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Patient Satisfaction Surveys: A Continuous NCODA Initiative for Improvement Within the Oncology Dispensing Practice

Joshua J. Nubla, PharmD; Robert D. Orzechowski, MBA; and Aaron Budge, PharmD
NCODA presents findings from over 700 patient responses across the country to determine patient satisfaction over 4 categories: time, convenience, staff interaction, and overall satisfaction.
“Undoubtedly, physicians have the twin responsi- bilities of giving the best healthcare to the patient and leading the MID practice in attaining the goal of satisfying the patient,” Bhanu Prakash writes.Listed below are a few “house rules” to handle patients so as to have all satisfied:4
  1. Break the ice: Make eye contact, smile, call patients by name, and express words of concern.
  2. Show courtesy: Kind gestures and polite words make patients very comfortable.
  3. Listen and understand: Encourage patients to narrate their problem. Invite and answer their questions.
  4. Inform and explain: These promote compliance. People are less anxious when they know what’s happening.
  5. See the whole person: Envision the whole person beyond the illness.
  6. Share the responsibility: Risks and uncertainty are facts of life in medical practice. Acknowledging risks builds trust.
  7. Pay undivided attention: This reduces distractions and interruptions as much as possible.
  8. Secure confidentiality and privacy: Watch what you say, where you say it, and to whom you say it to.
  9. Preserve dignity: Treat patients with respect. Respect modesty.
  10. Remember patients’ families: Families feel protective, anxious, frightened, and insecure. Extend yourself, reassure, and inform.
  11. Respond quickly: Keep appointments, return calls, and apologize for delays.
From a healthcare provider’s perspective, specifically a pharmacist, there are gaps and scenarios where patient satisfaction surveys are underutilized. For example, in one participating practice, surveys are considered beneficial primarily from a business and operations perspective. However, they should also be considered valuable for patient outcomes, because continuous quality improvement is a vital aspect of any dispensing service and healthcare practice. From a pharmacy and dispensing outlook, it is often difficult to distinguish and visualize the impact of the pharmacist and staff. At some practices, physicians and nurses are strained for time and often are unable to spend as much time with a patient as they would prefer. This gap, which in the past has gone unmeasured, could potentially be covered by pharmacists and the auxiliary staff (ie, pharmacy technicians, nurses, patient financial advocates, etc). The NCODA Patient Satisfaction surveys help to validate the continuity of care to help transverse the different disciplines involved.

There are also other opportunities where assessing patient satisfaction can be implemented at a practice, such as in an oral chemotherapy follow-up program, where a pharmacist can initiate education around a new oral chemotherapy drug with a patient. Patients who are part of an MID practice are also contacted at predetermine intervals, in addition to their office visits, to assess adherence and drug toxicity. Education and reinforcement are provided as needed.

Questions to always ask:
  1. Does the patient walk away feeling more comfortable with the information they need to begin taking the medication?
  2. Does the patient fully understand how to take their medication and why they are taking it?
  3. Does the patient feel that their adverse effects are under control?
  4. Does the patient feel they have the support they need if there is cognitive impairment or they face financial issues?
Anecdotal evidence suggests many patients are unaware of their diagnosis, why they are on a certain medication, or why their particular medication was discontinued, held, or switched. The MID is a service of the practice that can provide clarity and relieve fears about adverse effects.

When a patient understands and trusts the health- care providing team and their decisions, they can be much more satisfied knowing that they are being taken care of on a personal level.8 For example, in a scenario involving a personal exchange between a patient and pharmacist, a patient mentions that she does not trust the drug companies. The pharmacist then shows a study that found that adding a particular drug improved progression-free survival by 10.2 months. Through data and a friendly and understanding healthcare provider, the patient is able to visualize the effectiveness and see that the practice had her best interests in mind.

For drugs that are filled at SP, the MID practice’s responsibility as the patient’s healthcare provider is often mixed, given certain circumstances that disallow continued refills at the practice. Even in those situations, the burden may still be placed on the MID practice to ensure that the patient receives their medication on time. For certain restricted drugs in a practice, for example, prescriptions are not permitted to have refills. The physician must sign a new prescription every cycle and an authorization number must be obtained from the manufacturer.

MID practices can also help patients who cannot afford their medications by connecting them with charitable foundations that provide financial assistance. Without oversight, numerous patients may not get their medication on time especially during long events, such as holidays. For example, what if a patient needed an early refill/vacation override prior to embarking on a month-long vacation? A vacation override would be needed for the manufacturer, their specialty pharmacy, and their insurance provider. Patient satisfaction is readily apparent when they receive assistance in such scenarios. Patients are extremely grateful and happy that MID practices can provide this kind of service.

Utilizing Survey Data

How can these patient satisfaction survey results be utilized? Many satisfaction batteries can reliably distinguish between physicians who are great commu- nicators and those who are interpersonally challenged. Patient satisfaction is also related to a variety of possible downstream outcomes, such as the propensity to change health plans or to sue for malpractice. These results are clearly of interest to managers and marketers, but their relation to clinical quality improvement is tenuous. The important question is whether information on patient perceptions and values can stimulate genuine gains in patient-centered care. Providing physicians, payers, SPs, PBMs, employers, and staff with comparative quarterly satisfaction reports is likely to accomplish little except fuel resentment.

Accounting for all of these sources of variation, it is important to recognize that a satisfaction score is a perspective, not the truth, about a physician’s ability to deliver quality care. It is information that reflects a subset of daily interactions, and it is dependent on the number of variables involved.

NCODA plans to continue building an inventory of survey responses to help members better manage their IOD and other internal processes. We also hope to apply this data as one more piece of evidence that we are a better alternative to the current restrictions and barriers to cost avoidance, waste reduction, and more timely care.

Conclusion

Patient satisfaction is an attitude. Patient satis- faction is an indirect, or a proxy, indicator of the quality of care, the provider, or their MID practice overall. Delivery of patient-focused care requires that we provide care in a particular way, always. It must be the best care for every patient every time. Ideally what is needed is for the MID pratice to have the ability to manage the patient with cancer in totality, unencumbered by interference from specialty pharmacies; incomplete payer or PBM formularies; and the complicated system of authorizations and financial support, policy changes, inadequate beneficiary education on the part of policy purchasers and sellers, and regulations that frustrate the realization of lower cost, same or better quality of care, and a higher patient satisfaction score. 

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AUTHOR INFORMATION

Joshua J. Nubla, PharmD, is a manager of the National Community Oncology Dispensing Association.

Robert D. Orzechowski, MBA, is chief operating officer of the Lancaster Cancer Center in Pennsylvania.

Aaron Budge, PharmD, was a clinical pharmacist of Tri-County Hematology & Oncology when this article was drafted and is currently a practicing pharmacist in Northeastern Ohio.


ACKNOWLEDGEMENTS

National Community Oncology Dispensing Association


ADDRESS FOR CORRESPONDENCE:

Joshua J. Nubla, PharmD
PO Box 468
Cazenovia, NY 13035
Email: joshua.nubla@ncoda.org
 
 
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