You all know how much we hate the term "compliant," and especially its antonym "noncompliant"— suggesting a bunch of naughty, misbehaving patients who are simply too lazy or stubborn to follow orders. Ugh!
It's been encouraging in the last few years to see many healthcare and pharma professionals realizing how un-PC the term "compliant" is, because it doesn't reflect the least bit of empathy for just how difficult it is to perform some pretty unpleasant health tasks day in and day out, for the rest of our lives, often with frustrating results!
Also, "compliance" covers everything: eat right, exercise X hours per week, get your lab tests often, and test your sugar over and over in a perfect daily drumbeat of diabetes management. NOT.
Three of the big chain pharmacies have recently launched "adherence" programs specifically for diabetes:
* Express Scripts Inc. just unveiled a new program for contacting people who fail to take their prescription drugs — before they actually stop. They're using advanced data analytics to "accurately predict up to a year in advance which patients are most at risk of falling off their physician-prescribed drug therapy" and then they intervene by sending reminders, and offering consultations with a pharmacist, lower co-pays, transition to home delivery of meds, and/or auto refills and renewal assistance.
* CVS/Caremark is doing something similar, offering "pharmacist-initiated phone calls, or face-to-face counseling with a pharmacist at a local CVS/Pharmacy," and offering members "options and solutions to enable them to get the most out of their pharmacy benefit and identify opportunities for cost savings," along with educational materials.
* Walgreens is testing a new "Optimal Wellness" program that offers face-to-face diabetes care coaching with pharmacists in their stores. "Through accessible community pharmacies, our program brings patients the tools they need to live healthier and more productive lives," they claim.
I wonder, though, is adherence just another concept to flog patients with? Or is it possibly something parading as patient assistance that's really just an excuse to push product? If you look closely — despite the claims to offer patient education — many of these new adherence programs appear suspiciously like campaigns to 1) simply bug people to keep refilling their prescriptions, and 2) self-servingly "expand the pharmacist's role as a trusted provider of health care services" (a direct quote from the Walgreens press release).
Several problems here:
â™£ Digging into people's data to see who's been taking their meds also brings up a bevy of privacy and ethical concerns, as noted a few days ago in the Wall St. Journal.
â™£ Is the act of simply refilling prescriptions the right indicator?
Can you assume that just because patients are spending money to refill meds, that they're consuming them regularly and correctly?
Well... there's me for example, and that statin drug my endo insisted on. I filled the script all right, but later decided that I felt uncomfortable taking them, since my cholesterol was barely high, and there's still a lot of controversy over the effects of long-term statin use. So the pills sat in my medicine cabinet for a few months, until we recently changed insurance providers again and the script was automatically refilled. Snap! Now I own TWO three-month supplies of a medication I do not take. I sure as heck don't want anyone calling me to remind me I haven't refilled in a while.
â™£ I really wonder what the content and quality of the "patient education" portion from these pharmacies is? We PWDs know full well what variety exists in that arena.
â™£ And what happens after patients leave the pharmacy? What keeps them motivated over the long haul? As my wonderful CDE Gary Scheiner says, "If people take their health seriously, they'll take the meds — but motivation for each individual is all about finding something about (diabetes care) that's important to YOU."
"If I'm dealing with a teenager for example, I never talk about A1c or average blood glucose levels at all. They don't care about that. I talk about sports performance, academics, social life, and maybe that acne they've got (because if their sugars are high, the skin gets dehydrated and they'll have more skin problems). That's the stuff they care about."
I wonder, can institutional "adherence" programs possibly acknowledge the simple fact that people don't care about medical stats - they care about their lives?
Some studies are starting to show that the combination of med reminders and patient education efforts can help crack the nut on behavior change.
But I'd like to put the question out to the real patients living "in the trenches": what do you think would help you or other PWDs you know become more compliant, er... adherent? Or whatever you want to call it?