. identify antecedents and obtained. The response rate was 60%. Self- consequences of pharmacy loyal behaviour administered questionnaire method was utilized. (Athavale et al., 2014). Insani assessed the effect of In this study, there are 12 paths of analysis so that pharmaceutical service quality on patient loyalty the minimum sample size is 120. According to Hair and determined the mediating role of patient et al. (2014) the number of samples in partial least satisfaction (Insani et al., 2017). Heryanto square-structural equation modeling (PLS-SEM) is examined the effect of pharmaceutical service ten times the largest number of model paths quality on patient satisfaction and loyalty in public directed at certain constructs in the model. hospitals (Heryanto et al., 2016). In recent research, Castaldo developed and tested two models to Research instrument identify determinants of pharmacy store loyalty for The survey instrument was developed based community in Italy (Castaldo et al., 2016). However, on a literature review. A total of 27 indicators and the study only focused on a few determinants of 6 constructs were adopted from several existing loyalty and does not disclose the emotional factors literature, with the following details: 9 indicators of which roles were equally important. pharmacy service (Gupchup et al., 1996; Khudair Post-purchase behaviour is the outcome of and Raza, 2013; Tinelli et al., 2011), 3 indicators of information processing (cognitive) and emotional trust (Lien et al., 2014), 3 indicators of satisfaction experience (affective) of a product or service that is and 3 indicators of patient loyalty (Sumaedi et al., felt, then gives a conclusion (Darsono, 2012). The 2014) on a four-point Likert scale from “strongly involvement of emotional factors are important in disagree” to “strongly agree”. The positive and patient satisfaction and loyalty, numerous studies negative emotions consist of 3 and 6 indicators discovered a significant relationship between on a four-point scale from never to very often involvement and emotional level regarding service (Dubé et al., 1996; Vinagre and Neves, 2010, 2008). 242 Volume 32 Issue 2 (2021) Prasojo Pribadi Table I. The Respondents’ Demographic Profile Characteristic Number % Gender Female 172 57.3 Male 128 42.7 Marital status Married 174 58 Single 126 42 Age group 18-24 61 20.3 25-44 160 53.3 45-64 64 21.3 >64 15 5 Education Elementary School 12 4 Junior High School 26 8.7 Senior High School 153 51 Diploma 33 11 Bachelor 69 23 Master 7 2.3 Monthly income (IDR) <1.500.000 131 43.7 1.500.000-2.500.000 113 37.7 2.500.000-3.500.000 37 12.3 >3.500.000 19 6.3 Occupation Students 38 12.7 Government employee 28 9.3 Private employee 75 25 Entrepreneur 70 23.3 Farmer 20 6.7 Other 69 23 Type of insurance membership General patients 65 21.7 PBI (Contribution