Sunday, December 10, 2006

How Walgreens Helps us and Hurts us at the Same Time – the Slippery Scale of Customer Satisfaction

Speaking as a private citizen and not as an employee, I can be quite opinionated. So please forgive me in advance.

This word: Xifaxan (rifaximin) – I have difficulty pronouncing it J

This antibiotic has recently been found in a few small RCTs (randomized controlled trials) to provide benefit to people with one of the three types of IBS (Irritable Bowel Syndrome) whose symptoms are not controlled or entirely controlled by diet, exercise, and stress factors. My excellent stomach doctor prescribed this medication for my stomach that is usually given to people to treat diarrhea that is caused by bacteria from food you eat “traveler’s diarrhea”.

However, he prescribed rifaximin at a much higher dosage than is usually used to treat “traveler’s diarrhea. Please see: - {First GOOGLE suggested site without refinement by subtopic}. It is so expensive, that my doctor gave me a $30 rebate coupon so the company that markets Xifaxan (not yet available in generic form) can collect lots of information on me, and send me advertising email “newsletters.”

When I went to my local Walgreens (it IS as cheap as COSTCO) to get my diabetes meds (medications) and fill this new script (prescription), the Pharm Tech told me “there is a drug warning that the dosage is way too high and/or their may be an interaction with your other medications.” The pharmacy technician did not really want to give me that information. I had to probe with a couple of questions to get the information.

Once I got the information about why the computer was not letting them fill my order of three different medications, I told them, this is GREAT! The system worked the way it should. I am very impressed! Perhaps, my university faculty doctor made a dosing mistake. However, lingering in my mind was the nagging feeling that he did NOT give me the wrong dose, but the right dose for my diarrhea type IBS. He gave me an “off-label” or not yet totally approved by all the powers to be dosage for an indication (another disorder) other than the one the FDA approved the drug for (bacteria diarrhea). However, I like people to err on the side of safety, so I did not mind Walgreens pharmacy’s decision not to give me ANY of my medications (a FAIR thing to do) and told me to come back the next day after they talked to my stomach doctor.

A woman who was sitting in the waiting area at the pharmacy for at least the 25 minutes it took me to complete my transaction, spoke up at this point. She told me she was waiting there for 45 minutes for the pharmacy to talk to HER doctor (it is now 5:30 pm). No surprise, they are gone for the day. The problem is, SHE HAS TO HAVE HER MEDS because she is on insulin, so they cannot get rid of her as easily as they get rid of me. The pharmacist now has to try heroically to call the MDs after-hour service, whose employees probably just got to work. It is sad, but it will probably take over an hour and a half to work this all out so she can just get her medications. Diabetes treatment REQUIRES constant changes in dosages at least 3 medications. A system that has to make you wait days or hours to pick up your meds is NOT GOOD.

I returned the next day at about 5 pm and was told that I could not have the rifaximin yet (A BAD THING) because my insurance would not pay for it [Uniform Medical Plan – State of Washington (fee for service)]. I left from my SECOND Walgreens visit, without all my meds. I got home and the ironically GOOD thing was that they had left me a phone message (at home???) that my meds had a problem and to call in. Ironically, I do not stop home before I do my errands after work. I do not believe most people do. The good thing is, at least some type of warning was there and the routing to another phone would be very easy.

Now 3 days later, unbelievably, I am still trying to get my Xifaxan! I called the pharmacy the next morning (a Saturday). After waiting so long on hold that my call became new again, the patient pharmacist explained the situation to me. She also said, the MD and the pharmacist would have to appeal the decision of the insurance, and that would require the MD to fill out “over-ride” type papers that are faxed to the MD from the insurance company at the request of the pharmacy. This would take 2 days to 2 WEEKS. IS THIS PROCESS INSANE?

I would love to see GOOGLE HEALTH design interfaces that are based on patterns of actual usage, and simplicity rather than trying to make ONE SIZE FITS ALL computerization. That will not work in HEALTH CARE information processing. What we really need is the zero install application model that can be accessed everywhere like the Web. That is why I believe that the model proposed by Adam Bosworth seems a logical starting point for this new wave of health care information in the age of infinite content to link health information in real time.

Here is a HORRIBLE thing about Walgreens retail prices; they cheat customers with poor vision, absentmindedness or those who do not read well! While I was there, I was tempted by a couple of products that had big stickers on them saying boldly - 2 / $5.00 or something like that. I did not give it much thought and I grabbed two very different items and went to the cashier. When I got back to my car, I realized my bill was too much $. They had charged me about fifty cents more on each item. In very small, 4 point font, it says “$3.00 each.” I could not read the font without my glasses!

This Walgreens store primarily serves the elderly and poor people receiving public assistance and living in the public housing communities across the street. I talked with the very young and smug manager, who told me it was “corporate policy” and he had no control over that. I believed him. I thought, wow, instead of just feeling angry, gosh darn it, I can blog this! Maybe someone who matters in Walgreens could find this posting, maybe using DIGG, bring it to awareness of us people for who $1 matters.

My truthiness is that, Walgreens is not ALL good or ALL bad; it does some good things and some not so good things. The free Diabetes magazine I pick up there with my meds is GREAT, even though it is funded by the pharmaceutical industry. Who cares? Not me, its good bathroom reading. However, the way the retail marketing misleads us, and then over charges the people with the least money to spare, is not a nice thing. Walgreens I think you can do better.


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