Health Scores and HW2...

Followed a Tweet by Jessie Gruman from CFAH to a blog post from the NY Times (see: http://well.blogs.nytimes.com/2011/06/20/keeping-score-on-how-you-take-your-medicine/?ref=health). This blog describes a new scoring system for medication adherence (how well someone takes their medication). A score less than 200 is a person at "high risk" for medication non-adherence, while a score of more than 400 (out of 500) is good adherence. It got me wondering - especially in light of the incredible amount of research on medication adherence, compliance, persistence, patient engagement in their health, and other sociologic parameters of people's health behaviors - how does a score here "predict" what someone is going to do in a given situation?!

The folks behind the scoring system are the same folks that bring you credit scores (FICO). Credit scores, as we all know, are based on transactions and how each of us manages our debt. The better we are at paying our bills on time and in full, the higher the credit score - the more "credit worthy" we are. I'm not sure that the same rationale can be applied to a multi-factorial process like whether or not I fill or refill my prescription(s). This process is all about trust and belief - that is, do I believe my prescriber got it "right" with the diagnosis and am I therefore inclined to follow the advice and fill the prescription? Obviously not as straight forward as whether I bought a trinket and never paid for it.

Health, wellness and wholeness (HW2) are integrated and multivariate. We continue to try to take a complex system of action and reaction and simplify it to component parts. The blog details a situation of a man on 12 medications who was having problems managing them. No doubt, it is well documented in healthcare literature (especially Pharmacy) that the greater the number of medicines and the greater number of doses per day drammatically decreases the likelihood that a person will take them appropriately. This person would benefit from a high quality, face-to-face medication therapy management consult from a pharmacist - rather than a FICO score that suggests a phone call from a managed care company.

There are great data from pharmacist projects across America (Asheville and others) over the last 15 years that show how face-to-face counseling with pharmacists improves not only medication adherence, persistence and compliance, but improves health measures such as HbA1c, ED visits for out of control asthma, blood pressure and cholesterol. Now, if FICO scores were sent to Pharmacys that these "at risk" individuals use, then the pharmacist could use this information to tailor medication counseling and relationship building which would (I predict) improve scores. Just like a credit counselor does.

After all, as discussed in prior blog posts here, HW2 improvements come with improved relationships across our lives. Having people we trust, who we are in close relationship with, makes it much more likely that we will make healthier choices. See what we're doing about this at Possibilities Journey, Inc (www.possjrny.org).

This week, get to know your friendly neighborhood pharmacist. A great and underutilized resource in our journey towards HW2.

Peace,
Dan