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. I first met Jan 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.

Want to be more effective? Point North!

July 24, 2014 By scottdm Leave a Comment

Sime time ago, while on a flight, I watched a program from the Discovery Channel about the North American red fox.

The furry little creatures were shown hunting rodents hidden under three feet of snow. Three feet! Up in the air the foxes would hop, thrusting their noses deep into the drifts. Most of the time, they came up with nothing. That is, unless they were facing north. Then the odds changed considerably. Seventy-five percent of the time, the fox was guaranteed a meal. Scientists believe the animal uses the planet’s magnetic field to more accurately calculate and plot it’s trajectory–the same principle as the GPS in your car. Watch the video. It’s incredible.

In a similar way, the odds of successful treatment increase considerably when clinicians incorporate feedback into their work. Asking consumers to assess their progress and the quality of the therapeutic relationship is the “North Pole” of behavioral health services. Available evidence documents that when providers ask for and accommodate such feedback, dropout and deterioration rates plummet, and effectiveness doubles. Without it, the same body of evidence shows that likelihood of recovery for consumers is about 15-20%, roughly equivalent to foxes who hunt pointing in the wrong direction. The process, known as Feedback-Informed Treatment (FIT), is being used around the globe to improve the quality and outcome of therapy.

The Sounds of Silence: More on Research, Researchers, and the Media

July 21, 2014 By scottdm Leave a Comment

A while ago, I wrote about an article that appeared in The Guardian, one of the U.K.’s largest daily newspapers. Citing a single study published in Denmark, the authors boldly asserted, “The claim that all forms of psychotherapy are winners has been dealt a blow.” Sure enough, that one study comparing CBT to psychoanalysis, found that CBT resulted in superior effects in the treatment of bulimia.

As I pointed out at the time, I was surprised that such an obscure research finding would be covered by a major newspaper. “What could be the point?” I wondered–that is, until I saw who had written the piece. The authors were none other than psychologist Daniel Freemen, a strong proponent of the idea that certain treatments are better than others, and his journalist brother, Jason.

I have to admit, I suspected an agenda was at work. After all, scientists have learned not to depend on extraordinary findings from single studies. Replication is key to separating fact from hopeful fiction. In the service of this objective, I cited a truly massive study published in Clinical Psychology Review. Using the statistically rigorous method of meta-analysis, researchers reviewed results from 53 studies of psychological treatments for eating disorders. The result? No difference in effect between competing therapeutic approaches–a result confirming 50 years of robust research. Why hadn’t this particular study been cited? After all, it was available at the time the two brothers wrote their piece.

Fast forward six months. Another study from Denmark has been published, this one comparing two treatments for sexual abuse. The results? Both treatments worked and gains were maintained at 1 year follow up. What’s more, consistent with the much-maligned “Dodo verdict,” no differences in outcome were found between analytic and systemic treatment approaches.

So far, no article from the Freemans.