Pharmacist-Driven Compliance Enhancement Programs
The Asheville Project: Long-Term Clinical and Economic Outcomes of a Community Pharmacy Diabetes Care Program. Cranor C.W.; Bunting B.A.; Christensen D.B. Journal of the American Pharmaceutical Association Volume 43, Number 2, 173-184. 1 March 2003
Pharmacists score a healthy win as diabetes coaches By Ian Urbina New York Times News Service December 30, 2006
Highlighted in the newspaper article is a 10 year old program for municipal workers in the city of Asheville, North Carolina that supplies free diabetes medicines and supplies if those employees agree to monthly counseling from the program specified pharmacists.
By the account given, results have been dramatic:.
“We get a four-to-one return on investment,” said Barry Bunting, pharmacy director at Mission Hospitals, which runs the program in Asheville for about 450 city and hospital employees. For every $1 spent on medicines or counseling about diet, exercise and lifestyle, he said, the city saves $4 by preventing emergency room visits, dialysis, amputations or other common complications of diabetes.
During the first five years of the program, participants took an average of six sick days from work a year, half the number of previous years. Within three years of enrolling in the program, patients had halved their chances of going blind or needing dialysis or an amputation, a founder of the program said.
The Asheville program features pharmacists who, for a per-session fee paid by the program, serve as “coach, clinician and cheerleader for patients.”
The co-author of the March 2003 study of the Asheville Project published in by the Journal of the American Pharmacists Association, Carole Cranor, a pharmacoeconomist who was then at the University of North Carolina and now is a clinical pharmacist at Dorothea Dix Hospital in Raleigh, N.C., attributes the program’s success in helping patients control blood sugar with fewer cases of relapse than one would expect, to pharmacists:
About 40 other employers across the country have adopted versions of the program.
Finally, the newspaper article notes, “GalaxoSmithKline and Sanofi-Aventis, which make diabetes drugs, have jointly given about $1 million in the past five years to the American Pharmacists Association Foundation, a non-profit research group, to help promote and replicate the program.”
Commentary
1. In addition to the skills the pharmacists bring to the program, I would also suggest that compliance may have been enhanced by the patient’s buy-in itself. Patients who seized the opportunity to buy into the program, trading that enrollment for free diabetic supplies, may have then become more likely to adhere to treatment, or those who agreed to join the program may have, in effect, constituted a preselected group that was, by the nature of its members, more likely to follow the diabetic protocols.
2. Although it is a more sophisticated arrangement than paying patients to take medications, it could be argued that providing free supplies for patients who cooperate with a compliance program is merely a more covert form of bribery. As I noted in Cash For Compliance & Other Ethical Dilemmas, discerning between acceptable and unacceptable compliance enhancements is a difficult task unless one takes a radically polarized position.
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