STUDY OF SATISFACTION WITH PHARMACEUTICAL CARE AMONG THE ELDERLY IN REMOTE AREAS OF BELGOROD REGION

Full Text

INTRODUCTION

Elderly people represent a significant, steadily increasing and most vulnerable group of the population [1].

In Russian legislation, old age is most often associated with a person reaching retirement age, which is currently 60 years for women and 65 years for men [2].

Due to age characteristics and a number of accompanying diseases, this category of pharmacy visitors may face difficulties in providing and receiving pharmaceutical assistance not only when dispensing drugs and other products of the pharmacy assortment, but also in pharmaceutical consulting on their use [3, 4, 5].

Thus, in particular, due to age-related physiological changes that have a significant impact on the pharmacokinetics and pharmacodynamics of drugs, as well as the presence of multiple chronic pathologies that often require the simultaneous use of several drugs, the risk of developing undesirable drug interactions and side effects increases, in this regard, the features of pharmacotherapy of the elderly require a responsible approach [6, 7, 8].

To increase the safety and effectiveness of the treatment of an elderly person, special attention should be paid to the individuality of dosage selection, minimization of polypharmacy, regular monitoring of side effects and drug interactions, as well as active involvement of the patient and his relatives in the treatment process [9, 10].

In addition, elderly patients often have cognitive disorders, reduced vision and hearing, which makes it difficult to independently observe the medication regimen and requires additional attention from pharmaceutical workers [11, 12]. Thus, elderly patients need personalized and high-quality pharmaceutical care.

The availability and quality of pharmaceutical care can be significantly reduced for the elderly in small settlements due to a number of specific factors. So, in particular, in rural areas far from regional centers, insufficient provision of pharmacy facilities can be observed, which creates significant difficulties for the elderly in obtaining quality pharmaceutical care. The limited number of pharmacies, their territorial remoteness and low density of distribution in the territory of rural areas, as well as the insufficient development of the transport infrastructure lead to a decrease in the availability of pharmaceutical care for the elderly. All this can affect not only the timeliness, but also the effectiveness of the pharmacotherapy.

The study of satisfaction with pharmaceutical care by the elderly using the example of pharmacy organizations located in the rural areas of the Valuysky District, located 160 km from the regional center of the Belgorod Region, is relevant. Taking into account that the Valuysky District is a border territory of the Belgorod Region, the issues of availability and quality of pharmaceutical care for residents living there are particularly significant.

PURPOSE – to study the aspects of satisfaction with pharmaceutical care by elderly people in rural areas of the Belgorod Region.

MATERIAL AND METHODS

The methodological basis was made up of the approaches of the works of leading scientists in the field of management and economics of pharmacy and practical pharmacy.

Today, according to official reports on January 1, 2025, 1,609 people aged 60 and older live in the village, located in the Valuysky District, which is almost a quarter of the total population.

When determining the representative size of the sample population for the study of satisfaction with pharmaceutical care among the elderly population (N=1609), the Cochran formula was applied with an adjustment for the finiteness of the general population, which made it possible to establish a minimum sample size of 311 respondents at a confidence level of 95% (Z=1.96), an error of 5% (E=0.05) and the maximum variance of the sign (p=0.5). However, to increase the reliability of the study, the sample size was increased to 350 people, which is due to the need to compensate for the potential incomplete return of questionnaires (up to 15-20%). This correction, which corresponds to the principles of conservative design, allows you to reduce the standard error of the proportion from 2.8% to 2.6%, minimize risks and ensure the validity of conclusions. The expanded sample preserves the representativeness of the data within the confidence interval of ±5%, guaranteeing the extrapolation of the results to similar rural areas, taking into account local socio-demographic features.

The work used methods of content analysis of the respondents' answers, ranking, comparative, statistical, graphic methods, through which the interpretation of the obtained results was implemented.

RESULTS AND DISCUSSION

To realize the set goal, a research concept was developed, including 2 blocks.

Thus, within the framework of the first block of research, the theoretical aspects of pharmaceutical care are studied, during which the concepts and components of pharmaceutical care, the features of pharmacotherapy in the elderly and the main legal documents regulating pharmaceutical activities in pharmacy organizations are considered. Within the framework of the second, practical block of research conducted analysis aspects pharmaceutical help to elderly people, on an example of pharmacy organizations in a rural area in the Valuysky district of the Belgorod region by means of sociological research and interpretation of its results. At the final stage, a set of measures aimed at improving the quality and availability of pharmaceutical care for the elderly in the Belgorod region is proposed.

To implement the 2nd block of the research concept, an open-ended questionnaire was developed, including 3 items:

1. Characteristics of the socio-demographic portrait of the respondents;
2. Finding the degree of satisfaction with the availability of pharmaceutical care by the elderly;
3. Study of the quality of pharmaceutical care provided to elderly people.

The survey was conducted among visitors to pharmacy organizations in rural areas of the Valuysky district. In our opinion, this approach makes it possible to determine the features of the availability and quality of pharmaceutical care provided to the elderly.

As a result of the implementation of the first stage of sociological research, a general socio-demographic portrait of a respondent visiting a pharmacy in a rural area was formed. Yes, it is established that this is a woman - 83%; at the age of 65-74 years – 63%; lives in rural areas - 67%; mainly in a private house - 73%; has secondary professional education - 67%; single/widow – 63%; have children – 90% (Figure 1).

Figure 1. Socio-demographic portrait of the respondent, %

Figure 1. Socio-demographic portrait of the respondent,, %

At the next stage, an analysis of the degree of satisfaction of the respondents with the pharmaceutical assistance provided in the pharmacy organizations of the rural area of the Valuy district of the Belgorod region was carried out.

It is established that the frequency visits pharmacy elderly by people differs Thus, elderly residents of rural areas visit the pharmacy mainly several times a month - 60%, 30% of respondents visit the pharmacy once a month, and only 10% of respondents visit the pharmacy regularly (1-2 times a week) (Figure 2).

Figure 2. Frequency visits pharmacies, %

Figure 2. Frequency of visits to the pharmacy, %

It was revealed that the territorial accessibility of pharmacy organizations for elderly people in rural areas remains a serious problem. The fact that 60% of elderly people in rural areas note difficulties in visiting a pharmacy organization, in particular, due to their own limited mobility and lack of escort, and every third surveyed elderly person is able to visit a pharmacy only with the use of transport (Figure 3) draws attention .

Figure 3. Accessibility pharmacy organizations, %

Figure 3. Availability of pharmacy organization , %

The convenience of visiting pharmacies for the elderly is largely determined by availability elements available Wednesday. It was established that 60% of respondents noted the absence of elements of an accessible environment in a rural pharmacy (Figure 4). This fact is negative and reflects the low level of availability of pharmaceutical care for the studied category of visitors.

Figure 4. Availability elements available Wednesday in pharmacy organizations, %

Figure 4. Availability of accessible environmental elements in pharmacy organizations, %

It was established that absolutely all respondents - visitors to pharmacy organizations in rural areas prefer to receive pharmaceutical counseling in person with a pharmaceutical specialist - 100% of respondents. This fact is expected, since elderly people due to their age may experience difficulties with the perception of information through the Internet and various gadgets, and also have a need for live communication. It is interesting that at the same time, every third elderly person allowed the opportunity to receive pharmaceutical counseling in an alternative format - by phone.

During the study of aspects of the quality of pharmaceutical care, it was revealed that respondents in pharmacies in rural areas most often expressed dissatisfaction with the level of prices and the lack of information about analogues – 80%. We assume that this fact may be due to the limitation of the assortment, as well as the low level of motivation in the work of pharmaceutical personnel.

It was established that elderly respondents sometimes or often face the need to wait in line for pharmaceutical assistance (Figure 5).

Figure 5. Frequency emergence queues in pharmacies, %

Figure 5. Frequency of queues in pharmacies, %

At the final stage, aspects of the quality of pharmaceutical assistance to elderly visitors to pharmacy organizations in rural areas were studied. It was established that the overwhelming majority ­of respondents noted that when dispensing prescription drugs, the pharmaceutical specialist does not always ask to provide a prescription or doctor's appointment - 73%. This fact raises concerns about the risk of uncontrolled dispensing of medicinal products and potential threats to the health of the elderly.

Kindness – 83%, honesty – 63%, patience – 70% are among the most important qualities of a pharmaceutical specialist for the elderly. This fact demon struriuet, что elderly people appreciate attentive and respectful attitude k himself, and also the willingness of the pharmaceutical worker to spend time explaining the necessary information. The surveyed respondents also note the importance of professionalism and competence of pharmaceutical specialists.

It was revealed that more than 85% of the surveyed elderly people have one, more often several chronic diseases, which necessitates the regular intake of a significant range of medicinal products, and, often, their lifelong intake. This fact determines the need for a personalized approach to meeting the needs of elderly visitors not only in high-quality drug provision, but also in pharmaceutical counseling and information.

It was established that only 25% of visitors to rural areas receive detailed consultations from pharmaceutical specialists regarding the specifics of the use and storage of medicinal products answered affirmatively, the remaining 75% of respondents reported that pharmaceutical specialists are more often limited to dispensing drugs without explaining the specifics of their use and storage, referring to the instructions for use, which extremely negatively characterizes the quality of pharmaceutical care provided to elderly residents.

The obtained data indicate that there is a contradiction between informing elderly pharmacy visitors about the mode of taking medicines and the respondents' real need for such information. Despite the fact that pharmaceutical specialists may consider repetition of the information specified in the prescription or instructions for use of the drug to be superfluous, it is the elderly visitors to pharmacies, who make up a significant part of the consumers of medicinal products, who need additional explanations.

Thus, in the course of the research, problems were established in the availability and quality of pharmaceutical care for the elderly in pharmacy organizations located in the rural areas of the Valuysk District of the Belgorod Region .

At the final stage, recommendations were developed to increase the level of pharmaceutical care in pharmacy organizations located in areas far from the regional center. So, in particular, they can include:

- At the regional level, consider the possibility of creating a system of mobile on-site pharmacies to serve residents in remote settlements or to deliver medicines to the home for elderly people with limited mobility;

- Provision of an accessible environment: installation of ramps, staff call buttons and other elements of an accessible environment in pharmacies and pharmacy points in rural areas.

- Optimizing the assortment of medicinal products in rural pharmacies taking into account the needs of the elderly.

- Training of pharmaceutical personnel to provide information on available analogues of drugs, including those of domestic production.

- Improving the quality of pharmaceutical consulting:

• development and implementation of standard operating procedures in all pharmacy organizations of the Belgorod region, which will reflect the features of counseling elderly visitors to the pharmacy on the use and storage of medicinal products.
• staff training in communication skills with the elderly;
• the development of alternative consultation formats , such as telephone consultations for those elderly visitors who have difficulty visiting a pharmacy, or live at a considerable distance from the nearest pharmacy in a rural area.

- Reduction of waiting time in queues:

• optimization of the work of pharmacies in order to reduce the waiting time of customers, for example, by increasing the number of employees during peak hours.
• introduction of a system of pre-ordering medicines by phone or the Internet to reduce queues.

- Control of compliance with the pharmaceutical order:

• strengthening control over compliance with the rules for dispensing prescription drugs in pharmacy organizations throughout the Belgorod region, especially in small settlements.
• training personnel on the rules of working with prescriptions and reminding them of responsibility for violating the rules for dispensing prescription drugs.

- Organization of a personalized approach in servicing elderly customers:

• consideration of the individual needs of the elderly, including their chronic diseases and the need for regular medication.
• development of loyalty programs for elderly patients, such as discounts on medicines or additional services (for example, free home delivery).

- Increasing the motivation of pharmaceutical personnel:

• c stimulating employees for high-quality service to elderly customers, including bonuses or incentives for high level of service (based on customer reviews).
• conducting trainings to increase professional competence and motivation of personnel in providing high-quality pharmaceutical care.

- Development of information materials (booklets, posters) about available services and benefits for the elderly:

• conducting educational events for elderly customers (lectures, seminars) on the specifics of the use and storage of medicinal products and a healthy lifestyle.

       The implementation of these recommendations will increase the availability and quality of pharmaceutical care for the elderly in rural areas, which is especially important in the context of an aging population and a growing need for pharmaceutical care.

CONCLUSIONS

Thus, the results of the conducted study make it possible to establish a low level of quality and availability of pharmaceutical care for elderly customers of pharmacy organizations in settlements far from the regional center of the Belgorod region. Elderly people face not only significant difficulties when visiting pharmacy organizations, but also problems related to the acquisition and correct use of drugs, which is caused by an insufficient level of pharmaceutical counseling.

The obtained data are a fragment of a comprehensive study conducted as part of the research work of the Department of Management and Economics of Pharmacy, aimed at improving the aspects of optimizing pharmaceutical assistance to certain categories of the population in the Belgorod region.

About the authors

Yulia Dereglazova

Author for correspondence.
Email: yuliya.dereglazova@mail.ru
ORCID iD: 0000-0003-0194-9384
SPIN-code: 5880-2976
ResearcherId: rid102284

Associate Professor, PhD in Pharmaceutical Sciences, Department of Pharmacy Management and Economics, Institute of Pharmacy, Chemistry and Biology

References

Supplementary files