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!

Public Attitudes Toward Mental Health Services: A Change for the Worse

July 3, 2014 By scottdm 1 Comment

The results are not encouraging. A recent meta-analysis found that public attitudes toward psychotherapy have become progressively more negative over the last 40 years. The impact on practitioners is staggering. Between 1997 and 2007, use of psychotherapy declined by 35%. Not surprisingly, clinicians’ incomes also suffered, dropping 15-20% over the last decade.

So, if not psychotherapy, what do consumers of mental health services really want?

Well, if you trust the study I’ve cited, the answer seems clear: drugs. During the same time period that talking fell out of favor, use of pharmaceuticals increased a whopping 75%! Some blame society’s short attention span and desire for a “quick fix.” Such an argument hardly seems credible, however, given that psychotherapy works to alleviate distress as fast or faster than most psychotropics.

Others, including the authors of the meta-analysis, blame public education campaigns and pharmacological marketing aimed at “convincing the public that mental disorders have a neurobiological etiology that require biological treatments” (p. 103). At first glance, this idea is compelling. After all, every year, the pharmaceutical industry spends $5 billion dollars on direct-to-consumer advertising.

And yet, what is it the drug companies are really selling in those ads? In one of the most well-known TV commercials for a popular antidepressant, less than 7 seconds is spent on the supposed neurobiological cause. Instead, the majority of the time is spent depicting the positive results one can expect from the product. It’s marketing 101: focus on the benefits not the features of whatever you’re selling.

What do consumers want? The answer is: results. Your training, degree, certification, and treatment approach are irrelevant, mere features most consumers could care less about. Your rate of effectiveness is another matter entirely–its the benefit people are looking for from working with you.

So, how effective are you? Do you know? Not a guess or a hunch, but the actual number of people you treat that are measurably improved? If not, its easy to get started. Start by downloading two, simple, free, SAMHSA-approved scales for measuring progress and quality of mental health services. Next, visit www.whatispcoms.com to learn how individual practitioners and agencies can use these tools to monitor and improve outcome and retention in treatment, as well as communicate results effectively to consumers.

To see how outcomes attract consumers, just take a look at the Colorado Center for Clinical Excellence website. This Denver-based group of practitioners is a model for the future of clinical practice.

Is Supervision Important to you?

June 20, 2014 By scottdm 1 Comment

How valuable is clinical supervision to you? In their massive, long-term international study of therapist development, researchers Orlinsky and Rønnestad (2005) found that “practitioners at all experience levels, theoretical orientations, professions, and nationalities report that supervised client experience is highly important for their current and career development” (p. 188).

Despite the value most of us place on the process, the latest review of the literature found no empirical evidence, “that psychotherapy supervision contributes to patient outcome” (Watkins, 2011). Said another way, supervision does not produce more effective clinicians. The result? In the US, at least, opportunities for clinical supervision are in the decline, replaced by growing documentation requirements and administrative oversight–a trend destined to continue if the dearth of evidence persists.

What can be done? Simply put, solicit formal feedback from clients regarding their experience of progress and the therapeutic relationship. Such information, in turn, can be used to guide supervision, providing both a focus for the consultation and data supporting its effectiveness. After all, multiple studies already document that the process improves outcomes while simultaneously decreasing drop out and deterioration rates (Miller, 2013 ).

Getting started is not difficult. First, access two, free, easy-to-use scales for monitoring client progress and the relationship. Second, join colleagues in the largest, online community of behavioral health professionals in the world. It’s free–no hidden costs or secret levels of premium content. On the ICCE, you can connect and consult with practitioners who are using feedback to improve the quality and outcome of treatment and supervision. If you are new to feedback-informed work (FIT)–a SAMHSA certified evidence-based practice–you can get a thorough introduction at: www.whatispcoms.com .

Finally, get the Feedback-Informed supervision manual and newly released, two-hour DVD. Both provide step-by step instructions and examples of integrating feedback into supervision. While you are at it, join us for our Feedback-Informed Supervision Intensive. Last time around, it sold out months advance. Registration is now open for our next training in March 2015.