Monday, April 21, 2008

Breathalizer for Measuring Medication Adherence

So many of the studies on medication adherence are based on self reporting, that you can never really get an accurate account of when someone actually takes their medication. If you have a two way enabled device, the patient can text back that they took their pills, without taking them. If you have a pill bottle top monitor, it just lets the researcher know that someone has taken off the top of the pill bottle. With pillboxes that automatically dispense medications, again, you don't know if the patient has taken the pills, just that they were dispensed.

This article from the UF website, cites a breath monitoring device developed by UF scientists to monitor medication compliance. I have so say it is a pretty good concept for individuals who are housebound. It reminds me of the breathalizers that convicted DUI felons have to have installed in their cars if they want to drive again. They breathe in, and if there is no alcohol, they can start the car.

Here is a excerpt:

“The machine sits in your home and when it’s time for you to take your medication, it makes a beeping noise. If you don’t hit a button after about five minutes, it’s going to beep louder and louder until you come,” Melker said. “If you don’t come after a certain amount of time, the machine can call the clinical trial coordinator and indicate that subject or patient didn’t take the medication as prescribed.”

The device, which is slightly smaller than a shoebox, records the results of each breath test, allowing patients to bring a memory card or USB key to the clinic once a month and receive a printout of their results. Eventually, the researchers hope to reduce the size of their detection device to fit inside a cell phone. But for now, they’re satisfied that the technology works.

“The doctor can see how often you took it and exactly what time. If it made the patient really sick or dizzy and they didn’t take it, they can find out why,” Melker said. “It’s not just a question of did I or didn’t I take it, but when you took it or why you didn’t take it.”

The researchers developed the adherence monitor by incorporating minute amounts of an alcohol into a gel capsule. The additive, called 2-butanol, is one of many GRAS — Generally Recognized as Safe — compounds approved by the Food and Drug Administration for use in foods.

“We wanted (patients) to swallow a chemical and have it transform into something else that’s easy to monitor,” said Matthew Booth, an assistant professor of anesthesiology at the UF College of Medicine and an investigator in the study. “When it hits the stomach lining and liver, an enzyme converts the alcohol to a gas that can be measured in the breath.”

Wednesday, April 16, 2008

Sick Days Due to Chronic Conditions

One of our pharma salespeople brought me the USA Today front page for the weekend of April 4-6. Not for the Final Four update, but for the snapshot of Sick Days. I am not that technically inclined to post to the snapshot picture, but it was a graph that charted the "numbers of work days lost per year to affected workers of these chronic conditions":

Depression/Mental Illness: 26
Cancer: 17
Respiratory Disorders: 15
Asthma: 12
Migraine: 11

One of the main points of medication adherence we stress at Intelecare is how it affects not only the patient but all stakeholders. In this case, the employer is loosing work days due to chronic conditions which could be controlled with the proper medical adherence. Also, when their employees return to work, they will most likely need a day or two to adjust and get back on track.

I will not approach cancer, as there are to many variables, but patients who suffer from depression/mental illness have horrible adherence rates, and fall into relapse due to not taking their medications properly. When they then react to an episode by taking their medication, they start a whole new cycle, waiting for the drug/s to take effect.

Patients who suffer from respiratory disorders and asthma generally do not take their medications unless they have an attack, when it is too late. As for migraine sufferers, there are preventative medications that, for the most part, are not taken as prescribed. My wife and father-in-law suffer crippling migraines, but refuse to take their medications, instead, to live with the pain and lie in bed for a day or two until their reactive medication takes effect.

Medication adherence is the biggest drug problem today. I hate to beat the statistic drum, but $177 BILLION annually in unnecessary healthcare costs and lost revenue is a lot of money. With employers' investing money and resources into wellness and preventative health programs, EAPs and the like, it is time for them to address medication adherence.

84% of non-adherent patients cite simple forgetfulness as the reason for not taking their medications. That is up from 64% two years ago. It is time for a change in medication adherence. It is time for Intelecare. Sometimes a reminder is all you need.

Tuesday, April 15, 2008

New Facts (to me) about Medication Non-adherence and Chronic Conditions

I found this article by Dr. Onyekaba on Insight Most of the information is pretty remedial - drugs don't work unless you take them - but there were some new insights.

Here are some facts (not documented by their source) that I did not know about medication non-adherence and chronic care:

"In the general population it is estimated that about 90% of elderly patients make some medication errors with 35% making potentially serious life threatening errors.

Furthermore about 50% of all long term medications for chronic disease conditions such as high blood pressure, diabetes, asthma and depression are abandoned in the first year because the patients either claimed that they are cured or are bored taking the same medications on and on again."

"Non-compliance causes admission of 380,000 patients to nursing homes per year and in a society where the State could take custody of the infirmed elderly, and move them into assisted living facilities it becomes very important that the children and care giver should assure their medication compliance."

"Depression affects approximately 20 million people in the United States alone. It is estimated that about $43.7 billion a year is spent on medication, benefits and lost work days due to depression. One of the biggest problems with patients who are treated for depression is non-compliance with medication usage. "

Friday, April 4, 2008

Injectable Resperdal To The Rescue for Schizophrenia Patients


Thursday, Apr. 3 (Psych Central) -- With medication compliance a significant issue in some people who grapple with schizophrenia, drug companies often look toward injectable forms of their psychiatric medications to help with this issue. A new study suggests that an atypical antipsychotic in injectable form looks to be just as effective as its non-injectable counterpart.

Patients with psychosis treated early on in the course of their illness with risperidone long-acting injection demonstrated high response and remission rates with low relapse rates according to the study.

A reduction of the Positive and Negative Syndrome Scale (PANSS) total score of at least 50% was experienced by 84% of the 51 patients included in the study, with only four of these patients relapsing by the study endpoint. During the two-year trial period, the study also showed 64% of patients achieved remission.

Non-compliance or partial compliance remain key barriers in the management of schizophrenia and are often significant contributing factors in relapse. Relapse is associated with increased risk of hospitalization and a dramatically poorer quality of life. Patients experiencing numerous relapses are at high risk of never regaining previous levels of functioning.

Prevention of relapse, therefore, becomes an important factor to help support patients toward remission and recovery. It may be of particular importance in the early stages of the disorder to prevent irreversible decrease of functioning.

“The trial suggests that an atypical long-acting formulation introduced as first-line treatment may play an important role in the management of schizophrenia,” commented lead investigator of the study Professor Robin Emsley from the Department of Psychiatry at the University of Stellenbosch. “Whilst this is a small study, any data suggesting low relapse and high remission rates during this critical stage in a patient’s treatment pathway are welcome.”

In the study, risperidone long-acting injection (also known by its brand name, Risperdal Consta) was administered every two weeks to patients with an age range of 15 - 43 years with recent onset schizophrenia or schizophreniform disorder. A total of 27 patients had not been previously prescribed any medication.

The study period ran over two years in order to assess the effects of risperidone long-acting injection on symptom reduction and assess whether it can be used as a first-line treatment in early psychosis. Results showed that 84% of patients experienced a clinical response of at least 50% reduction of symptom severity on the PANSS. Of these patients, only four relapsed during the study. 92% of patients experienced a clinical response of at least 20% reduction of symptom severity.

Young patients who have never received previous medication treatment for their disorder may manifest high sensitivity to antipsychotics, both in terms of responsiveness and to side effects such as extrapyramidal symptoms and weight gain.

Therefore, the lowest dose of antipsychotic medication was used and patients were closely monitored throughout the study. Overall, the results suggest the treatment was well tolerated and the majority of patients responded well to treatment. As previously reported in studies of patients with early onset psychosis, weight gain was reported, particularly in the first 12 months. At endpoint, mean BMI gain was 4.8 (SD 3.8 [n=50]) from 20.6 (SD 4.6) at baseline (p< .001).