Use technology to aid your compliance efforts
Pharmacists enhance outcomes, protect privacy
By Jeff Herzfeld, PharmD
Medication compliance programs based on sophisticated database technology are producing impressive response rates and improving patient care. Some health care, government, and consumer groups, however, have expressed concerns that these programs infringe on patient privacy. These concerns have been recognized by pharmaceutical manufacturers, wholesalers, and pharmacists. With proper safeguards, however, medication compliance programs validate the concept of technology-driven compliance efforts.
According to the U.S. Food and Drug Administration, 30% to 50% of patients taking medications do not use them as directed. The Department of Health and Human Services reports that noncompliance may be responsible for as many as 10% of all hospital admissions. The National Pharmaceutical Council estimates that noncompliance costs more than $100 billion a year for services such as increased additional physician office visits, emergency room treatment, hospital admissions, nursing home admissions, lost productivity, and premature deaths.
Establishing database technology
The increase of computer processing speeds, data storage, and networking capabilities has created a powerful database technology that serves as the backbone of successful compliance programs, and some manufacturers and wholesalers have established compliance programs supporting these pharmacies’ participation.
Pharmacies can go on line with centralized databases capable of storing millions of patient names from thousands of stores. Critical to compliance success, the database gathers information in real time — identifying patients taking specific medications and when the prescriptions are filled.
A number of days after a prescription refill date, a letter is generated on behalf of the local pharmacist advising the patient that the refill is overdue. Information on the importance of maintaining the prescribed medication regimen also is included.
Raising compliance and patient care
Compliance programs built on powerful database technology work. The University of Pittsburgh performed a clinical study (funded by SmithKline Beecham) of 3,800 smokers who used Nicorette to quit. As a result, 36% of those in a compliance program quit smoking for six continuous weeks, compared with 24% who were not in the compliance program.
A program co-sponsored by DuPont Pharma ceuticals reported a 25% increase in compliance among patients who were three days late in refilling prescriptions for the blood-thinning product Coumadin. When patients who still had not refilled their prescriptions after 10 days received a follow-up refill reminder, compliance was 29% greater than among those who did not receive such a reminder. (The Pink Sheet, March 30, 1998.)
And along with simple compliance, outcomes have been shown to improve. For example, patients realized an estimated 39% reduction in cholesterol when fully compliant with their lipid-lowering medications, according to the authors of a study of seniors enrolled in New Jersey’s Medicaid and Pharmacy Assistance for the Aged and Disabled programs (published in the Journal of the American Medical Association, 1998). Another study by the Agency for Health Care Policy and Research (September 1995), showed that the increased use of a blood-thinning drug would prevent 40,000 strokes a year.
"Compliance with anti-hypertensive medication is one of the most important factors in successfully achieving blood pressure control," Peter Rudd, MD, a professor of medicine at the Stanford University School of Medicine, stated at the 1997 meeting of the American Society of Hypertension.
Medicine or marketing
While health benefits and the ability to help control health care costs have been widely acknowledged, the use of database technology in compliance programs has raised important questions regarding patient confidentiality. Some patients, consumer advocates, and legislators have expressed concern that such programs infringe on patient privacy.
Reflecting on this issue, The National Under writer (April 13, 1998) reported Congressional concerns about developing a national medical confidentiality standard. In response, pharmaceutical industry associations pointed out that patient compliance programs are conducted routinely by all segments of the health care industry — including health care plans, pharmacy benefit managers, pharmacies, drug manufacturers, and wholesalers — but that the more conscientious programs do not involve the sale of information to outside companies.
Some compliance program administrators have responded by adopting a policy of "prior consent." Patients are asked to give their permission to be included in a compliance program before their names and data are used in the database. Patients may stop participating in the program at any time.
Efforts like the Patient Care Enhancing Program (PCEP), sponsored McKesson Corp. in San Francisco, use just such an "opt in" feature. Beginning in November 1997, patients filling or refilling a prescription were asked to give their written consent to participate in PCEP. Manu facturers involved in sponsoring the program do not have access to patient-specific information.
Such patient care programs, which interface with existing pharmacy systems, consist of various components from which letters are sent to patients on behalf of the participating pharmacist. Refill reminders aim to enhance compliance and persistency through automatic mailings to patients who are late in refilling their prescriptions.
A second reminder may be sent if the patient still does not refill the prescription after receiving the first letter. Other optional programs send information on over-the-counter options, new formulations, or simple medical details about the prescription drug a given patient is taking.
The compliance programs are designed to inform patients about medications prescribed by their physicians, but they do not suggest switching to a different brand.
In recent years, pharmacists have been asked to play an increasingly greater role in patient health care. Almost all find themselves overextended with less time to provide one-on-one patient counseling than they would like. Database-enabled compliance programs supplement pharmacists’ communications and allow them to provide important advice to more patients.
As database technology grows in sophistication, pharmacists will have even more powerful tools with which to participate in compliance programs and better serve their communities. In turn, concerns about privacy must continue to be addressed so database technology remains a servant of the health care system, not its master.
Jeff Herzfeld, PharmD, is senior vice president of pharmaceutical product management at McKesson Corp. in San Francisco. E-mail: [email protected]. For guest column submissions, contact Drug Utilization Review at [email protected].
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