Sunday, November 18, 2007

It Is Not A Small World (or US) After All

I found this article in Synapse, the USCSF, the student paper. I'm not one to talk being 15 lbs over my optimum weight, but if you go to the entertainment parks and anywhere large amounts of people congregate, you will actually see that there is a big problem in the US with obesity.

A New Motto for Weight Loss: Keep Disneyland Open By Alison Silvis

Look to Disneyland for the latest symptom of the obesity epidemic. The park’s “It’s a Small World” ride is simply too small to accommodate the extra 24 pounds the average American has packed on since 1960. Stalls and stops are so common that extra platforms have been built at problem hotspots along the ride. Now, the ride will be closing for ten months beginning in January for refurbishment with larger flume cars and deeper waterways.

As future health-care professionals, this is one more sign of the environment in which we will be practicing. Patients are getting heavier, more sedentary and in greater need of preventative care and support for behavior change. Evidence-based medicine should be the gold standard for such care. But we still cannot answer the simple question: how much weight gain is bad? And how much is good?

The November 7 issue of JAMA contains an article that adds to our understanding of the already-complex relationship between weight and health, but raises many questions about the supposed protective effect of being overweight. Knowing how to interpret articles and how to individualize research findings to a patient is our responsibility. But this is only one component of employing evidence-based medicine. It also means making sure patients understand the information, and then following up to see how they apply that information to their lives. This is easier said than done, of course, but that does not justify giving up.

The same issue of JAMA offered some hope in how to support long-term weight management behaviors, in the discussion of one physician’s efforts to manage the care of an obese patient with several health complications (“Clinical Crossroads: A 63-Year-Old Man with Multiple Cardiovascular Risk Factors and Poor Adherence to Treatment Plans”). The author, Dr. Bodenheimer, emphasized the importance of clinical care teams that work to merge a patient’s goals with clinicians’ goals. A patient’s participation in her care may be the single most important factor in adherence to medication, and presumably plays a fundamental role in determining adherence to behavior change.

In this sense, a clinician’s role may evolve into one of “self-management support,” providing information and resources to initiate and maintain healthy behavior outside of clinic visits. One promising model of this type of chronic care is at Health Partners Medical Group in Minnesota. There, patients receive previsit, visit, postvisit, and between-visit care from a variety of health professionals. Clearly, collaboration within the health professions and between clinicians and patients is essential to this model. Whether or not it improves patient outcomes is yet to be determined, but the current system is clearly failing.

We cannot afford to ignore the painful reality of the obesity epidemic. In Disneyland, when heavy patrons are disgruntled at being asked to step off the ride, they are offered a food voucher. In the world of evidence-based medicine, we need to challenge patients to confront the reality of their daily lifestyle choices, and then work with them to modify those that are unhealthy. We owe it to them.

Wednesday, November 14, 2007

Diabetes in the West Indes

You forget that even in paradise there are chronic diseases and medication adherence is important. To that statement, here is a diabetes program in St. Kitts/Nevis to celebrate World DIabetes Day.

From the Sun St.Kitts/Nevis by Akedia Christopher

The Rotary Club of St. Kitts is hosting a ‘Diabetes Day Camp’ Saturday at the St. Johnson’s Community Center in recognition of World Diabetes Day celebrated today.

President of the club, Leah Sahely, told the SUN in an interview that the event was organised in hope of helping diabetics “find answers to questions about managing this disease.” She added the “disease is serious and we are going to cover all aspects of diabetes.”

The day, as described by the Sahely, is going to consist of breakdown sessions which would enable question and answer segments at the end of each presentation. She added that letters were sent out to health centres and doctors alike asking them to identify patients to participate in the event.

She further mentioned they were presenting educational opportunities by way of lectures, on how to control the disease and “to reinforce the need for compliance.” This, she said, would act as a source of encouragement for diabetics to follow doctors’ orders and also to live healthy lives.

Sahely also mentioned that some of the doctors who will be making presentations include Bichara Sahely who would present an overview of the disease, Cavelle Hobson who would discuss medication availability and consequences of non-compliance and also Dr. Caroline Lawrence who would address cardiovascular complications which can be created and the importance of monitoring the disease .

Earl Clarke is also among the team, according to Sahely, and he is going to speak to the need for exercise and the value of it, along with dietician Magaret Stevens “who is going to talk about eating habits.”

Tuesday, November 13, 2007

Voice Technology To Help The EU

Thanks to Dr. Showalter, I now know how to post a link that works!

From Eureka, written by Tom Shelley:
Two very dissimilar applications – one in machinery, the other in medicine – are both being solved by relying on spoken rather than written information.

Printed instructions are said to be meaningless to around 20% of the European Population. This, combined with the 8 million blind and partially sighted people in Europe, contributes to nearly 200,000 deaths a year in the EU due to mis-dose and non-compliance of prescribed medication.

UK-based Pera has developed ‘talking packaging’ in the shape of Medi-Voice. The idea is to take current compliance monitoring, enhance it and combine it with speech technology in smart pharmaceutical blister packaging which than can give spoken instructions.

The packaging will be powered by thin film, flexible, photovoltaic laminates, with homogenisation of the photovoltaic and the polymer packaging through in-mould labelling. The speech system and compliance electronics will be developed onto a flexible PCB that will be incorporated by over-moulded into the packaging.

A piezo-electric sounder is also to be encapsulated into the polymer packaging during the injection moulding process. Dosage assurance will be achieved through the printing of conductive ink electrodes onto the blister sealing film that will input to the compliance circuitry.

Eureka Magazine Article

Thursday, November 8, 2007

A Little Shamless Promotion

I am not that technologically savvy - I let our programmers handle that end of the business - but I learned how to post pictures yesterday and wanted to share our booth at the 2007 Working Mother WorkLife Congress. We were exhibiting to launch our product offering to employers. Intelecare's Personal Reminder Platform increases medication adherence by sending user created reminders via email, text and voice messaging. We serve the needs of patients and caregivers via our website,, and with our API, our technology can be integrated into any exiting website as a fully branded adherence solution.

For example, Employer X has a wellness program on their website, with Intelecare's API, Employer X can offer medical reminders (ie. daily medication, refills, appointments, etc...) to their employees. Intelecare handles all the backend programming and message delivery. All the client needs to worry about it their front end design.

Reasoning? 23% of all employer health insurance costs are related to patient medication non-adherence. 64% of patients who are non-adherent cite they simply forget to take their meds. 45% of Americans are on medication. 50% of them are non-adherent. Thus shouldn't employers want to lower their healthcare costs by focusing on medication adherence - a very simple problem that costs the US $177 billion annually in lost revenue and unnecesssary healthcare costs? We think so.

Our API is also available to insurers, pharmaceutical companies, social health networks, EAP providers, and pharmacies. As part of our Enlighten Together program, we offer our Express (email only) solution to non-profits that focus on chronic diseases. All of our products and services are outlined on our website,

With that bit of promotion, I shall retire to find more information about this devastating pandemic that affects us all somehow. Please visit the NCPIE site, NCPIE Home to read their August report on medication adherence to find more facts and figures - as well as their call to action.

Stay adherent!

Alignmap Post

Dr. Showalter is passionate about medication adherence and has the clout to question reports and scoff at findings. I always enjoy reading his posts and he usually scoops me on a couple of items, like his latests post.

Medication Noncompliance With Statins - Same Old Same Old

Wednesday, November 7, 2007

A Different Approach to Medication Adherence

I found this tidbit from the US News and World Report website - just a press release. A different approach to staying adherent to medications and dealing with side effects:

From Health Day News
Spirituality helps older black American women with high blood pressure stick to the drug regimens that keep the condition under control, new research suggests.

Older black Americans tend to have poorer anti-hypertensive medication adherence than either younger blacks or white patients, even though adherence helps reduce hypertension-related health problems and deaths, noted a team from the University of Pennsylvania School of Nursing.

This study included 21 black women, average age 73, who were members of a Program of All Inclusive Care for the Elderly. The women had been diagnosed with hypertension for an average of 16.7 years, and they were taking an average of 3.3 prescriptions to battle the condition.

All the women said they used their spirituality to manage their medication adherence. As part of this process, identified as "Partnering with God to Manage My Medications," the women accepted personal responsibility for adhering to their medication regimen and used their spirituality as a resource to make decisions to remain adherent, to cope with medication side effects, and to increase their ability to deal with barriers that kept them from sticking with their medicines.

The findings suggest that incorporating patients' beliefs into hypertension treatment may help them draw on inner resources to improve medication adherence, the researchers concluded.

The study was to be presented Wednesday at the American Heart Association annual meeting in Orlando, Fla.

Friday, November 2, 2007

Online Rx program helping cut errors

Just an article about the automakers efforts to implement ePrescribing.

From the Detroit News by Sofia Kosmetatos

Online Rx program helping cut errors
Big 3's e-drug plan boosts the use of generics while reducing glitches, analysis shows.

A Big Three-driven effort to replace prescription pads with computers is significantly reducing patient risk from medication errors and helping increase generic drug use, according to an analysis released today by the Southeast Michigan ePrescribing Initiative.

Launched nearly two years ago, the first review of the initiative shows that it is not only protecting patients from the harmful consequences of medication errors, but is also helping them have better discussions with their doctors about medications at the time a prescription is written.

"The benefits of ePrescribing are overwhelming in terms of reducing medication errors, lowering prescription drug costs for patients and plans, and decreasing physician practices' administrative costs," said Marsha Manning, General Motors Corp.'s manager of Southeast Michigan Community Health Care Initiatives, in a statement.

Through the initiative, doctors access online software on computers in patient rooms to write the prescriptions, prompting discussions about generic alternatives, drug interactions and allergies at the time a prescription is written. The results are savings on drug costs and fewer medical complications, doctors and coalition members say. EPrescribing also eliminates doctors' handwriting as a source for error, and saves patients and doctors' offices time because the scripts are sent to pharmacies electronically.

The analysis of a sample of 3.3 million prescriptions showed:
• The ePrescribing technology sent alerts of severe or moderate drug interactions to doctors for about one-third of those prescriptions. Doctors changed or canceled 423,000 (or 41 percent) of those prescriptions.
• The technology informed doctors of more than 100,000 medication allergies, and doctors acted on 41,000 of these alerts.
• When an alert showed a drug was not on a formulary, the doctor changed the prescription to comply 39 percent of the time.

The initiative, involving the automakers, Henry Ford Health System, Blue Cross Blue Shield of Michigan and others, aimed to help doctors set up electronic prescribing in their offices.

The three automakers -- GM, Ford Motor Co. and Chrysler LLC -- are involved because they think the initiative can cut down on their health care costs, which add up to billions of dollars. So far, some 6.2 million prescriptions have been written by 2,500 doctors using ePrescribing technology, with more than 282,000 written each month. The coalition plans to extend the initiative through March 2008.

Generic drug use up
GM spokeswoman Carey Osmundson said it's difficult to quantify how much the company has saved with ePrescribing, but GM has seen increases in its rates of generic drug prescribing and compliance with preferred drug lists, both of which save money. For each 1 percent shift to generic drugs from a brand name, GM saves nearly $20 million, she said.
GM spent $1.5 billion on prescription drugs alone last year for 1 million enrollees, a growing tab it had worked for years to stem.

Henry Ford Health System conservatively estimates it is saving $4 million a year with ePrescribing, mostly from switching HAP patients from brand-name drugs to less costly generic alternatives.

That's not including the savings patients see from reduced co-payments, said Matt Walsh, associate vice president of purchaser initiatives at Health Alliance Plan, a health insurer owned by Henry Ford.

Royal Oak's Dr. David Allard was one of the first Henry Ford doctors to use ePrescribing. His office has had electronic medical records for years, but had relied on pen and paper for prescriptions until January 2005. He says his staff saves a lot of time that used to be spent on the phone with pharmacies handling prescription refills and questions on scripts. "That was hours a day in my office," he said.

But more importantly, he sees the benefit in reducing the potential for errors. Refilling prescriptions, for example, involved a lot of hand-offs between staff members and interaction with pharmacies. With each step came a chance for a mistake.

Handwriting kills
More attention is being focused nationally on drug errors and how to avoid them. According to an Institute of Medicine report issued last year, drug errors kill 1.5 million Americans each year. The report said eliminating handwritten prescriptions is the most vital step health care providers must take to cut down on errors, and recommended that all prescriptions be written electronically by 2010.

The institute is a branch of the National Academy of Sciences, an independent adviser to the government on scientific issues.
Allard's patient Susan Smith said she appreciates saving money with generic alternatives that ePrescribing has brought up during her office visits. She loves the convenience of ePrescribing even more.

Because the script goes directly to the pharmacy, she doesn't have to wait to pick it up. "It's so much more efficient," she said. "My time is real precious to me."

For outside observers, the ePrescribing effort is laudable. "It not only reduces costs but improves the quality of care by reducing drug interaction," said Eileen Ellis, principal of Health Management Associates, a Lansing-based consulting firm.
Recognizing the benefits of electronic records, health systems across southeast Michigan have been spending millions to install electronic medical records.

But doctors' offices have lagged because of the cost, which can be in the tens of thousands and more for a practice.
At about $2,000 a doctor to implement, ePrescribing is much less expensive, but is nevertheless a step in that direction. The coalition helps participating doctors with a $1,000 subsidy.

"This is a great way to get technology into the doctor's office. It's not real expensive; it's fairly easy to adopt," Walsh said.

Thursday, November 1, 2007

November is National Caregiver's Month

To celebrate, go care for someone or give a caregiver the day off!

Exelon Follow-up

October 23rd 2007 was the first day that the Exelon transdermal patch, the first and only skin patch for the symptomatic treatment of mild to moderately severe Alzheimer's dementia, is available in the UK market. Here's some info on it from, no author given:

A clinical study of 1,195 people with Alzheimer's dementia demonstrated that the rivastigmine patch improves cognitive function (assessed using a tool that includes measures of orientation, memory and language), as well as a patient's ability to perform everyday activities compared to placebo. The study also showed that the 9.5mg/24h patch is as effective as the maximum titrated dose of rivastigmine oral capsules.

Applied once a day (replaced every 24 hours), the rivastigmine patch provides smooth and continuous delivery of rivastigmine through the skin, which reduces nausea and vomiting caused by peaks in medication levels when the drug is taken orally.
Dr Peter Connelly, Consultant in Old Age Psychiatry, Perth, Scotland comments, "The Exelon patch represents a valuable advance in the treatment of Alzheimer's disease. This formulation offers patients and their carers an effective, well-tolerated and convenient therapy option. I expect a significant proportion of carers will find the patch easier to use compared to the conventional formulation."

Family cargivers are the backbone of long-term care to Alzheimer's disease patients, frequently responsible for administering and managing patient medication. A survey conducted in over 1,000 caregivers showed that more than 70 per cent preferred the patch as a method of drug delivery compared to oral capsules(3). The most common reasons for preferring the patch were ease of following the schedule and ease of use.

The rivastigmine patch can be applied to the upper arm, chest or back(4). The patch may allow those caring for Alzheimer's disease patients to monitor treatment compliance because it provides visual reassurance that the medication has been taken. Compliance with prescribed medication regimens represents a challenge for most patients but may be particularly difficult for older people due to: the extent to which drug regimens interfere with daily living; lack of understanding or misinterpretation of instructions; complex and complicated drug regimens; and forgetfulness(6). 75% of older people are believed to not comply with their treatment regimens.

"Caring for a relative with Alzheimer's is very time-consuming and sometimes overwhelming. There's a lot to think about and sufferers are often on a number of medications," comments carer Lisa, who used to look after her sister at home. "People with the disease can find it difficult to take oral medication and to comply with a strict routine. A patch that provides 24 hour cover could help keep track of when medication has been taken."

I'm all for anything to improve patient medication adherence. Once again my hope is that patients remember they have the patch on and rmember to change them as well. To celebrate National Caregivers Month - here's to Novartis!