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!

1 comment:

Allan Showalter, MD said...

Other than leaving out the part about EnrichMap preventing cavities, improving ones performance on Guitar Hero by 87%, and bringing an end to world hunger, this a fine report. That, of course, has nothing to do with a bag filled with small, unmarked bills that the author might find in the trunk of his car - along with his unharmed grandmother who disappeared last month. Thanks.