Impact of non-medical switching on clinical and economic outcomes, resource utilization and medication-taking behavior: a systematic literature review

Nguyen, Elaine; Weeda, Erin R.; Sobieraj, Diana M; Bookhart, Brahim; Piech, Catherine Tak; Coleman, Craig I.

doi:10.1185/03007995.2016.1170673

Cited by 40 publications

(33 citation statements)

References 30 publications

(14 reference statements)

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“…Numerous studies have suggested a negative link between of non-medical switching and patient outcomes [6]. Nguyen and colleagues conducted a systematic review and identified 29 studies published between January 2000 and November 2015 that evaluated the impact of nonmedical switching on health outcomes.…”

Section: Office Visitsmentioning

confidence: 99%

“…This complex process misaligns with the widely accepted goal-The Quadruple Aim-of enhancing patient experience, improving population health, reducing costs and improving the work life of healthcare providers, including physicians and staff [3][4][5]. Non-medical switching, while decreasing acquisition costs for prescription medications, has been associated with unintended negative consequences on patients' clinical outcomes, healthcare utilization and medication adherence/persistence, physician-patient relationship, practice burden and physician and staff morale [6][7][8][9][10][11][12][13]. As a result, non-medical switching has been addressed in guidance documents and position statements released by the American Medical Association (AMA) as well as other medical societies, government entities and patient advocacy groups [1-2, 4-5, 8-13].…”

Section: Introductionmentioning

confidence: 99%

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Physicians’ perspectives regarding non-medical switching of prescription medications: Results of an internet e-survey

et al. 2020

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Background Physicians are in an ideal position to describe the impact of medication non-medical switching (switching commonly due to formulary changes by insurer for reasons unrelated to patient health) on their practice dynamics and patient care. We sought to examine physicians' openness to requests for non-medical switching and their experiences and opinions regarding the impact of non-medical switching on their practice, staff and patients. Methods An online survey of randomly-sampled physicians spending �10% of time providing patient care and having received �1 non-medical switch request during the prior 12-months. The impact of non-medical switching on clinical decision-making process; professional experience with clinical practice, patient-physician relationship, insurance process; and perceived impact on practice, staff and patients were assessed. Weighted percent responses were calculated. Results We sampled 1,010 physicians (response rate = 55.5%). Many responded being frequently not amenable (26.0%) or had reservations (41.8%) to non-medical switch requests; with >50% indicating patient stability on current therapy and suboptimal alternatives as factors frequently influencing amenability. Physicians agreed non-medical switching can create ethical concerns (clinical judgement, autonomy, ability to treat per guidelines; 74.8%, 82.3%, 53.5%, respectively), while forcing them to take responsibility for insurers' decisions (81.1%) and diverting their clinical time (84.3%). Most indicated non-medical switching increased practice burden (administrative, non-billable interactions, additional staffing, nonoffice patient contact, calls to/from the pharmacy; 85.

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Section: Office Visitsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Physicians’ perspectives regarding non-medical switching of prescription medications: Results of an internet e-survey

et al. 2020

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“…De façon générale, les cliniciens détestent les mesures administratives de contraintes visant à justifier leur conduite clinique [18,19]. De plus, le recours à des ressources non-médicales lors de ces procédures n'offre pas forcément de meilleure issue [20]. Il est important que les contraintes administratives appliquées à la sélection et l'encadrement de l'utilisation des médicaments soient pleinement justifiées [21].…”

Section: Discussionunclassified

Évaluation du niveau d’aisance d’étudiants en pharmacie face à la validation des ordonnances. Intérêt d’un dispositif didactique contextualisé

2018

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Évaluation du niveau d'aisance d'étudiants en pharmacie face à la validation des ordonnances. Intérêt d'un dispositif didactique contextualisé Assessment of the comfort level of a cohort of pharmacy students exposed to prescription validation. Relevance of a contextualized didactic device Methods: The descriptive cross-sectional study is the first part of a 10-step contextualized didactic device. The second part is an online questionnaire handed to third-year pharmacy students at Université de Montréal. The study was carried out using an online tool (SurveyMonkey, Palo Alto (CA), USA). Results: A total of 176 students provided complete and usable responses (participation rate: 95%). The contextualized didactic device raises participant awareness to the fact that they must make reasonable decisions (e.g. whether or not to validate a prescription). Conclusion: This study demonstrated the feasibility of using a contextualized didactic device to analyze and dispense a new drug. The data collected emphasizes the ability to adjust the comfort level regarding different actions based on various items of information. Most students state they are adequately trained to evaluate effectiveness, safety and compliance, but not so much on drug costs. It may be useful to consider more training on decision-making including the costs in pharmacy surroundings.

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“…Non-medical switching is defined as a change in a stable patient's prescribed medication to a clinically distinct, non-generic alternative for reasons other than poor clinical response, side-effects or non-adherence [1][2][3][4]. Non-medical switching is often the result of medication cost containment strategies implemented by insurers (e.g., formulary changes, prior authorization, step therapy) [2,3].…”

Section: Introductionmentioning

confidence: 99%

Specialist physician perspectives on non-medical switching of prescription medications

Costa

Salam

Duhig

et al. 2020

Journal of Market Access & Health Policy

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Introduction: A non-medical switch is a change to a patient's medication regimen for reasons other than lack of clinical response, side-effects or poor adherence. Specialist physicians treat complex patients who may be vulnerable to non-medical switching. Objectives: To evaluate specialist physicians' perceptions regarding the frequency of nonmedical switch requests, and the impact on their patients' outcomes and healthcare utilization. Methods: An online survey of randomly sampled physicians spending ≥10% of time providing patient care and having received ≥1 non-medical switch request during the prior 12-months. Results: Among 404 specialist physicians surveyed, non-medical switch requests were reported as very frequent or frequent by 35.0% of oncologists (for injectable cancer agents) and up to 80.3% of endocrinologists (for injectable anti-hyperglycemics). Respondents reported decreased medication effectiveness (25.0% of oncologists to 75.0% of dermatologists) and increased sideeffects (32.5% of oncologists to 66.7% of psychiatrists). Most specialists reported very frequent or frequent increases in non-office visits (52.5% of oncologists to 75.3% of endocrinologists) and calls with pharmacies (57.5% of oncologists to 80.5% of rheumatologists) due to non-medical switching. Conclusions: Receipt of non-medical switching requests were common among specialist physicians. Non-medical switching may lead to negative effects on patient care and require increased healthcare utilization. ARTICLE HISTORY

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Impact of non-medical switching on clinical and economic outcomes, resource utilization and medication-taking behavior: a systematic literature review

Abstract: Non-medical switching was more often associated with negative or neutral effects than positive effects on an array of important outcomes. Among patients with stable/well controlled disease, non-medical switching was associated with mostly negative effects.

Cited by 40 publications

References 30 publications

Physicians’ perspectives regarding non-medical switching of prescription medications: Results of an internet e-survey

Physicians’ perspectives regarding non-medical switching of prescription medications: Results of an internet e-survey

Évaluation du niveau d’aisance d’étudiants en pharmacie face à la validation des ordonnances. Intérêt d’un dispositif didactique contextualisé

Specialist physician perspectives on non-medical switching of prescription medications

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