Using Feedback Informed Treatment to Improve Medication Adherence and Reduce Healthcare Costs

September 10, 2014 By scottdm Leave a Comment

Medication adherence is a BIG problem. According to recent research, nearly one-third of the prescriptions written are never filled. Other data document that more than 60% of people who actually go the pharmacy and get the drug, do not take it as prescribed.

What’s the problem, you may ask? Inefficiency aside, the health risks are staggering. Consider, for example, that the prescriptions least likely to be filled are those aimed at treating headache (51 percent), heart disease (51.3 percent), and depression (36.8)percent).

When cost is factored into the equation, the impact of the problem on an already overburdened healthcare system becomes even more obvious. Research indicates that not taking the medicines costs an estimated $290 billion dollars per year–or nearly $1000 for every man, woman, and child living in the United States. It’s not hard to imagine more useful ways such money could be spent.

What can be done?

Enter Dr. Jan Pringle, director of the Program Evaluation Research Unit, and Professor of Pharmacy and Therapeutics at the University of Pittsburgh. As I blogged about back in 2009, Jan and I met at a workshop I did on feedback-informed treatment (FIT) in Pittsburgh. Shortly thereafter, she went to work training pharmacists working in a community pharmacy to use the Session Rating Scale ([SRS] a four-item measure of the therapeutic alliance) in their encounters with customers.

It wasn’t long before Jan had results. Her first study found that administering and discussing the SRS at the time medications were dispensed resulted in significantly improved adherence (you can read the complete study below).

She didn’t stop there, however.

Just a few weeks ago, Jan forwarded the results from a much larger study, one involving 600 pharmacists and nearly 60,000 patients (via a special arrangement with the publisher, the entire study is available by clicking the link on her publications page of the University website).

Suffice it to say that using the measures, in combination with a brief interview between pharmacist and patient, significantly improved adherence across five medication classes aimed at treating chronic health conditions (e.g., calcium channel blockers, oral diabetes medications, beta-blockers, statins, and renin angiotemsin system antagonists). In addition to the obvious health benefits, the study also documented significant cost reductions. She estimates that using the brief, easy-to-use tools would result in an annual savings of $1.4 million for any insurer/payer covering at least 10,000 lives!

Prior to Jan’s research, the evidence-base for the ORS and SRS was focused exclusively on behavioral health services. These two studies point to exciting possibilities for using feedback to improve the effectiveness and efficiency of healthcare in general.

The tools used in the pharmacy research have been reviewed and deemed evidence-based by the Substance Abuse and Mental Health Services Administration.

Known as PCOMS, detailed information about the measures and feedback process can be found at www.whatispcoms.com. It’s easy to get started and the measures are free for individual healthcare practitioners!

Good News and Bad News about Psychotherapy

March 25, 2014 By scottdm 3 Comments

Have you seen this month’s issue of, “The National Psychologist?” If you do counseling or psychotherapy, you should read it. The headline screams, “Therapy: No Improvement for 40 Years.” And while I did not know the article would be published, I was not surprised by the title nor it’s contents. The author and associate editor, John Thomas, was summarizing the invited address I gave at the recent Evolution of Psychotherapy conference.

Fortunately, it’s not all bad news. True, the outcomes of psychotherapy have not been improving. Neither is there much evidence that clinicians become more effective with age and experience. That said, we can get better. Results from studies of top performing clinicians point the way. I also reviewed this exciting research in my presentation.
Even if you didn’t attend the conference, you can see it here thanks to the generosity of the Milton H. Erickson Foundation. Take a look at the article and video, then drop me a line and let me know what you think. To learn more, you can access a variety of articles for free in the scholarly publications section of the website.

Click here to access the article from the National Psychologist about Scott Miller’s speech at the Evolution of Psychotherapy Conference in Anaheim, California (US)

Did you know your clients can tell if you are happy?

January 19, 2014 By scottdm 2 Comments

It’s true. Adding to a growing literature showing that the person of the therapist is more important than theoretical orientation, years of experience, or discipline, a new study documents that clients are sensitive to the quality of their therapist’s life outside of treament. In short, they can tell when you are happy or not. Despite our best efforts to conceal it, they see it in how we interact with them in therapy. By contrast, therapists’ judgements regarding the quality of the therapy are biased by their own sense of personal well-being. The solution? Short of being happy, it means we need to check in with our clients on a regular basis regarding the quality of the therapeutic relationship. Multiple randomized clinical trials show that formally soliciting feedback regarding progress and the alliance improves outcome and continued engagement in treatment. One approach, “Feedback-Informed Treatment” is now listed on SAMHSA’s National Registry of Evidence-Based Programs and Practices. Step-by-step instructions and videos for getting started are available on a new website: www.pcomsinternational.com. Seeking feedback from clients not only helps to identify and correct potential problems in therapy, but is also the first step in pushing one’s effectiveness to the next level. In case you didn’t see it, I review the research and steps for improving performance as a therapist in an article/interview on the Psychotherapy.net website. It’s sure to make you happy!