2013 National Consumer Survey on the Medication Experience

Jon C. Schommer, Ph.D.schom010@umn.edu

University of Minnesota, College of Pharmacy

Background

• Over 500 million times per day in the United States, individuals make the decision to-take or not-to-take a prescription medication.

• Eighty percent of the way chronic diseases are prevented and managed is with medications.

• A person’s regular interaction with medications is not only a frequently and consistently occurring health care event, it also interfaces with almost all other aspects of his or her health care.

Study Assumption

Individuals enter and exit various components of the health-care system and they shift between their preferred identity as a person and their sometimes necessary identify as a patient.

The “medication experience” can be a unifying and coordinating concept to bridge this dichotomy.

The Medication Experience

• The personal approach to the use of medications.

• It is shaped by traditions, religion, culture life experiences, and what has been learned from others.

• It influences expectations, concerns, understanding, involvement, confidence, trust, decisions, and behaviors.

The Medication Experience

The Medication Experience

The Medication Experience

The Medication Experience

The Medication Experience

The Medication Experience

The Medication Experience

The Medication Experience

The Medication Experience

The Medication Experience

The Medication Experience

The Medication Experience

The Challenge

• Patients vary widely in their make-up, their preferences, and their needs.

• Patients have different abilities, motivations, and social support systems.

• The challenge, then, is to meet the needs of each individual.

2013 NCSME: Study Objective

• Identify and describe consumer segments based on:– Health care consumer type– Medication beliefs– Patient activation– Information seeking– Nature of interactions with health professionals

for decision-making

2013 NCSME: Methods

• Cross-sectional, descriptive mailed survey.

• Random sample of 1,000 adult individuals residing in the United States.

• 136 were undeliverable and 93 signified that the person to whom the survey was addressed was not able to participate in the study.

• Of the remaining 771 surveys, 218 (28%) responded.

Average Population Density by Square Mile

Geographic Distribution of Responders to the 2013 NCSME

U.S. Census Divisions

National Consumer Survey on the Medication Experience

• http://www.d.umn.edu/gac/main/schommer.html

Context: Heart Disease in the United States

Context: Health Professional Shortage Areas

Context: Medically Underserved Areas

Context: Prevalence of COPD

Context: Median Household Income

Context: Median Age

Health Care Consumer Type

36%

14%

38%

12%

HEALTHY HALF DOCTOR LED SELF MANAGERS SOLUTION SEEKERS

The SOLUTION SEEKER was more likely to:

1. Be of moderate age2. Be moderate user of prescription drugs3. Experience highest financial hardship4. Use mail order pharmacies5. View meds as a necessity, but not a burden6. Report low patient activation7. Prefer a shared relationship with their physician

and interact with their pharmacists for advice, negotiation, or professional relationship.

Medication Beliefs: Necessity / Concern

30%

28%

21%

21%

HI SAVE HI BURDENHI SAVE LO BURDENLO SAVE HI BURDENLO SAVE LO BURDEN

The LO SAVE/HI BURDEN was more likely to:

• Be of moderate age• Be a low-to-moderate user of prescription drugs• Experience moderate financial hardship• Vary in terms of health consumer type• Have the highest OVERUSE/HARM beliefs• Report medium patient activation• Experience low satisfaction and high overload with

information about medications• Vary in their preferences regarding the nature of

interactions with their physician and pharmacist.

Medication Beliefs: Overuse / Harm

32%

28%

23%

17%

LO OVERUSE LO HARMLO OVERUSE HI HARMHI OVERUSE LO HARMHI OVERUSE HI HARM

The HI OVERUSE/HI HARM was more likely to:

• Reside in the West census region• Be a low-user of prescription drugs• Experience moderate financial hardship• Use a clinic pharmacy or no pharmacy at all• Have LO SAVE/HI BURDEN medication beliefs• Experience low satisfaction and high overload with

information about medications• Vary in their preferences regarding the nature of

interactions with their physician and pharmacist.

Patient Activation (involved/engaged)

25%

61%

14%

HIGH MEDIUM

LOW

The HIGH PATIENT ACTIVATION was more likely to:

• Be of younger age• Be female• Be a Self-Manager health care consumer type• Have LO SAVE / LO BURDEN medication beliefs• Experience high satisfaction and low overload with

information about medications• Be in the ALL HIGH segment for shared decision

making with healthcare providers (that is, highly engaged).

Information Seeking Behaviors

18%

47%

35%

HIGH MEDIUM

LOW

The HIGH INFORMATION SEEEKING was more likely to:

• Be of younger age

• Be Black

• Prefer a shared relationship with their physician and want to interact with their pharmacist for advice, negotiation, or professional relationship.

Information Evaluation

52%

32%

16%

HI SAT LO LOAD

MED SAT MED LOAD

LO SAT HI LOAD

The LO SAT / HI LOAD was more likely to:

• Have HI SAVE / HI BURDEN medication beliefs

• Have HI OVERUSE / HI HARM medication beliefs

• Be in the LOW Patient Activation segment

• Prefer an informed/paternalistic relationship with their physician and prefer to use their pharmacist as an information source only.

Interactions with MD and RPh

46%

39%

24%MD Shared RPh Information

MD Shared RPh Adv,Neg,Rel

MD Informed/Paternalistic RPh Information

The MD Informed/Paternalistic and RPh Information only was more likely to:

• Moderately high financial burden

• Be the Self-Manager healthcare consumer type

• Have HI SAVE / HI BURDEN medication beliefs

• Have LO OVERUSE / HI HARM medication beliefs

• Be relatively low information seekers

• have relatively low satisfaction and high overload with information about medications.

Shared Decision-Making

49%

42%

9%

HIGH MEDIUM

LOW

The HIGH Shared-Decision Making group tended to be:

• Female

• High for Patient Activation

Conclusions

• The medication experience is more than a clinical experience – it is a social and personal experience.

• The medication experience is rooted in medication beliefs, personal abilities and motivations, information processing, decision-making relationships, finances, and the effects of life experiences.

Future Work

• Expand the identification and description of segments based on components of the medication experience.

• Incorporate components of the medication experience into patient care processes

• Build systems for identifying and matching patients and providers based upon preferences and capacities in the medication experience domain.

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