The Institute of Medicine (IOM) published findings in 1999 on the quality of healthcare in America. That report, "To Err Is Human: Building a Safer Health System," concluded that as many as 7000 Americans die from medication errors each year.^[1] In July 2006, the IOM released a new report, "Preventing Medication Errors," stating that the frequency of medication errors and related injuries was still a serious concern.^[2]

A common question that arises is: "What drugs are most often involved in medication errors?" Matthew Grissinger, RPh, FASCP, is a medication safety analyst with ISMP, the nation’s oldest voluntary drug error reporting program, located in Huntingdon, Pennsylvania. His session on "The Top 10 Adverse Drug Reactions and Medication Errors" drew an audience that filled the meeting hall.^[3]

Grissinger first referred to a study that identified the 10 drugs most commonly implicated in adverse events requiring treatment in a hospital emergency department (ED).^[4] The study also documented the frequency with which each of the 10 drugs was involved:

1. Insulin (8%);
2. Anticoagulants (6.2%);
3. Amoxicillin (s) (4.3%);
4. Aspirin (2.5%);
5. Trimethoprim-sulfamethoxazole (2.2%);
6. Hydrocodone/acetaminophen (2.2%);
7. Ibuprofen (2.1%);
8. Acetaminophen (1.8%);
9. Cephalexin (1.6%); and
10. Penicillin (1.3%).

Unintentional overdoses made up 40% of these ED visits, representing the most prevalent mechanism of injury by far. Other mechanisms included side effects and allergic reactions. Some of the drugs on this list are especially common (eg, hydrocodone and amoxicillin), so the sheer volume of prescriptions written is a major factor.

The elderly also play a key role in this issue, as they account for 34% of all written prescriptions. The average number of prescriptions for an elderly person in the United States in 2000 was 28.5 per year. That number is estimated to reach 38.5 by the year 2010. Almost a quarter million seniors are hospitalized every year due to reactions between prescription and over-the-counter (OTC) medications.

Common misuses that lead to adverse drug events are taking incorrect doses, taking doses at the wrong times, forgetting to take doses, or stopping the medication too soon (all nonadherence issues). An example of commonly misused medications can be seen with arthritis therapies. Seventy million Americans suffer from arthritis and joint pain, which translates into 30 million people taking nonsteroidal anti-inflammatory drugs, either prescription or OTC. Misuse of these drugs leads to 103,000 hospitalizations and 16,000 deaths per year. Unnecessary use of nonsteroidal anti-inflammatory drugs also increases avoidable side effects, such as dyspepsia, peptic ulcer, and gastrointestinal bleeding.

Another high-volume prescription class is the antibiotics. This group represents significant inappropriate prescribing: Twenty-three million antibiotic prescriptions are written for colds, bronchitis, and upper respiratory infections each year, Grissinger said, despite the fact that antibiotics don’t kill viruses.

Top 10 Medications Involved in Drug Errors

A somewhat different top 10 list identifies medications that are most commonly misused or mishandled in some way by healthcare professionals. This list is based on information from the United States Pharmacopoeia (USP), which maintains a database of medication errors that are reported anonymously. The figures represent drug errors associated with acute hospital care^[5]:

1. Insulin (4% of all medication errors in 2005);
2. Morphine (2.3%);
3. Potassium chloride (2.2%);
4. Albuterol (1.8%);
5. Heparin (1.7%);
6. Vancomycin (1.6%);
7. Cefazolin (1.6%);
8. Acetaminophen (1.6%);
9. Warfarin (1.4%); and
10. Furosemide (1.4%).

Hospitals and healthcare systems use the USP database to track medication errors and identify trends. Drug errors are defined as unintentional acts committed by healthcare providers involving medications. Grissinger noted that comparable data are unavailable for outpatient care.

The number 1 error-prone medication is insulin. In fact, a 1998 ISMP study found that 11% of all serious medication errors involve insulin misadministration.^[6] Errors include mixing up products with similar packaging (look-alike products); confusing generic listings on computer databases; similarity in names (eg, Humalog and Humulin); and most importantly, confusing the abbreviation "u" for units with the number 0. ISMP reports that these errors have been occurring for over 30 years.

The second drug on this list is morphine, which can be extrapolated to include all opioids, Grissinger said. Similar names for some of these drugs often cause confusion, such as:

• Avinza and Evista;
• Morphine and hydromorphone;
• Oxycontin and MS Contin;
• Hydrocodone and oxycodone; and
• Oxycodone and codeine.

In the community pharmacy, these drugs often are stacked close together in a locked area, and many have similar packaging, making it easy to grab the wrong one when dispensing. Another common mistake is mixing up oxycodone with oxycodone ER (extended release), especially in handheld device order entry.

Morphine oral solutions cause many problems because of the multiple concentrations that are available, all stored close to each other. For example, it would be easy to confuse "mL" with "mg"; using 5 mL of morphine 20 mg/mL (100 mg) instead of the prescribed 5 mg (0.25 mL) would lead to overdosing the patient. Alternatively, an intended dose of 1 mL of morphine 20 mg/mL (20 mg) might be given as 1 mL of 10 mg/5 mL (2 mg), thus underdosing the patient. Grissinger also reported a case in which Avinza (morphine ER caps) 30 mg was misinterpreted and dispensed as "qid" (4 times daily) instead of "qd" (once daily), causing a near-fatal overdose.

Acetaminophen is another drug on the error list that causes many problems. It is available in many different strengths, and various measuring devices are available for dispensing it. In addition, it is found in many combination medications, both prescription and OTC. Prescription labels of combination products with acetaminophen can be very confusing for the patient. For example, hydrocodone 10/650 has 650 mg of acetaminophen, but many patients would not know how to interpret that.

Grissinger reminded the audience that acetaminophen can be toxic, even though it is sold OTC. A recent study showed that acetaminophen-induced liver toxicity accounts for more than 40% of US cases of acute liver failure.^[7]

Antibiotics are the next big group of drugs associated with medication errors. As with opioids, the liquid dose concentrations increase the risk for mistakes. Confusion over measurements in "mL" vs "tsp" (teaspoons) can cause a 5-fold overdose or underdose if undetected. In one case, for example, azithromycin suspension was dispensed with directions to take 2.5 tsp daily (equivalent to 12.5 mL) instead of the intended 2.5 mL daily, Grissinger reported. The entire contents of the bottle were administered according to the labeled instructions, and the child developed diarrhea.

Reconstituting antibiotics can also be problematic. Pharmacists have mistakenly reconstituted antibiotic suspensions with alcohol instead of distilled water.

System Errors May Interfere With Individual Efforts

Most healthcare professionals have learned the "5 rights" of safe medication use: the right patient, the right drug, the right time, the right dose, and the right route of administration.

However, in his book Medication Errors, Michael Cohen wrote that these "rights" focus on individual performance and can overlook system errors. Examples of system errors are poor lighting, inadequate staffing, handwritten orders, doses with trailing zeros, and ambiguous drug labels. All of these can prevent healthcare professionals from verifying the 5 rights.^[8]

Experts at ISMP have identified 10 key "system" elements that most influence medication use, reported Donna Horn, RPh, DPh, ISMP Director, Patient Safety - Community Pharmacy. Systems factors play a major role in increasing the likelihood that an individual will make an error. Deficiencies in any of these system elements can lead to medication errors^[9]:

1. Patient information (age, weight, allergies, diagnoses, and pregnancy status);
2. Drug information (up-to-date information readily available);
3. Communication (collaborative teamwork between all healthcare members and the patient);
4. Drug labeling, packaging, and nomenclature (limit look-alike and sound-alike drug names, confusing packaging);
5. Drug standardization, storage, and distribution (restricting access to high-alert drugs);
6. Medication delivery device acquisition, use, and monitoring;
7. Environmental factors (poor lighting, cluttered work spaces, noise, interruptions, nonstop activity, and deficient staffing);
8. Staff competency and education;
9. Patient education; and
10. Quality processes and risk management (systems are needed for identifying, reporting, analyzing, and reducing the risk for medication errors with a nonpunitive culture of safety).

When an error occurs, it is tempting to blame individuals, Horn said. A "systems approach," however, looks at the whole system rather than individual errors. For instance, failures in the design or implementation of systems can lead to excessive reliance on memory, lack of standardization, inadequate access to information, and poor work schedules. Thus, with a systems approach, accountability is expanded to include anyone who had any influence over the error, setting the stage for broader solutions.

How Can We Prevent Medication Errors?

Nearly half of all adverse drug events have some form of "preventability," and many do not represent errors of commission but, rather, errors of omission. This implies a failure on the part of someone (pharmacist, physician, patient, or the interactions between these groups) to detect certain factors that most likely led to the adverse event. These factors include:

1. Failure to detect a disease state contraindication to the drug therapy;
2. Failure to detect a significant drug interaction;
3. Failure to detect a significant drug allergy;
4. Failure to prescribe the correct dose for a specific patient;
5. Failure to monitor drugs with narrow therapeutic indexes; and
6. Patient knowledge deficits.

Many of these can be avoided by spending a few minutes counseling the prescriber and/or the patient. Communication is key, Horn said. Barriers to effective communication include illegible handwriting, abbreviations, verbal orders, ambiguous orders, and fax or ePrescribing problems.

When communicating with prescribers, pharmacists should identify the issues clearly and concisely, said Marialice Bennett, RPh, FAPhA, Professor and Pharmacy Director of the University Health Connection at Ohio State University in Columbus, Ohio.^[10] She offered these suggestions for such discussions:

• Outline the specifics of the problem;
• Keep focused on the patient;
• Provide possible solutions;
• Ask for prescriber feedback; and
• Document the final decision.

Conflict can lead to poor communication, which can hinder the discovery of medication errors, she said. Conflicting opinions about patient care should be handled objectively and professionally. The ISMP recommends that healthcare organizations create a code of conduct that encourages behaviors supportive of team cohesion, staff morale, and sense of self-worth and safety.

What a fun call tonight! Thanks to everyone who participated either before or during the show.

We talked about different needs that patients have and some complaints they’ve expressed online .

A caller wanted to know if you should list your herbals or supplements when you fill out the list of "stuff" you’re on. She also wanted to know how to approach asking doctors about herbals when you hear that certain things are good for you.

We spent a fair amount of time talking about preventing prescription errors. I discussed Trisha Torrey’s recommendations from her website

Enjoy!

What is non-compliance?

• Not filing a prescription initially
• Not refilling a prescription when still needed
• Taking a medication at the wrong time
• Stopping a medication before medication course is completed without your physician’s advice
• Taking the wrong dose
• Taking a medication incorrectly
• Skipping doses
• Taking someone else’s medication

Do you know what your medications are? What each of them are for? How you’re supposed to take them?

Can you remember them? If not, you should write them down and keep them with you at all times. Use an index card to write down the names, the dosages, how often you take them and if you have room, jot down what condition each one is for.

Look at these statistics:

• Approximately 125,000 people with treatable ailments die each year in the USA becaue they do not take their medication properly.
• Fourteen to 21% of patients never fill their original prescriptions.
• Sixty percent of all patients cannot identify their own medications.
• Thirty to 50% of all patients ignore or otherwise compromise instructions concerning their medication.
• Approximately one fourth of all nursing home admissions are related to improper self-administration of medicine.
• Twelve to 20% of patients take other people’s medicines.
• Hospital costs due to patient noncompliance are estimated at $8.5 billion annually.

Noncompliance is typically cited as occurring in from 50%-70% of patients.  In other words, 50%-70% of patients do not properly take prescribed medication. The rate of noncompliance is even higher in patients with chronic illnesses.

Absorb these statistics - look in your own medicine chest……go from there.

Til later,

Terrie

 Got a question?

Managing Stress in a Workplace Full of Risks

Pharmacy work can be highly stressful, and pharmacists who are under extreme stress are at risk for more errors, said Henry Cobb, PhD, MD, BS, CDM, Clinical Associate Professor, University of Georgia College of Pharmacy, Athens, Georgia.^[11] Pharmacists need to identify their own personal stress triggers and anticipate their responses to stress. He presented 5 questions that could be used for such self-analysis:

• How do you know whether stress is a problem for you?
• What is causing most of your stress?
• Is your supervisor aware of the problem?
• How do you deal with stress?
• What can you do to reduce the impact of stress?

Cobb described 3 ways that most workers deal with stress on the job. The active-cognitive person draws on past experience, taking one thing at a time. He or she considers several alternatives, looking for the positive side, and is able to step back and be objective. The active-behavioral person finds out more about the situation and takes positive action. He or she may talk with a friend or spouse, exercise more, or talk with a professional in order to find a solution. The person who practices avoidance keeps feelings to himself or herself, prepares for the worst, takes out frustrations on others, and eats or smokes more to reduce tension.

Identifying the phases of stress can be helpful. Phase 1, or the warning phase, includes vague anxiety, depression, and apathy. Phase 2, or mild stress, includes sleep disturbances, muscle aches, and irritability. Entrenched stress, or phase 3, includes alcohol abuse, depression, ulcers, withdrawal, and marital discord. Phase 4, or severe stress, includes asthma, heart problems, severe depression, violence (or suicide), paranoia, and uncontrolled anger. It is important to note that professional help is needed for phases 3 and 4.

To reduce stress on the job, Cobb presented this list of quick strategies:

1. Discontinue caffeine;
2. Engage in regular exercise (30 minutes 3 times weekly);
3. Practice relaxation-breathing exercises (20 minutes 2 times weekly);
4. Get adequate sleep (try going to bed 30 minutes earlier than usual);
5. Nurture your leisure time, engage in hobbies;
6. Set realistic expectations and avoid perfection;
7. Reframe your outlook to be optimistic, not pessimistic;
8. Eat right;
9. Maintain a sense of humor;
10. Talk and vent;
11. Write down your thoughts;
12. Avoid unhealthy habits (such as alcohol);
13. Set limits (learn to say "no"); and
14. Get help from a professional.

In some cases, however, a person who is in a job that does not match his or her personality and preferences may need to switch to another role or job, Cobb added. That may be a much better stress-reduction technique than any other.

 Another clip from Medical News Today about the number of pills and Daily Adherence to medication. Although it focuses on certain conditions, the issue is applicable to everyone and every condition. Compliance (adherence to instructions) is such a big factor in health success that we all (doctors and patients alike) must pay attention to what will improve a person’s ability to follow the advice/instructions:

New Study Suggests Number Of Pills Not A Factor When It Comes To Daily Adherence To Medication

There is no correlation between the daily number of pills a patient is prescribed to take and how well a patient will adhere to a dosing regimen, suggests a new study presented recently at the 19th Annual Meeting of the Academy of Managed Care Pharmacy (AMCP) held in San Diego (April 11-14). The large-scale study looked at patients taking a variety of high blood pressure medicines, specifically calcium channel blockers (CCBs), and provides more supportive evidence that adherence to prescribed medication is influenced by a multitude of factors. The study specifically examined dosing regimen to see if there was a relationship between that factor and adherence in patients with a co-payment of at least $20.

More on Do You Take Your Medicines As Prescribed?

Excellent article on compliance (following your doctor’s directions) and what influences it 

Most people follow only half of their doctor’s advice. The half they don’t follow often means the difference between a successful treatment and a lingering illness or even death. Find out what you can do to get the most out of your health care. It is so common for patients to disregard their doctor’s advice that there is a term for it in medical circles: Noncompliance. In fact, numerous studies and countless seminars and educational materials have been dedicated to solving this problem. A noncompliant patient is one who simply forgets to take medications on time, misunderstands the directions, cannot make the lifestyle changes required for certain treatments or simply ignores medical advice. Such neglect often has tragic consequences. It is estimated that 125,000 people with treatable ailments die each year simply because they do not take prescribed medications properly or they skip them altogether.

The blame for noncompliance, however, does not lie entirely with the patient. Health care professionals frequently fail to take the time to clarify a treatment, make sure the patient understands why it’s important to follow the plan precisely, explain possible side effects, or ask if a patient’s lifestyle might interfere with the therapy so that it can be customized.

Ideally, a patient and doctor should work together as a team to ensure the most effective medical care. But it doesn’t always work out that way. So don’t assume your health care provider is giving you all the pertinent information. Whenever treatment is prescribed–even if it’s a simple course of antibiotics–make sure you have all the facts, including the possible results of not following through with your doctor’s recommendations.

Why Patients Don’t Comply

Often, people do not follow their physician’s instructions because they don’t have adequate information regarding their condition or medication. Other reasons for noncompliance:

Excellent article discussing compliance (following directions) and who’s responsible when it’s lacking - and what can be done about it

Most people follow only half of their doctor’s advice. The half they don’t follow often means the difference between a successful treatment and a lingering illness or even death. Find out what you can do to get the most out of your health care. It is so common for patients to disregard their doctor’s advice that there is a term for it in medical circles: Noncompliance. In fact, numerous studies and countless seminars and educational materials have been dedicated to solving this problem. A noncompliant patient is one who simply forgets to take medications on time, misunderstands the directions, cannot make the lifestyle changes required for certain treatments or simply ignores medical advice. Such neglect often has tragic consequences. It is estimated that 125,000 people with treatable ailments die each year simply because they do not take prescribed medications properly or they skip them altogether.

The blame for noncompliance, however, does not lie entirely with the patient. Health care professionals frequently fail to take the time to clarify a treatment, make sure the patient understands why it’s important to follow the plan precisely, explain possible side effects, or ask if a patient’s lifestyle might interfere with the therapy so that it can be customized.

Ideally, a patient and doctor should work together as a team to ensure the most effective medical care. But it doesn’t always work out that way. So don’t assume your health care provider is giving you all the pertinent information. Whenever treatment is prescribed–even if it’s a simple course of antibiotics–make sure you have all the facts, including the possible results of not following through with your doctor’s recommendations.

Revealing Statistics The following statistics illustrate how widespread noncompliance really is among Americans: Only 55 percent of tuberculosis patients, 48 percent of diabetics, 46 percent of asthmatics, and 42 percent of glaucoma patients use their medicines correctly. From 14 to 21 percent of patients never even fill their original prescriptions. 10 percent of adolescent pregnancies result from non-compliance with birth control medication. 60 percent of all patients cannot identify their own medicines. From 30 percent to 50 percent of all patients ignore or otherwise compromise instructions on how to take medication. Nearly one-fourth (23 percent) of nursing home admissions are related to improper self-administration of medicine. From 12 percent to 20 percent of patients take other people’s medicines. The cost of hospital admissions is an estimated $8.5 billion annually just for patients who do not take their medications as prescribed. (Sources: The Food and Drug Administration and The National Council on Patient Information and Education)

Why Patients Don’t Comply

Often, people do not follow their physician’s instructions because they don’t have adequate information regarding their condition or medication. Other reasons for noncompliance:

Many medicines cause uncomfortable side effects, so when patients have disorders such as hypertension, which have few or no discernible symptoms, it is hard for them to see the benefit of taking a drug that makes them feel worse. For the same reason, noncompliance is very high when medication is prescribed to prevent an illness from developing.

Some patients with threatening health problems, such as high blood pressure or high blood cholesterol, refuse to take the necessary precautions because they believe heart attacks only happen to "other people."

Many patients have a difficult time making prescribed life-style changes, such as quitting smoking, exercising regularly and changing their eating habits.

Some people hate feeling dependent on drugs, so they stop taking their medication to deny they are sick. Others stop taking medicine to see if they are "cured" yet.

Many people, particularly those with chronic ailments, feel a need to take control of their problem. And they try to do so by taking control of their medication dosage.

Many prescription drugs are extremely expensive.

Due to hectic schedules, people sometimes find it hard to stick to their treatment regimen.

What You Can Do to Maximize Your Treatment

The most important factor in making the most of your medical care is good communication between you and your doctor. Here are some practical steps you can take to accomplish that goal:

1. Tape record or write down what the physician says.

2. Make sure you understand the prescription schedule, and let the doctor know if you think your activities will interfere with it. Call your physician if you find that you cannot take your medication at the appropriate times. Together, you can work out a schedule that meets your needs. (See Make the Most of Your Medications.)

3. Ask what you should do if you miss a dose of medication or a therapy session and whether you should discontinue treatment when you feel better.

4. Let your doctor know if you have had bad experiences in the past with any portion of the prescribed treatment plan and if you are currently being treated for another condition. Find out how to manage both treatment plans simultaneously.

5. Find out what side effects you should expect and which aren’t normal and should be reported to your doctor.

6. Ask for a referral to a support group that deals with your ailment. If your therapy calls for lifestyle changes you feel will be hard for you to make, ask for a referral to a professional who can help, such as a dietitian for changes in your diet or a smoking program for quitting smoking.

7. Don’t be afraid to ask the doctor to simplify instructions by using less technical terms or giving you concrete examples. If your doctor seems impatient with your questions or brushes them off, explain that it is important to you to understand the recommendations clearly because you want to be able to follow them. If your physician still is not responsive, you may want to consider finding another doctor who appreciates an involved patient.

8. If you cannot afford the prescribed drug, ask your doctor about manufacturer aid. Most major drug companies now have programs to give drugs to patients who either don’t have insurance or the means to pay for their medications. The details of such aid vary widely depending on the manufacturer, but all of them require that the doctor put in the application for you

Many patients discontinue medications or other forms of therapy as soon as they feel better, even though the healing process is not yet complete. This is particularly true with antibiotics.

More from About.com

Should You Change Doctors?

"C" if your needs are being met.

A doctor-patient relationship is a lifelong relationship for someone with chronic arthritis.

Since the illness is chronic, and without a cure, regular appointments are scheduled with your doctor to diagnose and problem-solve. It’s a process and a journey you take together with your doctor.  It is imperative that your needs are being met. Consider these 6 C’s: 

Communication 

It is clear that if you and your doctor are going to problem-solve and work towards achieving quality of life for you within the framework of your chronic illness, you must be able to communicate with each other. 

You must trust you will be heard, trust that his/her decisions are sound, and trust your options will be fully explained to you.  

Cost

 The financial impact of chronic illness can approach exhorbitant, so cost needs to be a factor. 

Boy is this a pertinent quip from Medical News Today .

In today’s world of very educated patients, most would be insulted if the physician even mentioned anything to do with depression. And yet, the universal presence of depression in the U.S. is phenomenal. Many people do not know that that is their diagnosis though. And therefore, they think that there "must be something wrong with me" - something that enough "tests", enough "diagnostic studies" - enough something - would show. The somatic symptoms of depression are multiple. And it should be considered in most scenarios. AND most patients should not be so resistant to the screening process. This resistance is what keeps physicians from even considering it as a diagnosis.

Providing a voice to an often silent disease, Epocrates, Inc. surveyed 500 clinicians to identify trends in depression diagnosis, prevalence and treatment. People dealing with stress, whether in the workplace or at home, should take note; nearly all clinicians identified stress as the leading contributor to depression.

The majority of clinicians reported seeing an increase in depression in the past five years, and believe this increase may be driven by greater disease awareness, and ultimately more patients seeking help. However, clinicians reported that many more patients may be experiencing symptoms that are going undiagnosed. More than half of survey respondents felt that physicians are hesitant to diagnose depression, primarily due to resistance from patients and lack of societal acceptance. Clinicians also reported uncertainty about diagnosing depression, as patients may present symptoms differently based on gender and ethnicity, or may be a product of another medical illness.

"In today’s digital age, the increasing pressure to get it done yesterday can lead to more stress and potentially depression. Early recognition and intervention are important to prevent the loss of jobs, damage to relationships or suicidal thoughts," said John Luo, MD, Assistant Clinical Professor of Psychiatry at UCLA Semel Institute for Neuroscience and Human Behavior.

The vast majority of clinicians reported recommending prescription therapies for their patients experiencing depression. Beyond pharmacotherapy and psychotherapy, 60 percent of respondents believe lifestyle changes such as diet, exercise and meditation may also be helpful in treating depression, depending on the patient’s individual situation.

Additional key survey findings include:

– Gender makes a difference when diagnosing depression

– Thirty percent of clinicians reported being less likely to discuss depression with men.

– Clinicians reported it is often more difficult to treat men because they are less "open" than women, and symptoms such as anger or addiction may not be immediately linked to depression.

– Clinicians may be more likely to experience depression

– More than 50 percent of clinicians reported experiencing depression at some point in their lives, which compared to the National Institutes of Health data, could make them more than twice as likely to experience depression as the general public.

– Additionally, 12 percent of clinicians reported missing work because they felt depressed. Clinicians are not alone-a national study revealed that depression is the leading cause of missed work days, and lost productivity due to depression is estimated at $83 billion a year.

For more about depression, including a podcast with UCLA psychiatrist Dr. Luo, clinicians’ comments and comprehensive survey results, please visit http://insights.epocrates.com/depression. Comprehensive dosing and drug interaction information for anti-depressants can also be found at http://www.epocrates.com.

I’ll tell you that the title of this turned me off but I forced myself to read it and then found it captivating…take a gander and see what you think. Thanks to Scott Wanless and the Business Intelligence Network. I’ve removed much of the business related info though. I think it’s interesting.

Increasing patient satisfaction is a critical goal for healthcare organizations of all types, especially in these times of increased competition, scrutiny and demand for services. Business intelligence based on satisfaction analytics can help you compete.

Our family doctor cements my loyalty as a patient every time I go to see him. He accomplishes this with one simple action combined with two sophisticated uses of patient intelligence. The simple action is to put notes into my care record that indicate what satisfies me. Currently, two of the notes in my record read: “Likes patient population statistics” and “Likes ideas that came from patients.” He has, for example, used both of these statements in a recent visit to diagnose and treat a sleep disorder I was experiencing. During our conversation, he asked one of the nurse practitioners to share statistics on the percentage of the clinic’s population who are experiencing the same type of sleep disorder, and then drill into the percentages for men vs. women and for men of my age group. This type of insight takes deep intelligence to be gathered, stored, processed and shared among the providers. This is business intelligence.

Taking this use of information one step further, our doctor then walked through a one-page sequence of events for my treatment. This included consult with a pulmonologist, an overnight study at a local hospital, education from a home health and medical equipment specialist, and finally follow-ups with both the pulmonologist and with him as my primary care physician. At each stage of this treatment, I was given information on what to expect and why, as well as homework I needed to do in preparation for the specific stage. He sealed the deal with me by telling me that this sequence of events originated with an idea from one patient, and has grown through refinements made in using it with a variety of patients over the past few years. This too is business intelligence.

What is Patient Satisfaction?
At first blush, patient satisfaction sounds like its cousin customer satisfaction. There are, however, significant differences between the two. Topping the list are the licensing and professional restrictions placed on healthcare providers, who must first consider what the patient needs before what the patient wants. In most businesses, trying to sell people what they need versus selling them what they want is an efficient way to go out of business because the competition will gladly reverse this order. I am free to buy just about anything I want in a grocery or hardware store without any regard to whether or not I need it. But I cannot just get an MRI scan or a prescription I saw advertised just because I want one.

In addition to these restrictions are the financial rules from payers, purchasers and the patients themselves. As a provider in a fee-for-service situation, another x-ray may be called for medically, and help the practice financially, but could very well be denied by the patient’s insurance plan. In a capitation situation, this additional x-ray comes out of the provider’s bottom line. Once again, need trumps want.

Patient satisfaction is the subject of numerous books, articles and studies. In Crossing the Quality Chasm, the Institute of Medicine identifies patient-centeredness as one of the six ingredients of quality healthcare. The book uses terms to describe this focus such as empathy, responsiveness to needs/preferences, involvement, respect, information, communication, education, emotional support, physical comfort, value, transparency and heeding expectations. Irwin Press (co-founder of Press-Ganey) discusses the importance of patient experiences and perceptions, and the need to go beyond technical quality to encompass service quality in his book Patient Satisfaction: Defining, Measuring and Improving the Experience of Care. Furthermore, the Gallup Organization has extended the concept of patient satisfaction to become patient engagement. In other words, involving the patient in their care and in the delivery of their care increases satisfaction, loyalty, cooperation and respect.

Common satisfaction measures were summed up in a recent study by DrScore and included:

• Accessibility – both physical access and financial access to care.
• Communication skills – of the doctors, nurses, PAs, NPs and others involved in direct patient care.
• Personality and demeanor – of the same group.
• Quality of medical-care processes – as provided directly to the patient.
• Care continuity – regarding the handoffs made provider-to-provider, as well as across time.
• Quality of healthcare facilities – in terms of having the appropriate equipment, supplies and peripheral resources available.
• Efficiency of office staff – in handling scheduling, billing, etc.

As you can see from these lists, the focus of patient satisfaction relies on providers going beyond the mechanical delivery of medical care to the delivery of a true health service.

Driving Forces for Increasing Patient Satisfaction
The list of benefits of paying attention to patient satisfaction is long and extends to virtually every corner of the healthcare organization whether hospital, physician practice, home health, long-term care and so forth. This makes sense, since the range of factors making up satisfaction is quite wide.

With greater patient satisfaction comes:

Clinical Benefits

• Greater patient trust and acceptance with treatment plans.
• Increasing buy-in for treatment plans more quickly, making best use of scarce physician time.
• Increasing trust, which allows physician to discover more factors that may affect the care needs of the patient.
• Enhancing patient involvement in their own care through preventative measures, corrective measures and so forth.

Operational Benefits

• Driving efficiency into the organization by focusing on what works well with patients, and eliminating what does not work well.
• Cross-over trust is enhanced. For instance, a good experience in scheduling appointments can cross over into a better experience with the care provider. In addition, a good experience with the patient’s PCP can cross over into a more positive experience with specialists that the PCP has referred.
• Increased internal support for other quality improvement efforts, such as timeliness improvement, care process improvement, etc.

References:
White B. Measuring Patient Satisfaction: How to Do It and Why to Bother. Family Practice Management; January 1999, Vol. 6, No. 1, pages 40-4.