November 9-11, 2003
Meeting Report
SOS Rx is a new collaborative coalition dedicated to promoting outpatient medication safety, initially among seniors. SOS Rx is a broad partnership of consumer, patient, physician, pharmacist and caregiver organizations. The coalition will focus on campaign-style education and information initiatives aimed at securing consumer actions and system changes to enhance the safe outpatient use of medications. To identify and prioritize those consumer actions and system changes that will most improve outpatient medication safety, SOS Rx invited over 40 experts to a Consensus Building Retreat.
The SOS Rx Consensus Building Retreat, held November 9-11, 2003 at the Aspen Institute at Wye Mills, MD, included 51 participants and observers from 37 organizations. Hugh Tilson, Senior Advisor to the Dean, University of North Carolina School of Public Health, and Chair of the Centers for Education and Research on Therapeutics (CERTs) Steering Committee, served as the moderator.
The National Consumers League is the convening organization for SOS Rx, with Express Scripts as the founding sponsor.
George Lundberg, Editor, Medscape General Medicine, delivered an introductory keynote speech on Sunday evening. On Monday morning, selected speakers shared lessons learned from past collaborative efforts to guide the afternoon’s breakout activity, which included brainstorming, prioritizing and developing consensus on the consumer actions and system changes needed to make outpatient medication use safer for seniors. Tuesday morning, both the consumer action and system change groups created individual action agenda projects and reported back to the full group. The retreat concluded with each group presenting its action agenda-based projects to federal agency officials and obtaining their feedback on how these might move forward with the agencies’ support.
The consumer action group achieved consensus on the following projects:
· Targeting at-risk populations – educating patients and providers about high-frequency, high-cost medical errors related to specific drugs.
Major public relations education campaign to reduce the incidence of medication safety problems by informing consumers and professionals. Key audiences are seniors and family caregivers. The actionable message to consumers: there are risks and benefits to taking medication. Consumers can do something about it by taking a role in their health care and changing visit behavior.
·
The system change group achieved consensus on the following projects:
· At risk identification and outreach through a clearinghouse
· Patient-centric information management focused on medication lists, allergies and adverse reactions
· Standards and incentives around appropriate technology for medication management, including e-prescribing
· Evidence-based research network on what interventions work; how they translate and how they are optimally communicated
In his keynote address, George Lundberg gave a broad overview of the “torturous” road to patient safety, and the many different issues to consider when looking at ways to enhance the safe use of medications. As the coalition works on medication safety, he encouraged the use of an outline that looks at the indication, medication, place, dispensing, compliance, and the effect of a medication. He viewed E-prescribing as a moral imperative, and that it must be required by law to make medication use safer. While recognizing the problem of patient safety may be easy, and figuring out a solution may also be easy, actually implementing the solution is not easy. He hoped that as an outcome of the retreat participants would feel it was worthwhile, and one year from now would feel they had done something to make the use of medications safer.
Linda Golodner made introductions and provided direction that the coalition is depending on this group to build an action agenda with defined projects to make the use of medications safer in the outpatient setting. Each attendee detailed what his/her organization is currently working on in the way of patient safety. Pre-selected individuals made brief presentations on lessons learned from past and current projects.
Lou Diamond, National Patient Safety Foundation (NPSF), presented the NPSF Pharmaceutical Safe Use Project that resulted in the “Think it Through” campaign and brochure. The primary lessons learned from the project include the following: secure funding, ensure commitment from all the stakeholders to collaborate, explore early issues of duplication of efforts by collaborators, identify an organization to drive the project, need a champion, and a commitment to a manageable first step.
Christine Williams, Agency for Healthcare Research and Quality (AHRQ), informed the group that the main lesson learned at AHRQ is to provide information in ways people can understand. Messages need to be targeted, short and simple, and should not duplicate what is already being done. You must convince policymakers or practitioners that a process or procedure that improves patient safety is also value added for them.
Tom Clark of the American Society of Consultant Pharmacists informed the group that the number one risk factor of older adults is the number of drugs taken. He emphasized that any symptom in an elderly patient should be considered a side effect of a medication unless proven otherwise.
Diane Cousins, United States Pharmacopeia (USP), emphasized their work on error reporting programs and the importance of clear patient-physician communication. She presented numerous examples of medication errors, including those that occurred in the patients’ homes. She emphasized that with new dosage forms and technologies things will go wrong. Communicating on how to best use these new technologies is critical.
Action Agenda
Building
Monday afternoon the participants met in two subgroups, one focusing on system change and the other one on consumer actions. The groups were instructed to “brainstorm” about the changes or actions that would improve the safe use of outpatient medications by seniors. Each group drafted a list of possible action agenda items.
Following the brainstorming, the participants reconvened to report back on the lists created. The consumer action group reported that their discussion focused on how to communicate effectively to consumers about the risks of medications. There was discussion on health literacy, how much to expect of consumers (especially seniors) and the role of the health care professional in communicating to patients. The concern was also raised to not duplicate the consumer messages already created on this issue or there may be confusion.
After a presentation of the items discussed, the entire group voted on the consumer actions they would like to see on the action agenda. The larger group determined the prioritized action agenda for consumer actions would be:
Ž Provide guidelines/checkpoints for visit behavior—30 votes
Ž Targeting at-risk situations for consumers, particularly around transition settings and the use of more than one medication—24 votes
Ž Shock/benefit message/align the message—19 votes
Ž Advocacy for system change, particularly e-prescribing—11 votes
The system change group reported on their discussion that produced many ideas for changes within the system that could enhance the safe use of medications. This list included management and use of appropriate technology (including e-prescribing and electronic medical records), and actions requiring coordination between government agencies and health care providers. The larger group determined the prioritized action agenda for the system changes would be:
Ž Patient-centric information management focused on medications lists, allergies and adverse reactions – 23 votes
Ž At-risk identification and outreach – 22 votes
Ž Personal medications management service—15 votes
Ž Evidence-based research—11 votes
Ž Standards and incentives around appropriate tech for medications management—10 votes
On Tuesday morning the subgroups were tasked with creating individual, realistic, saleable and fundable projects based on the two action agendas voted on last night. The groups worked on these projects and then presented them to the entire group and federal regulators/officials during lunch before the meeting was adjourned.
Consumer Actions
Projects:
· Targeting at risk populations. Short term—“Don’t Bleed to Death”
· Brief description: educating patients and providers about high-frequency, high-cost medical errors related to specific Rx drugs (ex: Warfarin or other drug and disease pairs)
· Target specific populations and providers/pharmacists
· Motivate patients to tell doctors about the other medicines they are taking (OTCs, dietary supplements, other remedies), and to ask about needed monitoring
· Method:
–Reaching consumers through media outreach/celebrity spokesperson
–Point-of-refill education
–Inform providers about campaign
· Players: Pharmacists, manufacturers, providers
·
Budget: unknown, ask players above for funding
· Public education campaign- Long term—Out of the Medicine Cabinet
· Brief description: major public education campaign to reduce the incidence of medication safety problems by informing consumers and professionals. Key audience is seniors and family caregivers.
· Actionable messages: There are risks and benefits to taking medications. Consumers can do something about it by taking a role in their healthcare, and changing visit behavior.
· Impact: Market to potential funders the potential for reducing healthcare costs via decreased medical errors. Providing efficiency and safety for new Medicare drug benefit. Economic and clinical safety net. No national campaign has done this. Downstream errors highly preventable.
· Method:
- PSAs, media, celebrity spokesperson, grassroots outreach
- Techniques to capture attention: shocking, targeted messaging (?)
- Not adversarial with doctors
- Market research, communications audit, surveys (baseline, ongoing)
- Focus groups (consumers, pharmacists, etc.) to support development of messages
·
Players: government, industry, advocates, media,
third-party organizations
System Changes
Projects:
· At-Risk Identification and Outreach
· Develop a clearinghouse of best practices around identification, dissemination, operational outreach and consumer empowerment for high-risk populations (this to include payers, providers, suppliers, caregiver organizations)
· Who does it? NCL? National agency? Funded through grants? Define “high-risk” – a medicine or a particular population? Does it identify interventions that may or may not work
· Identification of target initiatives along this – e.g., those with home devices for medication delivery, coumadin management, etc.
· To incorporate best practices and development of a model around pharmacy consultative services in the outpatient arena
·
Patient-Centric
Information Management Focused on Medication Lists, Allergies, and Adverse
Reactions
· Development and dissemination of a standard information and workflow model around patient-centric information set, to be co-managed by the patient regardless of provider setting.
· Targeted on all medications (prescribed, OTC, herbals), allergies, immunizations, conditions, lab test results. This would include patient-controlled and managed information.
· Identification and dissemination around best practices, both technologically and operationally focused, in deployment of patient-centric information.
· This initiative will be pursued as a parallel process to the evolution of the complete Electronic Health Record
·
Standards and
Incentives Around Appropriate Technology for Medication Management
· Gap analysis of existing and planned efforts in e-prescribing to understand and promote what standards (not limited to technical standards) around true interoperability are already developed and adopted, and identify those standards that require further definition and implementation
· The goal is to provide an initiative that will accelerate the success of initiatives (and tie them together) underway to achieve outpatient electronic prescribing to include financial incentives and specific technologic best practices
·
Evidence-based research network on what
interventions work; how they translate and how they are optimally communicated
· Advocacy for development and appropriate resourcing of AHRQ managed collaborative network of all private and federal partners of specific research, feedback, dissemination and other processes to support “grants and funded programs” re: safe outpatient medication management
Officials representing AHRQ, FDA and the VA joined the retreat for a lunch briefing on the proposed action agendas. The comments by the federal officials on the action agenda items were positive. The speakers reminded the coalition to be extremely focused in taking on these projects and to avoid information overload. Specific comments regarding the projects included the following:
1) Consumer action projects – Messages must be simple, clear and tested. Should spend the time and resources to find out what will change behavior. It is very important to focus on high-risk drugs.
2) System change projects
- Clearinghouse – need to look at how we do knowledge management, how we organize and distribute information, and how we can enable access to and learning by providers. Be careful of information overload. AHRQ recommended a private-public partnership.
- Evidence-based research network –long overdue. Federal agencies agreed upon need to combine resources to conduct collaborative, evidence-based research. Need to focus on how we translate the research from grants to disseminating what has been learned. AHRQ funds a few such networks.
- Standards and incentives around appropriate technology for medication management –Everyone agrees that e-prescribing can have a big impact – we may be at the tipping point for more broad implementation of this. But AHRQ believes we still need to make the business case for purchasers of this type of system.
- Patient centric information management focused on medication list, etc. – Patients need to have options as to how they can mange their records, and need to understand the tools they could use to do this.
The action agenda workgroup will meet December 2, 2003 to review the results of the retreat and plan next steps, and the education campaign workgroup will meet December 12, 2003 to work on plans for the 2004 education campaign. The next full SOS Rx coalition meeting will take place January 7, 2004 at AFL-CIO headquarters in Washington, DC, where the action agenda will be presented and approved. All materials from this and all meetings are available at www.nclnet.org/sosrx.