Does Changing Drugs Erode Trust

One of the big tools that PBMs use to manage drug trend and improve generic fill rate is step therapy. Another one is therapeutic substitution. Both of them rely upon the patient to change medications.

Based on a study published last year, one of the issues identified for adherence was the patient’s belief or trust in their physician. Switching medications (I.e., trial and error) was viewed as eroding that trust.

It creates an interesting question about these tools. Do they erode trust? Do they impact adherence? I think the standard perception would be that lower cost medications would improve adherence. I know research by Shrank has shown that starting on generics leads to better MPR. Is that true for patients that start on a brand and move to a generic?

On the other hand, the research points to the need for the physician to explain to the patient about the plan for care which might include “trial and error”. Certainly personalized medicine may change this need in the long-term, but in the interim, does this create a chance for PBMs to support MDs in a new way by providing this context to the patient?

More questions here than anwers, but an interesting topic.

Patient Educ Couns. 2010 Jul 30.
“Practicing medicine”: Patient perceptions of physician communication and the process of prescription.
Ledford CJ, Villagran MM, Kreps GL, Zhao X, McHorney C, Weathers M, Keefe B.
George Mason University, Fairfax, VA, USA.

Abstract
OBJECTIVE: This study explores patient perceptions of physician communication regarding prescription medications and develops a theory of the effects of perceived physician communication on the patient decision-making process of medication taking.

METHODS: Using a grounded theory approach, this study systematically analyzed patient narratives of communication with physicians regarding prescription medications and the patient’s resulting medication taking and adherence behavior.

RESULTS: Participants described concern about side effects, lack of perceived need for medications, and healthcare system factors as barriers to medication adherence. Overall, participants seemed to assess the utility of communication about these issues based on their perceptions of their physician as the source of the message.

CONCLUSION: The theory generated here includes patient assessments of their physician’s credibility (trustworthiness and expertise) as a critical influence in how chronically-ill patients process information about the need for prescribed therapy. Trial and error to find appropriate medications seemed to deteriorate patients’ perceptions of their physicians’ credibility.

PRACTICE IMPLICATIONS: A practical application of this theory is the recommendation for physicians to increase perceived expertise by clearly outlining treatment processes at the outset of treatment, presenting efficacy and timeline expectations for finding appropriate medications.

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