RESEARCH PROJECT
(BMBR5103)
WHAT FACTORS OF DRUG DISTRIBUTION SYSTEM
AFFECT THE SATISFACTION OF OUTPATIENT WITH
HEALTH INSURANCE AT DISTRICT 2 HOSPITAL?
STUDENT’S FULL NAME
: BUI ANH VU
STUDENT ID
: CGS00064957
INTAKE
: MARCH, 2016
ADVISOR’S NAME & TITLE
: ASSOC. PROF. DR. BUI PHI HUNG
August, 2017
Advisor’s assessment
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Advisor’s signature
EXECUTIVE SUMMARY
Improving the quality of patient care is always the highest goal of the health sector. Especially in
recent years, the policy for socialization of health care has facilitated a wide range of medical
services, the competition has contributed to boosting the demand for service quality improvement.
The drug distribution system has been considered the most important and the most costly
component of any health system and therefore it affects significantly the overall quality of health
care. As a result, evaluating the quality of this system is a vital part of the process of improving
both the quality and efficiency of health care.
Patient satisfaction is the "property" of hospital. The patient satisfaction index is the criterion used
to measure the response of health facilities to the expectations of patients. In other words, patient
satisfaction is the highest measure of the quality of the operation of health facilities, not other
forms of honor
Program 527/CTr-BYT (June 18, 2009) of the Ministry of Health on "Improving the quality of
medical examination and treatment at medical facilities for the purpose of meeting the patient
satisfaction with the health insurance" require: improve morale, patient service attitude; reform
administrative procedures; reduce inconvenience in reception, medical examination, treatment and
payment to patients; improve the quality of health services in hospitals and healthcare facilities;
ensure the rights of patients with health insurance, avoid abusing medicine, technology and test in
order to save health resources and costs (Ministry of Health, 2009). In addition, Ministry of Health
Circular No. 19/2013/TT-BYT dated July 12, 2013 guiding implementation of medical service
quality management requires all hospitals to assess the effectiveness of criteria, standard and
quality management model indicators by 2018 (Ministry of Heath, 2013).
Medicine supply is one of the important tasks that affect the quality of hospital treatment and is
also a significant factor in assessing the quality of pharmacy's department.
In fact, the distribution of drugs has many factors affecting to patient satisfaction such as: drug
quality, drug delivery process, waiting time, medicine consultation. Therefore, it is necessary to
have sufficient research to find out what factors make the patient dissatisfied.
In Vietnam, the issue of drug supply in hospitals still exist many inadequacies and receive social
attention. This inadequacy can occur at all stages of the drug delivery process: from procurement
to delivery, from prescription to instructional use.
Despite continuous efforts, the health sector has not yet met the needs and expectations of patients.
There is always a gap between the current response and demand . In order to measure and narrow
this gap, the quality of drug supply and quality improvement work needs to be concentrated on the
basis of a highly relevant assessment of patients.
When the Health Insurance Law came into force on July 1, 2009, District 2 Hospital in Ho Chi
Minh City became the place of registration for primary healthcare for patients with health
insurance. As a result, the number of outpatient with health insurance has increased from 800 to
1000 patients per day, leading to overload in some departments, especially in drug distribution
system.
Therefore, the topic "What factors of drug distribution system affect the satisfaction of outpatient
with health insurance at District 2 Hospital ? " be done.
Overall objective:
Providing factors of medicine dilivery activities affecting patient satisfaction.
Specific objectives:
1. Describe and explain how each factor influence patient satisfaction.
2. Find out which factors actually impact patient satisfaction
3. Provide recommendation to improve the quality of drug distribution system.
CONTENTS
CHAPTER 1 - INTRODUCTION........................................................................................... 1
1.1. Introduction .................................................................................................................... 1
1.2. Research Aims ................................................................................................................ 3
1.3. Research Question ......................................................................................................... 3
1.4. Context and Relevance .................................................................................................. 3
1.5. Scope of research ........................................................................................................... 4
1.6. Structure ......................................................................................................................... 5
1.7. Conclusion ...................................................................................................................... 6
CHAPTER 2 - LITERATURE REVIEW .............................................................................. 7
2.1. Introduction .................................................................................................................... 7
2.2. What is the drug distribution system? ......................................................................... 7
2.3. What is patient satisfaction? ....................................................................................... 10
2.4. What factors may affect patient satisfaction? ........................................................... 12
2.5. How to measure patient satisfaction? ........................................................................ 14
2.6. Gap in liturature .......................................................................................................... 15
2.7. Conclusion .................................................................................................................... 16
CHAPTER 3 - METHODOLOGY ....................................................................................... 17
3.1. Introduction .................................................................................................................. 17
3.2. Research approach ...................................................................................................... 17
3.3. Research design ............................................................................................................ 18
3.4. Data collection .............................................................................................................. 19
3.5. Data analysis ................................................................................................................. 20
3.6. Reliability ...................................................................................................................... 21
3.7. Validity.......................................................................................................................... 21
3.8. Ethical considerations.................................................................................................. 22
CHAPTER 4 - FINDINGS - DISCUSSION ......................................................................... 24
4.1. Introduction .................................................................................................................. 24
4.2. Descripting and explaining each factor ..................................................................... 24
4.2.1. Personal question .................................................................................................... 24
4.2.2. Reliability................................................................................................................ 25
4.2.3. Responsiveness ....................................................................................................... 26
4.2.4. Assuarance .............................................................................................................. 29
4.2.5. Empathy .................................................................................................................. 31
4.2.6. Tangible .................................................................................................................. 32
4.3. Reliability analysis ....................................................................................................... 33
4.4. Correlation analysis ..................................................................................................... 35
4.5. Regression analysis ...................................................................................................... 37
4.6. Conclusion .................................................................................................................... 38
CHAPTER 5 - CONCLUSION ............................................................................................. 40
5.1. Introduction .................................................................................................................. 40
5.2. The purpose of the research ........................................................................................ 40
5.3. Addressing the research question ............................................................................... 41
5.4. Key findings .................................................................................................................. 41
5.5. Limitation and Recommendation ............................................................................... 42
5.6. Answering the Research question .............................................................................. 43
REFERENCE .......................................................................................................................... 44
Apendices - Questionnaire ..................................................................................................... 49
CHAPTER 1 - INTRODUCTION
1.1. Introduction
In this chapter, I will introduce the research, overview District 2 Hospital, outline the
aims and discuss why it is relevant to quality of healthcare in Vietnam. It will briefly
measure the circumstance of the research and present the structure for this dissertation.
Firstly, I will sketch some highight of public hospitals in Vietnam and overview of
District 2 Hospital. Then we will discuss the study aims and this will help us to develop
a focused research question to investigate. It will then state how this research is important
and the relevance to the quality of healthcare in Vietnam. Following which it will
highlight what this dissertation will examine and the confines of it. Finally it will finish
by outlining the structure for the rest of the research.
Public hospitals play a crucial role in the healthcare system in Vietnam because they are
the dominant provider of hospital care compared with private hospitals. Among 1,099
hospitals national wide, there are 962 public hospitals, accounting for 87.5 per cent of
the whole hospital system (Vietnam General Statistics Office, 2012). As a result,
evaluating the quality of drug distribution system would help to better understand the
current supply capacity and quality of supply and significantly contribute to the aim of
improving the health outcomes for people in Vietnam.
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Figure 1.0 District 2 Hospital
District 2 Hospital was built in 1998 with the initial size of only 60 beds, but with the
support of the state, District 2 Hospital has been raised to 150 beds since 2015. Besides
upgrading advanced medical equipment and facilities, District 2 Hospital may also pay
much attention to improving the level of medical staff, working principles, behaviors for
physicians, nurses, technicians through training. With a better goal of serving, the board
of directors, doctors and nurses have been constantly innovating and improving their
capacity. Since 2015, District 2 Hospital has attracted from 1,000 to 1,100 outpatients to
medical examination and treatment every day, 2.5 times higher than in 2014. The number
of inpatients has also increased, beds were always filled with over 90% patients. The rate
of referral to upper levels in 2015 decreased by 72% compared to 2014. In the first six
months of 2017, the hospital has reduced the rate of referral to higher levels up to 82%
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over the same period in 2016 due to technical advances, actually hospital currently
owned about 650 complicatied techniques. People now are gradually becoming more
confident in the quality of medical examination and treatment of hospitals and this has
contributed significantly to reducing the overload of such hospitals: Cho Ray, Binh Dan,
Nhan Dan Gia Dinh,...
1.2. Research Aims
This research aims to define what factors of drug distribution system affect outpatient
satisfaction at District 2 Hospital. Based on these factors, managers can find solutions to
improve the efficiency of drug distribution system and enhance the quality of healthcare
in their hospital.
1.3. Research Question
A research question is the core of a research, the overall purpose of the research is
therefore to find an answer to the research question. In this instance, the research
question should be tightly focussed, that is, it should be extremely clear exactly what
aspect of practice the researcher is investigating and with which population of patients
or clients. So the study was conducted to answer the following research questions:
- What factors of drug distribution system affect the satisfaction of outpatient with health
insurance at District 2 Hospital?
- Why/How these factors affect the quality of drug distribution system at District 2
Hospital?
1.4. Context and Relevance
The Vietnamese public hospital system is overloaded, especially at the provincial and
national levels, both in general and specialty public hospitals. Further, the current
shortage of experienced medical doctors, pharmacist and other professional staff has put
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increasing burden on hospital capacity to meet healthcare needs of the population. This
situation therefore affects the quality of healthcare system (Le TP, 2014).
Decision No. 68/QD-TTg dated January 10, 2014 of the Prime Minister approving the
National Strategy on Vietnam pharmaceutical industry’s development to 2020 and with
the vision to 2030. The overal objectives is to supply medicines adequately, timely with
quality and rational prices according to the disease structure respectively with each
socio-economical development stage and ensure medicine usage to be safe and rational.
To attach special importance to medicine supply for subjects belonging to social.
The current drug distribution model illustrates a complicated process can influence the
quality of drug distribution system that is expressed by patient satisfaction. Over the past
20 years, patient satisfaction surveys have gained increasing attention as meaningful and
essential sources of information for identifying gaps and developing an effective action
plan for quality improvement in healthcare organizations. However the application of
these findings is not the same in each healthcare center. Each hospital should conduct its
own patient satisfaction studies in order to improve the quality of healthcare.
Why I choose District 2 Hospital? District 2 Hospital is a secondary hospital
undercontrolled by Ho Chi Minh City Ministry of Health. In the past, there was no
systematic study to evaluate customer satisfaction about the quality of drug distribution
system for outpatients at District 2 Hospital. A number of surveys have been conducted
at other hospitals, however, those research could not apply to enhance the quality of
healthcare for this hospital. Therefore a systematic study is needed to discover and
answer the research questions posed.
1.5. Scope of research
The research involves the concepts of service quality in general and quality of drug
distribution system in particular. Quality of drug distribution system perceived by
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patients has been considered the transformation of the most frequently-used term: patient
satisfaction.
The results of the research will provide evidence-based suggestions for applying the
framework to identify factors affecting to patient satisfaction in Vietnam, contributing
to assess and improve the service quality of the drug distribution system in general and
of District 2 Hospital in particular.
Due to time restraints, the sample will be limited to 174 participants. This may mean that
the results cannot be generalised to the whole population. Due to limited time and budget,
the research will ask participants to self evaluate their satisfaction levels and therefore it
may have poor construct validity.
1.6. Structure
The next chapters of the thesis will address the intellectual and organisational context of
the thesis. In Chapter 2, a critical literature review will focus on the fundamental issues
of drug distribution systems in general and District 2 Hospital within the drug
distribution system in Vietnam. The basic concepts of service quality and current models
of quality management will be presented before concentrating on the conception of
satisfaction in the context of patients’ perception on quality of hospital care. Chapter 3
will detail the study methodology, target population, instruments used, and the
procedures of analysing the quantitative data.
The findings and the discussion will then be presented using tables and graphs to
highlight the key points found. Averages and correlations will be calculated to help form
an answer to the research question. Each high-light will be explained and discussed what
has been found and to relate it back to the existing literature. This will allow the
researcher to draw conclusions from the data.
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1.7. Conclusion
This chapter has introduced the research and discuss the aims and relevance of it. It has
outlined the scope of the research and created a research question that can be
investigated. The next chapter will present existing literature surrounding the question
“What factors of drug distribution system affect the satisfaction of outpatient with health
insurance at District 2 Hospital ?” This will give background knowledge for the topic
and will be informative about what has previously been investigated.
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CHAPTER 2 - LITERATURE REVIEW
2.1. Introduction
Drug distribution system are seen as the most prominent and vital component of any
healthcare system. This Chapter firstly examines the role of the drug distribution system
within the healthcare system in Vietnam. Some available drug distribution models that
are provided by international advisory bodies such as the World Health Organization and
the International Pharmacy Federation may be also discussed when seeking to describe
the pharmaceutical system.
Moreover, the concept of satisfaction and in particular, patient satisfaction as an
important indicator of quality of care will be introduced and analysed through related
worldwide studies.
Patient satisfaction is an important and commonly used indicator for measuring the
quality in healthcare. Patient satisfaction affects clinical outcomes, patient retention, and
medical malpractice claims. It affects the timely, efficient, and patient-centered delivery
of quality healthcare. Patient satisfaction is thus a proxy but a very effective indicator to
measure the success of doctors and hospitals (Bhanu Prakash, 2010).
2.2. What is the drug distribution system?
People are constantly looking for quality products and services. The existence of this
desire for quality has caused firms and organisations throughout the world to consider it
as an essential component of any service and production process. Quality is a strategic
differentiator tool for sustaining competitive advantage. Improving quality through
improving structures and processes leads to a reduction of waste, rework, and delays,
lower costs, higher market share, and a positive company image (Lagrosen, 2005),
(Rahman, 2001). As a result, productivity and profitability improve (Alexander, 2006).
Therefore, it is very important to define, measure and improve quality of healthcare
services in general and drug distribution system in particular.
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According to World Health Organization, drugs may be widely distributed through
shops, drug sellers of various sorts and other informal channels. However, the range,
quality and storage conditions of drugs distributed in these ways are highly variable
(WHO, 1997).
In any hospital, a drug distribution system is required to supply the medication prescribed
for each inpatient. The drug distribution system includes all the processes that occur
between the prescription of a drug and the administration of that drug to the patient.
There are many varieties of drug distribution system in use throughout the world, but all
have the same goal: to ensure that each dose of medication administered to each patient
is exactly that which was intended by the prescriber (Katja, 1999).
In less developed countries with large, medically underserved populations, pharmacists’
major responsibility remains providing or managing drug distribution systems. In some
countries, government at all levels may be actively involved in selecting which
medications will be available, choosing a source of supply, maintaining integrity of that
supply, ensuring quality and stability of medications, arranging for storage and shipping
of medicines, paying for them and, indeed, creating much of the infrastructure necessary
to provide medication to their citizens. (Kohler, 2014)
WHO has developed extensive guidelines for the drug procurement process in
developing countries. The guidelines describe four strategic objectives for good
pharmaceutical procurement: procure the most cost e ective drugs in the right quantity;
select reliable suppliers of high quality products; ensure timely delivery; achieve the
lowest possible cost. Twelve operational principles are suggested to meet these
objectives including using a transparent drug tendering process, having appropriate audit
processes for drug procurement, using appropriate accounting and payment procedures,
and assuring that all medications are of suitable quality (WHO, 1999). The chart below
is one of drug distribution models that WHO suggest for developing countries.
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Chart 2.0 Distribution network for essential medicines in the public, private and NGO
channels in developing countries.
Since 2008, the hospital board has relied on WHO's drug distribution model to build a
appropriate model for itself. This model did not mimic exactly WHO’s, but it was well
suitable to the disease pattern and epidemiological situation at the hospital. The chart
below illustrates current drug distribution model for outpatients in District 2 Hospital. It
will help us to build a suitable questionnaire to evaluate patient satisfaction.
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Outpatient activity chart
Rx written by doctor
Rcvd by pharmacist
Filling of prescription
Dispensing of patient
Prescription Payment
Receipt of payment
cash
Change
Prescription filled
Regular
Prescription file
Narcotic
Prescription file
Static and report
Chart 2.1 Current drug distribution system at District 2 Hospital
2.3. What is patient satisfaction?
Outpatient with health insurance
Outpatients are patients who have examined and analyzed the disease but no lifethreatening illness, so these patients are referred to treated at home (outside the hospital).
Health insurance is insurance that covers the whole or a part of the risk of a person
incurring medical expenses, spreading the risk over a large number of persons. By
estimating the overall risk of healthcare and health system expenses over the risk pool,
an insurer can develop a routine finance structure, such as a monthly premium or payroll
tax, to provide the money to pay for the healthcare benefits specified in the insurance
agreement. The benefit is administered by a central organization such as a government
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agency, private business, or not-for-profit entity. According to the Health Insurance
Association of America, health insurance is defined as "coverage that provides for the
payments of benefits as a result of sickness or injury. It includes insurance for losses
from accident, medical expense, disability, or accidental death and dismemberment"
(Gary, 2002).
In this dissertation, outpatient with health insurance are called patient.
Patient satisfaction
Oliver (1981) summarizes current thinking on satisfaction in the following definition:
“(satisfaction is a) summary psychological state resulting when the emotion surrounding
disconfirmed expectations is coupled with the consumer’s prior feelings about the consumption experience”. This and other definitions (Howard and Sheth, 1969), (Hunt,
1979) and most all measures of satisfaction relate to a specific transaction.
Parasuraman (1985) explained satisfaction in relation to service quality. He argued that
service quality is defined as the gap between predicted or expected service (customer
expectations) and perceived service (customer perceptions). If customers’ expectation is
greater than performance, then perceived quality is regarded less than satisfactory and a
service quality gap arises.
There is no consensus between the literatures on how to define the concept of patient
satisfaction in healthcare. Most of researcher are familiar with customer satisfaction, so
can we see patient as a consumer or not? The word “consumer” is derived from the Latin
word “consumere” which literally means one who acquires commodities or services.
Similarly, the word customer is also defined as “a person who purchases goods or
services.”( Brown, 1993). Today the patient sees himself as a buyer of health services.
Once this concept is accepted, then there is a need to recognize that every patient has
certain rights, which puts a special emphasis on to the delivery of quality healthcare. In
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Donabedian's quality measurement model, patient satisfaction is defined as patientreported outcome measure while the structures and processes of care can be measured
by patient-reported experiences (Oyvind, 2011).
Many authors tend to have different perceptions of definitions of patient satisfaction.
Jenkinson C. et al. (2003) and Ahmed et al. (2011) pointed out that patient satisfaction
mostly appears to represent attitudes towards care or aspects of care (Jenkinson, 2003)
(Iftikhar, 2011).
While Rama et al. (2011) referred to patient satisfaction as patients’ emotions, feelings
and their perception of delivered healthcare services. On the other hand, other authors
defined patient satisfaction as a degree of congruency between patient expectations of
ideal care and their perceptions of real care received (Iftikhar, 2011).
In this dissertation, Parasuraman’ theory will be used as core concept to built the
questionnaire.
2.4. What factors may affect patient satisfaction?
In order to understand various factors affecting patient satisfaction, researchers have
explored various dimensions of the perceived service quality, as meaningful and
essential measures of patient perception of healthcare quality. Kane et al. (1997) stated
that measuring satisfaction should "incorporate dimensions of technical, interpersonal,
social, and moral aspects of care" (Kathryn, 2004). Research of patient satisfaction in
advanced as well as developing countries has many common and some unique variables
and attributes that influence overall patient satisfaction (Iftikhar, 2011).
Most of the studies in the literature review examined the correlation between
demographic factors such as age, gender, health status and level of education with patient
satisfaction; however, the findings from these studies are conflicting. Two studies, one
conducted in Scotland whereby 650 patients discharged from four acute care general
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hospitals during February and March 2002, and the second study was conducted in 32
different large tertiary hospitals in the USA; both showed that male patients, patients
older than 50 years of age, patients who had a shorter length of stay or better health status
and those with primary level education had higher scores related to variable health
service-related domains (José, 2006), (Otani, 2011).
On the other hand, a national survey performed in different accredited hospitals of
Taiwan found that patient characteristics such as age, gender and education level only
slightly influenced patient satisfaction but that the health status of patients is an
important predictor of a patient’s overall satisfaction (Shou-Hisa, 2003). In addition,
Nguyen et al. (2002) and Jenkinson et al. (2002) declared from their studies that the two
strongest and most consistent determinants of higher satisfaction are old age and better
health status.
While two studies reported contrary results regarding the influential effect of the two
controlled variables (age and gender) on overall patient satisfaction in different aspects
of healthcare services (Tonio, 2011), (Rama, 2011). In contrast, a 2006 national survey
of 63 hospitals in the five health regions in Norway showed that age, gender, perceived
health and education level were not significant predictors of overall patient satisfaction
(Oyvind, 2011).
A remarkable outcome of four studies conducted in tertiary hospitals in different
countries revealed that the nurses' courtesy, respect, careful listening and easy access of
care was particularly the strongest driver of overall patient satisfaction. These aspects of
nursing care are highly ranked by patients compared to other independent factors such
as physician care, admission process, physical environment and cleanliness (Tonio,
2011), (Forough, 2007), (Yogesh, 2011), (Kui-Son, 2005). In addition, a study carried
out in 430 hospitals in the USA found the nurse work environment and patient-nurse
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staffing ratio had statistically significant effects on patient satisfaction and
recommendations (Ann, 2009).
While three other studies found that interpersonal communication skills of physicians in
terms of their attitude, explanation of conditions, level of care, emotional support, respect
for patient preferences and involving patients in decision making were more influential
factors than clinical competence and hospital tangibles on patient satisfaction (ShouHisa, 2003), (Sung Soo, 2004) (Andrabi, 2012).
A study conducted in a public hospital in France found the most common problems
experienced by patients were related to hospital living arrangements and amenities
(Nguyen, 2002). A similar result was reported in a study conducted at five hospitals
served under the BJC Healthcare System (Koichiro, 2009). Furthermore, in 2012
Andrabi et al. reported that the major dissatisfaction in an outpatients department was
the long waiting time and overcrowded registration (Andrabi, 2012). In contrast, a study
carried out in five different hospitals in Scotland found that physical comfort had the
highest satisfaction rate compared to other core dimensions: information, coordination
of care and emotional support (Jenkinson, 2003).
2.5. How to measure patient satisfaction?
In this research, the scientific questionnaire will be built based on Parasuraman’ model.
Parasuraman et al., (1988) designed the SERVQUAL instrument to specifically measure
functional service quality using both the gap concept and service quality dimensions.
The SERVQUAL instrument, in its original form, contains twenty-two pairs of Likert
scale statements structured around five service quality dimensions: These dimensions
are:
(i) Reliability: deals with the ability to perform the promised service dependably and
accurately.
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(ii) Responsiveness: considers the willingness to help customers and provide prompt
service.
(iii) Assurance: talks about the knowledge and courtesy of employees and their ability
to inspire trust and confidence
(iv) Empathy: ability to provide caring and individualized attention to customers.
(v) Tangible: describes the appearance of physical facilities, personnel and equipment.
In this dissertation, the questionnaire survey was based on the content and structure of
the SERVQUAL scale and the questionnaire survey of previous studies in the health
sector (Diem Vo Thi Ngoc 2012, Thanh Nhu Ngoc, 2103).
2.6. Gap in liturature
When conducting this literature review and reading many articles on patient satisfaction,
it has been apparent that it is quite difficult to apply these results to Vietnam public
hospital system in general and District 2 Hospital in particular. As mentioned above,
there is no standard drug delivery model can be applied to all hospitals. An effective
model must be appropriated to the patient's characteristics, disease pattern, capacity of
the medical staff and facilities of each hospital. Now in the world, there are few studies
about the effectiveness of drug delivery systems at hospital, most of them are conducted
in developed countries. In Vietnam, there are about 5-10 studies per year conducted in
relation to drug distribution system and most of these researchs are guided by experts
from two major pharmaceutical universities (Hanoi and Ho Chi Minh City). Therefore,
those researchs are not high quality and very difficult to apply.
When reading worldwide articles, I find out some problems such as: In regard to health
insurance discount, most previous studies have said that patients are satisfied but it did
not mention exactly how they satisfied... Another factor is often overlooked when
examining the patient satisfaction was the waiting time to receive the drug. In this study,
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all questions will be adjusted to better suitable with current drug distribution model at
District 2 Hospital and this will help patients to evaluate accurately.
2.7. Conclusion
In this chapter, the literature review has discussed many aspects of patient satisfaction
so as to gain a whole view of the issue and gain more knowledge on it. Throughout the
review, many experts have contradicted each other and therefore each term and concept
within the topic of patient satisfaction, may not be able to be clearly defined. Besides,
the concept of drug distribution system has been introduced in various respects.
However, there are few researchs about the quality of drug distribution system in the
world in general and Vietnam in particular. Nevertheless, the review has showed the
author with wider background knowledge on the topic which will allow a deeper
discussion of findings after the study has been completed. Dissertation – “What factors
of drug distribution system affect the satisfaction of outpatient with health insurance at
District 2 Hospital?”
In conclusion, this literature has discussed and analysed existing literature surrounding
the topic of patient satisfaction. This has given background knowledge of the topic and
therefore will help in answering the question “What factors of drug distribution system
affect the satisfaction of outpatient with health insurance at District 2 Hospital?” The
literature has built a strong foundation for the dissertation and will help when discussing
the findings. The next chapter will outline the methodology that will be used in the study
that will be conducted.
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CHAPTER 3 - METHODOLOGY
3.1. Introduction
The previous chapter discussed the existing research on the topic of patient satisfaction,
including what healthcare quality is, what satisfaction is, the factor affecting to patient
satisfaction. Now that the current research has been analysed, this chapter will go on to
discuss the research approach that was used during this dissertation. The approach and
design will be analysed to decide what the best method of data collection will be to
answer the question “What factors of drug distribution system affect the satisfaction of
outpatient with health insurance at District 2 Hospital? This chapter will cover the
method of data collection and analysis, as well as the validity and reliability of the study
being conducted.
3.2. Research approach
Research approaches fall into two categories: inductive and deductive. Inductive
approach, also known in inductive reasoning, starts with the observations and theories
are proposed towards the end of the research process as a result of observations
(Goddard, 2004). Inductive research “involves the search for pattern from observation
and the development of explanations – theories – for those patterns through series of
hypotheses” ( Bernard, 2011). Whereas a deductive approach is concerned with
“developing a hypothesis (or hypotheses) based on existing theory, and then designing a
research strategy to test the hypothesis” ( Wilson, 2010). Each of these approaches has
advantages and it can be said that “any research effort uses both inductive and deductive
thinking”
To keep the study unbiased and reliable, an inductive approach was used. This was so
that findings were not swayed by a leading research question as the researcher had not
previously decided what the outcome should be. This approach aims to generate
meanings from the data set collected in order to identify patterns and relationships to
17
build a theory; however, inductive approach does not prevent the researcher from using
existing theory to formulate the research question to be explored (Saunders, 2012). By
using an inductive approach, this dissertation was able to analyse which factors affecting
to patient satisfaction.
Data can be split into two main categories: quantitative and qualitative. Quantitative data
is any data that is in numerical form such as statistics, percentages, etc (Given, 2008).
Qualitative research is a method of inquiry employed in many different academic
disciplines, including in the social sciences and natural sciences, but also in nonacademic contexts including market research, business, and service demonstrations by
non-profits (Denzin, 2005).
To ensure that the research being conducted was scientific, quantitative data was used
throughout the data collection as it can then be clearly analysed in the form of tables and
graphs. This was helpful when trying to draw conclusions from the data and presented
trends and correlations in clear format.
3.3. Research design
In terms of data collection methods, a questionnaire was used for this research. They are
a valuable method of collecting a wide range of information from a large number of
individuals, often referred to as respondents. This therefore means that it was an
appropriate form of data collection for this dissertation as it allowed the results to be
easily analysed in a scientific format.
There are many benefits of using a questionnaire to collect data. One of the main
positives is that data can be collected quickly, at little cost when compared to face-toface interviews. Questionnaires are easy to analyze and reduce bias. Data entry and
tabulation for nearly all surveys can be easily done with many computer software
packages. Moreover, they are familiar to most people and less intrusive than telephone
or face-to-face surveys. Nearly everyone has had some experience completing
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questionnaires and they generally do not make people apprehensive. Therefore, this was
the chosen method for this research as it suits its needs well.
However, there are also many disadvantages to using questionnaires and these may mean
that the research has limitations. Questionnaires are not always the best way to gather
information. For example, if there is little previous information on a problem, a
questionnaire may only provide limited additional insight. On one hand, the investigators
may not have asked the right questions which allow new insight in the research topic.
On the other hand, questions often only allow a limited choice of responses. If the right
response is not among the choice of answers, the investigators will obtain little or no
valid information. Another setback of questionnaires is the varying responses to
questions. Respondents sometimes misunderstand or misinterpret questions. If this is the
case, it will be very hard to correct these mistakes and collect missing data in a second
round.
In conclusion, even though there are limitations to this research method, there will be
limitations to all methods and therefore questionnaires were still used as the source of
data collection.
3.4. Data collection
The data for this dissertation was collected in random sampling. Simple random
sampling (also referred to as random sampling) is the purest and the most straightforward
probability sampling strategy. It is also the most popular method for choosing a sample
among population for a wide range of purposes. In simple random sampling each
member of population is equally likely to be chosen as part of the sample (Gravetter,
2011).
A trained data-collection team of 2 people went to District 2 Hospitals to conduct faceto-face interviews with the patients. In most cases the interviewers asked questions and
filled in the questionnaire. Necessary explanations were provided to the respondents
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