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June 17, 2008

Patient compliance with prescription regimens, evil for-profit health care companies, and Health 2.0

Last week, Paul Levy blogged on patient compliance with drug regimens, offering some statistics courtesy of Express Scripts, the recently-fined PBM.  (I caught wind of Paul's post only yesterday, thanks to my wife the Luddite who has the Boston Globe delivered to our doorstep.) 

No surprise, compliance is kinda low.  Commenters on Paul's post noted -- among other things -- that (1) using the word "compliance" is un-PC, as it assumes that Doctor Knows Best, (2) MDs are run ragged by HMOs so they can't be expected to explain drug regimens to patients and (3) can't trust Express Scripts.

(Interestingly, as an aside, Express Scripts announced this spring the establishment of The Center for Cost-Effective Consumerism once it realized that it could influence consumers to switch to higher-profit-margin generic cholesterol medications.)

This brought to mind a troubling statistic I saw a few weeks ago: Massachusetts is number one in the nation for e-prescribing, but that only means that 13% of scrips are handled electronically.  The rate of adoption has been infernally slow here in Beantown, even worse elsewhere (top ten states include some barely above the 2.5% mark).  The federales may try to mandate encourage eprescribing using legislative carrots, and have laid the groundwork for a national e-prescribing system with uniform standards through regulations (see the e-prescribing regs issued recently by CMS (see related press release and e-prescribing page).      

The regs address many of the concerns of the naysayers (esp. interoperability, and also privacy concerns, though further legislative action -- e.g. "TRUST" -- would be helpful), and the potential benefits are enormous: avoiding the illegible scrawl/med error issue, automated drug interactions checks, cost savings to patients through improved and automated prescriber-insurer-pharmacy communication about formulary restrictions and -- back to Paul's issue --  feedback to prescribers regarding whether or not a prescription has been filled (many are not), giving prescribers and their staffs an opportunity to contact noncompliant patients with reminders or potentially other resources (including financial resources and referrals to sources of payment/insurance) to address the reasons for noncompliance.

-- David Harlow

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