1. The Eleventh International Symposium on the Analytic Hierarchy Process Paolo Melillo 1, Alice Delle Donne 1, Giovanni Improta 1, Santolo Cozzolino 2, Marcello Bracale 1 1 Department of Biomedical, Telecommunication and Electronic Engineering University of Naples “Federico II” 2 Centro di Biotecnologie - A.O.R.N. "A. Cardarelli" Naples paolo.melillo@unina.it June 15-18, 2011, SORRENTO, Naples, ITALY

2. ISAHP 2011 Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale Case study: patients who used the service of pharmaceutical distribution of the hospital “A.O.R.N. A. Cardarelli” in Naples (about 1000 users for year). Increasing interest for the patient satisfaction among research activity: Number of papers indexed in PubMed with the word “satisfaction” in the title (over the years 1995-20005) Total number: 6728 articles, almost half of which have been published since 2000 Speight J. Assessing Patient Satisfaction: Concepts, Applications, and Measurement. Value in Health. 2005;8:S6-S8.

3. ISAHP 2011 Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale Patient satisfaction can be described as: “the extent of an individual's experience compared with his or her expectations” (Asadi-Lari, 2004); Shikiar and Rentz have proposed a three-level hierarchy of satisfaction: 1)satisfaction with health-care delivery (i.e., the clinic or service, including issues of accessibility, clinician-patient communication, quality of facilities); 2)satisfaction with treatment 3)satisfaction with medication In our case study, we are interested in the first level “There is no gold standard when it comes to measuring patient satisfaction” (Speight) Asadi-Lari M, Tamburini M, Gray D. Patients' needs, satisfaction, and health related quality of life: towards a comprehensive model. Health Qual Life Outcomes. 2004 Jun 29;2:32. Shikiar R, Rentz AM. Satisfaction with medication: an overview of conceptual, methodologic, and regulatory issues. Value Health. 2004 Mar-Apr;7(2):204-15. Speight J. Assessing Patient Satisfaction: Concepts, Applications, and Measurement. Value in Health. 2005;8:S6-S8.

4. ISAHP 2011 Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale From a recent review by Panvelkar we knew that: the studies measured patient satisfaction with pharmacy service adopted questionnaires administered in different ways (face to face interviews or via telephone or mailed …); only few studies compared patient satisfaction with services provided at different types of pharmacies; the majority of studies measured satisfaction using self-developed, non validated instruments or ad hoc instruments with items adapted from previously published papers. Panvelkar PN, Saini B, Armour C. Measurement of patient satisfaction with community pharmacy services: a review. Pharm World Sci. 2009 Oct;31(5):525-37.

5. Of the ISAHP 2011 Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale ItemDimension 1. Pharmacy location d1. Facilities 2. Accessibility 3. Room comfort 4.Courtesy d2. Personnel’s skills 5.Pharmacists’ explanation 6. Privacy 7. Drugs’ availability d3. Dispensing process 8. Waiting time 9. Opening time Panvelkar, P.N., Saini, B., & Armour, C. (2009). Measurement of patient satisfaction with community pharmacy services: a review. Pharmacy World & Science, 31, 525-537.

6. ISAHP 2011 Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale The questionnaire submitted to the patients consisted of three parts: 1)questions about sex, age and other anonymous information; 2)questions about the level of satisfaction of each item (LS i ) and dimension (LSd i ); 3)questions for the pair-wise comparisons of items and dimensions according to AHP methods.

7. ISAHP 2011 Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale The pharmacy is easy to reach 5- strongly agree4- agree3- not sure2 – disagree1- strongly disagreeLS 1 The pharmacy staff is always kind 5- strongly agree4- agree3- not sure2 – disagree1- strongly disagreeLS 4 The prescribed drugs are always available in stock 5- strongly agree4- agree3- not sure2 – disagree1- strongly disagreeLS 7 The building is also accessible to disabled people 5- strongly agree4- agree3- not sure2 – disagree1- strongly disagreeLS 2 The pharmacist is available for giving information 5- strongly agree4- agree3- not sure2 – disagree1- strongly disagreeLS 5 The time needed to serve is short or reasonable 5- strongly agree4- agree3- not sure2 – disagree1- strongly disagreeLS 8 The waiting room is adequate and comfortable 5- strongly agree4- agree3- not sure2 – disagree1- strongly disagreeLS 3 The pharmacist take care about my privacy 5- strongly agree4- agree3- not sure2 – disagree1- strongly disagreeLS 6 The opening hours of the pharmacy are adequate 5- strongly agree4- agree3- not sure2 – disagree1- strongly disagreeLS 9 The facilities (in terms of location, accessibility, comfort of the rooms) are adequate 5- strongly agree4- agree3- not sure2 – disagree1- strongly disagreeLSd 1 The attitude of pharmacist towards patients (courtesy, availability, respect of privacy) is satisfactory 5- strongly agree4- agree3- not sure2 - disagre1- strongly disagreeLSd 2 The service (availability of drugs, waiting times, opening hours) is satisfactory 5- strongly agree4- agree3- not sure2 - disagre1- strongly disagreeLSd 3 Express your global level of satisfaction of the service in a scale 1-100GLS The levels of satisfaction of each item (LS i ) and of each dimension (LSd i ) were evaluated by the 5-point Likert scale, A Global Level of Satisfaction (GLS) is asked to the users in a scale from 1 to 100

8. ISAHP 2011 Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale For each respondent, we computed according to AHP: 1)the local weight (LWi) of each item within its dimension 2)the weight of each dimension (Wdi); 3)the global weight (GWi) of each item. We defined: a Global Quality Index (GQI) as a linear combination of the level of satisfaction of each item, LSi, and their global weight, Gwi; a Quality Index (QIdi) as a linear combination of the level of satisfaction of the items of the dimension, LSi,,and their local weight, GWi. We evaluated the correlation between GLS and GQI of the respondents and between LSd i and QId i.

9. ISAHP 2011 Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale We computed the consistency measures of the judgment matrix (Saaty, 1980); We accepted as consistent matrixes within the 20% level of inconsistency (Pecchia, 2010). As regards the respondents, we accepted an inconsistency in one judgment matrix. Saaty, T.L. (1980). The Analytic Hierarchy Process: Planning, Priority Setting, Resource Allocation. New York: McGraw-Hill. Pecchia, L., Bath, P.A., Pendleton, N. & Bracale, M.(2010). Web-based System for Assessing Risk Factors for Falls in Elderly People. International Journal of the Analytic Hierarchy Process, 2, 135-157

10. ISAHP 2011 Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale We computed the consistency measures of the judgment matrix (Saaty, 1980); We accepted as consistent matrixes within the 20% level of inconsistency (Pecchia, 2010). As regards the respondents, we accepted an inconsistency in one judgment matrix. Saaty, T.L. (1980). The Analytic Hierarchy Process: Planning, Priority Setting, Resource Allocation. New York: McGraw-Hill. Pecchia, L., Bath, P.A., Pendleton, N. & Bracale, M.(2010). Web-based System for Assessing Risk Factors for Falls in Elderly People. International Journal of the Analytic Hierarchy Process, 2, 135-157

11. ISAHP 2011 Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale A sample of 101 users of the service completed the questionnaire. 74 subjects refused to answer the questionnaire for unknown reasons. Patients interviewed (n=49) Users (non patient) interviewed (n=52) Age (year)49.0 ± 14.748.7 ±12.1 Male31 (63.3%)28 (53.8%) Female18 (36.7)24 (46.2%)

12. ISAHP 2011 Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale AHP-based indexLevel of Satisfaction# Correlation coefficient p-value GQI: Global Quality IndexGLS: Global Level of Satisfaction220.5164 0.014 QId 1 : Quality Index referred to Facilities LSd 1 : Level of Satisfaction referred to Facilities 290.8285<0.001 QId 2 : Quality Index referred to Personnel’s skills LSd 2 : Level of Satisfaction referred to Personnel’s skills 420.5650<0.001 QId 3 : Quality Index referred to Dispensing process LSd 3 : Level of Satisfaction referred to Dispensing process 320.3649 0.040 The correlations were significant for all indexes (p-value <0.05)

13. ISAHP 2011 Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale In order to check the application of the AHP methods: we defined AHP-base quality indexes; we evaluated the correlation of these indexes with the Level of Satisfaction asked to the respondents for redundancy; The significant correlation show that the AHP method could be used to provide information about the quality of the service, the patient satisfaction and the importance of each item / dimension. Limitation of the current study: most of the respondents were inconsistent in their judgment; we did not adopt a conventional methods for measuring quality as benchmark; we did not pool the judgments (out of the aim of the study).

14. ISAHP 2011 Paolo Melillo, Alice Delle Donne, Giovanni Improta, Santolo Cozzolino, Marcello Bracale Our results are consistent with those proposed by Ramanathan, who compared the use of AHP and SERVQUAL to measure quality service quality of a company engaged in pharmaceutical distribution. Ramanathan concluded that customers could express their satisfaction and comparisons more easily with the AHP questionnaire than with SERVQUAL. Ramanathan stated that same respondent has been diagnosed to be an unhappy customer by SERVQUAL and happy by AHP. The method proposed is based on a fewer number of questions than Ramanathan Ramanathan, R., & Karpuzcu H. (2010). Comparing perceived and expected service using an AHP model: an application to measure service quality of a company engaged in pharmaceutical distribution. OPSEARCH