1.

Introduction
Pharmaceutical services at the time this is not just serving purchases and submit
medication to patients. Service activities pharmacy which originally only focused on
management medicine as a commodity becomes a service comprehensive aiming to
improve quality life of the patient. The change gives challenges for pharmacists to
increase knowledge, skills and bevahiors to be able to provide optimal pharmaceutical
services to support patient success.
Optimal pharmacy services are needed supported by providing information, education as
well monitoring drug use by pharmacists for ensuring patient therapy goals have been
achieved and well documented. In addition, the pharmacist must also understand and
realize the possibility of occurrence medication error (medication error) in the process
service. Therefore pharmacists must apply pharmaceutical service standards in running
pharmaceutical practices.
Standard pharmaceutical services at pharmacies have been determined by the government
through Decree No. 73 of the year 2016. Pharmaceutical services that comply with the
standards will reduce the risk of medication errors. Other than that also meet the needs
and demands of the community so that the community will give a good perception to
pharmacies. There has been an agreement that quality health services are focused on
needs and demands of service users related to satisfaction patient as a consumer.
According to handayani et al. (2009) several aspects or dimensions to measure the quality
of service fields, including pharmacy services, have been identified, namely:
1) Dimensions tangible (physical equipment, equipment, employees and others),
2) Dimensions of reliability (service reliability),
3) Dimensions responsiveness (service responsiveness)
4) Dimensions assurance (assurance/ guarantee) and
5) Empathy dimensions (attention to understanding customer needs).

If pharmacy consumers are satisfied with the services provided then consumers will have
a good perception to pharmacies. Conversely, if the pharmacy consumer feel dissatisfied
with the service provided consumers will have a bad perception of pharmacy.

1
 This study aims to determine overview of the quality of prescription services by
pharmacists so can be used as a reference in improving pharmacy services in pharmacies.
Improvements to pharmacy services at pharmacies are expected to improve quality of
pharmaceutical services at pharmacies in the future come and can meet the patient’s
expectations as consumer.

2. Method
This research has received a certificate ethical conduct (Ethical clearance) No,
174/EC/KEPK-S1-FARM/03/2014 issued on March 10 2014 by the Faculty Health
Ethics Research Commission Medical Universitas Brawijaya.
This research is a descriptive research carried out several pharmacies in the Klojen
District area Malang city. When the study began in March 2014 after obtaining ethical
approval and ending in May 2014. Instruments used in research this is a questionnaire
used to measure service quality. The questionnaire used is SERVQUAL model.
The population in this study were all patients who redeem recipes or copies of recipes at
the pharmacy at Klojen Subdistrict, Malang City. While the simple in this study were
patients who were visit redeem recipes or copies of recipes at the pharmacy who are in
the Klojen District of Malang City selected by purposive sampling according to criteria
of researchers as a place of research. For withdrawals patient samples using simple
random techniques sampling. The inclusion criteria in this study were (1) patients who
redeem prescriptions or copies of prescriptions at pharmacies, (2) patients who receive
prescription services or prescription salina from a pharmacist. While the exclusion
criteria are (1) patients the copy of the recipe must not be redeemed (sec), (2) patients
who redeem prescriptions or copies of recipes at pharmacy but not willing to fill aot the
questionnaire, (3) patients who redeemed the recipe or copy of the recipe but the
medicine redeemed is not available at the pharmacy or must take medication to another
pharmacy.
3. Results
Data from Malang City Health Office states that there are 52 district pharmacies Klojen
Malang City and after surveying at Klojen district Malang City is known to have an
additional 5 pharmacies that are not contained in the data obtained from Malang City
Health Office. Selection of pharmacies as the place of research was conducted by

2
 purposive sampling. A total of 8 pharmacies meet the criteria, but the data is obtained in
this study only came from 7 pharmacies. At 1 pharmacy did not get the data so it fell out.
The research sample in this study were patients who were redeem recipes or copies of
recipes that match the criteria researcher. To determine the sample of patients in the study
this uses a simple random sampling technique. Total patients who were respondents this
study were as many as 100 people consisting of 40 pharmacies A, B pharmacies as many
as 20 people, C pharmacies as many as 4 people, 4 pharmacies, 3 pharmacies, 1 F
pharmacy and 28 G pharmacies.
A. Pharmacy Demographics
In table data can be found about pharmacy ownership, pharmacy opening hours, number
of recipes served, and the number of pharmacist assistants. The pharmacy owner most are
individuals and SOEs, opening hours pharmacies with a maximum of 13-18 hours, the
number of recipes served at most is less than 10 sheets of recipes, the highest number of
pharmacist assistants is 1-3 people.
B. Demographics of Pharmacy Pharmacists (APA)
In table 2 data can be found about age WHAT, WHAT gender, APA’s experience is
working at pharmacy, the number of APA work days in 1 week and hour APA work at
the pharmacy. The APA age is the most 20-30 years, what gender is the most male man.
The most experience working in a pharmacy is between 1-10 years, the number of APA
workdays in 1 most weeks are APA’s 6 days and working hours at most pharmacies are 8
hours.
C. Companion Pharmacist Demographich
In table 3, we can find data about age companion pharmacist, sex of a companion
pharmacist, experience of companion pharmacists working in pharmacies, amount
companion pharmacistworking day in 1 week and hour assistant pharmacist work at the
pharmacy. All pharmacists companion between the ages of 20-30 years, gender
companion pharmacists are all women. Experience working at a pharmacy that that is no
more than 1 years at the most, the number of working days of all accompanying
pharmacists in 1 week is 6 days and working hours of the companion pharmacist at most
pharmacies are 7 hours.

3
 D. Demographic Data of Respondents (Patients)
In table 4 the sample can be known most in women, ages between 26-35 years. Visit
patients to the pharmacy for the most redeeming recipe is more than 5 time. Patients have
the highest level of patient education at college high/equal and highest employment for
entrepreneurs. Service quality.
a) Service Quality Assessment
In table 5 it can be seen that quality service at the pharmacy is still not as expected.
Patients seen from a minus (-) service value. The lowest service quality value is in the
dimension physical evidence of -1.40.

b. Cartesian Diagram of Service Quality

An overview of the quality of service from each dimension is illustrated in the Cartesian
diagram. In part A is the part that shows the top priority to be addressed because it gets the
lowest rating. Part B shows that the services provided are considered better than other services
and need to be maintained. Section C shows the services for which implementation is considered
less important and less satisfying. Section D shows services that are considered less important
but satisfying15. Based on the Cartesian diagram in Figure 1, it can be seen that the dimensions
of service quality, physical evidence and empathy require priority to be addressed then the
dimensions of responsiveness and reliability and finally the guarantee dimension.

Table 4. Respondent Demographic Data

Information Total %

Gender
Man 47 47
Women 53 53
Age
16-25 years 20
26 - 35 years old 20 40
36 - 45 years old 40 18

4
46 - 55 years old 18 16
56 - 65 years old 16 5
> 65 years old 5 1
Number of visits to the 1
pharmacy to redeem recipes
(at the pharmacy where
patients redeem recipes)
For the first time 24
2-5 times 24 37
> 5 times 37 39
Last education 39
Elementary School / 1
equivalent 1 7
Graduated from junior high 7 39
school / equivalent 39 50
Graduated from high school / 50 3
equivalent 3
College / equivalent
graduation
Etc
Work 11
PNS / TNI / POLRI 11 23
Private employees 23 27
entrepreneur 27 17
Housewife 17 12
Student / Student 12 10
Etc 10

Table 5. Each Dimensional Service Quality Value

Dimensions of Value of the Reality Value of Service Value of Service

5
Service Quality felt Expected Quality

Physical Evidence 5,45 6,46 -1,04

Reliability 5,89 6,59 -0,7
Response 5,85 6,59 -0,74
Guarantee 5,96 5,59 -0,63
Empathy 5,69 6,52 -0,83

Figure 1. Cartesian Diagram of Dimensional Service Quality

4. Discussion

In this study using a research instrument in the form of a questionnaire that uses
SERVQUAL standards. This questionnaire is given to respondents (patients) with the aim that

6
researchers can find out the assessment of prescription service quality by pharmacists according
to the views of respondents (patients).
The pharmacy ownership data which as in Table 1 the most are individuals and SOEs as
much as 42.86% (n = 3). The number of pharmacies owned by individuals and SOEs does not
reflect the proportion of ownership of pharmacies in Klojen Subdistrict, most of which are
individuals and state-owned enterprises, but those pharmacies provide permission for research.
In accordance with the laws and regulations, the pharmacist can either become a PSA (owner of
a pharmacy facility) or work with the owners of capital to establish a pharmacy for individuals,
groups, BUMN or BUMD7. Data for pharmacy opening hours is used to find out how long the
pharmacy is open in one day. This can be related to the pharmacist's working hours. According
to Kepmenkes no. 26 of 1981, stating that as long as the pharmacy is open, the pharmacist
managing the pharmacy must be at the pharmacy. But if APA is unable to carry out his duties on
the days of opening the pharmacy he can be replaced by companion pharmacist.7 Data on the
number of prescriptions served per day and per month at the pharmacy is used to find out how
many recipes are served by the pharmacy in one day and one month. There are no rules that
regulate the maximum number of recipes served per day, but the pharmacy should add AA,
racers, cashiers, accountants, janitors and other employees according to the need for prescription
services that can be handled well. 7 Data on the number of pharmacist assistants available in the
pharmacy is used to find out how much pharmacy staff at the pharmacy can help pharmacists in
conducting pharmacy services at pharmacies, especially in prescription services. The pharmacist
assistant (AA) does not have to be in a pharmacy, the pharmacy that adjusts the amount of AA
needed. 7 The pharmacist's age data shows that all pharmacists are in productive age so that all
pharmacists at the pharmacy can still carry out their roles as pharmacists in accordance with
applicable laws. Productive age in Indonesia is at the age of 15-64 years
The sex data of pharmacists, both APA and companion pharmacists, were used to
compare the male and female pharmacists who worked in the pharmacy where the study was
conducted which was not far adrift. This is an illustration that the pharmacist profession does not
see men or women and uphold human rights in accordance with the Indonesian pharmacist's
code of ethics.8 The old data of pharmacist management pharmacists (APA) and companion
pharmacists is used to find out the experience of pharmacists working in pharmacies. According
to WHO, a pharmacist has a role as a Long life learner who must continue to study from college

7
to work to sharpen his skills and experience.7 Data on the number of pharmacists working days
in 1 week is used to determine the schedule for research at a pharmacy when a pharmacist
provides services. According to Kepmenkes no. 26 of 1981 states that as long as the pharmacy is
open, the pharmacist managing the pharmacy must be at the pharmacy. However, if APA is
unable to carry out its duties on the opening days of the pharmacy, it can be replaced by a
companion pharmacist.7 From the data on the number of pharmacists working days in 1 week, it
is known that pharmacists are not available at the pharmacy every day, which is not in
accordance with applicable regulations. But there are 3 pharmacies that have a companion
pharmacist that shows that the three pharmacies have implemented the applicable regulations.
According to Hartini and Sulamono (2007), the provisions regarding the non-pharmacy and the
presence of pharmacists need to be rearranged so as not to harm patients or pharmacists.
Pharmacist working hours are used to find out how long the pharmacist works at the pharmacy.
From the data of pharmacist working hours in 1 day it is known that the pharmacist is not in 1
full day at the pharmacy which means it is not in accordance with the applicable rules. But there
are 3 pharmacies that have a companion pharmacist which indicates that the pharmacy has
implemented the applicable regulations.

Data on the sex of respondents (patients) was used to determine the ratio of respondents
(patients) to men and women in this study. Research conducted by Phau and Baird (2008) shows
that of all respondents as much as 48.1 percent were male and 51.9 percent were female and
there was no significant difference between men and women in making complaints (p = 0.734).
This shows that men and women do not have a significant difference in terms of assessing the
quality of services to express their opinions. Age has a role in patient decisions in providing an
assessment of service quality. Age determines a person's maturity in acting including
complaining when their expectations of a product or service are not met. Research by Ngai et al.
(2007) showed a significant relationship found between age and consumer complaint behavior.
People between the ages of 31 and 50 tend to complain. Regarding customer loyalty can be seen
from the number of patient visits to the pharmacy to redeem recipes. The results of the study
show that patients visiting pharmacies are customers who have loyalty to the pharmacy.

8
But from the results of the assessment of service quality as a whole which is still not fulfilling
expectations but patients still visit the pharmacy to redeem recipe, patient loyalty to a pharmacy
is classified in spurious loyalty. Spurious loyalty is loyalty with a relatively weak attitude with a
pattern strong purchases such as respondents (patients) inside this study16. The last education
patients also have contributing to the assessment of the quality of care by patients. Education and
work are two characteristics interconnected consumers. Education will determine the type of
work performed by a person consumer. A person's level of education will affect the values he
adheres to, in connection by way of thinking, perspective and even perception against a problem.
Consumers who own higher education tends to be responsive to information. Education also
affects consumers within choice of products and brands. Different education will cause consumer
tastes to be different. Of the data can be known to the majority of patients who become
respondents were college graduates followed by high school graduates where those two levels
can said the level of higher education. Based on the results Low ratings indicate that level
education is found to have a relationship with behavior consumer complaints. Like research
conducted by Yulianti and Anzola (2009) who suggested that the overall education level of
complaining consumers can said to be at the upper middle level because it has been completing
compulsory schooling for twelve year, but the largest proportion of education is S1 36,4 percent.
The work data of respondents (patients) is used to find out the livelihood of the respondents
(patient). Education and work are two characteristics interconnected consumers. Education will
determine the type of work performed by a person consumer. A person's level of education will
affect the values he adheres to, in connection by way of thinking, perspective and even
perception against a problem. Consumers who own higher education tends to be responsive to
information.

The first dimension is the dimension tangible (physical evidence), which is related to
appearance physical quality of services, equipment / equipment, sources human resources, and
pharmacy communication materials. There are 4 questions to assess the dimensions of physical
evidence include: the pharmacy has a clean and comfortable consultation room (question 1); the
pharmacy has a clean waiting room and comfortable (question 2); pharmacies have spatial
planning interesting (question 3) and pharmacists and employees others look neat and polite
(question 4). Based on the results of the service quality assessment overall for the dimensions of
service quality physical evidence the expected service value is 6,46 and perceived reality of 5,42.

9
Quality value services for physical evidence dimensions of -1.04 and values this is the lowest
among the other dimensions. Position the physical proof dimension is also in the A quadrant
need priority to be fixed. As per results the research reality that patients felt was not bad because
it gets a rating of more than 5 (just agree) even though the quality of service is a dimension of
physical evidence still unable to meet patient expectations. Initial repair can be done by
implementing service standards the best pharmacy in the pharmacy. According to the Ministry of
Health (2004), the pharmacy environment must be kept clean

The pharmacy must have:

1) A waiting room that is comfortable for patients,

2) A place to display information for patients, including placement of brochures / information

material.

3) Room closed for counseling for patients who are equipped with tables and chairs and a
cupboard to store patient medication record

4) concoction room and

5) place washing tool. Then for an interesting arrangement pharmacies need to understand the
customer's response to various aspects of the pharmacy layout.

According to Mudie and Cottam (1993) in Tjiptono (2004), there are at least six factors that must
be carefully considered concerning the layout of service facilities, including: planning spatial,
room planning, equipment / furniture, layout light, color and messages conveyed graphic. In
addition to the problem of employee appearance and polite and neat pharmacists need to be
improved.

The second dimension is reliability relating to the ability of the pharmacy to deliver
service promised accurately from the first time. according to your request (question 6);
pharmacist serving recipe or copy of the recipe as promised (question 7); and pharmacies seek
prescription services who convinced you (question 8). Based on the results overall service
quality assessment for dimensions of service quality reliability are obtained values the expected
service is 6.59 and that is the reality felt at 5.89. Value of service quality for the reliability

10
dimension is -0.7. Position dimension reliability is in quadrant B indicating service has been
according to expectations compared to other dimensions but still need repairs. This shows overall
service quality dimension reliability still unable to meet patient expectations. But value reality
felt more than 5 (quite agree) and approaching 6 (agree) which indicates the reality the patient
feels good enough for the service dimension reliability. According to Azwar (1998), service to
patients need precision when doing examination and treatment.

The third dimension is responsiveness regarding the willingness and ability of service
providers to help customers and respond to their requests immediately. There are four questions
to assess the dimensions of responsiveness, among others: the pharmacy employee or pharmacist
tells you when to be served (question nine); pharmacy employees or pharmacists are always
ready to serve you immediately (question ten); pharmacy employees or pharmacists are always
ready to serve you (question eleven); and employees try to respond to your request even in a
crowded pharmacy (question twelve). Based on the results of the overall dimensions the
expected service value is six, five nine and the perceived reality is five, eight five. Value of
service quality for responsiveness dimensions of –nol, seven four. This shows that overall the
quality of service dimensions of responsiveness still cannot meet patient expectations. The
position of responsiveness dimensions is in quadrant B which indicates that the service has been
in line with expectations compared to other dimensions but still needs improvement. however,
the perceived value of more than five (quite agree) and close to six (agree) which indicates that
the service dimension of responsiveness is still quite good. then for the dimensions of
responsiveness, the quality of service must be reviewed. Therefore there is a need for training for
pharmacists and employees to improve the response to patients. this is because according to
Knapy (2002), explains that the characteristics of good service are knowledgeable, unhurried, do
not shirk responsibility, thank you, fast service, consider the time the customer is pleasant and
smiling, sincerely friendly and make the customer feels important. It is necessary to educate
patients that preparing medicines that have been prescribed requires precision so they cannot be
rushed.

the fourth dimension is assurance (assurance) relating to the knowledge and politeness
of employees and their ability to foster trust and customer confidence (confidence).
there are four questions to assess the dimensions of collateral, among others: what the pharmacist
does makes you believe in the ability of the pharmacist (thirteen questions); you feel safe and
comfortable when redeeming recipes or copies of recipes (question fourteen); pharmacists and
employees always try to be polite to you (fifteen questions); and the pharmacist provides all the
information you need (sixteen questions); based on the results of the research service quality
assurance obtained the expected service value of six, fifteen and employees perceived at five,
nine six. the value of service quality for guarantee dimensions is zero, sixth. this shows that
overall the service quality of the guarantee dimension still cannot meet the patient's expectations.

11
the position of the guarantee dimension is in the D quadrant which shows that the service
matches expectations compared to other dimensions but is considered less important. but the
perceived value of more than five (quite agree) and close to 6 (agree) which indicates the reality
felt by patients is still quite good for the guarantee dimension. then for the guarantee dimension,
the quality of service must be reviewed. hi this is because this dimension relates to the ability
that pharmacists have in the field of pharmacy to convince patients that the pharmacist who
serves it is truly capable. according to MOH (2004),
in pharmacy managers, pharmacists must always have the ability to provide and provide good
service, make the right decisions, be able to communicate between professions, place themselves
as leaders in multidisciplinary situations, the ability to manage human resources effectively,
always learn throughout their careers and help provide education and opportunities to increase
knowledge.

The fifth dimension is empathy (empathy) which shows that the pharmacy understands
the customer's problems and acts in the interests of the customer, and gives personal attention to
customers and has a comfortable operating hours. There are five questions to examine the
dimensions of empathy, among others: (the final question); the pharmacist gives you counseling
(eighteen questions); the pharmacist cares about your needs regardless of your status (question
nineteen); the pharmacist will respond to your request according to what you really want
(question twenty); and pharmacists always prioritize your interests (questions and answers).
Based on the results of the overall service quality assessment for the dimension of empathy, the
expected service value is six, five and the reality is felt at five, enamsembilan. The value of
service quality for the dimension of empathy is -nol, eighty-three. This shows that overall the
quality of the servant's dimensions of empathy still cannot meet the patient's expectations. The
position of the empathy dimension is in quadrant A which shows the dimension of empathy
requires priority to be addressed. But the perceived value of more than five (quite agree) and
detect enm (agree) which indicates the reality felt by patients is still quite good for the dimension
of empathy. So for the dimension of empathy, the quality of service must be reviewed. This is
classified as failure due to the unexpected actions of employees or pharmacists due to the
indifference that ignores customers. Therefore training of pharmacists and employees is needed
to increase sensitivity to patients and there must be a standard of service to patients, for example,
like five Ss (smile, greetings, greetings, polite, polite).

Based on the results of the overall service quality assessment for all dimensions of
service quality obtained the expected service value of six, five and the perceived reality is five,
seven. The value of service quality for all dimensions of service quality is -nol, seven-nine. This
shows that overall service quality still cannot meet the expectations of all patients. But the reality
that is felt is still quite good according to consumers because it is still in the range of five (quite
agree) and six (agree) even though they still cannot meet patient expectations.

According to Tjiptono (2004), the problems faced by service providers can be traced
from the main source namely: forty percent of the time caused by the pharmacy itself, twenty
percent of the employee's problems and forty percent are caused by customers. Every provision
of services must make a mistake. But the ability of service providers to handle problems is a key
factor that determines success or failure to retain customers.

12
 According to Bowen and Johnston (1999) in Tjiptono (2004) after research and the
results turned out to be not in accordance with customer expectations, service recovery needs to
be done which includes several things, including: response, information, action and
compensation.
Through this research, the health office can evaluate the prescription services that have
been carried out so far, because after the decision of the Republic of Indonesia health minister
number satukosongduatujuh / MENKES / SK / IX / DUARIBUHEMPAT regarding the standard
of pharmacy services at the pharmacy, evaluation has not been carried out pharmacy at the
pharmacy, especially in prescription services.

13