Saturday, January 31, 2009

Responding to a Comment

I don't usually respond to comments in new posts, but I felt like directly addressing this one. Please note that it is not my intention to mock or insult the commenter. I just thought this comment deserved a thorough response.

Mike, I will let you in on a "secret" about this damn gimmick which you sound like you've at least half figured out anyway. I attended a lecture about a year and a half ago by a guy who coaches independents to grow their business. The original idea is genious if looked at from a strictly business point of view and, more importantly, if executed properly. So here goes... You announce you're giving away the free antibiotics, and people come in to get them. The next point is the critical one which no one does and that's why the whole idea ends up not working to its full potential. When the customer comes in with the prescription, the PHARMACIST, and NOT the techs or interns should be taking in that prescription, start up little talk, basically build a foundation with some kind of interaction that the customer should enjoy. Just as importantly, while taking in their demographics, you should be recording as much of their medical history as possible, not just drug allergies, but the most important thing: Disease States. This is the key to the whole thing.
Once all the info is collected, it is entered into the database... including, and most especially the disease states. The lecturer described databases as being the equivalent of Gold or Platinum in the marketing world. You need to build yours up as much as possible. What you do with it next is up to you, but it's worth a LOT of money, whether used for your own business, or sold to someone else who wants access. In this case, it is supposed to be used internally to then send mailers and fliers to attract these customers back to the store as often as possible. The most lucrative patients are the diabetics if I remember correctly (estimated annual prescription and supply expenses abour $7000-$8000 every year).
So you see, the original idea is a great business generating idea, the problem is no one gets the medical history and the disease states, and rarely does the pharmacist get to interact with these new customers, so they don't end up coming back. Hope this helps you understand it better.

Now I'll let you in on a secret...

That model sounds wonderful in theory, but it does not work in the wonderful world of busy retail pharmacy.

Let's say my company decided to do this free antibiotic thing and put it on me to get all this disease-state information. We fill 400 prescriptions per day (20 to 30 of them would probably be for antibiotics on that free list). I don't have time to be going to the counter every time someone comes with an antibiotic script. Moreover, out of the 20 to 30 free antibiotic scripts, maybe only 2 or 3 will be new customers. We already have all the drug information for the rest of those customers (assuming they're not just chasing coupons, or in this case, free antibiotics).

Even if I had the 5 minutes to spend with everyone dropping off an antibiotic script, even if I got all that information, I have nowhere to record it. Our pharmacy software does not have a place to enter disease states. I would guess that most pharmacy software doesn't. The reason? Knowing disease states isn't entirely necessarily to filling prescriptions. Good pharmacy software streamlines the filling process. Having to wade through disease states just slows us down.

Besides, we already have a pretty good idea what disease states our customers have by looking at the medications on their profiles. If you see someone getting metformin, glipizide, and lisinopril every month, you can be pretty confident they have diabetes. Our computer systems look at drug/disease interactions based on the drugs in the profile not some medical history we got from the patient.

A disease state history, while being nice in the utopian world of pharmaceutical care, is superfluous to 99% of my job.

Maybe the idea of disease state tracking has a chance of helping a small independent grow business in a specialized area. After all, new independent pharmacies (do they exist anymore????) cannot compete with the big chains as far as pricing and prescription volume. However, if they can get the word out that their pharmacists specialize in diabetes care, perhaps they can attract just enough diabetics to make them profitable. If you couple that with diabetes education classes and other health screenings, you have a chance for a nice specialized practice.

However, the point of your comment was that the free antibiotics are the means by which these small independents collect this information. The thing is that small independents are not the ones giving away free antibiotics. Right now, as far as I can tell, it seems to be confined to grocery store chains. Independents have a hard time doing any of the special pricing or the promotions that the big chains have. That’s why most pharmacists were outraged when Walmart brought out their $4 prescriptions. They knew this would drive 3rd party reimbursements down and would put more pressure on independents that were already struggling to stay in business.

The FACT of all this is that free antibiotics are nothing more than a sneaky way of having a coupon or gift card promotion without using coupons or gift cards. Instead of giving out a $20 store coupon with new or transferred prescriptions, they get to increase traffic into the store while putting up the appearance of caring for the public’s health. For reasons I already mentioned in my previous post, free antibiotics do more harm than good for the public's health.

The lecturer was correct that it is beneficial to new independents to use disease state information to attract new customers. They just aren't doing so through free antiobiotics.


persimmon said...

QS1/NRX has a place to enter disease states. So do Pharmaserve and Rite Aid's NexGen--and, for that matter, so did the shittiest command-line software I had to use as an outpatient hospital intern. I like having the information on hand, although I know most people can't be arsed to remember their chronic conditions.

But none of that makes the commenter correct. Using my database for marketing would be a violation of the trust my patients put in me. And I don't have time to take in every goddamn prescription. My presence is way more important for counseling on outgoing prescriptions than it is for intake.

Anonymous said...

In a busy chain, it's difficult to get information about a patient's weight, or ensure that an adequate allergy and sensitivity history is obtained and documented...

The other thing---am pretty sure that HIPPA compliance and interpretation would limit information passed on from a patient to a pharmacist to anywhere else.

In my smallish town north of Indianapolis, to a specialty pharmacy I refer patients occasionally, and attempt to convey up front, as well, that one should neither expect up their services are free or accessible any time day or night.

JenRPh said...

In Arizona we are required to document disease states. When the board does its audits they check for this.

Anonymous said...

Question: in documenting disease states, is one given an cavernous 'bin' to input data, or the choices already present? So, how does the pharmacist 'document' the disease state? Guessing the correct indication? Asking the patient? Or, does the physician write the indication on the script, and if that is what meets the required letter of the law, how often does it occur, or just on the scripts for patients on Medicaid/Medicare?

sickofstupidpeople said...

Wasington state requires documentation of disease states, too. At my company, the software has a spot for disease states, and when a script is processed, it screens for drug-disease interactions as well. The biggest problem is getting the patients to give us the information. "Do you have any medical conditions? Like asthma, diabetes, heart disease?" "No." "This prescription is for a blood pressure medication. Do you have high blood pressure?" "Oh yeah." "How about this one for Paxil? Are you taking it for depression?" "Oh yeah."
Patients don't know what disease states or medical conditions are...