Medical Education, American College of Physicians, Philadelphia, PA, USA.
Consulting Services, Xcenda, Palm Harbor, FL, USA.
Clin Ther. 2020 Jun;42(6):1077-1086. doi: 10.1016/j.clinthera.2020.04.007. Epub 2020 May 14.
Nonmedical switching is defined as a change in a stable patient's prescribed medication to a clinically distinct, nongeneric alternative for reasons other than lack of clinical response, adverse effects, or poor adherence. Nonmedical switching often results from formulary changes implemented by insurers to lower medication costs. We sought to survey randomly sampled physicians to elicit their opinions regarding insurers' communication about nonmedical switching.
We performed an online, cross-sectional survey of licensed, practicing physicians who were >2 years but <30 years out of residency and/or fellowship, who practiced in an internal medicine, family medicine, or specialist setting, spent ≥10% of their work time providing direct patient care, and had received at least 1 request for a nonmedical switch for ≥1 patient in the prior 12 months. The survey was fielded from November to December 2018. We report weighted percent responses categorized from 5- or 7-point Likert scale questions.
E-mail invitations were sent to 13,117 randomly sampled physicians, and 1818 opened the e-mail and followed the embedded survey link to participate. Of these, 1010 total physicians (55.5%), 606 primary care and 404 specialists, who treated patients experiencing nonmedical switching in the prior 12 months completed the survey. A few physicians were notified about nonmedical switches by insurers; more frequently physicians learned about them from pharmacies serving their patients. Notification frequently occurred at or after a refill came due. Notification via electronic medical record or insurer letter was less frequent. Few thought that insurers clearly communicated information about alternative medications when a nonmedical switch was required, and most disagreed that insurers provided clear procedures, timelines, and methods to track challenges. Nearly all agreed that insurers should provide supporting documentation or rationale for nonmedical switches and specifics on alternatives. Respondents overwhelmingly agreed that steps to improve communication and physicians' and patients' ability to navigate nonmedical switches or challenge procedures should be implemented.
This survey of primary care and speciality physicians suggests that physicians believe that insurers' current level of communication regarding nonmedical switching is suboptimal. Respondents suggested that insurers did not optimally communicate information about alternative medications when a nonmedical switch was required and did not provide clear procedures, timelines, and methods to track challenges. A preponderance of physicians agreed that steps to improve physician-insurer communication to aid in the navigation of nonmedical switch and to challenge procedures should be implemented. If not addressed, these identified nonmedical switch communication issues may have a negative effect on achieving the quadruple aim of enhancing patient experience, improving population health, reducing costs, and improving the work life of health care practitioners and their staff.
非医疗性换药是指在稳定的患者中，由于缺乏临床反应、不良反应或用药依从性差等原因，将处方药物更换为临床明显的非专利替代品。非医疗性换药通常是由于保险公司为降低药物成本而实施的保险范围变更所致。我们试图对随机抽样的医生进行调查，以了解他们对保险公司关于非医疗性换药沟通的看法。
我们对 1010 名执业医师进行了在线横断面调查，这些医师在住院医师规范化培训或专科培训结束后 2 至 29 年，从事内科、家庭医学或专科医疗工作，至少 10%的工作时间用于直接为患者提供护理，并在过去 12 个月内至少收到 1 位患者的非医疗性换药请求。调查于 2018 年 11 月至 12 月进行。我们报告了从 5 点或 7 点李克特量表问题得出的加权百分比反应。
向 13117 名随机抽样的医生发送了电子邮件邀请，有 1818 名医生打开了电子邮件并点击了嵌入式调查链接参与调查。其中，606 名初级保健医生和 404 名专科医生共 1010 名（55.5%）接受了调查，这些医生在过去 12 个月内治疗过经历非医疗性换药的患者。一些医生是由保险公司通知非医疗性换药的；更多的医生是从为他们的患者提供服务的药店了解到这一点的。通知通常发生在药物即将用完或用完之后。通过电子病历或保险公司信函进行通知则较少。很少有医生认为保险公司在需要非医疗性换药时清楚地传达了替代药物的信息，大多数医生不同意保险公司提供了明确的程序、时间表和方法来跟踪挑战。几乎所有医生都同意，保险公司应该提供非医疗性换药的支持文件或理由，以及替代药物的具体信息。受访者一致认为，应该采取措施改善沟通，并提高医生和患者应对非医疗性换药或挑战程序的能力。
这项对初级保健和专科医生的调查表明，医生认为保险公司目前在非医疗性换药沟通方面的水平不理想。受访者认为，当需要非医疗性换药时，保险公司没有最佳地传达替代药物的信息，也没有提供明确的程序、时间表和方法来跟踪挑战。大多数医生一致认为，应该采取措施改善医生与保险公司之间的沟通，以帮助医生处理非医疗性换药并对程序提出质疑。如果这些问题得不到解决，可能会对实现提高患者体验、改善人口健康、降低成本和改善医疗保健从业者及其员工工作生活的四重目标产生负面影响。
