Physicians’ perspectives regarding non-medical switching of prescription medications: Results of an internet e-survey
Autoři:
Tabassum Salam aff001; Amy Duhig aff002; Aarti A. Patel aff003; Ann Cameron aff002; Jennifer Voelker aff003; Brahim Bookhart aff003; Craig I. Coleman aff004
Působiště autorů:
Medical Education, American College of Physicians, Philadelphia, PA, United States of America
aff001; Consulting Services, Xcenda, Palm Harbor, FL, United States of America
aff002; Janssen Scientific Affairs, LLC, Titusville, NJ, PA, United States of America
aff003; University of Connecticut School of Pharmacy, Storrs, CT, United States of America
aff004; Evidence-Based Practice Center, Hartford Hospital, Hartford, CT, United States of America
aff005
Vyšlo v časopise:
PLoS ONE 15(1)
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pone.0225867
Souhrn
Background
Physicians are in an ideal position to describe the impact of medication non-medical switching (switching commonly due to formulary changes by insurer for reasons unrelated to patient health) on their practice dynamics and patient care. We sought to examine physicians’ openness to requests for non-medical switching and their experiences and opinions regarding the impact of non-medical switching on their practice, staff and patients.
Methods
An online survey of randomly-sampled physicians spending ≥10% of time providing patient care and having received ≥1 non-medical switch request during the prior 12-months. The impact of non-medical switching on clinical decision-making process; professional experience with clinical practice, patient-physician relationship, insurance process; and perceived impact on practice, staff and patients were assessed. Weighted percent responses were calculated.
Results
We sampled 1,010 physicians (response rate = 55.5%). Many responded being frequently not amenable (26.0%) or had reservations (41.8%) to non-medical switch requests; with >50% indicating patient stability on current therapy and suboptimal alternatives as factors frequently influencing amenability. Physicians agreed non-medical switching can create ethical concerns (clinical judgement, autonomy, ability to treat per guidelines; 74.8%, 82.3%, 53.5%, respectively), while forcing them to take responsibility for insurers’ decisions (81.1%) and diverting their clinical time (84.3%). Most indicated non-medical switching increased practice burden (administrative, non-billable interactions, additional staffing, non-office patient contact, calls to/from the pharmacy; 85.0%, 72.5%, 62.2%, 64.2%, 69.5%, respectively). Physicians felt insurer processes discouraged non-medical switch challenges (76.7%) and required inconvenient lengths-of-time (76.1%) speaking to insurer representatives without proper expertise (62.0%). They believed non-medical switching negatively impacted aspects of care (effectiveness, side-effects, medication adherence and abandonment, out-of-pocket costs, medication errors; 46.5%, 53.2%, 50.6%, 49.4%, 59.6%, 54.5%, respectively).
Conclusions
Physicians were frequently not amenable or had reservations regarding non-medical switching. They noted ethical concerns due to non-medical switching. Most felt non-medical switches burdened their practice and negatively impacted care.
Klíčová slova:
Physicians – Drug therapy – Surveys – Decision making – Insurance – Primary care – Treatment guidelines – Medical ethics
Zdroje
1. American Medical Association. H-125.991 Drug formularies and therapeutic interchange. Available at: https://policysearch.ama-assn.org/policyfinder/detail/Drug%20Formularies%20and%20Therapeutic%20Interchange%20H-125.991?uri=%2FAMADoc%2FHOD.xml-0-227.xml. (Last accessed on August 6, 2018).
2. Prior Authorization and Utilization Management Reform Principles. American Medical Association. 2017. Available at: https://www.ama-assn.org/sites/default/files/media-browser/principles-with-signatory-page-for-slsc.pdf. (Last accessed on November 10, 2018).
3. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med 2014;12:573–576. doi: 10.1370/afm.1713 25384822
4. Centers for Medicare and Medicaid Services. Patients Over Paperwork. Available at: https://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/PatientsOverPaperwork.html (Last accessed on April 24, 2019).
5. Patients Before Paperwork. American College of Physicians. Available at: https://www.acponline.org/advocacy/where-we-stand/patients-before-paperwork (Last accessed on April 24, 2019).
6. Nguyen E, Weeda ER, Sobieraj DM, Bookhart BK, Tak Piech C, Coleman CI. Impact of non-medical switching on clinical and economic outcomes, resource utilization and medication-taking behavior: a systematic literature review. Curr Med Res Opin. 2016;32:1281–1290. doi: 10.1185/03007995.2016.1170673 27033747
7. Gray T, Bertch K, Galt K, Gonyeau M, Karpiuk E, Oyen L, et al.; American College of Clinical Pharmacy. Guidelines for therapeutic interchange– 2004. Pharmacotherapy. 2005;25:1666–1680. doi: 10.1592/phco.2005.25.11.1666 16232030
8. Erickson SM, Rockwern B, Koltov M, McLean RM, for the Medical Practice and Quality Committee of the American College of Physicians. Putting Patients First by Reducing Administrative Tasks in Health Care: A Position Paper of the American College of Physicians. Ann Intern Med. 2017;166:659–661. doi: 10.7326/M16-2697 28346948
9. Not What the Doctor Ordered. Barriers to Healthcare Access for Patients. The Doctor-Patient Rights Project. August 2017. Available at: https://doctorpatientrightsproject.org/dprpreports/not-what-the-doctor-ordered/ (Last accessed on April 24, 2019).
10. Putting Profits Before Patients: Provider Perspectives on Health Insurance Barriers That Harm Patients. The Alliance for the Adoption of Innovations of Medicine. 2018. Available at: https://aimedalliance.org/wp-content/uploads/2018/10/Aimed-Alliance-Primary-Care-Survey-Report.pdf (Last accessed on April 24, 2019).
11. Special Commission to Study Switching Medications Report to the Massachusetts Legislature. 2018. Available at: https://www.mass.gov/files/documents/2018/06/06/final-report-special-commission-report-on-medication-switching.pdf. (Last accessed on November 10, 2018).
12. 2018 AMA Prior Authorization (PA) Physician Survey. American Medical Association. 2019. Available at: https://www.ama-assn.org/system/files/2019-02/prior-auth-2018.pdf (Last accessed on April 23, 2019).
13. National Ambulatory Medical Care Survey: 2015 State and National Summary Tables, Centers for Disease Control and Prevention. 2015. Available at: https://www.cdc.gov/nchs/data/ahcd/namcs_summary/2015_namcs_web_tables.pdf. (Last accessed on April 22, 2019).
14. Eysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res. 2004;6:e34. doi: 10.2196/jmir.6.3.e34 15471760
15. Holt D, Smith TMF. Post Stratification. J R Stat Soc Ser A. 1979;142:33–46.
16. 2018 Physician Specialty Data Report: Executive Summary. Association of American Medical Colleges. 2018. Available at: https://www.aamc.org/download/492910/data/2018executivesummary.pdf (Last accessed on April 22, 2019).
17. Nickel WK, Weinberger SE, Guze PA; Patient Partnership in Healthcare Committee of the American College of Physicians. Principles for Patient and Family Partnership in Care: An American College of Physicians Position Paper. Ann Intern Med. 2018;169:796–799. doi: 10.7326/M18-0018 30476985
18. A Crisis in Health Care: A Call to Action on Physician Burnout. Massachusetts Medical Society, Massachusetts Health and Hospital Association, Harvard T.H. Chan School of Public Health, and Harvard Global Health Institute. 2018. Available at: http://www.massmed.org/News-and-Publications/MMS-News-Releases/Physician-Burnout-Report-2018/ (Last accessed on April 27, 2019).
19. Han S, Shanafelt TD, Sinsky CA, Awad KM, Dyrbye LN, Fiscus LC, et al. Estimating the Attributable Cost of Physician Burnout in the United States. Ann Intern Med. 2019 May 28. doi: 10.7326/M18-1422 [Epub ahead of print] 31132791
20. Prescription Drug Formulary Legislation in Select States. Research Report. Connecticut Office of Legislative Services. 2017. Available at: https://www.cga.ct.gov/2017/rpt/pdf/2017-R-0203.pdf (Last accessed on April 27, 2019).
21. Phillips AW, Reddy S, Durning SJ. Improving response rates and evaluating nonresponse bias in surveys: AMEE Guide No. 102. Med Teach. 2016;38:217–228. doi: 10.3109/0142159X.2015.1105945 26648511
22. Allery LA. Design and use questionnaires for research in medical education. Educ Prim Care. 2016;27:234–238. doi: 10.1080/14739879.2016.1175914 27126779
23. Young A, Chaudhry HJ, Pei X, Arnhart K, Dugan M, Snyder GB. A Census of Actively Licensed Physicians in the United States, 2016. J Med Reg 2017; 103:7–21.
24. The Number of Practicing Primary Care Physicians in the United States. Content last reviewed July 2018. Agency for Healthcare Research and Quality, Rockville, MD. Available at: http://www.ahrq.gov/research/findings/factsheets/primary/pcwork1/index.html (Last accessed on April 22, 2019).
25. Professionally Active Specialist Physicians by Field. Henry J. Kaiser Family Foundation. March 2019. Available at: https://www.kff.org/other/state-indicator/physicians-by-specialty-area/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D (Last accessed on April 22, 2019).
26. Dalen JE, Ryan KJ, Alpert JS. Where Have the Generalists Gone? They Became Specialists, Then Subspecialists. Am J Med. 2017;130:766–768. doi: 10.1016/j.amjmed.2017.01.026 28216448
Článok vyšiel v časopise
PLOS One
2020 Číslo 1
- Metamizol jako analgetikum první volby: kdy, pro koho, jak a proč?
- Parazitičtí červi v terapii Crohnovy choroby a dalších zánětlivých autoimunitních onemocnění
- Nejasný stín na plicích – kazuistika
- Masturbační chování žen v ČR − dotazníková studie
- Eliquis (apixaban) nově hrazen ze zdravotního pojištění
Najčítanejšie v tomto čísle
- Psychometric validation of Czech version of the Sport Motivation Scale
- Comparison of Monocyte Distribution Width (MDW) and Procalcitonin for early recognition of sepsis
- Effects of supplemental creatine and guanidinoacetic acid on spatial memory and the brain of weaned Yucatan miniature pigs
- Accelerated sparsity based reconstruction of compressively sensed multichannel EEG signals