Friday, June 29, 2007

Patient Compliance: Is There a Solution? - 2

MedAdNews and Guildeline surveyed consumers and physicians to determine their attitudes about patient compliance. I attended their breakfast launch to hear the results and the panel discussion on Wednesday 06.27.07. Most of what they discovered I knew, however I was surprised by some of the stats which I will share here.

Morris Whitcup and Al Koster, both from Guideline, are credited as the authors of this study which was published as The Trend Report in June's MedAdNews. I am going to focus on the facts that I find interesting and were new to me, there is plenty more data in the report which I am not going to address.

Of those polled, 59% (6 in 10) said they were noncompliant during the past year. Pretty Standard.

They broke down the noncompliant by Behaviorally Noncompliant (BN) and Attitudinally Noncompliant (AN). I had never heard of that breakdown and think it is an interesting measure. 27% (1 in 4) of respondents were attitudinally noncompliant - meaning that their answers based on the questions asked, reflected a noncompliant attitude. There was also crossover with behaviorally noncompliant in this group.

After accounting the overlap with the two groups, Guideline found that 64% (2 in 3) polled were noncompliant.
Attitudinally Only: 5%
Behaviorally Only: 37%
Both: 22%
Neither: 36%

The results using this BN and AN were fascinating, as the AN were the most interested in learning more about medications, would be more compliant if they understood the importance of taking medications (60%), were the most knowledgeable in the family about medications (59%), and thought it was OK to skip a dosage or two (39%).

The AH did admit to not being as careful as they should about taking their medications properly (67%) and thankfully the majority said they were more careful with their children's medication that their own (61%). So pretty big numbers, some disturbing, some disappointing - 50% wished their doctor spent more time with them explaining their medication.

The physician's understanding or ideas about patient compliance were a little off the real numbers. Before that though, how long do you think the average doctor spends explaining medications to their patients? 2.9 minutes per the consumers, 3.2 mins per the physicians. That horrifies me. I do not go to the doctor that often, but at my first physical in 6 years Dr. Lim put me on Tricor for my trigliceride levels (diet, lack of exercise and inherited traits were the cause).

I did not time her, but it felt a lot longer than 3 minutes - the reason, what it does, the dosage, the side effects, how long I have to take it - could it all be summed up in three minutes? I also had two telephone conversations with her about it - lab tests, was it working, etc... Maybe I'm wrong about the time, but it is a pretty simple statin. I can't imagine if I had to take a complicated schedule with multiple medications and only have 3 minutes to get everything straight? No wonder the noncompliance rates are so high.

More to come.

Thursday, June 28, 2007

Patient Compliance: Is There a Solution?

I went to the Guideline/MedAdNews breakfast launch of their report, Patient Compliance: Is There a Solution, on Wednesday and learned some interesting facts from their online poll of patients and doctors.

I am still digesting the information and will post the results and my comments soon.

It's Always Nice to Be Recognized

It happens to me a lot when I walk down the street, but not for my blog, until now. Dr. Showalter from AlignMap gave me a "shout out" in his blog which you can read at: Just scroll down to his 06.20.07 entry.

He was very complimentary and I thank him for that. He is the authority on Medication Noncompliance and I often read his website for his new findings, articles and studies related to compliance issues.

If you visit the blog, you will see a bit about Ted Nugent - if not, here is a great quote from the Motor City Madman from a CNN interview regarding his take on national healthcare and personal responsibility: If you don’t care about your health, how dare you ask for healthcare.

Eventhough I do not agree with most of Ted Nugent's politics, Dr. Showalter suggested he would be a great celebrity spokesperson for noncompliance. If I recall from his VH1 show, he doesn't take crap or excuses from anyone. I can only imagine him chasing overweight noncompliant diabetics around with his bow, yelling at them to take their medication and lose weight. I would like that.

On another note, Ted has done a lot for underprivileged kids with his camp (like Don Imus whom I do not particularly like either) and he should be lauded for that.

Friday, June 22, 2007

Antibiotic Noncompliance

I found this article by Jill Stein in Medical News Today! - obviously it is a little dated.

NICE, FRANCE, April 20, 2006- Only slightly more than a third of individuals polled in a recent global survey know that noncompliance with a prescription for antibiotics can lead to antibiotic resistance, according to data recently released at the 16th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID).

Researchers involved in the COMPLy (Compliance, Modalities by Population, Lifestyle and Geography) survey examined noncompliance rates and factors affecting noncompliance in 4,500 persons who were 18 years of age or older and had taken a self-administered antibiotic over the last year.

Participants, who were drawn from eleven countries, were considered noncompliant if they had omitted doses or days or if they had leftover antibiotics even though they had been told to take them until they were gone.

Overall, 22 percent of respondents said they had not complied with their last antibiotic treatment, and the noncompliance rate exceeded 30 percent in some countries, COMPly Steering Committee Chairman Jean-Claude Pechere, MD, emeritus professor of medicine at the University of Geneva in Geneva, Switzerland, said. Fifty one percent believed that leftover antibiotics could be saved and used later on, and 73 percent of those who had leftover antibiotics said they saved them.

Not surprisingly, the number of doses per day was directly correlated with noncompliance. Thus, a 15 percent noncompliance rate was noted in persons taking one dose per day versus 27 percent in persons taking three or more doses per day.

Eighty percent of those polled believed that antibiotic-resistant germs represent a serious problem but only 61 percent knew that improper antibiotic use can diminish efficacy.

Dr. Pechere said that misperceptions about appropriate antibiotic use is the main reason for noncompliance in some countries, while a lack of faith in their doctor's ability and concern about their doctor's ability to manage their illness may be a more important factor for patients in other countries.

Results also identified age as an important factor. Of respondents 18 to 29 years of age, 30 percent were noncompliant versus 14 percent of persons 60 years of age or older.

Antibiotic resistance is considered a major public health concern.

Pfizer Inc. funded the COMPLy survey.

By Jill Stein

Thursday, June 21, 2007

AARP Members Rally For Lower Drug Prices

This falls under one of the reasons people on a budget are noncompliant with their medication. There is only so much people can pay for their prescriptions when they are on a fixed income or have low income. On Long Island, the elderly are doing something about it. Over 100 AARP members rallied NY state lawmakers to pass a bill to make prescription drugs more affordable. The members had a whistle stop tour of 15 district offices of state sentators and assembly members is Suffolk and Nassau Counties.

They are supporting a bill that passed last year in the Assembly requiring drug companies to report all gifts to doctors over $75 BUT, due to big pharma pressure, the Senate failed to act on the bill.
"We want to be sure that the drugs that end up in our medicine cabinets are there for the right reason -- because they are best drug for the best price, not because of a slick sales pitch and a nice meal," said Adele Klenk, Volunteer Regional Coordinator for AARP on Long Island.

I think it is grand that the AARP members get out there and let their voice be heard to their representatives. If they cannot afford to continue with the newest medications there are prescribed, then they obviously will not get better and possibly die. This is no good to anyone - doctor loses patient, pharma loses customer. Family loses loved one. Keep those prices affordable and keep compliant!

Sales Reps Wasting Time Communicating - FYI

I found this on PharmaExec and thought is was pretty neat. To summarize O. Schwindt, a lot of time is wasted due to interoffice communiques resulting in millions of lost revenue for pharma.
Here are the Stats:
Due to accidental use of Reply to all, mislabeled & long voice mails, and repetitive emails, a pharma rep wastes an average of 4.4 hours - 1/3 of the total time spent on internal communication.
Based on $3.5M for average sales per 1000 sales reps - it's $309M per company.
To cut down, one recommends labeling emails FYA or FYI, limiting the time on voice mailbox. One company removed the Reply All button from their email service.
Don't waste too much time reading this.

Monday, June 18, 2007

More Information and Facts About The Friday Post From NCCBH

As I stated, I am a little behind the times, but this is the press release from the National Council for Community Behavioral Healthcare from June 13th addressing the "lawyer ads" about Zyprexa.

Survey results released today shed light on a new barrier to treatment affecting people with severe mental illness. The findings show fears raised by product liability litigation involving antipsychotic drugs may be putting patients with schizophrenia and bipolar disorder at risk for relapse. These fears add to the already heavy burden that patients face as they work to manage symptoms, stay on their medication and work with their treatment providers to improve their mental and physical health.

The survey, which was conducted among 402 psychiatrists who treat patients with schizophrenia and bipolar disorder, showed that, even when patients were responding well to their prescribed antipsychotic treatment, many requested a medication change because these drugs are featured in law firm advertisements. Other patients stopped taking their medication, often without telling their psychiatrist, for the same reason.

“Many of our patients already struggle with accepting their illness and staying on their prescribed treatment, and now they are experiencing new levels of fear due to the increasing incidence of these jarring advertisements,” said Dr. Ralph Aquila, assistant clinical professor of psychiatry, Columbia College of Physicians and Surgeons; director, residential community services, St Luke's-Roosevelt Hospital Center, New York, NY. “This irresponsible advertising is hindering the progress of therapy for many of these patients and disrupting the important relationship between them and their healthcare providers. Plaintiffs attorneys need to consider the consequences that these advertisements may have on patients.”

The findings from this survey, which was commissioned by the National Council for Community Behavioral Healthcare and Eli Lilly and Company, are consistent with a Harris Interactive® poll of 250 physicians commissioned by the U.S. Chamber of Commerce in 2003 that examined how pharmaceutical litigation impacts prescribing decisions across disease states. However, this new survey went one step further by asking psychiatrists to examine the potential impact of this type of litigation on patient care. These new findings have implications for doctors who treat serious and persistent mental illnesses, and confirm trends in clinical practice that many people in the mental health community have observed, but have not been quantified until now.

Ninety-seven percent of surveyed psychiatrists had one or more patients who stopped taking medication or reduced their dosage. Of these psychiatrists, 52 percent believed patients took this action due to law firm advertisements about antipsychotic drugs, and reported the following:
• Ninety-three percent stated that one or more of their patients made medication changes without consulting them first, and the majority of these psychiatrists (94 percent) reported patient relapse as a result of discontinuing medication.
• The most frequent consequences of relapse were symptom recurrence (93 percent), hospitalization (75 percent), loss of an important relationship (40 percent) and suicide attempts (26 percent).

Even when patients were improving on their prescribed medication, they still approached their psychiatrists about stopping or changing. Ninety-seven percent of surveyed psychiatrists received one or more patient requests to stop or switch their medication. Of these psychiatrists, 59 percent felt patients made these requests based on concerns raised by law firm advertisements about antipsychotic drugs, and reported the following:
• The majority of these psychiatrists (93 percent) felt these patients were responding to treatment.
• Of the patients that were responding but requested a stop or switch, 71 percent of psychiatrists reported that one or more experienced a relapse, which also led to symptom recurrence, hospitalization, loss of an important relationship and suicide attempts.
• Half of the surveyed psychiatrists reported that patient caregivers also requested a medication switch or stop due to concerns generated by law firm advertisements, even if their loved one was responding to treatment.

“Doctors and patients need to discuss the risks and benefits of any medication in order to determine what is appropriate for each patient,” said Linda Rosenberg, MSW, president and CEO of the National Council. “That assessment becomes difficult in today’s atmosphere because so much of the advertising is alarmist and frightening. It’s especially crucial for patients to speak with their doctor before stopping their medication. Such discussions are an important part of the therapeutic relationship.”

The findings from the survey are especially pertinent given the number of barriers that already exist in helping patients adhere to their treatment. Among the many challenges psychiatrists noted they faced when selecting an antipsychotic medication to treat schizophrenia and bipolar disorder, the five most challenging issues identified were:
• Side effects (75%),
• Lack of adherence due to unwillingness to accept illness (73%),
• Medication costs (58%),
• Lack of adherence due to lack of support (50%), and
• Co-occurring mental illnesses (49%).

More than half (55%) of surveyed psychiatrists indicated that they had changed their prescribing practices over the last five years due to product liability cases involving antipsychotic medications – and reported frustration and concern that this type of litigation sometimes interferes with patient treatment. Furthermore, many psychiatrists (62%) reported that they know of colleagues who have made similar changes in their prescribing practices.

Friday, June 15, 2007

Zyprexa "Lawyer Ads" adding to Noncompliance

I am a little behind the times, but I just read an article about the “lawyer’s ads” for Zyprexa that are scaring patients into not being compliant with their mental illness medications. This does not sound good. Lilly (maker of Zyprexa) is in the middle of settling some 30,000 lawsuits and has spent over $1.2 billion already. The ads feature the drug’s side effects and the amount Lilly has spent to settle their lawsuits.

One lawyer who is creating some of these ads is William Berg. His firm is Berg Injury Lawyers. What is his motivation? "If we advertising lawyers don't tell people about their legal rights, who will? Eli Lilly sure isn't going to," he said.

I am unfamiliar with Zyprexa, but it treats schizophrenia and bipolar disorder and had over $4.4 billion in sales last year. The problem is that is causes diabetes or high blood sugar. I can’t believe that prescribing doctor’s did not know the risks – it’s just foolish. Also with any new treatment, I would imagine the psychiatrists would monitor their patients’ blood levels to see what effects the drug has on them. Lilly says all doctor's knew the side effects since the drug's launch in 1996 whereas Allen Rothberg, another lawyer representing the patients, claims that Lilly withheld information from patients and doctors alike.

The worst part about this, other than patients’ suffering, is that the advertising blitz is causing all these other patients to stop taking their other medications. I know that schizophrenics and bipolars can be paranoid – so just imagine what could happen to a patient after seeing ads reinforcing negative side effects. Couple that with claims for financial gain, and you have a bipolar fiesta. They stop taking their meds, let a little mania take hold and then they believe they can claim some of the billion dollar pot for themselves.

The wave of noncompliance among these patients could turn into a horrible mess. Here are the facts from a Lilly survey released on Wednesday: 402 psychiatrists who treat patients with bipolar disorder or schizophrenia completed an online questionnaire and more than half of the psychiatrists said they believed their patients stopped medication or reduced their dosage after seeing lawyers' advertisements about anti-psychotic drugs.

This is really big and really bad. 201 psychiatrists. Let’s say 20 patients each? That is 4000 unstable patients running around. A few years ago, after the media reported the FDA mandated severe "black box" warnings for a group of common antidepressants, suicide rates rose among those patients on the drugs.

Dr. Nada Stotland, president-elect of the American Psychiatric Association, said: "You can't prove a cause-and-effect, but you can draw a pretty good hypothesis that there's a relationship between suicides going up and people not being treated for depression." I hope this doesn’t happen again. The good thing is, Berg assured us all in saying, “In all of our ads, we tell folks, 'Do not stop taking any medication without consulting your doctor.'" I’m glad he is looking out for possibly already unstable patients, who will definitely heed that warning.

Another concern is what side effects are these patients going to suffer. These are not addressed in the regular side effect warnings for these drugs. A friend of mine went off Paxil or another antidepressant and was in bed for two weeks. Not so bad, but again just not taking medication for people with schizophrenia and bipolar disorder is bad enough.

On another note, what are the financial implications of this noncompliance for 4,000 patients? On the pharma end, let’s say the average medication is $250 a month. That’s $1M if these patients don’t refill their medications. That’s like 1/8 of a penny to pharma so they aren’t worried. Let’s say 1/3 go into a mental ward since they have adverse effects – let’s call it $1000 a night for 4 nights. Not bad only $5.2M in expenses. I’m sure insurance will cover it.

I am going to assume at least 3/4ths of these patients have jobs (@ $30K a year) and will not work for a week. That’s about $1.8M in lost revenue, plus another $2.5M to cover the jobs with temp help - that's just for the week. And a fair portion of these people might not return to their jobs if they don't get sorted out with the proper medication so you can add another $3M of lost revenue. Put that all together and you get $13.5M. I think I did the math correctly.

That might not be a lot to some, but it sure will cost us all down the road if noncompliance continues at this rate. I mean this is just fallout from 402 psychiatrists polled. I don’t know how many patients are out there on bipolar and schizophrenia medication, but Zyprexa did make $4.4 BILLION dollars last year, so go figure.

Thursday, June 14, 2007

White Coat Adherence

One of the questions I always have is about the white coat adherence - i.e. before you go to the dentist you floss like mad for two days and when she asks, you say, "Oh, of course I floss everyday". Your dentist knows if you floss or not. Just like your doctor knows if you have been taking your cholesterol drugs or not. Your blood test won't lie for you.

I admit that if you do not have any apparent symptoms you will forget to take your medication from time to time or you will stop taking your antibiotics once the infection has gone away - but you need to stay on that medication for a reason. For it's full run. Or ask your doctor.

Unfortunately I have been very noncompliant (it doesn't sound as good as naughty) with a script I filled for Lamacil. I can't take it due to another medication and its possible side effects on my liver, but it was prescribed to me. I did fill it. It is sitting in my drawer with my other medications. The results of not taking it are very apparent. So I am not going to say I have been taking it, I'm just going to wait til my tests come back and she says I can take it. BUT it could end up like 70% of all medication in America and not be consumed.

Off topic, but I wanted to include a couple of facts from Dr. H. Gottlieb's report (thanks to Jen Milman from the Healthcare Intelligence Network for the info):
40 to 60% of patients could not correctly report medication expectations 10 to 80 minutes after physicians provided information, AND
More than 60% of patients misunderstood prescription directions immediately after doctor visits.

I think that is astounding. How can this be corrected?

Hippocrates Started It All

Thanks to Dr. Showalter from AlignMap for reminding me of Hippocrates' quote: "Keep watch also on the faults of the patients which often make them lie about the taking of things prescribed.” Also Dr. C. Everett Koop's keen insight: "Drugs don't work in patients that don't take them." Which I regularly misquote.

Also from Dr. Showalter, some facts I did not know about the cost of noncompliance:
20% of unintentional pregnancies in the US are attributed to medication noncompliance which costs about $2.6 BILLION. I have known a few girls who forgot to take their pills and luckily there wasn't a problem, but can you believe that number? Just because they forgot? I can understand ignorance or trusting a guy for protection, but again, 20% of unwanted pregnancies could have been avoided by simply remembering to take a daily dose of Desigen!

3 times as many doctor visits & $2,000 per year in additional costs compared to patients who follow their treatment plan. Do you want to pay that extra nut in healthcare costs or Social Security or taxes for Medicare if 50% of Americans are noncompliant? See how this trickles down to $100 BILLION!

10-25% of hospital & nursing home admissions are due to noncompliance, resulting in 340 deaths per day. Could this be your grandmother? Mine went off her medications every couple of months in her final years because she did not like her side effects. This bounced her in and out of a nursing home and eventually led to her death. She was 88 years old at the time and she thought she deserved to do what she wanted to do. The doctors tried to keep her on her meds, but she was very stuborn.

I don't fault her, she had a great life but the last few years were tough as all her friends were dying off and she didn't want to stick around. BUT I will not accept my father or mother going off their diabetes medication or heart medication or cholesterol pills just because they don't like what happens to them. Or support their trip to the hospital because they forgot to take their hypertention medication.

So to wrap things up, as parents, children, godparents, grandparents and care givers alike, heed Hippocrates, the father of it all.

Tuesday, June 12, 2007

The facts about Noncompliance

Compliance is simply following your doctor's orders. Whether it be taking medication, refilling prescriptions or getting your blood tested. 1 out of 2 people are noncompliant with their doctor's prescribed regime. 1 out of 8 heart attack patients stop taking their medication after two months. 15% of all hospital visits and 125,000 deaths annually are due to medication noncompliance. 64% of people say they just forget to take their medication.
From a recent poll from the National Comunity of Pharmacists:
31% of prescriptions are never filled;
24% of people take less than the recommended dosage;
29% stopped taking their medication before it ran out;
38% had forgotten if they had taken their medication or not.