Isabelle Adenot: "21 months on, the pharmaceutical record is being introduced to the public"

Services | 09 Nov 2010
The view of Isabelle Adenot (president of the French national pharmacists association – CNOP)
 
On 15 December 2008, after 18 months of trials, the pharmaceutical record (DP), which respects human rights and the confidentiality of patients' health data, was declared "fit for service" by the French data protection commission (CNIL), and the decree confirming its rules was published by the Ministry of Health. It is now ready to be rolled out, and from this point onwards, anyone with a Carte Vitale (CV) insurance card can open a DP. In addition, pharmacists are now obliged to enter the prescriptions they dispense into these newly created records.
Isabelle Adenot 21 months on, what is the state of play?

There are three essential things we have to know in order to assess the acceptance of the service:
 
  • The number of records created, by age
  • The number of record creation refusals, by age
  •  The number of records closed at the patient's instigation

How does the DP score on these three key indicators?

Les créations enregistrées au 1er juillet 2010 sont les suivantes :

Créations de DP par tranche d’âge

  0 to 19
20 to 39
40 to 59
60 to 74
75 +
Total
Total population 15 930 184 16 642 648 17 498 941 5 436 527 5 451 700 63 960 000
Population with a DP 1 551 252 1 665 995 2 472 423 1 953 645 1 167 650 8 810 965
Population with a DP (%) 10% 10% 14% 23% 21% 14%

22% of people aged 60 and above had opened a DP by 1 July 2010. This might be explained by the fact that, once over the age of 60, the number of age-related health risks increases (cardiovascular and osteoarticular disease, sensory disturbance, etc). Patients who have been diagnosed with a particular pathology/pathologies are monitored regularly by one or more doctors, and are receptive to the benefits offered by the DP in the monitoring of their treatment.

This figure makes sense in the context of the French population because it confirms that older people are the group most open to creating DPs; they are also the biggest consumers of medication and the group most susceptible to iatrogenesis (on average, serious iatrogenic events tend to affect patients over the age of 61).

At either end of the scale, we can see that many parents have opened DPs for their young children: in fact, the 0 to 1 age range has the highest number of DPs. Moreover, take-up has been just as strong among patients over 75, despite the fact that they have reduced mobility and a lower propensity to adopt new technologies.

We have also analysed the percentage of record creation refusals, by age, since the DP trials began in 2008. For each age range, the figure is now somewhere between 19% and 24%. Note that these figures represent the total number of refusals, so when people have refused to create a DP several times, each refusal has been counted. If we leave out multiple refusals, this rate is reduced by 5 to 6 points.

This small variation demonstrates that, overall, the pharmaceutical record has been well received by patients in all age ranges, even though there is a slight increase in refusal rates in the highest age brackets. There are several explanations for this difference:
  • Reticence among older patients to open a record, as they say they always visit the same pharmacy;
  • A lower proportion of patients accepting the DP when it was first proposed.
The final, and by no means insignificant criterion for evaluating public confidence over the long term, is the number of records that have been closed. In France as a whole, the number of records closed is stable in proportion to the number of records created each month: this equates to 1 in every 500.

Although they can have their DP closed at any time, at any pharmacy in the network, without having to give a reason, very few patients have done this. The majority of those who take up this option tend to do so in the month after their DP is created.

These initial results are encouraging and demonstrate one thing – a health innovation which is useful, secure and tailored to professional practice can be introduced quickly to the public.

At our next panel discussion we will be able to examine the resources implemented to facilitate the take-up of the DP…