Lo B, Alpers A
Center for AIDS Prevention Studies, and the Division of General Internal Medicine, University of California, San Francisco, USA.
JAMA. 2000 Feb 9;283(6):801-6. doi: 10.1001/jama.283.6.801.
A 1998 incident in which patients' prescription information was used to advertise a new drug exemplifies the importance of confidentiality in the era of managed care and computers. The ethical concerns voiced about this incident can also apply to pharmacy benefits management programs. The use of personal health information in pharmacy benefits management is particularly important because of increased pressures to control rising drug costs. Specific confidentiality concerns include whether the goal of benefiting patients will be achieved and whether the means are appropriate. The means may be problematic because of financial conflicts of interest, lack of patient authorization, inappropriate access to information by third parties, and inadequate safeguards for confidentiality. Policies should be crafted that protect confidentiality while allowing appropriate use of personal health information in pharmacy benefits management. Sound policies should require clear evidence of benefit to patients, an oversight committee, patient authorization, disclosure or prohibition of conflicts of interest, additional safeguards for sensitive medical conditions, strong confidentiality protections, and restrictions on advertising.
1998年发生的一起利用患者处方信息为一种新药做广告的事件，体现了在管理式医疗和计算机时代保密的重要性。针对这一事件所表达的伦理担忧也适用于药品福利管理项目。由于控制药品成本不断上涨的压力增大，在药品福利管理中使用个人健康信息尤为重要。具体的保密问题包括是否能实现使患者受益的目标以及手段是否恰当。由于存在经济利益冲突、缺乏患者授权、第三方对信息的不当获取以及保密措施不足，手段可能会出现问题。应该制定相关政策，在保护保密的同时允许在药品福利管理中合理使用个人健康信息。合理的政策应该要求有对患者有益的明确证据、一个监督委员会、患者授权、披露或禁止利益冲突、对敏感医疗状况的额外保护措施、强有力的保密保护以及对广告的限制。
