Who’s To Blame For Lousy Patient Adherence?
23 CommentsBy Ed Silverman // September 15th, 2011 // 9:54 am
This may depend upon who one asks, but a majority of pharmacists apparently believe they have only themselves to blame. At least that is the outcome of new survey, which finds that 76 percent of pharmacists say they have the most responsibility for patient adherence and compliance. Another 16 percent cite physicians, while only 5 percent point to manage care and 3 percent finger drugmakers.
Yet, sufficient incentive programs appear to be lacking to encourage pharmacists to spend more time on patient compliance and adherence. Although some drugmakers and insurers offer,programs to pay pharmacists for medication counseling sessions with patients, only 24 percent participate, according to the survey by Industry Standard Research, a market research firm.
In fact, only 14 percent are very familiar with these programs and another 34 percent are somewhat familiar. But 20 percent have never heard of these programs at all. ISR, by the way, canvassed 86 US pharmacists, of which 64 percent work in large retail chains, 33 percent work in independent pharmacies and 3 percent work as compounders. Hospital pharmacists were not queried.
“One thing that has come to light through our research was the disproportionate number of pharmacists who indicated that they were not incentivized to promote adherence, compliance, or refills,” ISR president Andrew Schafer says in a statement. “On top of that, those who would benefit the most from such programs, pharmaceutical manufacturers and managed care organizations, have shown less than satisfactory performance in providing pharmacists with necessary information and materials when a program is in place.”
For those wondering what pharmacists think of drugmakers and managed care, well, this is a mixed bag. Two-thirds of the pharmacists are satisfied with pharma; of course, this means one third are not. And only 46 percent of pharmacists are satisfied with managed care. Given the tension that is often described by pharmacies, though, this actually seems higher than what one might have expected.
Salient point
So patients bear no responsibility whatsoever for adhering to their Rx’s. What a strange world we live in.
Karl in FL
“One thing that has come to light through our research was the disproportionate number of pharmacists who indicated that they were not incentivized to promote adherence, compliance, or refills,” ISR president Andrew Schafer says
You’ve got to be kidding me! All pharmacists graduate today as PharmDs and are paid handsomely for their work. They are supposed to be professionals who should NOT (in my mind anyway) need any special incentives to do their job!
Believer
Salient, EXACTLY my feelings. If they are incompetent,then that’s another story.
Ancient PharmD
1. 46% - it depends on the population of pharmacists being asked. Community RPh’s or RPh in any practice setting.
2. In community settings the reimbursement structure essentially forces pharmacists to do things that are paid for and to avoid activities that do not help pay the bills. Consequently, it’s not that pharmacists need ’special’ incentives it’s just that the pharmacist employers need an incentive so that they will even allow the pharmacist to devote time to compliance. If you are an independent pharmacy and can decide for yourself if you want to provide a service that is not reimbursed at all. However for the majority of community pharmacists that work in chains their employers will actively discourage it and place impediments in the way as it doesn’t contribute to the bottom line.
Barbara Duck
This is an interesting topic indeed and of course the data world thinks they can solve this and there might be some advantages here but also take the case of FICO marketing which is mis matched data and information from the web combined with patient credit standings.
With all of healthcare marketing their “ass” off today it’s gets a bit gray as to what is marketing and what is good predictive behavior analytics. Myself I called FICO on their analytics as shear marketing to sell their analytics services to pharma and insurance companies. This will indeed lead to denial of drugs and services when interpreted incorrectly and used as the “gospel” when looking at cost for treating patients. We have a lot of good analytics out there today but I don’t this this is one of them.
http://ducknetweb.blogspot.com/2011/06/fico-analytics-press-release-marketing.html
Working with MDs in health IT, a lot are based on their pay for performance bonuses based on the information supplied by the insurers and it is not accurate as if a patient goes outside the plan and buys a $4 generic prescription and it is not under their current health plan the MDs get dinged for non compliant patients, old story happens all the time.
Yes you are correct with insurers paying pharmacists for P4P too, United having a pretty well publicized agreement with Walgreens that are compensated for signing up patients for the YMCA and other programs, and again somewhere along the line someone gets data for sale it seems. Walgreens publicly said their data selling business is worth just under $800 million.
http://ducknetweb.blogspot.com/2011/08/unitedhealth-ymca-expand-diabetes.html
I think no matter how the cut it, the best compliance comes from a strong doctor-patient relationship, but that’s just me.
Salient point
Believer-I agree, minors & incompetents should be excluded, but like you I’m not sure why a man who doesn’t comply with his hypertension meds for 20 years gets to hang his heart attack on his pharmacist.
And where oh where are all those people posting about Gardasil, who seem to think people taking personal responsibility for their own actions is the solution to every communicable disease, on this issue?
Believer
Salient, you are again spot on.
Karl in FL
Ancient PharmD - Then it is worse than I thought. A brand, spanking new PharmD who spends a lot of time learning how to function as a clinical pharmacist, is basically told to fuhgedaboutit when starting at a chain. How demoralizing is that?
Salient and Believer - Your points are valid - what about those patients who never were told just how important it is to following the dosing instructions? Doctors rarely do so in my experience; this leaves the pharmacist; because certainly few patients will read the PPI given to them.
original industry insider
We see these patients all the time, such as the patients who are feeling “ok” and skip their generic BP pills, and eventually wind up on the ER doorstep with a hemorrhagic stroke.
I’m looking at a medication bottle as I type. It says “TAKE X MEDICATION BID AS DIRECTED”. Even a donkey with a third grade education can figure that out. Agree with Salient on personal responsibility. Then again, in many spheres of life these days people are increasingly less willing to take their responsibility for their actions, and in this case the health care system has to deal with the fallout.
Hels
As a pharmacist with almost 10 years of experience… Even taking the single store, there are a lot more things I have to do today than 4 years ago when I first started at this location, yet my tech hours have been cut to almost half of what they were then. There is ONE pharmacist on duty (except for an hour in the middle of the day when morning pharmacist has not left yet and the evening pharmacist has just come), ONE technician at a time (and there are times when there is no technician, such as early during the day, late at night, and in the middle of the day when both pharmacists are there), and the pharmacy processes between 250 and 300 prescriptions a day. Add to that facts that the population which is 90% non-English speaking with a lot of first-time patients, there are a lot of calls to physicians to change prescriptions due to them not being covered by the patient’s insurance - and you get between 4 and 8 patients either standing in line at the pharmacy window or waiting in the pharmacy waiting area at any given time, and at least two phones ringing at any given time. Then there are two drive through lanes to add to it. And compounding service. And doing flu shots (which is not that long to do the shot, but the amount of paperwork for each shot is staggering). Guess how much time that leaves for counseling? Unless the patient asks for it, the patient is not going to get it. They are asked “do you have any questions about your med?” but then it is up to them to say yes. Which most people don’t do.
And yes, I have seen a decrease in willingness and ability of patients to take care of themselves. Too many people expect to be taken care of, waited on hand and foot, and never assume accountability for anything.
Karl in FL
Right, Hels - Then we must look to the owners of the pharmacies to provide sufficient number of pharmacists and techs to allow each to perform their job the way they know it should be. It’s time for the owners to invest in their patients, even if it leaves less to the bottom line.
Angry Pharm.D
I really do feel bad for the pharmacists who have to deal with their employer who puts the opinion of the public over their own employees.
These days pharmacists have to council their half-witted, smoking, attention-deficit patients through a drive through window and whatever music happens to be playing in their car.
Cant blame pharmacist for that; its the chains who thought up that clever idea.
original industry insider
In one of the offices I visit, the instructions to the janitorial staff on the garbage cans are printed in three different languages. Maybe if the patient PI’s were printed in multiple languages it might help since we have a multilingual society in the US
These documents should already exist since most drugs are sold world wide. Just a few key strokes would get the multilingual PI’s into the hands of the pharmacist.
CPH Researcher
This research is simply a marketing play by the big pharmacy chains to get more pharma companies to pay them to DO THEIR JOB.
Pharmacy chains are walking a tight rope on this issue. On the one hand, they want to put patient adherence on the list of responsibilities of pharmacy and offer services for a fee to pharmaceutical companies. They will contract with pharmaceutical companies to send emails, letters and make phone calls to patients who are not coming in for refills. In many cases, these emails and letters will come with all sorts of marketing messages from the pharma company. The pharmacy chains define this as part of the practice of pharmacy because if they don’t do that it would look like a marketing program that they do for pharma companies. And if it’s realy just a marketing program, then the privacy laws say that the pharmacies need an authorization from their patients first. But the pharmacy chains don’t want to do that, it will slow eveything down at the point of sale. So they take the position that it’s not marketing, it’s actually part of the practice of pharmacy and therefore does not need any patient authorization. Hmmmmmm, interesting.
So this approach leads to two interesting questions: 1. if it’s really part of the practice pharmacy, then why should pharmacists only do it if they are paid by pharma companies? Why aren’t they doing it for generics? Why aren’t they doing it for every patient who is not being compliant with their meds? And 2. If it’s really part of the practice of pharmacy and the pharma companies are paying them to do it, then does that mean that pharma companies are paying pharmacists to do their jobs? Doesn’t that raise kickback concerns that maybe someone should be looking at?
Maybe this is one area where some pharmaceutical companies are actually taking the high road, recognizing that if it’s really part of the practice of pharmacy then pharmacy chains shouldn’t be asking to get paid for it. Maybe they should just do it.
Just a thought.
Salient point
original-I typically agree with you but not in this instance. The PI is US-specific; it doesn’t exist in other countries.
More importantly, the idea that a government institution like FDA would spend resources reviewing & approving documents in Spanish &, dare I say it, Arabic in this political climate seems naive.
original industry insider
Salient, I agree in principle. Language barriers notwithstanding, one of the requirements in NJ for physician CME accreditation is demonstrating what is called “cultural competence”. The requirements are very specific, and are summarized as follows:
1.A context for the training, common definitions of cultural competence, race, ethnicity and culture and tools for self assessment.
2.An appreciation for the traditions and beliefs of diverse patient populations, at multiple levels- as individuals, in families and as part of a larger community.
3.An understanding of the impact that stereotyping can have on medical decision making.
4.Strategies for recognizing patterns of health care disparities and eliminating factors influencing them.
5.Approaches to enhance cross-cultural skills, such as those relating to history-taking, problem solving and promoting patient compliance.
6.Techniques to deal with language barriers and other communication needs, including working with interpreters.
On rare occasions I observe pharmacists demonstrating these competencies, as they are encouraged, but not required to do so (see link). Perhaps if the requirements for continuing pharmacy education were to include examinations to demonstrate cultural competence patients with language barriers might feel more comfortable discussing their Rx’s with pharmacists.
Before that can be done we need to get the pharmacist off the phone with the insurance cos. and PBM’s so that they can spend more time counseling patients.
Salient point
orginal-Afraid I still disagree with the political feasibility of this. NJ may have these requirements but it’s hardly representative of the nation. It hasn’t supported a GOP presidential candidate since 1988.
Introducing additional regulations to increase “cultural competence” for a retail industry on a national basis seems extraordinarily unlikely.
original industry insider
Salient, you’ve convinced me. Therefore my answer is to take pharmacist licensing and regulations out of the hands of the individual states and on nationalize it. While I think that I can make a case for state-based regulation of physicians based on the well accepted regional differences in “usual and customary practices”, I see no reason why, for example a prescription for Prozac to an Hispanic patient in California should be dispensed any differently, and without any differences in cultural competency as compared to a pharmacist who dispenses that same Prozac Rx to an Hispanic patient in New Jersey. Thus my arguement for a uniform national standard, with all pharmacists taking the same exam and answering the same questions on cultural competence.
Salient point
original-Just to be clear–I’m not taking issue with your proposals, I just don’t think they’re realistic. And now we’re dragging in the rights of states to regulate themselves, which I’m afraid only adds another layer of road blocks to everything I’ve said up to now.
Doc
Patients.
original industry insider is an IDIOT
oii:
What the heck do you know about cultural competence? What the heck would your proposed test look like?? Are you proposing to make every healthcare professional fluent in Spanish before they can obtain licensure? Sounds like you should be on the Obama administration with that worthless, impossible-to-implement idea.
You are such an ignorant know-it-all, spreading your mis-information here, I have decided to permanently change my username to codify your idiocy.
Happy weekend.
original industry insider
To oiiiai: In fact there is at least one urban medical school in a city with a concentrated Hispanic population that in fact does require second year medical students to learn the basics of conversational Spanish. Therefore not only is such language instruction not far fetched, it is a required course for med students as it should be for other health care students in these urban areas.
Therefore, before you comment on the way out nature of teaching foreign languages to students in the health care professions you should do a bit of homework. Or you can choose not to do your homework and the rest of us can chuckle at your ignorance. Your choice.
original industry insider
What do ketchup packets have to do with patient adherence? The answer is a lot. There was an article in todays WSJ (I’m an industry shill, after all, what else would I read?) that discusses the design of the new Heinz ketchup packets. Fast food chains have noticed a decreasing percentage of patrons who order french fries “to go” with their burgers and nuggets, and the strong suspicion was that patrons didn’t want to deal with the difficulty and messiness of trying to open those pesky Heinz ketchup packets.
Thus Heinz was commissioned to do a study to evaluate how customers opened and used the packets. Heinz representatives hid out in fake minivans in the parking lot behind one way glass to watch the packets being opened. Their suspicions were confirmed. As a result Heinz has redesigned a more user-friendly packet, although I must confess that I will miss the feeling of squirting the ketchup from the old packet directly into my mouth, followed by a french fry chaser.
If a study could be designed to put hidden cameras in people’s homes they would probably learn a lot more about how people store and take medicine, not the least of which is the difficulty arthritic seniors have with opening child-proof caps. I think a lot could be learned about patient adherence from such a study.