Following on from the information released by the BHTA in regard to the survey undertaken by Ricability on the subject of prescriptions through the retail model, we now have the full Ricability report.
We also have a reaction from one of the retailers involved in the Cheshire retail model but whose figures are not part of the survey.
Mike Williams of Ableworld contacted THIIS to say…
“Great News. The survey shows 71% of the people involved are either the customer themselves, the family, or the professional. If you then take on board that another 20% of the prescriptions were delivered hopefully by experienced and caring retail staff (no different than loan store staff), then I'd argue it's a resounding success.”
“The problem here though is that the survey was carried out by an organisation, mainly funded by the very people who have most to lose by the success of the Retail Model. I have no problems with the suppliers to the Loan Stores voicing opinions as they are protecting their business, however, if figures are going to be published, then they should be more representative of what is happening and not simply a snapshot from one business that is not just purely a retailer.”
“We would support in the Autumn an Independent Survey, where the questions are discussed and agreed by all parties and the presentation of the results are totally Independent of the retailers, the suppliers, the BHTA and the Health Authority.”
“Let's have some truth and accuracy in this matter and move forward.”
Here is the report from Ricability
Audit of prescriptions redeemed at Ross Care, Chester
Introduction
In 2007 the Department of Health, social service departments and PCTs piloted a new system of providing equipment based on prescriptions that can be exchanged at accredited retailers.
This pilot has been closely monitored. There has been considerable interest in the circumstances under which prescriptions are redeemed and, in particular, how many equipment users exchange the prescriptions themselves. It is argued that users who do this may ‘top up' the prescription if they see an alternative piece of equipment they like better, and may also browse around to see what other equipment may help them.
Research commissioned by the Department of Health has suggested that over 80% of people who received a prescription exchanged it in the shop personally. This figure has been questioned by the British Healthcare Trades Association (BHTA) and some retailers.
For this reason Ross Care carried out their own analysis of prescriptions exchanged in their Chester store from November 2008 to January 2009. It showed that over this period equipment was collected by only 10% of users – in nearly half of cases this was done by family members, with deliveries accounting for another fifth of cases and collection by professional staff (ie prescribers) for a further 14%.
BHTA have commissioned Ricability, as an independent research organisation, to audit these figures.
The audit
Ross Care provided Ricability with photocopies of some 690 prescriptions forms that had been redeemed between 3rd November 2008 and 30 January 2009. They also provided copies of the summary sheets they had made of the data.
Findings
Overall Ross Care's summary of the prescription forms was accurate. There were minor discrepancies (noted below), but these were few and had only a very slight affect on the percentages calculated by Ross Care.
An analysis of the audited figures is given in the Table at the end of this report. Its main findings were that 10% of prescriptions were exchanged by users, 14% by professionals and 49% by family members.
Scope of the audit
How representative is Ross Care? Ross Care's catchment area is in the area of Ellesmere Port and North Chester. We cannot tell from the audit how far Ross Care's customers are typical of those of other retailers in the area.
n The ease of getting to a particular store might have some affect on the proportion of prescription recipients who collect equipment personally. However Ross Care is reasonably easy to get to and is well served by local bus routes. The railway station is some two miles away, but there are bus links between it and the store. The store is close to the motorway and is on the main road from Chester to Ellesmere Port.
n The store is next to a 64 bed community hospital that provides rehabilitation, assessment and intermediate care for in-patients with physiotherapy and ‘outreach' services for older out patients. Common sense suggests that hospital prescriptions are less likely to be collected personally by patients at the time of discharge, which might point to a difference in the profile of Ross Care customers if a high proportion of prescriptions were issued by this hospital. However Ross Care state that ‘only around 5% of prescriptions redeemed at our Ellesmere Port shop come from Ellesmere hospital'.
As a further check on how typical Ross Care might be, a questionnaire was sent to five retailers in the immediate area to ask how far the Ross Care's profile of customers matched their own experience. Three replied. Two said their own profiles of customers did not differ significantly from the audit; the third said that 15% of their customers were users exchanging prescriptions for themselves while 65% were exchanged by family or friends.
True and complete record? We have checked the information provided to us. We take as a matter of faith Ross Care's assurance that the paperwork was complete and genuine. An analysis by day shows that the volume of prescriptions collected did not vary in any way that might hint at missing data. In fact the only significant variation we noted was that collections increased just before Christmas, which might be expected.
Collection by family member? The conclusions of this audit turn on the proportion of prescriptions which were redeemed by family members. The prescription required customers to sign for the equipment they collected. When a family member picked up the equipment the store noted their relationship to the user – this information was not required by the form and so was collected specially to provide information for the analysis. Ross Care assure us that if the user had accompanied a family member who collected the equipment, this would have been noted. We found only three cases where this had happened although we cannot tell if there were any failures by Ross Care staff to note the presence of users.
Ross Care and Ipsos MORI results
Ipsos MORI Social Research Institute carried out a survey for the Department of Health in April 2008. The research consisted of 102 telephone interviews with users in the three areas which were running the pilot prescription system.
This survey found that over four out five people collected equipment for themselves. This was based on answers to the following question (1)
Q4. And can I just check, for your recent prescription are you redeeming this for yourself or on behalf of somebody else? And are you that persons carer or not?
%
For myself - 84
On behalf of someone else - Carer 7
On behalf of someone else – Other 9
Don't know 0
Explanations for the differences between the MORI survey and Ross Care figures could include:
Time differences. Ross Care figure relate to the period from November 2008 to January 2009, while the MORI survey reported on prescriptions issued between October 2007 and April 2008. We have no reason to think the difference between the two were due to the different periods covered.
Differences in samples. The MORI survey was carried out in three areas, and it may be that each area has markedly different patterns of prescription exchange. Common sense suggests this is unlikely to explain the very large discrepancy between the two sources of information. One very real difference is that the Ross Care information is a census of all prescription exchanges in their Chester store. The actual response rate of the MORI survey is unknown because while interviews were achieved with 39% of those who gave their consent, we do not know how many people declined to give their consent in the first stage of the sampling procedure.
The question asked. The use of the word redeemed may have been misinterpreted by some respondents who simply thought the interviewer was asking who the prescription had been for, particularly as it does not make much sense to ask users if they had redeemed the prescription on behalf of someone else.
Ricability
April 2009
[1] Evaluating the Transforming Community Equipment Pilots Research Study Conducted for Department of Health. DoH May 2008