Thursday, August 28, 2008

Multisystemic Therapy for Adolescents With Poorly Controlled Type 1 Diabetes

Today's medical adherence abstract comes to you from Diabetes Care.

The study aim was to determine if multisystemic therapy (MST), an intensive home-based psychotherapy, could reduce hospital admissions for diabetic ketoacidosis (DKA) in youth with poorly controlled type 1 diabetes over 24 months. Potential cost savings from reductions in admissions were also evaluated.

A total of 127 youth were randomly assigned to MST or control groups and also received standard medical care.

Youth who received MST had significantly fewer hospital admissions than control subjects (2 = 11.77, 4 d.f., n = 127; P = 0.019). MST-treated youth had significantly fewer admissions versus their baseline rate at 6-month (P = 0.004), 12-month (P = 0.021), 18-month (P = 0.046), and 24-month follow-up (P = 0.034). Cost to provide MST was 6,934 USD per youth; however, substantial cost offsets occurred from reductions in DKA admissions.

The study demonstrates the value of intensive behavioral interventions for high-risk youth with diabetes for reducing one of the most serious consequences of medication noncompliance.

Monday, August 25, 2008

BarCamp | HealthCampDC

I will be attending HealthCamp DC on September 12th.

I really do not know what to expect from this unconference, as I have never attended one before. Several Health 2.0 and patient advocates will be there who I have connected with on Twitter, through email and via the good old telephone will be there, so I am looking forward to meeting them in person.

If anyone would like to get together to talk about medication adherence, Health 2.0 or how Intelecare can help your organization on the 11th, please let me know: Alex.Sicre [at] Intelecare [dot] com, as I will line up a few meetings the day before.

Look forward to seeing you there!

What I Found Today

Lots of news about medication adherence today. As part of my job, I often educate people about the effects of medication non-adherence when pitching them our services. It is surprising how many people are unaware of the pandemic, even though there has been so much research over the last 20 years about it.

I am always looking around the web for more information, and today I have found a few companies attacking medication non-adherence through a variety of ways.

At The Earth Times, a press release about Pleio launching their GoodStart program with the Outcomes Personal Pharmacy Network. I have been following this Canadian company for awhile, and it is great to see they are in the marketplace. Their niche is helping patients stay adherent to their medications for the 1st 100 days through a handful of interventions at the pharmacy level.

It is great to use the pharmacist in the intervention, however how will this slow down the fulfillment procedures at the pharmacy? Patients are already yearning for a more automated system, what if they have to wait even longer for the 1st time fill, and wait for the people ahead of them to enroll in the program?

Two stories from MarketWatch. The first, a press release about HC Innovations signing a LoA to use InforMedix's Med-eXpert System for up to 500 of ECI's complex patients. I have been following InforMedix for over a year, and they have made some great steps toward increasing medication adherence pill dispenser /monitor. In fact, it is being used in AETNA's Medication Adherence Lottery Clinical Trial.

I am surprised there is not more news from the NACDS Conference this weekend, since I have only seen this press release about ValueTrak from ValuCentric and PDX. Their new program allows for linking of ValueCentric's trade data with's prescription data to give manufacturers a "full visibility of their product activity".

And finally this weird story from The Chicago Tribune about a man who stole the identity of a mentally disabled friend to get heart by-pass surgery.

"You can't just walk in with somebody's Medicaid card like it's a credit card and have heart surgery done," said Jeff Nelligan, spokesman for the federal Centers for Medicare and Medicaid Services. "A doctor would need to know blood type, cardiac history, medical history and other comprehensive records that just couldn't be faked. This doesn't make sense."

Very bizarre that this would happen with all of the checks and balances in place at a hospital for such an expensive procedure.

Enjoy the news!

Thursday, August 21, 2008

Some Quickies From Around the Web

I have been working on a couple of interesting blog posts, specifically one about Twitter for health. I am working on the proper angle, outlining how I use the service, and how others can as well. It is taking longer than I thought, so I appologize.

Here are some quick snippets of news from other sources that I have seen this week so far. Sorry for the retread.

At Psychiatry MMC, there is an abstract about short-acting versus long-acting medications for the treatment of ADHD:

"Medication adherence is also a well-known problem in a chronic disorder like ADHD, with only about 20 percent of patients remaining on the same medication 15 months after first being prescribed that medication. The need for multiple daily dosing of immediate-release medications only further increases the risk of nonadherence in children, adolescents, and adults.

As there is a significant likelihood that one of the parents of a child with ADHD will also have ADHD (often undiagnosed), or another psychiatric disorder, there is potentially a significant risk that the parent will forget to give the additional immediate-release doses of medication to the child every 4 to 6 hours."

Over at MedTrack Alert, they discuss how juices can interfere with medication absorption:

"Researchers say grapefruit juice has been known to dangerously increase the amount of medication absorbed into the body--particularly drugs for high cholesterol and high blood pressure. But a new study by the same researchers has found that apple, orange, and grapefruit juice may also decrease the absorption of some meds, including drugs commonly used to treat diabetes, cancer, allergies, and some antibiotics."

Dr. Showalter at Alignmap discussed the new medication adherence tool: Zuri. FD it is kind of a competitor to Intelecare, however you do not have to spend $200 on a new device and adapt to new technology - Intelecare works with your existing cellphone, land line and computer. Also, you don't have to pay $40 - $50 a month for online services.

The Healthcare Blog now has it's own channel on ICYou. Hat tip to @mindofandre on Twitter.

SHPS to present at Harvard Colloquium about Six Sigma Principles Drive Healthcare Behavior Change -- Using Medication Compliance to Improve Healthcare Outcomes.

Over at Health Management Rx, Jen gets exited about the NextHealth Model launching in beta soon.

That is it for now. You can follow me on Twitter and contribute to the conversation.

Friday, August 15, 2008

How Hurricane Katrina Affected Medication Adherence

Today's medical adherence related abstract comes from The American Journal of The Medical Sciences:

Previous research indicates that many patients with hypertension ran out of medications and had difficulties getting refills immediately after Hurricane Katrina. The extended effect of Hurricane Katrina on antihypertensive medication adherence is not well characterized.

Data were analyzed for 2194 participants who completed the baseline survey for the Cohort Study of Medication Adherence among Older Adults between August 2006 and September 2007. Based on pre-Katrina zip codes, the study population was categorized into high- and low-affected areas. Low medication adherence was defined as a score less than 6 on the 8-item Morisky Medication Adherence Scale.

Prevalence of low adherence was similar among participants living in high and low affected areas. Low medication adherence was similar for participants with greater than or less than 25% of the residence damaged by Hurricane Katrina and for participants with and without symptoms of post-traumatic stress disorder.

In high affected areas, nonsignificant associations were present for those who had moved since the storm and those with a friend or immediate family member who had died in the month after the storm. These factors were not associated with low medication adherence in low affected areas. In both high- and low-affected areas, lower scores on the hurricane coping self-efficacy scale were associated with low medication adherence (P < 0.05).

The effect of Hurricane Katrina on patient adherence to antihypertensive medication was limited in the second year after the storm. Intrinsic patient factors, such as low coping self-efficacy, remain important factors associated with low adherence.

Airborne to Pay Millions In Lawsuit

So here is the question: if something works for you (like Airborne) but is proven to have no scientific evidence of its effects, do you continue to take it?

When I was a senior in high school, through my sophomore year in college, I used Echinacea at the first sign of anything. I don't really know if it worked, but it sort of made me feel better about myself - that I was taking action.

Over Christmas 2007 I became very ill with a fever for a few days (my mother brought a bug from Michigan), and a friend told me to take Airborne. He travels a lot and swears by it. I took it for awhile, but didn't necessarily see the value or get any qualified results.

Here are some quotes from today's Washington Post Article, Airborne Coughs Up Millions to Settle Suit by Annis Shyn:

"There is no credible evidence that Airborne products . . . will reduce the severity or duration of colds, or provide any tangible benefit for people who are exposed to germs in crowded places," said Lydia Parnes, director of the Federal Trade Commission's Bureau of Consumer Protection, which filed a complaint against Airborne's makers."

"Airborne, however, when used as directed does not prevent class-action lawsuits, charges of deceptive advertising -- or, according to the government, the common cold."

"Under a settlement announced yesterday, the privately held Airborne Health, based in Bonita Springs, Fla., will add $6.5 million to funds it has already agreed to pay to settle a related class-action lawsuit. That suit, which alleged that Airborne falsely claimed its products could cure or prevent colds, was settled earlier this year for $23.5 million.

Consumers who bought Airborne products between 2001 and 2008 have until Sept. 15 to apply for a refund for as many as six purchases, the FTC said. Claims will be paid by Oct. 15, 2008, the company said in a statement."

"Even if Airborne isn't doing anything for you, believing it helps," said microbiologist Stephanie Scovel-Toney, 28, of Fredericksburg.

"It may be mental, but it works for me," said Robin Roane, 46, manager of an Alexandria nonprofit. "I can't tell you the last time I had a cold."

So back to my question: if it works for you, but has no scientific proof, do you continue to take it? I believe that if a medication or supplement makes you feel better and does not do any harm (ie. Vicodin makes me feel better but is addictive), why not? There was a study that showed an expensive placebo had better results than a "generic" placebo in a trial. People thought they were taking a brand drug, and judged its effectiveness by the price.

Granted the Airborne lawsuit is over packaging and false claims: "It's important to note that this is a settlement over older advertising and labeling, and has nothing to do with public safety," said Airborne chief executive Elise Donahue. "We've offered a money-back guarantee for our products since 1997, and we have millions of satisfied customers. A class-action lawsuit sparked this matter. We're just one of many major consumer brands across America that are under assault by class-action lawyers."

So there it is. Airborne always has offered a money back guarantee and has millions of happy customers (sales were $100M in 2004 after an Oprah appearance).

So is this lawsuit frivolous? Do those who feel fleeced deserve their money back - sure, the company offers a guarantee on the label.

Should those that love Airborne continue to take it? Sure, if it makes them feel like they are preventing a cold, why not?

Should a doctor prescribe or recommend Airborne - definitely not.

I do not take any medications or supplements that don't have proven results, ie. my cholesterol pills. I get blood work done, see my cholesterol level drop, I know the pills work. I have a cold, I drink chicken soup, I get better, I know it works. Just kidding.

Thursday, August 14, 2008

CFC Ban Will Affect Medication Adherence For Asthmatics

Today's abstract brought to you by The National Center For Policy Analysis:


A federal ban on ozone-depleting chlorofluorocarbons (CFCs), to conform to the Clean Air Act, is, ironically, affecting 22.9 million people in the United States who suffer from asthma, says Scientific American. Generic inhaled albuterol -- the most commonly prescribed short-acting asthma medication that requires CFCs to propel it into the lungs -- will no longer be legally sold after December 21, 2008.

As more patients see their prescriptions change and costs go up -- the reformulated brand-name alternatives can be three times as expensive, raising the cost to about $40 per inhaler -- many question why this ban must begin before generics become available. Some skeptics point to the billions of dollars to be gained by the three companies, GlaxoSmithKline, Schering-Plough and Teva, holding the patents on the available HFA-albuterol inhalers.

However, the main public health issue may not be the drug's chemistry, but rather the side effects of the economics:

Multiple studies have shown that raising costs leads to poorer adherence to treatment; one study discovered that patients took 30 percent less antiasthma medication when their co-pay doubled.

In the case of a chronic disease such as asthma, it is particularly difficult to get people to follow regular treatment plans.

The choice to forgo medication could affect more than just the patient; for example, in a pregnant mother with untreated asthma, less oxygen is delivered to the fetus, which could lead to congenital problems and premature birth.

Considering that the disease disproportionately strikes the poor, what seemed to be a good, responsible environmental decision might in the end exact an unexpected human toll, says Scientific American.

Source: Emily Harrison, "Change in the Air: Banning CFC-driven inhalers could levy a toll on asthma sufferers," Scientific American, August 2008.

This might be a little cheap reposting a post from another source, but I thought it was interesting. This has happened before: he government steps in to help a cause, and ends up hurting someone else. Surprisingly adherence with asthma medication in low already - since asthmatics who feel good, do not take their medications in general. It is only when they have an attack that they reach for their inhalers. Of course raising the price of medications affects adherence as well - perhaps there will be a subsidy to help asthmatics or there will be a protest to let the CFCs still be used in inhalers?

Tuesday, August 12, 2008

Other Blog /News Reading Today

I haven't seen any interesting abstracts about medication adherence today, but wanted to share some blog posts and articles I have read about various medical topics including medication adherence.

Tara Parker-Pope writes about the dangers /effects of early cancer screenings in today's NYT Well. This is particularly haunting for me as a recent ER X-ray found something on my lung, and my wife wants me to get a lung cancer screening tomorrow. I will write a post about my whole ER experience soon. Thanks to Kevin MD for the tip.

Health on MSN has picked up a Forbes article about the most medicated US States. National average for 2006 was 11.1 prescriptions per capita. I think it is now 14 per capita.

In-Pharma Technologist writes about the shake-up of Pharma top sales spots in 2014.

The Health Care Blog turns 5 today. I have only been reading it for about 18 months. Interesting to read Matthew Holt's take on the evolution of healthcare blogging and its effect on the space. Congrats Matthew and the whole team @ THCB who has been providing brilliant content for years!

New blog I discovered today is the blog for the Placebo Journal. The blog to the magazine, who's tagline is "Medical Humor With a Purpose".

PyschCentral has a good article on BiPolar Medication Adherence Issues.

I'm Too Young For This! has posted their Summer edition of The Stupid Cancer News. If you look really closely in one of the pics from the Stupid Cancer Gala, you can see me and my friend Vanessa in the background!

Thanks to all on Twitter for the tips. You can follow me on Twitter @knightsicre.


Monday, August 11, 2008

Hard of (Ad)hearing in Pharma Exec Magazine

I came across this article in Pharmaceutical Executive Magazine this morning, even though it was published on August 1st.

George Koroneos writes about Big Pharma's take on medication adherence programs and different people's take on adherence, including our friend Dr. Nash from the Jefferson Medical College. Nothing really new in the article, but it is a good summary of some programs that have worked - ie. Gardasil.


Friday, August 8, 2008

Adherence to acitretin and home narrowband ultraviolet B phototherapy in patients with psoriasis

Today's medical adherence focused abstract brought to you from The Journal of the American Academy of Dematology:

In the treatment of psoriasis, patient adherence to oral medications is poor and even worse for topical therapy. However, few data exist about adherence rates to home phototherapy, adding to concerns about the appropriateness of home phototherapy as a psoriasis treatment option.

We sought to assess adherence to both oral acitretin and home ultraviolet B phototherapy for the treatment of psoriasis.

In all, 27 patients with moderate to severe psoriasis were treated with 10 to 25 mg of acitretin daily, combined with narrowband ultraviolet B, 3 times weekly at home, for 12 weeks. Adherence to acitretin was monitored by an electronic monitoring medication bottle cap, and to phototherapy by a light-sensing data logger.

Adherence data were collected on 22 patients for acitretin and 16 patients for adherence to ultraviolet B. Mean adherence to acitretin decreased steadily during the 12-week trial (slope −0.24), whereas mean adherence to home phototherapy remained steady at 2 to 3 d/wk. Adherence was similar between patients who reported side effects and those who did not.

Small sample size and lack of follow-up on some patients were limitations of this study.

Adherence rates to home phototherapy were very good and higher than adherence rates for the oral medication. Side effects of treatment were well tolerated in this small group and did not affect use of the treatment. Home phototherapy with acitretin may be an appropriate option for some patients with extensive psoriasis.

Very surprised that the phototherapy treatment had a higher adherence rate. Possibly the side effects of the oral medication were so bad that the time spent on the PTT was worth it? I am not familiar with the PTT but it sounds very interesting, and a more adherent treatment than oral medication for psoriasis. Another question: what is the cost for this treatment? It is a one time cost or rental for the equipment, then recurring costs? Cheaper than oral medications?

Wednesday, August 6, 2008

Email Bank of America Scam

This has nothing to do with Medication Adherence or Healthcare, but an email scam I discovered and am passing along, which could directly relate to how you pay for healthcare.

I have never been one to put too much trust in online banking, although I do pay some bills online ( for 8 months) and check my balance every few days (for 3 years). I find it very annoying and helpful at the same time. Today I got the following email from

"Dear Bank of America customer,

Security and confidentiality are at the heart of the Bank of America. Your details (and your money) is protected by a number of technologies, including Secure Sockets Layer (SSL) encryption.
We would like to notify you that Bank of America carries out customer details confirmation procedure that is compulsory for all our customers. This procedure is attributed to a routine banking software update.

Please visit our Customer Verification Form using the link below and follow the instructions on the screen.

Bank of America Customer Service"

Clicking on the link brought me to a very official looking B of A page that asked me to "Confirm your Bank of America credit/debit card details". It asked for my state, ATM or Credit Card Number, Exiration date, ATM or Credit Card PIN.

All very official looking as I stated (you can cut and paste if you want to check it out), except for the grammatical and spelling errors.

Interesting I thought. I do not have a personal B of A account, but we have a business account for BONDA Restaurant, which I co-own, and am a signatory but not the primary account holder. After looking at the page for 30 secs of so, I realized the email was send to an address I do not use for BONDA. Still strange, I thought, then I looked at the URL "".

I can't remember the name of this type of URL, but I know it is some sort of scam.

The email has the B of A logo, and looks ligit. If I had a personal account, I might have have started to enter my info without really thinking, but most likely I would have taken a step back and asked why they would have wanted this information. I count myself somewhat savvy to the ways of scams, but I sometimes live in a bubble where I think I am immune to them.

Point being, this is a warning if anyone gets a similar email or would like to pass around the specifics to any B of A customers they know who might not have internet banking scams top of mind.

Thank you and beware!

Another Report On QuiqMeds

I feel like I am becoming a cheerleader or spokesperson for QuiqMeds, without even seeing it in action. In any case, I have nothing to do with the company, but I think it is a neat technology /device that allows for patients and caregivers to get their medications at the doctor's office and eliminate that step of going to the pharmacy.

As I can attest second hand, when my wife takes our kids to the pediatrician and gets a script, she doesn't go directly the pharmacy unless it is on her way home (which it is not). Even if she leaves the kids with the nanny and gets her own script from her MD, chances are it will sit in the car, her purse or drawer for at least two or three days.

With QuikMeds, the doctor can dispense medications from a machine with a few touches of a screen. I have some problems with this, but I assume that he company has already taken security, and compliance measures into account. My worries being the "freshness" of the medications, the waste of the medications not filled, the accuracy, etc... All the issues that arise without the human touch of a pharmacist - plus the trust that the medication is the proper medication.

Can I trust that the person who checked the machine and loaded the meds is not a junkie or thief who replaced all the narcotics with OTC generic headache pills? Maybe they do not even dispense these types of meds? That being said, I will check into the company and try to get a demonstration.

Here is a link to a short article and the video of a story that ran last week on CBS 3.

Book Review of Improving Medication Adherence: How to Talk With Patients About Their Medications

I found a book review for "Improving Medication Adherence: How to Talk With Patients About Their Medications" on Psychiatry OnLine by Dr. Jeffrey Geller. Having never attended medical school, I just assumed medication adherence and how to speak with patients would be covered during one's studies. Maybe I am wrong.

From the review:

"Shawn Christopher Shea's book, Improving Medication Adherence: How to Talk With Patients About Their Medications, should be read by every medical student at the end of his or her first year of medical school and again at the end of his or her fourth year. If read anytime after that, I fear it just might be too late.

Shea's book is about how to approach patients sensitively and how to work with patients as partners in their health care. He chooses to focus on medication adherence, but the lessons could be generalized to almost every aspect of the doctor-patient relationship."

Here is the rest of the book review.


Friday, August 1, 2008

A Video Game Improves Behavioral Outcomes in Adolescents and Young Adults With Cancer: A Randomized Trial

BONUS Medication adherence abstract! From the AAP:

Suboptimal adherence to self-administered medications is a common problem. The purpose of this study was to determine the effectiveness of a video-game intervention for improving adherence and other behavioral outcomes for adolescents and young adults with malignancies including acute leukemia, lymphoma, and soft-tissue sarcoma.

A randomized trial with baseline and 1- and 3-month assessments was conducted from 2004 to 2005 at 34 medical centers in the United States, Canada, and Australia. A total of 375 male and female patients who were 13 to 29 years old, had an initial or relapse diagnosis of a malignancy, and currently undergoing treatment and expected to continue treatment for at least 4 months from baseline assessment were randomly assigned to the intervention or control group.

The intervention was a video game that addressed issues of cancer treatment and care for teenagers and young adults. Outcome measures included adherence, self-efficacy, knowledge, control, stress, and quality of life. For patients who were prescribed prophylactic antibiotics, adherence to trimethoprim-sulfamethoxazole was tracked by electronic pill-monitoring devices (n = 200). Adherence to 6-mercaptopurine was assessed through serum metabolite assays (n = 54).

Adherence to trimethoprim-sulfamethoxazole and 6-mercaptopurine was greater in the intervention group. Self-efficacy and knowledge also increased in the intervention group compared with the control group. The intervention did not affect self-report measures of adherence, stress, control, or quality of life.

The video-game intervention significantly improved treatment adherence and indicators of cancer-related self-efficacy and knowledge in adolescents and young adults who were undergoing cancer therapy. The findings support current efforts to develop effective video-game interventions for education and training in health care.

Barriers to Medication Adherence in Poorly Controlled Diabetes Mellitus

Your daily dose of medication non-adherence abstract from Sage Journals.

The purpose of this study is to characterize the adherence and medication management barriers for adults with poorly controlled type 2 diabetes mellitus (DM) (those with A1c 9% or above) and to identify specific adherence characteristics associated with poor diabetes control.

This was a cross-sectional analysis of baseline data from a randomized, controlled diabetes intervention conducted in University of Washington (UW) Medicine Clinics in the greater Seattle, Washington, area. The goal of the original study was to evaluate the effect of a pharmacist intervention on improving diabetes control over 12 months.

Evaluation measures for medication adherence included self-reported adherence and medication management challenges using the Morisky question format and difficulty with taking medications for each diabetes medication based on the Brief Medication Questionnaire. Specific adherence characteristics associated with poor diabetes control (A1c >9%) were identified using multivariate regression analysis.

Seventy-seven subjects (mean A1c, 10.4%; mean duration of DM, 7 years) were studied. The most common adherence challenges included paying for medications (34%), remembering doses (31%), reading prescription labels (21%), and obtaining refills (21%). Taking more than 2 doses of DM medication daily (β = .78, SE = 0.32, P = .02) and difficulty reading the DM medication prescription label (β = .76, SE = 0.37, P = .04) were significantly associated with higher hemoglobin A1c. Self-reported adherence was not related to A1c control.

In this study, we identified 2 factors that were associated with poorer A1c control. These findings highlight the importance of identifying potential challenges to medication adherence for those with DM and providing support to minimize or resolve these barriers to control.

I am glad to see another study that supports cost and forgetfulness as the two major factors of medication non-adherence, but at the same time I am not glad to see it. I had an interesting thought the other day: with companies and health plans reducing and eliminating co-pays for generic medications for chronic diseases, and with pharmacos' PAPs, will this cost factor be eliminated in 10 years?

Most likely distribution and obtaining refills with then rise as factors, and forgetfulness is still #1 with 84% nationally. I have talked about a pharmacy system that will automatically send refills to patients, whether they trigger the refill or not. This eliminates some factors, but, this also has some problems. As one person who commented to a post last week, the way she takes her pills, she is on a 38 day schedule for a 30 day script - thus she would end up with extra pills every month.

As we all know, medication adherence is America's #1 Drug Problem that needs to be addressed by all stake holders. I will continue to report what I find in my research to explore how we can "fix" this issue.