Wednesday, July 30, 2008

Two News Items That Tie Together

So I have been looking at this Harris Poll Report that states "4% or an estimated 9M American adults believe that they or a family member have had confidential personal medical information either lost or stolen", and trying to figure out if I know of anyone who this has happened to and if this is a low or high number.

The second round of figures: "about 7 in 10 (69%) of adults have either read or heard about medical records with personal health information being lost or stolen from doctor's offcies, clinics, hospitals, health insurers, employers or government agencies".

I definitely fit into this category, and it was even further reinforced with this article in the Atlanta Journal-Constitution about BCBS of Georgia sending out "an estimated 202,000 benefits letters containing personal and health information to the wrong addresses last week." That seems like a big screw-up.

So what do people really think about privacy, health records and the advent of EHRs? I am going to pull a few quotes from each piece to state my point. HPR: when asked which medical records, computerized or paper may be lost or stolen more often, 47% state computerized records, with 16% for paper, and 23% think the same.

My conclusion, Americans do not trust electronic records. Further support: of the 69% who had heard about medical records being lost or stolen, 54% believed it was from electronic records.

Recent medical "breaches" have included Wellpoint, U of Miami, NIH, the Cleveland Clinic, CVS, - with over 50 breached from healthcare providers reported to the Identity Theft Resource Center in the first 6 months of 2008. I have heard of these companies. Aren't they supposed to be the biggest and most secure in their fields?

BCBS of Georgia said the recent mix-up was caused by a change in the computer system that was not properly tested. Why would they implement a computer system without testing it, considering they are a HIPAA covered entity? Isn't there a law and governmental regulations in place to protect this data? Oh yeah, that's right, there is. Since HIPAA was fully implemented in 2003, very few fines have been assessed.

AJC: "This is very, very serious," [state Insurance Commissioner John] Oxendine said. A person with knowledge of medicine or billing, for example, could determine if the patient was treated for cancer, HIV or fertility problems, he said....

...Rhonda Bloschock, a registered nurse in Atlanta, said Monday that she discovered EOB forms from nine other patients in a large envelope she received Friday from Blue Cross. "This is a serious privacy breach," Bloschock said. Nurses and other hospital staff "jump through all sorts of hoops protecting people's privacy," she said....

...consumers have become more attuned to privacy issues, said Anne Adams, chief privacy officer for Emory Healthcare. "There is an expectation that their personal information is protected and not used inappropriately," Adams said. But with the movement toward keeping health records electronically, there's more potential for breaches to happen, Adams said."

So going back to Google Health, Microsoft Health Vault and EMR, PHR vendors - will the American people trust their records online to these companies, GOOG and MSN not being HIPAA covered, when other companies cannot protect this data already? And those that can protect it, still have mechanical errors?

Telenursing Intervention Increases Psychiatric Medication Adherence in Schizophrenia Outpatients

And here is today's medication adherence abstract from Journal of the American Psychiatric Nurses Association:

Promoting medication adherence is a critical issue in optimizing both physical and mental health in persons with schizophrenia. Average antipsychotic medication adherence is only 50%; few studies have examined nonpsychiatric medication adherence. Psychosocial interventions with components of problem solving and motivation have shown promise in improving adherence behaviors.

This study examines telephone intervention problem solving (TIPS) for outpatients with schizophrenia. TIPS is a weekly, provider-initiated, proactive telenursing intervention designed to help persons with schizophrenia respond to a variety of problems, including adherence problems.

The authors completed objective measures of adherence to psychiatric and nonpsychiatric medications in 29 community-dwelling persons with schizophrenia, monthly for 3 months.

Persons receiving TIPS had significantly higher objective adherence to psychiatric medications throughout the study period, F(1, 20) = 5.47, p = .0298.

Clinicians should consider using TIPS as an adjunct to face-to-face appointments to support adherence in persons at risk. J Am Psychiatr Nurses Assoc, 2008; 14(3), 217–224. DOI: 10.1177/1078390308318750

Tuesday, July 29, 2008

The Role of Cognitive Functioning in Medication Adherence of Children and Adolescents with HIV Infection.

Here is today's medication adherence abstract from Medline:

OBJECTIVE: To evaluate the relationship between cognitive functioning and medication adherence in children and adolescents with perinatally acquired HIV infection.

METHODS: Children and adolescents, ages 3-18 (N = 1,429), received a cognitive evaluation and adherence assessment. Multiple logistic regression models were used to identify associations between adherence and cognitive status, adjusting for potential confounding factors.

RESULTS: Children's average cognitive performance was within the low-average range; 16% of children were cognitively impaired (MDI/FSIQ <70). Cognitive status was not associated with adherence to full medication regimens; however, children with borderline/low average cognitive functioning (IQ 70-84) had increased odds of nonadherence to the protease inhibitor class of antiretroviral therapy. Recent stressful life events and child health characteristics, such as HIV RNA detectability, were significantly associated with nonadherence.

CONCLUSION: Cognitive status plays a limited role in medication adherence. Child and caregiver psychosocial and health characteristics should inform interventions to support adherence.

Mention in Brass and Ivory /Inside Health Media's Blog List

As a follow-up to today's earlier post, I was looking at Technorati, which referenced the Medication Non-adherence blog in another blog. This time it was Brass and Ivory reporting on "Inside Health Media's huge new blog directory gives PR pros an inside guide to influential bloggers covering health, medicine and fitness."

So that is great for the blog, and I didn't even know about it.

The eDrugSearch Top 100 Health Blogs and Phrase Cloud

I was watching my Twitter stream and saw a mention of a "phrase cloud" posting of the 883 health and medicine blogs listed by eDrugSearch. I have seen the eDrugSearch Top 100 Health Blogs mentioned before on blogs, but have never really thought the Medication Non-adherence blog would ever get there. Here is the "phrase cloud" of the Top 100.

However, in reading this post and doing some research (thanks Twitter), I see there are actually 883 blogs that are the Top 100 list, so I am going to throw my hat into the ring. A handful of the blogs that I read are in the Top 100, with a handful of the blogs I really like and respect ranging between 300 and 600.

The question is, what does it say about your blog if you have a "high" ranking or no ranking at all? I don't think it discounts what the author has to saw with a "high" ranking, however if a blog is in the top 20, more readers will flock to it, thus keeping the blog's "low" ranking.

eDrugSearch has an algorithm that tracks the "popularity" of your blog based on various other website ranking systems. Here is the outline. If I spend some more time looking into figuring out how to get a higher rank, I might be able to move my number up, but what would be the point? More exposure equals more readers mean that more people will learn about the problems of medication non-adherence and hopefully realize that it is a serious problem that needs to be addressed. And that is the point of this blog, right?

I usually think that rankings and reviews should happen organically, however the more I read about blogging and social media, the more I realize there sometimes you need to be a little PR. Also, you have to register to have your blog reviewed, so here I go into the fray.

Monday, July 28, 2008

Impact of Health Literacy on Health Outcomes in Ambulatory Care Patients: A Systematic Review

Here is your medication adherence abstract of the day from The Annals of Pharmacotherapy:

OBJECTIVE: To examine the relationship between low health literacy and disease state control and between low health literacy medication adherence in the primary care setting.

DATA SOURCES: The following databases were searched for relevant articles from date of inception to April 2008: The Cochrane Database of Systematic Reviews, Cumulative Index to Nursing & Allied Health Literature, EMBASE, Education Resources Information Center, PsycINFO, International Pharmaceutical Abstracts, and Iowa Drug Information Service. MEDLINE was searched from 1966 to April 2008. Key words included literacy, health literacy, health education, educational status, disease outcomes, health outcomes, adherence, medication adherence, and patient compliance. Additional articles were identified by reviewing reference sections of retrieved articles.

STUDY SELECTION AND DATA EXTRACTION: Studies using a validated measure of health literacy and performing statistical analysis to evaluate the relationship between health literacy and disease state control or medication adherence were evaluated.

DATA SYNTHESIS: Eleven evaluations, including 10 discrete studies, met eligibility criteria. Six studies evaluated the relationship between health literacy and disease state control, 3 evaluated health literacy and medication adherence, and 1 study evaluated health literacy and both outcomes. A quality rating of poor, fair, or good was assigned to each study based on the study question, population, outcome measures, statistical analysis, and results. Eight studies had good quality, 1 was fair, and 2 were poor. Two high-quality studies demonstrated statistically significant relationships with health literacy, 1 with disease state control and 1 with medication adherence. Limitations of the other studies included inadequate sample size, underrepresentation of patients with low health literacy, use of less objective outcome measures, and insufficient statistical analysis.

CONCLUSIONS: There may be a relationship between health literacy and disease state control and health literacy and medication adherence. Future research, with adequate representation of patients with low health literacy, is needed to further define this relationship and explore interventions to overcome the impact that low health literacy may have on patient outcomes.

Friday, July 25, 2008

EnrichMap: A Profile for Medication Non-Adherence

Dr. Alan Showalter, leader of the AlignMap empire, has been working for many years in the field of medication non-adherence, and has developed a patient survey and compliance profile which can be found on .

Here is their statement of purpose from their website:

"EnrichMap focuses on proactively managing adherence to treatment regimen in clinical trials by identifying, prior to enrollment in the study, groups of patients based on their behavioral patterns pertinent to compliance and providing pragmatic, group-specific strategies to minimize unnecessary treatment failures caused by noncompliance and, in turn, reduce the consequent morbidity and mortality, research confoundments, delays, and financial waste."

I took the plunge a few months ago and was delivered a very interesting report and "compliance assignment based on a national population PROFILE". I apologize that it has taken me so long to post.

Based on my responses to the Emap questionnaire the results indicated compliance related characteristics in two groups, with nearly equal weight to both sets of traits. The Primary Compliance Group is "Sage & Satisfied", the Secondary Compliance Group is "Security Seeking". The report is two pages. I am going to summarize a few statements from the report, some of which I agree with, some not. My comments are in bold.

Sage & Satisfied
The most significant characteristic of individuals with the Sage and Satisfied Group is their confidence in and positive view of traditional healthcare. They trust their doctors and believe that trust is reciprocated by the clinicians’ genuine concern for their patients. This is TRUE.

As one might expect, they are more likely than average to evaluate any treatment they are receiving as successful and report few negative or adversarial experiences with healthcare professionals. They quietly embrace the notion that they bear a personal responsibility for implementing good healthcare practices. This is TRUE.

This group is more likely to monitor their own health, including participation in recommended screenings (e.g., mammograms and colonoscopies), and to take appropriate action upon discovering problems (e.g., promptly contacting their doctor). They are willing to make use of any medical specialty from dermatology to dentistry. This is TRUE.

The Sage and Satisfied are conscientious, concerned and educated. They are responsive to healthcare ideas that have become accepted as “common sense” or are endorsed by an authority. They read food labels, recycle, and avoid smokers. This is TRUE.

They are exceptionally active and are, in fact, the most heavily involved in all types of personal and social activities surveyed, whether intellectual and physical in nature. Sort of true. I play golf, tennis, swim and walk my dog. Somewhat social.

Unsurprisingly, the Sage and Satisfied also have the lowest incidence of self-destructive habits such as smoking and heavy use of alcohol. I stopped smoking 2.5 years ago.

Secondary Compliance Group: Security Seeking
Individuals in the Security-Seeking Group are second only to those from the Sage and Satisfied Group in demonstrating a positive view of physicians and healthcare. They have the strongest belief in the power of medication as a remedy (and in the power of medication to cause problems, especially if not used appropriately). This is TRUE.

Consequently, it is hardly surprising that these individuals maintain close relationships with doctors and agree with the importance of following medical directions. They rarely express concern or cynicism about the skill and integrity of clinicians. I am very cynical, but do believe that the doctor knows more than me. I do seek 2nd and 3rd opinions though.

Their only common complaint about the medical system, in fact, is the number of restrictions their third-party healthcare funding places on the services they receive.This is NOT TRUE.

Despite their fearfulness, members of this Group are not hypochondriac. They, in fact, perceive their health as being good. They are average in the frequency and variety of clinical interventions and in their use of non prescription medications and vitamins. They do read printed instructions. This is TRUE, but I do not take vitamins.

They neither demand excessive medical attention nor avoid seeking necessary help. The Security-Seeking Group is second only to the Sage and Satisfied in adhering to their doctors’ prescribed treatment. True to their defining characteristics, the Security-Seeking Group makes healthcare choices based on the overwhelming need to avoid risks. This is TRUE.

While attentive to their physicians’ instructions, they are reluctant to seek medical information. Even if the trusted clinician offers them written material, they mistrust it – or at least their own interpretation of it. As would be expected, these individuals avoid self diagnoses and novel medical methodologies. This is NOT TRUE.

Overall, the EnrichMap survey and profile are great tools to help a patient identify who they are and why they are non-adherent. No two patients are the same, so it is difficult to make a group and classify a patient in that group then expect all the characteristic to fit said patient. Sage and Satisfied pretty much nailed my medical behavior, whereas Security Seeking was a little off - but still 60% correct with my behavioral pattern.

If you are interested, the survey is free to take, and I would recommend visiting the site. FD: Dr. Showalter bribed me for this plug. No, his treatment of medication non-adherence with his blog posts and research has been an inspiration for me, and my blog. His humor abounds, while seriously addressing awareness and concern. I am glad he is back to blogging after a few months away.

Stay Adherent!

Tobacco to Help Cure Cancer

I came across an article on in-Pharma regarding a Stanford University study "described [as] the first-in-man Phase I safety trial of the tobacco-produced vaccines against follicular B-cell lymphoma."

"In an ironic twist, researchers have shown that the tobacco plant, the cause of millions of cases of cancer, can be harnessed to produce personalised cancer vaccines." Full Article here

I really have no comment save that is it more ironic than a fly in your Chardonnay, and it seems as if this might be a real break through for advancing the speed of vaccine growth.

Thursday, July 24, 2008

The Darkside of Medication Non-adherence

This is a sad case of the dark side of medication non-adherence: prescription medicine abuse. This form of drug abuse has been gaining "popularity" over the last few years, the most serious cases involving OxyCotin, and well publicized by Hollywood Celebrity overdoses.

I found this article on WDAY Channel 6's website from Fargo ND, taken from an AP story about a doctor who's license was suspended for "sloppy handling of narcotics, letting assistants fill out drug prescription forms for patients, and accepting unused drugs from his patients and keeping them in an unlocked drawer."

The whole situation sounds very fishy to me. Here is a patient profile and quote:

Chastity Woodbury, 32, of Fargo, said she was hit by a train when she was 5 years old and has been in several accidents, leaving her in chronic pain and depression. She said she needs medication to function. "No other doctor understands us," Woodbury said. "Everyone looks at us as pain medication seekers, but Dr. Lee cares about us."

And another patient quote: "Yes, the paperwork in his office is stacked on the floor, but I don't go there for that," said R.D. "Dick" Knutson. "I go there for help."

I understand the need for patients with chronic pain to need medications, but when it turns to abuse, that is what it is: drug abuse.

Wednesday, July 23, 2008

One More AllTop Plug

AllTop has accepted my query to be listed in their blog aggregator for their health section. One of the great features I really like is that AllTop lists the last 5 or so posts for each blog, so when you search for blogs, you do not have to go to each blog to see if you want to read it or not.

Check out AllTop Health and the other sections to find the information you are looking for.

Another thank you to Guy and the Team at AllTop.

Pre-Diabetes Needs To Be Treated

Here is a great article in the USA Today about pre-diabetes and preventative treatment. I am pre-diabetic and have a family history of diabetes, so I am a very aware of the escalating problems. I started monitoring my glucose levels 8 weeks ago, and so far I have not had any huge spikes.

Some takeaways from the article. Everything NOT in quotes are my comments:

"We, as endocrinologists, are saying we truly recognize a state of pre-diabetes, and I think the most important issue is that there is not one unifying point that defines it, says Daniel Einhorn, vice president of the American Association of Clinical Endocrinologists."

This is somewhat troubling as it seems the only way to detect this condition is blood monitoring.

"In an early release of the new recommendations, members of the endocrinologist group agreed that diagnosing pre-diabetes should be based on more than the results of blood glucose tests, such as history of diabetes during pregnancy and family history of the disease. The group also decided that changes in ways of living, not medication, should be the first line of treatment in staving off diabetes."

I am happy to hear that changes in diet and lifestyle is the first line of defense instead of medication. That being said, I am on tricor and niaspan for high triglycerides - but I have adjusted my diet.

"The guidelines recommend that people with metabolic syndrome — defined by three or more of the following: elevated triglycerides, a low HDL (the so-called good cholesterol), a high fasting glucose, a big waist circumference and high blood pressure — be considered at high risk for pre-diabetes, as well as women with prior gestational diabetes, people with a family history of type 2 diabetes and obese patients."

Yeah, three for me: HT, Low HDL, and type 2 in family.

"The new guidelines also advise that primary-care physicians and specialists address cardiovascular problems such as blood pressure and lipid levels when diagnosing pre-diabetes. Though there was some debate at the conference over whether medication should be used to treat pre-diabetes, the final consensus is that certain drugs may have a place if diet and exercise do not bring down glucose levels first."

Again, exercise and diet should be the first treatment. So often, medications are prescribed instead of naturally treating the problem. And yes, I am a hypocrite, but my levels were so high, my doctor thought it best that I take medication until my levels drop to "safe" level - which I should accomplish at the end of July - then go off the meds.

With childhood obesity at an all time high (1 in 3 are obese or at risk), and diabetes following suit, something must be done. CT Senator Chris Dodd is proposing a task force and a Childhood Obesity Bill, so hopefully pre-diabetes and diabetes will be addressed.

One service that has helped me with resources and has provided me with a forum to discuss pre-diabetes and ask questions is TuDiabetes, a diabetes social network founded by the Diabetes Hands Foundation. Here is my profile. FD: Diabetes Hands Foundation has been offered to join Intelecare's pro bono Enlighten Together Program like Diabetes Sisters.

Here is a post stating 25 ways to add movement into your day, as most people need to exercise more!

Tuesday, July 22, 2008

Intelecare In Shape Magazine

Sorry for the shameless promotion of Intelecare.

For those of you who cannot read the copy: Intelecare; For $5 a month you can receive unlimited text message, email, or voice mail reminders for prescriptions and appointments. We still offer a free service as well.

Here is the link to Shape magazine online.


Monday, July 21, 2008

Trial for Integration of Depression and Hypertensive Treatment

I have read a handful of abstracts today from studies regarding medication adherence. Here is a .pdf from the Annals of Family Medicine regarding a pilot program that integrates depression and hypertension treatments. I am going to hit the high notes, and you can read the full article. Hat tip to Healthy Future Life.

Authors: Hillary R. Bogner, MD, MSCE and Heather F. de Vries, MSPH, Department of Family Medicine and Community Health, School of Medicine, University of Pennsylvania, Philadelphia

We wanted to examine whether integrating depression treatment into care for hypertension improved adherence to antidepressant and anti-hypertensive medications, depression outcomes, and blood pressure control among older primary care patients.

Older adults prescribed pharmacotherapy for depression and hypertension from physicians at a large primary care practice in West Philadelphia were randomly assigned to an integrated care intervention or usual care. Outcomes were assessed at baseline, 2, 4, and 6 weeks using the Center for Epidemiologic Studies Depression Scale (CES-D) to assess depression, an electronic monitor to measure blood pressure, and the Medication Event Monitoring System to assess adherence.

In all, 64 participants aged 50 to 80 years participated. Participants in the integrated care intervention had fewer depressive symptoms (CES-D mean scores, intervention 9.9 vs usual care 19.3; P <.01), lower systolic blood pressure (intervention 127.3 mm Hg vs usual care 141.3 mm Hg; P <.01), and lower diastolic blood pressure (intervention 75.8 mm Hg vs usual care 85.0 mm Hg; P <.01) compared with participants in the usual care group at 6 weeks. Compared with the usual care group, the proportion of participants in the intervention group who had 80% or greater adherence to an antidepressant medication (intervention 71.9% vs usual care 31.3%; P <.01) and to an antihypertensive medication (intervention 78.1% vs usual care 31.3%; P <.001) was greater at 6 weeks.

A pilot, randomized controlled trial integrating depression and hypertension treatment was successful in improving patient outcomes. Integrated interventions may be more feasible and effective in real-world practices, where
there are competing demands for limited resources.

I am very pleased with the outcomes of this trial, and surprised by how low the adherence rates were for the usual care group. Usual care group was 31.3% adherent! That is horrible. I never thought of the connection between hypertension and depression, but in that age group, I can see the fit. I wonder if there is a similar study running for increasing adherence with diabetes and depression medications?

Friday, July 18, 2008

Would You Trust Your Eldercare To A Robot?

I came across a GeckoSystems Press Release and found these quotes regarding their CareBots. It is kind of spooky to think this will become a reality. They speak of it as if it is. Thought you might like to read about it:

The consumer has needs for family care assistance with remote monitoring and notification. This is for family care for the elderly, chronically ill, and children. Since GeckoTrak™ enables the CareBot to automatically follow a designated care receiver using sensor fusion, it allows the care giver to remotely see how they are doing using the onboard wireless webcam. Should the designated family member not respond to our CareBot’s inquiries the caregivers would be contacted by GeckoChat™ forthwith by telephone.

Professional healthcare needs cost effective night time errand running, portable telemedicine, etc., enabling specialist nurses to be more efficient and productive with less work by allowing them to video conference (telepresence) doctors for more timely, "on the spot," diagnosis of patients. The CareBotPro™ can carry all the specialized supplies and equipment the IV or wound care nursing specialists might need. At night the MSR can deliver bed pans, medications, even take vital signs, etc. to those in need while the night shift nurses are busy with a crisis, or other important duties on their wing or floor.

For a non technical discussion of what a GeckoSystems' CareBot does, the short answer is that it decreases the difficulty and stress for the caregiver that needs to watch over grandma, mom, or other family members most, if not much, of the time day in and day out due to concerns about their well being, safety, and security.

Much like these useful and cost effective appliances, a CareBot helps the care giver as a new type of labor saving, time management automatic home appliance.

For example, time stress is frequently felt by the care giver when they need to go shopping for 2 or 3 hours, and are uncomfortable when they have to be away for more than an hour or so. Time stress is much worse for the caregiver with a frail elderly parent who must be reminded to take medications at certain times of the day. How can the care giver be away for 3-4 hours when Grandma must take her prescribed medication every 2 or 3 hours? If the caregiver is trapped in traffic for an hour or two beyond the 2 or 3 they expected to be gone, this “time stress” can be very difficult for the caregiver to moderate.

Not infrequently, the primary caregiver has a 24 hour, 7 days a week responsibility. After weeks and weeks of this sometimes tedious, if not onerous routine, how does the caregiver get a “day off?” To bring in an outsider is expensive (easily $75-125 per day for just 8 hours) and there is the concern that medication will be missed or the care receiver have an accident requiring immediate assistance by the caregiver, or someone they must designate. And the care receiver may be very resistant to a “stranger” coming in to her home and “running things.”

So what is it worth for a care receiver to have an automatic system to help take care of Grandma? Just 3 or 4 days a month “off” on a daylong shopping trip, a visit with friends, or just take in a movie would cost $225-500 per month. And that scenario assumes that Grandma is willing to be taken care of by a “stranger” during those needed and appropriate days off.

So perhaps an automatic care giver, a CareBot, might be pretty handy, and potentially very cost effective from the primary care giver’s perspective.

The care receiver's perception of a CareBot is much different from the care giver's. It’s a new kind of companion that always stays close to them enabling family and friends to care for them from afar. It tells them jokes, retells family anecdotes, reminds them to take medication, reminds them that family is coming over soon (or not at all), recites Bible verses, plays favorite songs and/or other music. It alerts them when unexpected visitors, or intruders are present. It notifies designated care givers when a potentially harmful event has occurred, such as a fall, fire in the home, or just not found by the CareBot for too long a time. And it responds to calls for help and notifies those that the caregiver determined should be immediately notified when any anticipated event occurs.

The family can customize the personality of the CareBot. The voice’s cadence can be fast or slow. The intonation can be breathy, or abrupt. The voice’s volume can range from very loud to very soft. The response phrases from the CareBot for recognized words and phrases can be colloquial and/or unique to the family’s own heritage. The personality can range from brassy to timid depending on how the care giver, and others appropriate, chooses it to be.

Generally, the care receiver is pleased at the prospect of family being able to drop in for a “virtual visit” using the onboard webcam and video monitor for at home “video conferencing.” The care receiver may feel much more needed and appreciated when their far flung family and friends can “look in” on them any where in the world where they can get broadband internet access and simply chat for a bit.

Why is Grandma really interested in a CareBot? She wants to stay in her home, or her family’s home, as long as she possibly can. What’s that worth? Priceless. Or, an average nursing home is $5,000 per month for an environment that is too often the beginning of a spiral downward in the care receiver’s health. That’s probably $2-3K more per month for them to be placed where they really don’t want to be. Financial payback on a CareBot? Less than a year- Emotional payback for the family to have this new automatic caregiver? Nearly instantaneous.

Pharmaceuticals and Word Of Mouth

An article in today's Emarketer, reports on a study by Keller Fay that "less than 10% of pharmaceutical-related word-of-mouth in the US takes place online, compared with nearly three-quarters that happens in person".

I was very interested in this study, and how they measure offline word-of-mouth. It is not as if they can talk to everyone. Their methodology is to poll 36,000 people >13 to find out what the buzz is of the moment and how worth-of-mouth marketing travels. Is this ligit for pharmaceutical marketing?

I rarely have conversations with friends about medications, except to tell them the negative side effects of what I am taking (Niaspan burn). Maybe 8 conversations in the last two years, not including my wife and family. Whereas online, I have had over a hundred "discussions" including conversations through Daily Strength, Revolution Health, posted blogs, hit up chat rooms, commented on other blogs, etc...

Fard Johnmar and I had a "conversation" on Twitter yesterday about the Keller Fay report and how it relates to online trust. He discusses the marketing angle with social media today on his Healthcare Vox Blog. He tweeted the question, how do you define online trust vs. offline when you actually talk to people you know. Per Fard, from an iCrossing Study, only 23% of patients trust others with the same condition online.

How does this relate to medication adherence? Most of these "discussions" are about medications that I have taken, explaining the efficacy, as well as the side effects both positively and negatively - just factual about my personal experiences. On all of the posts I have been very transparent about my ID, and can be easily Googled. Does that mean that a stranger should or would trust me because we both have high triglycerides? 23% do. What effect do I have? Well, 1 in 4 will heed my warnings and trust my positive outcomes.

When I look at a patient who has commented online about a medication that I have taken, I will trust them if they have had the same experience, but I am not really looking for their advice or input. I prefer to rely on my doctor who has prescribed the medication for me and went to med school and who is an authority. Is this a double standard since I freely dose out my own advice? Probably. I have seen patients who have had bad side effects from a script where I had none. They will probably not trust what I have to say, considering we had a different experience.

My point is that I feel I have more influence online, not that I am trying to influence anyone, but I will answer questions, comment when I have something to add, and try to help others figure out what medication regime is best for them based on my own experience. Granted I am 35, and the majority of my friends are not on any medications so I do not have that offline word-of-mouth experience because no one needs my advice or cares. I am also in the Healthcare Technology biz and Health 2.0 movement, so I am more online health sensitive than others.

Will patients take or not take medications based on what they read about online? That is the real question for pharma marketers, and how do you control all the negative reporting?

AllTop Aggregator

This has little to do with Medication Adherence, but everything to do with information on the web. If you are reading this, you probably read blogs and find health information online. Wouldn't it be great if a website captured all of these sites for you in one place, instead of searching different search engines? Now there is. It is called AllTop.

Here is their "purpose" taken from their About page:

We help you explore your passions by collecting stories from “all the top” sites on the web. We’ve grouped these collections — “aggregations” — into individual Alltop sites based on topics such as environment, photography, science, Muslim, celebrity gossip, military, fashion, gaming, sports, politics, automobiles, and Macintosh. At each Alltop site, we display the headlines of the latest stories from dozens of sites and blogs.

You can think of an Alltop site as a “digital magazine rack” of the Internet. To be clear, Alltop sites are starting points—they are not destinations per se. The bottom line is that we are trying to enhance your online reading by both displaying stories from the sites that you’re already visiting and helping you discover sites that you didn’t know existed. In other words, our goal is the “cessation of Internet stagnation” by providing “aggregation without aggravation.”

I have linked AllTop Health in my BlogRoll to the right if you are interested in going straight to the source. As you can tell, it not only is great for health blogs, but for almost everything else you can think of! I like the analogy to a "digital magazine rack", and have found some interesting blogs I did not know were out there.

Great job AllTop Team!

Here is my email to them to ask for inclusion on their site:

Dear AllTop Team:

I have been following Guy's tweets for the last few weeks about AllTop and am constantly amazed at how quickly you are adding topics and feeds. My own blog is about Medication Non-adherence, a pandemic that effects everyone involved in healthcare. 1 in 2 patients do not take medication as prescribed, costing the US over $300 Billion annually in unnecessary healthcare costs and lost revenue.

I discuss this issue, what is being done to address it, Health 2.0, pharma, and the healthcare industry in general. I do not think there is another blog quite like mine, save my inspiration, AllignMap, although I often pull information from different sources. With full disclosure, my company, Intelecare Compliance Solutions, is a healthcare technology company focused on increasing medication adherence, which I state front and center.

Today has been about following advice for me. I read @chrisbrogan's Mashable post about online branding, and followed some of his tips. I also read AllTop's About section and am now following your hints as to how to get on AllTop. I wrote a post about AllTop and have linked AllTop Health in my blogroll (which I would have done anyway since I use it).

Thus, I am submitting my blog for consideration to be added to AllTop Health. If accepted, I will add a badge, most likely "Kick Ass" although I do like "Bribes Work". I thought it inappropriate to add one without actually being accepted.

Thank you for consideration and I look forward to be listed on your site.

Alex Sicre

Thursday, July 17, 2008

Logicalis Top Ten HIT List

I found this list in a Logicalis press release from July 7th. They have revenues of over $1B annually, so I guess they know what they are talking about. Glad to hear that though only 8% of patients have access to EHRs or EMRs, it is #1 on this HIT list.

Logicalis Top Ten HIT List
1. Electronic Health/Medical Records (EHR or EMR)
2. Disaster Recovery/Business Continuity
3. Medical Archiving Systems (MAS)
4. Storage Consolidation and Virtualization
5. Backup (disk-based and online storage)
6. Business Intelligence
7. Picture Archiving and Communication System (PACS)
8. Infrastructure for Health Information Systems
9. Compliance
10. Securing Electronic Protected Health Information (ePHI)

Wednesday, July 16, 2008

Patient 2.0 Blog

A colleague of mine, Emily Stanziale, has started her own blog: Patient 2.0.

This blog chronicles her evolution as a patient in today's modern world, who uses both traditional and holistic methods for achieving better health. As with our Adherence 2.0 model, no patient is the same, and I can obviously say ditto for personal health blogs.

Over the last few months, she has suffered some ailments, and her doctor has had a difficult time deciphering what was wrong. This has lead her to re-examine her PCD's role, and search for answers. She is very honest with what she has been going through and well informed about the industry, as she works in pharma sales.

Please visit her blog to see her unique perspective on her own health, today's healthcare industry and Health 2.0. I hope you enjoy!

Improving medication adherence with a targeted, technology-driven disease management intervention

I found this abstract in NCBI: Pub Med from a BCBS of South Carolina study. The results definitely support our Adherence 2.0 model. The question is, should mail order pharmacies start sending refills if they are due? I know several pharmacies have auto-fill programs, but should there be a triggering mechanism that gets the refills out the door after a week?

I transfered a refill online at a big box retailer to check out their pharmacy services, and did not get around to picking it up for three weeks (I sent the refill early, and my wife had our second son the day after I sent the request). I went to pick it up, and the meds had been put back. They said it would be an hour wait, so I came back the next day.

I understand why they returned the meds, but there wasn't any contact to me - no one reached out. They had my email and telephone number, and I was signed up for their reminder program - but I received no notice. This not only lost the pharmacy money, but contributed to my non-adherence.

Would a community pharmacy have made a personalized call to let me know the script was sitting there? Should I have paid more for that service instead of opting for the "deal" at the big box? Should my health plan have been in the mix? These are all questions a patient has to decide for themselves, and the industry needs to think about.

From Pub Med:

Treatment adherence is critical in managing chronic disease, but achieving it remains an elusive goal across many prevalent conditions. As part of its care management strategy, BlueCross BlueShield of South Carolina (BCBSSC) implemented the Longitudinal Adherence Treatment Evaluation program, a behavioral intervention to improve medication adherence among members with cardiovascular disease and/or diabetes.

The objectives of this study were to 1) assess the effectiveness of telephonic intervention in influencing reinitiation of medication therapy, and 2) evaluate the rate and timing of medication reinitiation. BCBSSC applied algorithms against pharmacy claims data to identify patients prescribed targeted medications who were 60 or more days overdue for refills. This information was provided to care managers to address during their next patient contact.

Care managers received focused training on techniques for medication behavior change, readiness to change, motivational interviewing, and active listening. Training also addressed common barriers to adherence and available resources, including side effect management, mail order benefits, drug assistance programs, medication organizers, and reminder systems.

Overdue refills were tracked for 12 months, with medication reinitiation followed for an additional 3 months. In the intervention group, 94 patients were identified with 123 instances of late medication refills. In the age- and gender-matched comparison group, 61 patients were identified with 76 late refills.

The intervention group had a significantly higher rate of medication reinitiation (59.3%) than the control group (42.1%; P < 0.05). Time to reinitiation was significantly shorter in the intervention group, 59.5 (+/- 69.0) days vs. 107.4 (+/- 109) days for the control group (P < 0.05).

This initiative demonstrated that a targeted disease management intervention promoting patient behavior change increased the number of patients who reinitiated therapy after a period of nonadherence and decreased the time from nonadherence to adherence.

Thursday, July 10, 2008

The President's Fitness Challenge

In response to a previous blog post, a colleague informed me that the President's Fitness Challenge is still around and is available online for adults.

How fit are you? Take the Challenge to find out.

Tuesday, July 8, 2008

Prescription Assistance Programs from Washington Post

I thought I had written about prescription assistance programs from major pharmaceutical companies in the past, but after reviewing my previous posts, I did not see any mention of them.

These PAPs are fantastic programs that basically give away medications or sell them at reduced costs for those patients who cannot afford to pay for them. Pfizer helped 1.1M patients last year with $800M worth of medications at wholesale pricing.

Here is the Washington Post Article from last week discussing PAPs and a not-for-profit web resource called NeedyMeds which connects patients to PAPs.

Cholesterol Drugs for Kids: New AAP Recommendations

I'm sure you have seen this blog by Tara Parker Pope by now or read about it from another news source, but I am a little slow coming back from vacation.

Cholesterol drugs for kids? I think this is a little ridiculous. When I was in grade school in the 80s, we had this thing called the President's Fitness Challenge (or Test?) - where all the students had to take this fitness test to see how you fared against the national average. That was only 25 years ago.

Do they still use this in schools? I agree testing for cholesterol is important, but how about diet and exercise instead of medicating children. We are so quick to medicate children for everything - can't concentrate, drug em, too fat, drug 'em. Shouldn't parents be a little more responsible in regards to their children's health?

I was diagnosed with high triglycerides and high cholesterol 14 months ago, and have been taking Tricor, and now Niaspan to lower my levels, and I have changed my diet. I am about 5 points from getting off the medications, luckiy, or the next step would have been a stain. From what I heave heard though, I wouldn't want to wish a statin on anyone, let alone a child.

This is a brief reporting on the AAP recommendation for cholesterol drugs for children from FirstWord by Bryan DeBusk:

The American Academy of Pediatrics on Monday announced new guidelines recommending cholesterol screening and treatment options for children. According to the new policy, patients over 8 years of age with high LDL concentrations should be considered for cholesterol-lowering drug therapy.

The organisation recommended that children and adolescents undergo cholesterol screening if they have a family history of high cholesterol or heart disease, an unknown family history, or risk factors such as obesity, high blood pressure or diabetes. Screening should occur between the ages of two and 10 years.

According to the new policy, patients over 8 years of age with high LDL concentrations should be considered for cholesterol-lowering drug therapy. Children under age 8 with high cholesterol should focus on exercise, nutrition and weight reduction, according to the AAP.

Stephen Daniels, a member of the AAP’s nutrition committee, said the guidelines are based in part on recent research demonstrating the safety of cholesterol-lowering drugs in children, and predicted that the new guidelines will result in long-term health benefits. “If we are more aggressive about this in childhood, I think we can have an impact on what happens later in life...and avoid some of these heart attacks and strokes in adulthood," Daniels suggested.

Previous recommendations from the AAP stated that cholesterol drugs should only be considered in children older than 10 years if they have not been able to lose weight.