I found this press release earlier in the week from InnovationRx, announcing a pilot program in CA for their pharmacy based adherence programs. I saw their presentation at the DM colloquium earlier this year and found their services to be very similar to Intelecare's, however InnovationRx is a paid service, not a free service to patients like Intelecare's consumer offerings. Also in the announcement was the declaration of Medication Adherence Awareness month, co-sponsored by the American Pharmacists Association, the FDA OWH and the Pharmacists Planning Service.
Of course I was very excited to hear about Medication Adherence Awareness Month, however I could not find any information on any of the aforementioned partner websites, nor on InnovationRx's website either. I emailed my medication adherence enthusiast buddy Dr. Showalter from AlignMap, and looked at his blog, but no info there either. I even did a Google Search, but could only find InnovationRx's press release (excerpt below).
Every month for me is Medication Adherence Awareness Month, as everyday I educate patients, caregivers, industry executives (Health 2.0 companies, health plans, pharmacies, non-profits, etc...) on the pandemic that is medication non-adherence.
QUICK STORY: My wife and I were at a wedding last weekend for one of her best friends, and inevitably the question of "what do you do" came up. I hate to bore people in social situations about healthcare issues (most of the guests were in the fashion industry and artists, musicians, etc...), but found that everyone I spoke with had no idea the impact medication non-adherence has to patients and the US economy. And they were interested. I even spoke with a heart surgeon, who said "sure I know about medication non-adherence, but I did not know it was so rampant".
So here is a salute to Medication Adherence Awareness Month! Please spread the word and stay adherent to your medications, and let others know about the importance of their doctor's prescribed care plan. 1 in 2 patients does not take their medications as prescribed, costing the US $300 BILLION annually in unnecessary healthcare costs and lost revenue. 84% cite simple forgetfulness as the reason for their non-adherence.
Medication non-adherence is America's Biggest Drug Problem, but it need not be.
From BusinessWire:
"InnovationRx, a wholly owned subsidiary of Innovation Group (UK:TIG: news, chart, profile) , today launched a medication adherence awareness campaign targeting pharmacists and patients in California. The campaign, a pilot for a nationwide effort, aims to provide pharmacists with resources that will help their patients to achieve medication adherence and improve health. InnovationRx is collaborating with the American Pharmacists Association (APhA), the Food and Drug Administration's Office of Women's Health (FDA OWH), and Pharmacists Planning Service, Inc. (PPSI) for this campaign.
Medication non-adherence is a costly and prevalent problem in the United States. As part of Pharmacy/Medication Adherence Awareness Month, InnovationRx and its partners will raise awareness of the consequences of non-adherence and showcase programs that are available to help patients simplify their medication regimen and build reminder systems."
Showing posts with label Medication Noncompliance. Show all posts
Showing posts with label Medication Noncompliance. Show all posts
Wednesday, October 8, 2008
Thursday, September 18, 2008
Express Scripts Studies Show Home Delivery Improves Medication Adherence and Generic Sales
Two studies released from by Express Scripts show that home delivery 1) improves patient medication adherence, and 2) increases generic sales. Good for pharmacos for Express Scripts to increase adherence, however bad for pharmacos when Express Scripts wants to increase generic traffic. Good for patients, providers, and payors all around.
It is kind of a duh! revelation when you think that improving access to medication, as well as medication possession will also increase medication adherence. I mean if I have a 90 day supply sent to me at home, I will more likely take my meds on day 32 than I will if I have a 30 day script and need to refill it at my local pharmacy.
The method of introducing the generic was by a letter, another duh! revelation that by increasing patient knowledge of the generic, you increase patient acceptance and uptake. Six months ago my formulary changed and one of my scripts went up to a $75 co-pay. I asked if there was a generic and had my doc prescribe that instead. No one told me of the generic, but if I had been informed, I would have chosen it and lowered my costs earlier. It wasn’t until I was presented with a bill 3x of what I normally paid, that I asked – actually it took two refills to understand the increase, as my wife picked up the first refill and no one told her of the increase.
From MarketWatch
“In one study, compliance, or taking a medication as prescribed by your doctor, was nearly eight percentage points higher for home delivery pharmacy patients taking medications to treat high blood pressure. These patients were 78.6 percent compliant, but those using a retail pharmacy were 70.8 percent compliant.”
“….Cox explained that in addition to cost savings, home delivery promotes better medication compliance through patient communications such as refill reminders by phone or email, renewal assistance, a convenient reorder process, and less frequent re-ordering.”
“In the second study, a letter alerting patients to the availability of a generic alternative, the likelihood of choosing generics in home delivery was 34% greater compared to the impact in retail. The letters were sent following the introduction of generic Ambien(R) (zolpidem) in 2007.”
“Express Scripts estimates that use of generic sleeping aids will increase to 70 percent of all sleeping aid prescriptions in 2008. However, even that increase will not capture the $1.5 billion in additional savings available nationwide for commercial and government-paid plans from realizing the category's full generic potential of 95 percent.”
“The Center was inspired by research showing that a targeted communications program implemented around the 2006 introduction of generic Zocor (simvastatin) was nearly two to three times more effective than financial incentives alone. The greatest impact came among consumers using the company's home delivery pharmacy. The campaign generated over a billion dollars in savings for Express Scripts' pharmacy benefit plan sponsors and consumers.”
MY COMMENTS
8% is a fair amount in the adherence game. Congrats Express Scripts. Also in saving BILLIONS of dollars for their clients, Express Scripts should be commended. And an increase of 34% in generics from home delivery v. retail is outstanding.
At HealthCampDC, we had a short discussion about generics v. brands. The public does not actually know generic names, just the brand. “Oh, give me the generic of Zocor” not “I want simvastatin”. It is up to doctors, PBMs, and pharmacies to alert the patients as to what exists in the generic market to lower health care costs.
I wish two of my meds had generic equivalents, as they are $40 a month – not that this is so much, but it adds up, plus my wife’s scripts, plus our son’s script, and doctors’ bills and specialists. It was so much easier and inexpensive when I was single and did not go to the doctor. I can only imagine what the downturn in the economy is going to do to the average family and their healthcare costs.
It is kind of a duh! revelation when you think that improving access to medication, as well as medication possession will also increase medication adherence. I mean if I have a 90 day supply sent to me at home, I will more likely take my meds on day 32 than I will if I have a 30 day script and need to refill it at my local pharmacy.
The method of introducing the generic was by a letter, another duh! revelation that by increasing patient knowledge of the generic, you increase patient acceptance and uptake. Six months ago my formulary changed and one of my scripts went up to a $75 co-pay. I asked if there was a generic and had my doc prescribe that instead. No one told me of the generic, but if I had been informed, I would have chosen it and lowered my costs earlier. It wasn’t until I was presented with a bill 3x of what I normally paid, that I asked – actually it took two refills to understand the increase, as my wife picked up the first refill and no one told her of the increase.
From MarketWatch
“In one study, compliance, or taking a medication as prescribed by your doctor, was nearly eight percentage points higher for home delivery pharmacy patients taking medications to treat high blood pressure. These patients were 78.6 percent compliant, but those using a retail pharmacy were 70.8 percent compliant.”
“….Cox explained that in addition to cost savings, home delivery promotes better medication compliance through patient communications such as refill reminders by phone or email, renewal assistance, a convenient reorder process, and less frequent re-ordering.”
“In the second study, a letter alerting patients to the availability of a generic alternative, the likelihood of choosing generics in home delivery was 34% greater compared to the impact in retail. The letters were sent following the introduction of generic Ambien(R) (zolpidem) in 2007.”
“Express Scripts estimates that use of generic sleeping aids will increase to 70 percent of all sleeping aid prescriptions in 2008. However, even that increase will not capture the $1.5 billion in additional savings available nationwide for commercial and government-paid plans from realizing the category's full generic potential of 95 percent.”
“The Center was inspired by research showing that a targeted communications program implemented around the 2006 introduction of generic Zocor (simvastatin) was nearly two to three times more effective than financial incentives alone. The greatest impact came among consumers using the company's home delivery pharmacy. The campaign generated over a billion dollars in savings for Express Scripts' pharmacy benefit plan sponsors and consumers.”
MY COMMENTS
8% is a fair amount in the adherence game. Congrats Express Scripts. Also in saving BILLIONS of dollars for their clients, Express Scripts should be commended. And an increase of 34% in generics from home delivery v. retail is outstanding.
At HealthCampDC, we had a short discussion about generics v. brands. The public does not actually know generic names, just the brand. “Oh, give me the generic of Zocor” not “I want simvastatin”. It is up to doctors, PBMs, and pharmacies to alert the patients as to what exists in the generic market to lower health care costs.
I wish two of my meds had generic equivalents, as they are $40 a month – not that this is so much, but it adds up, plus my wife’s scripts, plus our son’s script, and doctors’ bills and specialists. It was so much easier and inexpensive when I was single and did not go to the doctor. I can only imagine what the downturn in the economy is going to do to the average family and their healthcare costs.
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.
OBJECTIVE
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.
RESEARCH DESIGN AND METHODS
A total of 127 youth were randomly assigned to MST or control groups and also received standard medical care.
RESULTS
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.
CONCLUSIONS
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.
OBJECTIVE
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.
RESEARCH DESIGN AND METHODS
A total of 127 youth were randomly assigned to MST or control groups and also received standard medical care.
RESULTS
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.
CONCLUSIONS
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.
Tuesday, January 15, 2008
CVD Literature Review and Some Stats from the AHA
This is a literature review of noncompliance in... well the title tells the tale. I will post some comments on the end. This was found on Envirovaluation.org, but I am pretty sure the paper is from a conference on hypertension from 2006 in Spain.
The economic consequences of noncompliance in cardiovascular disease and related conditions: a literature review
Summary:
Objectives: To review studies on the cost consequences of compliance and/or persistence in cardiovascular disease (CVD) and related conditions (hypertension, dyslipidaemia, diabetes and heart failure) published since 1995, and to evaluate the effects of noncompliance on healthcare expenditure and the cost-effectiveness of pharmaceutical interventions.
Methods: English language papers published between January 1995 and February 2007 that examined compliance/persistence with medication for CVD or related conditions, provided an economic evaluation of pharmacological interventions or cost analysis, and quantified the cost consequences of noncompliance, were identified through database searches. The cost consequences of noncompliance were compared across studies descriptively.
Results: Of the 23 studies identified, 10 focused on hypertension, seven on diabetes, one on dyslipidaemia, one on coronary heart disease, one on heart failure and three covered multiple diseases. In studies assessing drug costs only, increased compliance/persistence led to increased drug costs. However, increased compliance/persistence increased the effectiveness of treatment, leading to a decrease in medical events and non-drug costs. This offset the higher drug costs, leading to savings in overall treatment costs. In studies evaluating the effect of compliance/persistence on the cost-effectiveness of pharmacological interventions, increased compliance/persistence appeared to reduce cost-effectiveness ratios, but the extent of this effect was not quantified.
Conclusions: Noncompliance with cardiovascular and antidiabetic medication is a significant problem. Increased compliance/persistence leads to increased drug costs, but these are offset by reduced non-drug costs, leading to overall cost savings. The effect of noncompliance on the cost-effectiveness of pharmacological interventions is inconclusive and further research is needed to resolve the issue.
COMMENTS:
Yes, we have repeatedly seen that increase medication adherence leads to increase medication costs. This is a given, just like any consumption increase. With diseases that have nor apparent symptoms, other than a heart attack, it is hard to argue the case that in the long run, spending more on your medication will lower your overall healthcare costs. Event hough it is the truth and I believe it, it is sometimes hard to argue because in three years, there will be someone else to pick-up the bill. Whether it is a different employers, healthcare plan or the government, people want to shift the cost to the next person.
I was reading the AHA's new report on CVD, and I knew that the numbers were pretty high, but a person dies every 37 seconds from CVD, totaling 2400 Americans a day. In 2008, 770,000 Americans with have a new coronary attack, with 430,000 expected to have a recurrent attack. Every 40 seconds someone dies from a stroke - that is one in seventeen deaths in the US. In 2004, heart failure was mentioned in 1 in 8 deaths. 80,700,000 Americans have 1 or more types of CVD.
These numbers are crazy. We are a sick nation that needs to be healed. Starting at childhood with diet and exercise, these numbers can be decreased, probably not in my lifetime, but hopefully my son's. My father had a mild heart attack last year, and it was a real wakeup call for him at 63. Now he is on more medication and he is adherent.
Sorry for the rant, but it has been on my mind today.
The economic consequences of noncompliance in cardiovascular disease and related conditions: a literature review
Summary:
Objectives: To review studies on the cost consequences of compliance and/or persistence in cardiovascular disease (CVD) and related conditions (hypertension, dyslipidaemia, diabetes and heart failure) published since 1995, and to evaluate the effects of noncompliance on healthcare expenditure and the cost-effectiveness of pharmaceutical interventions.
Methods: English language papers published between January 1995 and February 2007 that examined compliance/persistence with medication for CVD or related conditions, provided an economic evaluation of pharmacological interventions or cost analysis, and quantified the cost consequences of noncompliance, were identified through database searches. The cost consequences of noncompliance were compared across studies descriptively.
Results: Of the 23 studies identified, 10 focused on hypertension, seven on diabetes, one on dyslipidaemia, one on coronary heart disease, one on heart failure and three covered multiple diseases. In studies assessing drug costs only, increased compliance/persistence led to increased drug costs. However, increased compliance/persistence increased the effectiveness of treatment, leading to a decrease in medical events and non-drug costs. This offset the higher drug costs, leading to savings in overall treatment costs. In studies evaluating the effect of compliance/persistence on the cost-effectiveness of pharmacological interventions, increased compliance/persistence appeared to reduce cost-effectiveness ratios, but the extent of this effect was not quantified.
Conclusions: Noncompliance with cardiovascular and antidiabetic medication is a significant problem. Increased compliance/persistence leads to increased drug costs, but these are offset by reduced non-drug costs, leading to overall cost savings. The effect of noncompliance on the cost-effectiveness of pharmacological interventions is inconclusive and further research is needed to resolve the issue.
COMMENTS:
Yes, we have repeatedly seen that increase medication adherence leads to increase medication costs. This is a given, just like any consumption increase. With diseases that have nor apparent symptoms, other than a heart attack, it is hard to argue the case that in the long run, spending more on your medication will lower your overall healthcare costs. Event hough it is the truth and I believe it, it is sometimes hard to argue because in three years, there will be someone else to pick-up the bill. Whether it is a different employers, healthcare plan or the government, people want to shift the cost to the next person.
I was reading the AHA's new report on CVD, and I knew that the numbers were pretty high, but a person dies every 37 seconds from CVD, totaling 2400 Americans a day. In 2008, 770,000 Americans with have a new coronary attack, with 430,000 expected to have a recurrent attack. Every 40 seconds someone dies from a stroke - that is one in seventeen deaths in the US. In 2004, heart failure was mentioned in 1 in 8 deaths. 80,700,000 Americans have 1 or more types of CVD.
These numbers are crazy. We are a sick nation that needs to be healed. Starting at childhood with diet and exercise, these numbers can be decreased, probably not in my lifetime, but hopefully my son's. My father had a mild heart attack last year, and it was a real wakeup call for him at 63. Now he is on more medication and he is adherent.
Sorry for the rant, but it has been on my mind today.
Friday, August 10, 2007
Compounding Pharmacists - Who knew?
In a lot of my research on medication non-adherence (that is the new accepted term for noncompliance), I come across what researchers deem as the "important role of the pharmacists". Especially in all of the pharmacists surveys and reports! For me (I have taken two or three medications on and off for 8 years) I just pick up my drugs and leave. I recall once, maybe five years ago, the pharmacist gave me the option of getting a generic as opposed to the branded drug - and I think I took it.
BUT after thinking about their role a couple of weeks ago, I started engaging the pharmacist. I had a phlegmy cough in Nantucket over the 4th of July weekend and wondered what I should take - musanex (sp), robitussin, etc... She was very helpful and outlined the pros and cons of each. Helpful, but not exactly prescription help.
So in the last two days I was surprised to find two articles about compounding pharmacists - a job I never knew existed. I have always just gotten my pills as they come from the pharma company. I guess other people are pickier than I am. At least both articles state that it helps with Medication Non-Adherence.
Here are the two articles:
The first from the website Hometownlife by Nathan Mueller:
Kenny Walkup has hands that can turn a solid into a liquid; change the taste of medicine to anything from bubble gum to beef; and change certain aspects of a prescription to remove parts that people or animals are allergic too.
OK, Walkup does not do it all with his hands — some high-tech equipment and technicians also play a role — but they are a key reason Specialty Medicine Compounding Pharmacy has been successful.
"I always liked working with my hands. I should have been a mechanic but I can't fix a car," he joked. "Plus it gives me a chance to be creative." But he can fix medicine.
Walkup's job as a compounding pharmacist is solely based on the individual he is working for. He works with the patient and physician to create a medication that will work for the customer.
The most common situation he comes across is "patient non-compliance." Many people or animals are allergic to certain parts of a prescription or sensitive to strengths, and a compounding pharmacist can — with physician consent — change the strength, change the form from solid to liquid, etc. and change the flavor. Flavors range from chocolate to pineapple to bubble gum for humans and from apple to catnip to chicken for pets.
"All prescriptions are made from scratch, specific to each patient," he said. Walkup owned both the compound pharmacy and the South Lyon Pharmacy before splitting them in February 2003. He has been in South Lyon since 1998.
A graduate of the School of Pharmacy at Ohio Northern University in Ada, Ohio, Walkup joined the Professional Compounding Centers of America and began training there before opening the pharmacy in South Lyon. His pharmacy is a clinical site for Ohio Northern and the University of Michigan, and he gives lectures and does work for both universities.
"I enjoy (talking to students) but I like being in the lab too," he said. "Most of the new stuff I make myself the first time."
The pharmacy has been so successful that it was recently featured on the Heath Watch on the Channel 4 News. Reporter Rhonda Walker said the pharmacy was the "ultimate when it comes to personalized medicine."
It also touched on a story about a patient, Noel Gelfund, who was undergoing treatments to remove a birthmark and the pain killing cream he needed was discontinued. Walkup got to work and formed a new cream that worked better and cost half as much.
Gelfund was killed in a car accident in 2004 and the cream was named "Noel's Numbing Cream" in his honor.
Walkup donates 20 percent of the proceeds of the sale of the product to the Sturge-Weber Foundation which researches Port Wine Stain conditions.
"I have the best job in the world," Walkup said. "I get to help people and do something I truly enjoy."
Here's the second article from the Salt Lake Tribune by Fitzgerald Petersen
Tad Jolley may have the pharmacy business coursing through his veins, but innovation runs in them, too. Jolley was recently awarded "Innovative Pharmacy Practice" by the Utah Pharmacy Association at their yearly convention. Jolley won for his creation of an in-house program to train pharmacy technicians, who are a critical component to Jolley's pharmacy business.
Prior to the creation of the program, aspiring pharmacy technicians would need nine months of schooling before becoming certified. Jolley's program allows technicians in training to receive a paid education while gaining valuable work experience. Jolley benefits by gaining technicians who know their way around his unique store.
Jolley's pharmacies specialize in compounding, which Jolley calls "a lost art." Compounding is highly specialized and involves mixing ingredients specifically for each patient. Of the hundreds of pharmacies competing to fill prescriptions in the Salt Lake Valley, only a handful offer this special service. Most simply rely on pre-made formulations from big drug companies.
Tad Jolley is the third generation of compounding pharmacists to sit behind the counter of the family business. Joel Jolley opened the first Jolley's Pharmacy in 1954. Fifty-three years and four stores later, the family business is still going strong.
Jolley's Pharmacy employs 30 pharmacy technicians in all, so the in-house program makes a significant impact - and not just for Jolley's. The program has caught on with other pharmacies as well. Jolly has received numerous calls from colleagues asking for his advice on implementing their own in-house training. Jolley acknowledges that his program "does something outside the norm" but, he says, "It's helped a lot of other pharmacists as well."
Though Jolley has been working as a pharmacist since 1980, he still loves picking up his mortar and pestle to serve the community. While his award from the association hangs modestly on a wall in his store, he hopes the positive impact of his training program will be felt for years.
Compounding the cure
Pharmacy compounding is the long-established tradition in which medicines that are specially prepared by pharmacists to meet patients' individual needs. Physicians often prescribe compounded medications when:
* Medications are discontinued by or generally unavailable from pharmaceutical companies.
* The patient is allergic to certain preservatives, dyes or binders in available off-the shelf medications.
* Treatment requires tailored dosage strengths for patients with unique needs.
* A pharmacist can combine several medications the patient is taking to increase compliance.
* The patient cannot ingest the medication in its commercially available form.
* Medications require flavor additives to make them more palatable for some patients, most often children.
BUT after thinking about their role a couple of weeks ago, I started engaging the pharmacist. I had a phlegmy cough in Nantucket over the 4th of July weekend and wondered what I should take - musanex (sp), robitussin, etc... She was very helpful and outlined the pros and cons of each. Helpful, but not exactly prescription help.
So in the last two days I was surprised to find two articles about compounding pharmacists - a job I never knew existed. I have always just gotten my pills as they come from the pharma company. I guess other people are pickier than I am. At least both articles state that it helps with Medication Non-Adherence.
Here are the two articles:
The first from the website Hometownlife by Nathan Mueller:
Kenny Walkup has hands that can turn a solid into a liquid; change the taste of medicine to anything from bubble gum to beef; and change certain aspects of a prescription to remove parts that people or animals are allergic too.
OK, Walkup does not do it all with his hands — some high-tech equipment and technicians also play a role — but they are a key reason Specialty Medicine Compounding Pharmacy has been successful.
"I always liked working with my hands. I should have been a mechanic but I can't fix a car," he joked. "Plus it gives me a chance to be creative." But he can fix medicine.
Walkup's job as a compounding pharmacist is solely based on the individual he is working for. He works with the patient and physician to create a medication that will work for the customer.
The most common situation he comes across is "patient non-compliance." Many people or animals are allergic to certain parts of a prescription or sensitive to strengths, and a compounding pharmacist can — with physician consent — change the strength, change the form from solid to liquid, etc. and change the flavor. Flavors range from chocolate to pineapple to bubble gum for humans and from apple to catnip to chicken for pets.
"All prescriptions are made from scratch, specific to each patient," he said. Walkup owned both the compound pharmacy and the South Lyon Pharmacy before splitting them in February 2003. He has been in South Lyon since 1998.
A graduate of the School of Pharmacy at Ohio Northern University in Ada, Ohio, Walkup joined the Professional Compounding Centers of America and began training there before opening the pharmacy in South Lyon. His pharmacy is a clinical site for Ohio Northern and the University of Michigan, and he gives lectures and does work for both universities.
"I enjoy (talking to students) but I like being in the lab too," he said. "Most of the new stuff I make myself the first time."
The pharmacy has been so successful that it was recently featured on the Heath Watch on the Channel 4 News. Reporter Rhonda Walker said the pharmacy was the "ultimate when it comes to personalized medicine."
It also touched on a story about a patient, Noel Gelfund, who was undergoing treatments to remove a birthmark and the pain killing cream he needed was discontinued. Walkup got to work and formed a new cream that worked better and cost half as much.
Gelfund was killed in a car accident in 2004 and the cream was named "Noel's Numbing Cream" in his honor.
Walkup donates 20 percent of the proceeds of the sale of the product to the Sturge-Weber Foundation which researches Port Wine Stain conditions.
"I have the best job in the world," Walkup said. "I get to help people and do something I truly enjoy."
Here's the second article from the Salt Lake Tribune by Fitzgerald Petersen
Tad Jolley may have the pharmacy business coursing through his veins, but innovation runs in them, too. Jolley was recently awarded "Innovative Pharmacy Practice" by the Utah Pharmacy Association at their yearly convention. Jolley won for his creation of an in-house program to train pharmacy technicians, who are a critical component to Jolley's pharmacy business.
Prior to the creation of the program, aspiring pharmacy technicians would need nine months of schooling before becoming certified. Jolley's program allows technicians in training to receive a paid education while gaining valuable work experience. Jolley benefits by gaining technicians who know their way around his unique store.
Jolley's pharmacies specialize in compounding, which Jolley calls "a lost art." Compounding is highly specialized and involves mixing ingredients specifically for each patient. Of the hundreds of pharmacies competing to fill prescriptions in the Salt Lake Valley, only a handful offer this special service. Most simply rely on pre-made formulations from big drug companies.
Tad Jolley is the third generation of compounding pharmacists to sit behind the counter of the family business. Joel Jolley opened the first Jolley's Pharmacy in 1954. Fifty-three years and four stores later, the family business is still going strong.
Jolley's Pharmacy employs 30 pharmacy technicians in all, so the in-house program makes a significant impact - and not just for Jolley's. The program has caught on with other pharmacies as well. Jolly has received numerous calls from colleagues asking for his advice on implementing their own in-house training. Jolley acknowledges that his program "does something outside the norm" but, he says, "It's helped a lot of other pharmacists as well."
Though Jolley has been working as a pharmacist since 1980, he still loves picking up his mortar and pestle to serve the community. While his award from the association hangs modestly on a wall in his store, he hopes the positive impact of his training program will be felt for years.
Compounding the cure
Pharmacy compounding is the long-established tradition in which medicines that are specially prepared by pharmacists to meet patients' individual needs. Physicians often prescribe compounded medications when:
* Medications are discontinued by or generally unavailable from pharmaceutical companies.
* The patient is allergic to certain preservatives, dyes or binders in available off-the shelf medications.
* Treatment requires tailored dosage strengths for patients with unique needs.
* A pharmacist can combine several medications the patient is taking to increase compliance.
* The patient cannot ingest the medication in its commercially available form.
* Medications require flavor additives to make them more palatable for some patients, most often children.
Tuesday, July 31, 2007
Atlanta Lawyer with DR-TB in Recovery
I found this in the Gainesville Times over the weekend written by Debbie GIlbert. It doesn't really focus on adherence, but it goes with my TB strand from before. The best adherence is the supervised therapy, but it only is the case with these types of diseases in the US.
Andrew Speaker, the Atlanta attorney who set off an international panic when he flew on commercial airplanes after being diagnosed with drug-resistant tuberculosis, now is living in Hall County, at least temporarily. But health officials say there's no reason for local folks to worry.
"Patients with TB, once they're past the contagious stage, are not a threat to anyone's health," said Dave Palmer, spokesman for District 2 Public Health in Gainesville. "But if they quit taking the medication, it's possible for them to become contagious again."
Speaker spent two months at a Denver hospital, where he underwent surgery July 17 to remove an infected lobe of his lung. He was released from the hospital Thursday, with orders to take antibiotics for two years to eliminate the infection.
Because TB is so difficult to cure, public health rules require patients to undergo directly observed therapy. They must report to their local health department every day, where a staff member watches them take their medication.
Speaker took his first dose at the Hall County Health Department Friday morning. Palmer said Georgia law allows patients to be on a five-day dosing schedule so they don't have to take the medicine on weekends when the department is closed.
April Majors, spokeswoman for the Fulton County Department of Health and Wellness, has said Speaker eventually intends to return to Fulton County, where he would then report to the department there for treatment.
Speaker apparently is spending time in Hall while he continues to recuperate from his surgery. Palmer said he does not know how long Speaker plans to stay. Even if Palmer did know, he said federal privacy laws would prohibit him from disclosing any information.
Palmer added that he did not know whether the health department is taking any special precautions to prevent Speaker from being recognized, since images of the attorney have been widely circulated in the media.
Though Speaker may be one of the most famous patients the Hall County Health Department has ever had, Palmer said his treatment regimen is not unusual.
"We've had other TB patients in District 2 who needed supervised therapy," Palmer said.
In the 13 Northeast Georgia counties comprising District 2, there are currently six patients with active TB, he said.
Palmer said patient compliance is typically not a problem.
"Most people work with us because they want to get well," he said. "If they move to another county, they're pretty up-front about notifying us."
Because of the importance of nonstop treatment in TB cases, Palmer said health officials are vigilant about monitoring the patient's whereabouts.
"If the patient stops coming in for treatment, the staff tries to locate that person and will even go to their home if necessary," he said. "We try to make sure people are where they're supposed to be when they're supposed to be."
Andrew Speaker, the Atlanta attorney who set off an international panic when he flew on commercial airplanes after being diagnosed with drug-resistant tuberculosis, now is living in Hall County, at least temporarily. But health officials say there's no reason for local folks to worry.
"Patients with TB, once they're past the contagious stage, are not a threat to anyone's health," said Dave Palmer, spokesman for District 2 Public Health in Gainesville. "But if they quit taking the medication, it's possible for them to become contagious again."
Speaker spent two months at a Denver hospital, where he underwent surgery July 17 to remove an infected lobe of his lung. He was released from the hospital Thursday, with orders to take antibiotics for two years to eliminate the infection.
Because TB is so difficult to cure, public health rules require patients to undergo directly observed therapy. They must report to their local health department every day, where a staff member watches them take their medication.
Speaker took his first dose at the Hall County Health Department Friday morning. Palmer said Georgia law allows patients to be on a five-day dosing schedule so they don't have to take the medicine on weekends when the department is closed.
April Majors, spokeswoman for the Fulton County Department of Health and Wellness, has said Speaker eventually intends to return to Fulton County, where he would then report to the department there for treatment.
Speaker apparently is spending time in Hall while he continues to recuperate from his surgery. Palmer said he does not know how long Speaker plans to stay. Even if Palmer did know, he said federal privacy laws would prohibit him from disclosing any information.
Palmer added that he did not know whether the health department is taking any special precautions to prevent Speaker from being recognized, since images of the attorney have been widely circulated in the media.
Though Speaker may be one of the most famous patients the Hall County Health Department has ever had, Palmer said his treatment regimen is not unusual.
"We've had other TB patients in District 2 who needed supervised therapy," Palmer said.
In the 13 Northeast Georgia counties comprising District 2, there are currently six patients with active TB, he said.
Palmer said patient compliance is typically not a problem.
"Most people work with us because they want to get well," he said. "If they move to another county, they're pretty up-front about notifying us."
Because of the importance of nonstop treatment in TB cases, Palmer said health officials are vigilant about monitoring the patient's whereabouts.
"If the patient stops coming in for treatment, the staff tries to locate that person and will even go to their home if necessary," he said. "We try to make sure people are where they're supposed to be when they're supposed to be."
Wednesday, July 25, 2007
Spiriva Inhaler to help Compliance
I have been hinting about the new pharmaceutical devices that help aid medical compliance, so it is now time to write. It is the best interest of the pharma brands to come up with devices to make their patients more compliance with their medication regime.
First it makes them money (here’s the math: average drug therapy cost: $200; average length of therapy: 3 months - $600 plus another $200 per person per additional month). Second it makes the patient better (sometimes I like to think the pharma companies want to heal people). When the patients are better, their doctor’s look like they know what they are doing and prescribe the medication to more people – thus making the pharma brand more money to put back into their pockets, I mean R & D. It is a great cycle that compliance fuels.
BI and Pfizer just got European approval for Spiriva Respimat Inhaler for people who suffer from COPD. Here are the highlights from their press release:
"SPIRIVA Respimat represents a major step forward in COPD and inhalation therapy. Many patients find certain inhaler devices difficult to coordinate and use," said Professor Marc Decramer, Respiratory Division, University Hospitals, Katholieke Universiteit Leuven, Belgium. "SPIRIVA Respimat has a unique and sophisticated delivery system, and a user friendly design, making it easy to use and suitable for a broad range of patients with COPD. In addition the long-lasting, soft mist cloud generated by SPIRIVA Respimat ensures optimized delivery of SPIRIVA to the lungs, helping patients breathe more easily," he added.
In clinical studies comparing inhaler devices, patients preferred Respimat Soft Mist Inhaler, which may help increase patient compliance with therapy. The novel dose-delivery system of the SPIRIVA Respimat also means that unlike dry powder inhalers, the dose delivered is not dependent on patients' inspiratory flow.
SPIRIVA(R) (tiotropium), a first-line maintenance therapy for COPD, positively impacts the clinical course of the disease, helping to change the way patients live with their condition. The efficacy of SPIRIVA has been demonstrated by an extensive clinical development programme, which has treated over 25,000 patients. It is the most prescribed brand in COPD in the world.
The SPIRIVA Respimat delivery system relies on energy released from a spring, rather than propellants, to produce a long-lasting, slow moving Soft Mist. The innovative design makes SPIRIVA Respimat easy to use, and the Soft Mist results in improved delivery of SPIRIVA to the lungs, with reduced deposition in the mouth and throat compared to a pressurized metered dose inhaler (pMDI). One study showed that 72% of all patients use pMDIs incorrectly and almost half (47%) have problems with coordinating use of the device.
600 million people worldwide live with COPD and its prevalence is predicted to rise making it the world's third leading cause of death by 2020. It is estimated that up to 50% of Americans and 75% of Europeans with COPD are undiagnosed.””
I don’t know if I believe that 600 million people suffer from COPD, but this is from a pharma company so their measurement for COPD is probably a cough. Even though I think the percentages of undiagnosed COPD are high, I am not surprised that is a commonly undiagnosed condition.
I never had an inhaler, but I remember kids in school with them. It was either very nerdy, kinda neat or something for the bullies to steal. Whatever the case, it was always difficult to get a good pull. With the new spring loaded mist, I can hear all the COPD affected breathe a sigh of relief!
First it makes them money (here’s the math: average drug therapy cost: $200; average length of therapy: 3 months - $600 plus another $200 per person per additional month). Second it makes the patient better (sometimes I like to think the pharma companies want to heal people). When the patients are better, their doctor’s look like they know what they are doing and prescribe the medication to more people – thus making the pharma brand more money to put back into their pockets, I mean R & D. It is a great cycle that compliance fuels.
BI and Pfizer just got European approval for Spiriva Respimat Inhaler for people who suffer from COPD. Here are the highlights from their press release:
"SPIRIVA Respimat represents a major step forward in COPD and inhalation therapy. Many patients find certain inhaler devices difficult to coordinate and use," said Professor Marc Decramer, Respiratory Division, University Hospitals, Katholieke Universiteit Leuven, Belgium. "SPIRIVA Respimat has a unique and sophisticated delivery system, and a user friendly design, making it easy to use and suitable for a broad range of patients with COPD. In addition the long-lasting, soft mist cloud generated by SPIRIVA Respimat ensures optimized delivery of SPIRIVA to the lungs, helping patients breathe more easily," he added.
In clinical studies comparing inhaler devices, patients preferred Respimat Soft Mist Inhaler, which may help increase patient compliance with therapy. The novel dose-delivery system of the SPIRIVA Respimat also means that unlike dry powder inhalers, the dose delivered is not dependent on patients' inspiratory flow.
SPIRIVA(R) (tiotropium), a first-line maintenance therapy for COPD, positively impacts the clinical course of the disease, helping to change the way patients live with their condition. The efficacy of SPIRIVA has been demonstrated by an extensive clinical development programme, which has treated over 25,000 patients. It is the most prescribed brand in COPD in the world.
The SPIRIVA Respimat delivery system relies on energy released from a spring, rather than propellants, to produce a long-lasting, slow moving Soft Mist. The innovative design makes SPIRIVA Respimat easy to use, and the Soft Mist results in improved delivery of SPIRIVA to the lungs, with reduced deposition in the mouth and throat compared to a pressurized metered dose inhaler (pMDI). One study showed that 72% of all patients use pMDIs incorrectly and almost half (47%) have problems with coordinating use of the device.
600 million people worldwide live with COPD and its prevalence is predicted to rise making it the world's third leading cause of death by 2020. It is estimated that up to 50% of Americans and 75% of Europeans with COPD are undiagnosed.””
I don’t know if I believe that 600 million people suffer from COPD, but this is from a pharma company so their measurement for COPD is probably a cough. Even though I think the percentages of undiagnosed COPD are high, I am not surprised that is a commonly undiagnosed condition.
I never had an inhaler, but I remember kids in school with them. It was either very nerdy, kinda neat or something for the bullies to steal. Whatever the case, it was always difficult to get a good pull. With the new spring loaded mist, I can hear all the COPD affected breathe a sigh of relief!
Monday, July 23, 2007
The Flip Side of Medication Noncompliance
I usually focus on the negative effects that cause harm to people's health by not taking medications when talking about medication noncompliance, but there is the other side which accounts for abuse. If you think about all those people who are/were addicted to OxyCotin - the scripts had to come from somewhere.
I remember in college a friend always had a prescription of Valium and Percodan (or of that family). Not that she really needed them, but her doctor gave it to her "just in case". I believe there was some recreation use, not only by her but others. I also remember reading a piece a few years ago about kids trading medications. I'll have to find it.
Here is a piece addressing prescription abuse and medication noncompliance from MyWestTexas by Colin Guy:
A study recently completed by Midland-based Ameritox found that out of 240,000 long-term chronic pain patients, 77 percent were not in strict compliance with their physician's instructions.
Ameritox, a company that performs urine analysis for physicians' patients, found 11 percent of all samples contained illicit substances such as cocaine and marijuana and 30 percent of the samples contained prescription drugs that were not prescribed by the patients' doctors.
The study also found 13 percent of the urine samples contained a dosage of medication below the expected range and 30 percent did not contain any of the prescribed medication.
Tobyn Dyer, lab operations manager for Ameritox, told the Reporter-Telegram that in some instances this could indicate patients acquire prescriptions and sell the narcotics on the black market rather than take them as prescribed.
"Diversion is a big issue with the street value of drugs," he said.
According to Ameritox Chief Executive Officer Ancelmo Lopes, the misuse and abuse of prescription pain medication is costing taxpayers an estimated $8.5 billion per year including Medicare and Medicaid expenditures and the cost of treating patients at emergency rooms.
Dennis Wilson, a licensed chemical dependency counselor and program coordinator for Turning Point, told the Reporter-Telegram that many of the people in rehabilitation are abusers of prescription medications. He indicates even the legitimate use of narcotics may lead people with addiciton or a predisposition to addiction to fall into a pattern of substance abuse.
"If a doctor prescribes a 30-day supply it usually lasts 10 days, then five days, then two days," he said. Doctors typically have no way of knowing that their patients are misusing prescription medications unless the patient divulges their addictive tendencies, Wilson said, and are often unaware that prescribing a powerful narcotic could interfere with their rehabilitation efforts.
He said clients are encouraged to recognize the potential for abuse if they use narcotics to treat ailments and to look into alternatives such as non-narcotic painkillers and over-the-counter medications.
According to a press release issued by Ameritox, a Cornell University study found that doctors were unable to detect a patient misusing medications as much as 90 percent of the time and were also likely to mistakenly identify patients who are in compliance as medication abusers.
Ameritox's RxGuardian program, which provides feedback to doctors on what their patients are taking, is intended to help address this problem, Lopes said.
"Even within our own data these are pretty startling numbers," he said. "What Ameritox is trying to do is help physicians monitor their patients who have chronic pain. If they are not taking the medications appropriately doctors can try to get them back to their prescribed regimen."
I remember in college a friend always had a prescription of Valium and Percodan (or of that family). Not that she really needed them, but her doctor gave it to her "just in case". I believe there was some recreation use, not only by her but others. I also remember reading a piece a few years ago about kids trading medications. I'll have to find it.
Here is a piece addressing prescription abuse and medication noncompliance from MyWestTexas by Colin Guy:
A study recently completed by Midland-based Ameritox found that out of 240,000 long-term chronic pain patients, 77 percent were not in strict compliance with their physician's instructions.
Ameritox, a company that performs urine analysis for physicians' patients, found 11 percent of all samples contained illicit substances such as cocaine and marijuana and 30 percent of the samples contained prescription drugs that were not prescribed by the patients' doctors.
The study also found 13 percent of the urine samples contained a dosage of medication below the expected range and 30 percent did not contain any of the prescribed medication.
Tobyn Dyer, lab operations manager for Ameritox, told the Reporter-Telegram that in some instances this could indicate patients acquire prescriptions and sell the narcotics on the black market rather than take them as prescribed.
"Diversion is a big issue with the street value of drugs," he said.
According to Ameritox Chief Executive Officer Ancelmo Lopes, the misuse and abuse of prescription pain medication is costing taxpayers an estimated $8.5 billion per year including Medicare and Medicaid expenditures and the cost of treating patients at emergency rooms.
Dennis Wilson, a licensed chemical dependency counselor and program coordinator for Turning Point, told the Reporter-Telegram that many of the people in rehabilitation are abusers of prescription medications. He indicates even the legitimate use of narcotics may lead people with addiciton or a predisposition to addiction to fall into a pattern of substance abuse.
"If a doctor prescribes a 30-day supply it usually lasts 10 days, then five days, then two days," he said. Doctors typically have no way of knowing that their patients are misusing prescription medications unless the patient divulges their addictive tendencies, Wilson said, and are often unaware that prescribing a powerful narcotic could interfere with their rehabilitation efforts.
He said clients are encouraged to recognize the potential for abuse if they use narcotics to treat ailments and to look into alternatives such as non-narcotic painkillers and over-the-counter medications.
According to a press release issued by Ameritox, a Cornell University study found that doctors were unable to detect a patient misusing medications as much as 90 percent of the time and were also likely to mistakenly identify patients who are in compliance as medication abusers.
Ameritox's RxGuardian program, which provides feedback to doctors on what their patients are taking, is intended to help address this problem, Lopes said.
"Even within our own data these are pretty startling numbers," he said. "What Ameritox is trying to do is help physicians monitor their patients who have chronic pain. If they are not taking the medications appropriately doctors can try to get them back to their prescribed regimen."
Thursday, July 19, 2007
ADHD and Compliance
Just a quickie. Dr. Brian Doyle from ADHD Spotlight has a good post on compliance at his blog: http://www.drbriandoyle.com/?p=238.
Wednesday, July 18, 2007
Jamaica Has a Problem with Compliance
I hate to keep posting articles I find, but it is a way to bring to light information that others might have missed. Sometimes there is only so much I can say - other than see, see, it is a problem everywhere! Why don'ts you take your meds!!!!!
I am currently mulling over some information regarding medication patches and gels which will greatly improve adherence. My thoughts coming soon!
When you think of Jamaica, you do not think of medication noncompliance, but this article from the Jamaica Gleaner Newspaper, tells a different story.
Pharmacy Today: Take your pills, NOW! by Ellen Campbell-Grizzle
Medicines work best when they are taken as prescribed. People are buying medication and not taking them or taking them incorrectly. This is emerging as a major public health concern. Persons are not taking life-enhancing medication appropriately and continue to adopt risky behaviours.
We accept that swallowing medication is not a natural act and that some drugs are unpleasant and bitter, and we know that always remembering to take medication on time is most challenging. However, medication wastage is having a devastating effect on the lives of individuals and the public purse.
Privacy is paramount
Jamaica's pharmacists are now being challenged to make a greater effort to be part of the solution to this problem. In order to do this, pharmacists need to spend more time in conversation with each patient and ask some pointed questions.
However, in recent times, our patients are feeling that such queries are intrusive and have not welcomed them. There are good reasons for this. Many patients do not have the opportunity to develop comfort levels with pharmacists who tend to work in various locations. There is always discomfort in sharing private information with strangers.
Patients often resist probing questions from their pharmacists and do not supply the necessary information. Privacy at the point of information and handing over of medication is a major barrier. This situation has to change. The cost of medication noncompliance to the individuals, governments and insurers is spiralling. Pharmacists must develop better therapeutic relationships with patients who will be more comfortable and confident in answering questions related to their health and medication status.
Better medication use
New systems are now being developed to solve this problem at the pharmacy level. Jamaican consumers must be prepared to be more forthcoming to their pharmacists' questions. This will assist in the design of a better medication use plan for you. Here is how you can help to ease this problem. Be prepared to:
Show what medicines you are taking.
Tell how you are currently taking your medication.
Explain (to the extent that you know) what each medicine is intended for.
Talk about side effects that worry you.
Give some information as to whether you feel your medicines are working.
Talk about problems that you have with taking your medication such as difficulty in swallowing tablets, remembering to take your medication, difficulty in opening containers.
Share your difficulty in affording medication, if this exists.
Talk about spare/excess medication that you may have.
Talk about the medication that you purchase from other pharmacies, supermarkets and gas stations and your use of herbal and other types of remedies.
Give information about your favourite fruit juices such as cranberry or grapefruit juice.
Have your questions fully explored and answered.
A different paradigm
In this new type of partnership, pharmacists will have to designate consultation areas in the establishment, ensure that patients and pharmacists can speak in normal volumes without being overheard, keep records of advice given and ensure that patient data is confidential. In recent times, you may have experienced some of these changes but more needs to be done.
Patients and pharmacists working together can help to reduce medication noncompliance.
I am currently mulling over some information regarding medication patches and gels which will greatly improve adherence. My thoughts coming soon!
When you think of Jamaica, you do not think of medication noncompliance, but this article from the Jamaica Gleaner Newspaper, tells a different story.
Pharmacy Today: Take your pills, NOW! by Ellen Campbell-Grizzle
Medicines work best when they are taken as prescribed. People are buying medication and not taking them or taking them incorrectly. This is emerging as a major public health concern. Persons are not taking life-enhancing medication appropriately and continue to adopt risky behaviours.
We accept that swallowing medication is not a natural act and that some drugs are unpleasant and bitter, and we know that always remembering to take medication on time is most challenging. However, medication wastage is having a devastating effect on the lives of individuals and the public purse.
Privacy is paramount
Jamaica's pharmacists are now being challenged to make a greater effort to be part of the solution to this problem. In order to do this, pharmacists need to spend more time in conversation with each patient and ask some pointed questions.
However, in recent times, our patients are feeling that such queries are intrusive and have not welcomed them. There are good reasons for this. Many patients do not have the opportunity to develop comfort levels with pharmacists who tend to work in various locations. There is always discomfort in sharing private information with strangers.
Patients often resist probing questions from their pharmacists and do not supply the necessary information. Privacy at the point of information and handing over of medication is a major barrier. This situation has to change. The cost of medication noncompliance to the individuals, governments and insurers is spiralling. Pharmacists must develop better therapeutic relationships with patients who will be more comfortable and confident in answering questions related to their health and medication status.
Better medication use
New systems are now being developed to solve this problem at the pharmacy level. Jamaican consumers must be prepared to be more forthcoming to their pharmacists' questions. This will assist in the design of a better medication use plan for you. Here is how you can help to ease this problem. Be prepared to:
Show what medicines you are taking.
Tell how you are currently taking your medication.
Explain (to the extent that you know) what each medicine is intended for.
Talk about side effects that worry you.
Give some information as to whether you feel your medicines are working.
Talk about problems that you have with taking your medication such as difficulty in swallowing tablets, remembering to take your medication, difficulty in opening containers.
Share your difficulty in affording medication, if this exists.
Talk about spare/excess medication that you may have.
Talk about the medication that you purchase from other pharmacies, supermarkets and gas stations and your use of herbal and other types of remedies.
Give information about your favourite fruit juices such as cranberry or grapefruit juice.
Have your questions fully explored and answered.
A different paradigm
In this new type of partnership, pharmacists will have to designate consultation areas in the establishment, ensure that patients and pharmacists can speak in normal volumes without being overheard, keep records of advice given and ensure that patient data is confidential. In recent times, you may have experienced some of these changes but more needs to be done.
Patients and pharmacists working together can help to reduce medication noncompliance.
Tuesday, July 17, 2007
Dermatology Problems with Compliance
Who would have though? It is a problem you see everyday and would want to cure, yet noncompliance still happens!
Patients Not Complying With Treatment A Universal Problem
Science Daily — Patients not complying with their dermatologic treatment is a universal problem that doctors need to address, according to Steven Feldman, M.D., Ph.D., from Wake Forest University School of Medicine in an editorial published in the current issue of Archives of Dermatology. He said non-compliance can explain why some conditions may seem resistant to treatment.
"Physicians must develop practical measures to improve patients' compliance behavior: establishing strong, trusting physician-patient relations, choosing medications that can fit patients' lifestyles, using patient education materials designed to motivate without overly stressing risks, and scheduling a follow-up visit shortly after initiating a new treatment," writes Feldman, a professor of dermatology.
Feldman says that dermatology research studies that involve electronically recording patients' usage of a treatment, without them being aware of it, show that non-compliance is more pervasive that previously estimated.
"Understanding that non-adherence to treatment is widespread is essential for addressing many of the difficult-to-manage skin disease dilemmas seen in dermatology," Feldman said. "By addressing adherence, we can achieve better success for patients with psoriasis and other chronic skin diseases."
Feldman says he has had personal experience with patient noncompliance. He had acne and wanted to see how well current anti-acne medications work. He planned to take a photo of the rash, put the medicine on once a day and then take a photograph one week later.
"I wanted to make sure I didn't forget to apply the medication, so I put it on top of my toothbrush," he said. "The first night I used the medication. The second night I managed to brush my teeth and still forget to put the medication on. The third and fourth nights I went out of town and forgot to bring the medication with me. And I tend to be on the obsessive compulsive side!"
Patient forgetfulness is just one part of the problem, he said. Sometimes, patients consider treatment the worst part of the disease. For example, scalp psoriasis may seem resistant to treatment, he said. Actually, psoriasis treatments probably work better on the scalp than on other areas of the skin, if patients would just apply the medication.
Rather than having patients continually try new treatments for scalp psoriasis, he suggests having patients try the treatment for three to four days.
"It is much easier to be compliant for three or four days than for eight weeks," Feldman said. "After that, patients will know they have a treatment that works and will use it as needed to keep their scalp psoriasis under control."
He said that when prescribing medications, physicians need to consider which form is most likely to be used. Many patients prefer pills over creams and ointments, he said. Another option is physician-administered treatments, such as injections, that will assure adherence.
Feldman says doctors shouldn't be surprised by poor adherence to using creams and ointments in the home environment, especially involving pediatric patients. "Those of us who are parents will recognize how difficult it is to apply sunscreen or other topical agents to our own children," he said.
In addition to considering the form of therapy that patients are most likely to use, Feldman said the patient-physician relationship is an important part of the equation. He said research shows that if patients are satisfied with their physician visit three days afterwards, they are more likely to report an improvement in their condition a month later.
"Patients who are more satisfied with their visit are more trusting of their doctor, worry less about adverse effects and use their medication more regularly," he said. Feldman's co-authors are Saba M. Ali, B.S., Robert T. Brodell, M.D., and Rajesh Balkrishnan, Ph.D., all with Wake Forest.
Note: This story has been adapted from a news release issued by Wake Forest University Baptist Medical Center.
Patients Not Complying With Treatment A Universal Problem
Science Daily — Patients not complying with their dermatologic treatment is a universal problem that doctors need to address, according to Steven Feldman, M.D., Ph.D., from Wake Forest University School of Medicine in an editorial published in the current issue of Archives of Dermatology. He said non-compliance can explain why some conditions may seem resistant to treatment.
"Physicians must develop practical measures to improve patients' compliance behavior: establishing strong, trusting physician-patient relations, choosing medications that can fit patients' lifestyles, using patient education materials designed to motivate without overly stressing risks, and scheduling a follow-up visit shortly after initiating a new treatment," writes Feldman, a professor of dermatology.
Feldman says that dermatology research studies that involve electronically recording patients' usage of a treatment, without them being aware of it, show that non-compliance is more pervasive that previously estimated.
"Understanding that non-adherence to treatment is widespread is essential for addressing many of the difficult-to-manage skin disease dilemmas seen in dermatology," Feldman said. "By addressing adherence, we can achieve better success for patients with psoriasis and other chronic skin diseases."
Feldman says he has had personal experience with patient noncompliance. He had acne and wanted to see how well current anti-acne medications work. He planned to take a photo of the rash, put the medicine on once a day and then take a photograph one week later.
"I wanted to make sure I didn't forget to apply the medication, so I put it on top of my toothbrush," he said. "The first night I used the medication. The second night I managed to brush my teeth and still forget to put the medication on. The third and fourth nights I went out of town and forgot to bring the medication with me. And I tend to be on the obsessive compulsive side!"
Patient forgetfulness is just one part of the problem, he said. Sometimes, patients consider treatment the worst part of the disease. For example, scalp psoriasis may seem resistant to treatment, he said. Actually, psoriasis treatments probably work better on the scalp than on other areas of the skin, if patients would just apply the medication.
Rather than having patients continually try new treatments for scalp psoriasis, he suggests having patients try the treatment for three to four days.
"It is much easier to be compliant for three or four days than for eight weeks," Feldman said. "After that, patients will know they have a treatment that works and will use it as needed to keep their scalp psoriasis under control."
He said that when prescribing medications, physicians need to consider which form is most likely to be used. Many patients prefer pills over creams and ointments, he said. Another option is physician-administered treatments, such as injections, that will assure adherence.
Feldman says doctors shouldn't be surprised by poor adherence to using creams and ointments in the home environment, especially involving pediatric patients. "Those of us who are parents will recognize how difficult it is to apply sunscreen or other topical agents to our own children," he said.
In addition to considering the form of therapy that patients are most likely to use, Feldman said the patient-physician relationship is an important part of the equation. He said research shows that if patients are satisfied with their physician visit three days afterwards, they are more likely to report an improvement in their condition a month later.
"Patients who are more satisfied with their visit are more trusting of their doctor, worry less about adverse effects and use their medication more regularly," he said. Feldman's co-authors are Saba M. Ali, B.S., Robert T. Brodell, M.D., and Rajesh Balkrishnan, Ph.D., all with Wake Forest.
Note: This story has been adapted from a news release issued by Wake Forest University Baptist Medical Center.
Monday, July 16, 2007
XDR-TB in South Africa due to Noncompliance
Here is more news about the deadly new strain of TB - now in South Africa as well. This feels like something out of a doomsday movie. The increased strength of viral strains due to medication noncompliance.
From The Chronicle Newspaper (Lilongwe) by Moses Kaufa.
In Malawi, Tuberculosis (TB) is closely linked to the HIV epidemic. Of the 28,000 cases of TB reported in the year 2005, approximately 70% of the patients tested HIV positive.
Although TB can be cured, the recent surfacing of an Extensively Drug Resistant-TB (XDR-TB) in South Africa is cause for concern.
With the current official rate of 14% HIV infection in Malawi and the link between HIV and TB, the need to put TB firmly on the political agenda of the country has become more necessary and urgent.
The government, through the Ministry of Health and the National TB Control Programme has committed to making sure that there a plan in place to respond effectively should any cases of XDR-TB surface in Malawi.
Advocacy, Communication and Social Mobilization (ACSM) an initiated component of the Malawi National TB Control Programme, seeks to create awareness, facilitate community involvement and participation and promote activities that will inform the public on the importance of adhering to treatment and medical advice for Tuberculosis in an effort to avoid the possible development of the fatal, Extremely Drug Resistant TB (XDR-TB).
Henry Chimbali, the Communications Officer of the National TB Control Program, ACSM has embarked on an advocacy campaign involving activities designed to place TB high on the political and development agenda.
The campaign also aims to increase financial and other resources on a sustainable basis as well as hold authorities to account. Additionally, the campaign seeks to ensure that pledges are fulfilled at the local level.
A major and very important part of the campaign is to prevent the possible development of the deadly XDR-TB in Malawi.
Reports indicate that XDR-TB probably developed because cases of normal TB are not treated properly. TB that is not effectively treated will resurface with resistance to the drugs used in the treatment and become Multi Drug Resistant - TB (MDR-TB). Concerns are high that XDR-TB could develop if patients are not aware of the importance of following the strict medical regime necessary to treat MDR- TB.
Records indicate that no one knows yet exactly how many cases of XDR-TB exist but surveillance shows that countries most affected by TB are those that are poor.
Chimbali told Health Check that XDR-TB mostly develops in patients who at one time used the drugs for other ailments or if they had defaulted in the treatment of TB.
However, the infection of XDR-TB is transmitted in the same way as the standard TB.
He says the intervention embarked on by ACSM seeks to prevent any possible occurrence of XDR-TB in this country and the further spread of infections should it occur.
"The program will be looking at adherence and compliance of treatment. This will be achieved by ensuring that all TB patients are under closely supervised treatment and all health workers have adequate knowledge on TB treatment guidelines. There will be a need to engage more health care providers in TB treatment monitoring, strengthening treatment monitoring systems at all levels and intensifying proper diagnosis of all TB suspect cases," Chimbali said.
He said the program is also focusing on prevention and control of the transmission of XDR-TB to health workers and the public.
"This will be achieved through early diagnosis of all TB treatment failures, relapses and tracing of all treatment defaulters and the establishment of special treatment centers for XDR-TB," said the Communications Officer.
XDR-TB is said to be very difficult to treat as it involves a regime that lasts for a long period of time. Drugs to treat the infection are extremely expensive making access to treatment of XDR-TB impossible for many under-privileged people
From The Chronicle Newspaper (Lilongwe) by Moses Kaufa.
In Malawi, Tuberculosis (TB) is closely linked to the HIV epidemic. Of the 28,000 cases of TB reported in the year 2005, approximately 70% of the patients tested HIV positive.
Although TB can be cured, the recent surfacing of an Extensively Drug Resistant-TB (XDR-TB) in South Africa is cause for concern.
With the current official rate of 14% HIV infection in Malawi and the link between HIV and TB, the need to put TB firmly on the political agenda of the country has become more necessary and urgent.
The government, through the Ministry of Health and the National TB Control Programme has committed to making sure that there a plan in place to respond effectively should any cases of XDR-TB surface in Malawi.
Advocacy, Communication and Social Mobilization (ACSM) an initiated component of the Malawi National TB Control Programme, seeks to create awareness, facilitate community involvement and participation and promote activities that will inform the public on the importance of adhering to treatment and medical advice for Tuberculosis in an effort to avoid the possible development of the fatal, Extremely Drug Resistant TB (XDR-TB).
Henry Chimbali, the Communications Officer of the National TB Control Program, ACSM has embarked on an advocacy campaign involving activities designed to place TB high on the political and development agenda.
The campaign also aims to increase financial and other resources on a sustainable basis as well as hold authorities to account. Additionally, the campaign seeks to ensure that pledges are fulfilled at the local level.
A major and very important part of the campaign is to prevent the possible development of the deadly XDR-TB in Malawi.
Reports indicate that XDR-TB probably developed because cases of normal TB are not treated properly. TB that is not effectively treated will resurface with resistance to the drugs used in the treatment and become Multi Drug Resistant - TB (MDR-TB). Concerns are high that XDR-TB could develop if patients are not aware of the importance of following the strict medical regime necessary to treat MDR- TB.
Records indicate that no one knows yet exactly how many cases of XDR-TB exist but surveillance shows that countries most affected by TB are those that are poor.
Chimbali told Health Check that XDR-TB mostly develops in patients who at one time used the drugs for other ailments or if they had defaulted in the treatment of TB.
However, the infection of XDR-TB is transmitted in the same way as the standard TB.
He says the intervention embarked on by ACSM seeks to prevent any possible occurrence of XDR-TB in this country and the further spread of infections should it occur.
"The program will be looking at adherence and compliance of treatment. This will be achieved by ensuring that all TB patients are under closely supervised treatment and all health workers have adequate knowledge on TB treatment guidelines. There will be a need to engage more health care providers in TB treatment monitoring, strengthening treatment monitoring systems at all levels and intensifying proper diagnosis of all TB suspect cases," Chimbali said.
He said the program is also focusing on prevention and control of the transmission of XDR-TB to health workers and the public.
"This will be achieved through early diagnosis of all TB treatment failures, relapses and tracing of all treatment defaulters and the establishment of special treatment centers for XDR-TB," said the Communications Officer.
XDR-TB is said to be very difficult to treat as it involves a regime that lasts for a long period of time. Drugs to treat the infection are extremely expensive making access to treatment of XDR-TB impossible for many under-privileged people
MDR-TB in Pakistan Directly Linked to Noncompliance
From the Daily Times of Pakistan by Urooj Zia
KARACHI: Medication for Multi-Drug Resistant Tuberculosis (MDR-TB) is generally smuggled into Pakistan from parts of India, sources in the federal health department and medicine-vendors in Karachi told Daily Times.
MDR-TB is a “higher form” of TB, and is a lot more difficult to cure than regular TB, mostly because the bacteria in this case have become resistant to most drugs used in the first line of treatment for (regular) TB. Medication for regular TB is provided free by the government, under the WHO-sponsored DOTS programme, run by the National TB Control Programme (NTP).
MDR-TB develops mainly due to non-compliance with the first line of treatment, which lasts around six to eight months. A number of patients, however, stop taking medication after the first three months (around the same time that TB symptoms disappear). “The bacteria are still there, though. They just become dormant, which is why the symptoms disappear. People think they’re cured, and stop taking the medication. The treatment during the next few months, however, works towards killing these bacteria, so the disease doesn’t make a comeback,” doctors said.
Once a patient drops out mid-treatment, the disease comes back with a vengeance, in the form of MDR-TB. These bacteria are resistant to the first line of treatment, and a different combination of drugs has to be used to combat them. These drugs are extremely expensive in Pakistan. Treatment generally lasts around two- to two-and-a-half years, and the total cost of medication alone comes up to around Rs 200,000,” Sindh TB Control Programme director, Prof. Iqtedar Ahmed, said.
Moreover, even a patient who has never contracted TB before can contract the drug-resistant form of the disease, if infected directly by a person suffering from MDR-TB. Four major drugs are used to combat MDR-TB – Cycloserene, Oflobid (a wide-spectrum antibacterial), Pas, and Ethomid.
Each of these medicines costs less than Rs 10 in India. After being smuggled into Pakistan, however, the cost increases to between Rs 50 and Rs 75 per capsule. An MDR-TB patient is expected to take at least two of each daily for the duration of the treatment. The total cost of treatment depends on the combination of drugs being used – all four medicines are not used at the same time.
Interestingly three of the four medicines are also produced locally in Pakistan, “but they are produced by multi-national companies (MNCs), so the difference in cost isn’t much,” a shopkeeper at the Medicine Market in Katchhi Gali # 2 (behind M.A. Jinnah Road) told Daily Times. “MNCs have their own costs of production to look at too.” “Locally-produced” versions of Pas, however, cost Rs 375 for a box of 50 tablets (Rs 7 per tablet). Ethomid costs Rs 476.85 for a pack of 30 tablets (Rs 16 per tablet), and Oflobid costs Rs 115 for a pack of 10 tablets (Rs 11.5 per tablet).
A cheaper variant of Ethomid is sold under the trade name “Marbital.” These are available at Rs 175 for 100 tablets (Rs 1.75 per tablet). Both versions are “legal” – the more expensive Ethomid is produced in Lahore, while the cheaper Marbital is produced in Karachi.
Cycloserene is produced in Seoul, Korea, and is marketed by a firm in Karachi. It is available at Rs 59 for a pack of 30 tablets (Rs 2 per tablet).
These are the prices that are generally applicable. “Most of the time, the supply of the locally-produced medicines falls short in the market, and drugs smuggled in from India have to be used,” medicine-vendors said. “That is when prices shoot up. If a patient has to take these medicines for two years, he or she will find the cheaper versions readily available for merely three to four months out of a total of 24. The rest of the time, the patient’s family will have to search hard and long for even the Indian versions of the medicines. This is how the treatment costs for MDR-TB shoot up. The government should subsidise the production of these medicines, so they are readily available, at cheaper rates.”
Another factor pharmacy salespeople and owners brought up was the fact that the availability of these medicines in rural areas is next-to-zero.
The WHO has a programme for treating MDR-TB. This programme is referred to as DOTS+. It is yet to be implemented in Pakistan, however. “Right now, we are concentrating on implementing the DOTS programme completely. We have been advised by the WHO to not touch MDR-TB as a programme yet,” Sindh TB Control Programme director, Prof. Iqtedar Ahmed, told Daily Times. “Keeping our human resources, financial resources, and technical resources in mind, our first priority is the first line of treatment for TB (under the DOTS programme). Our next target is paediatrics (incidence of TB in children under the age of 12).”
The National TB Control Programme has started to work on a protocol for implementing a programme for MDR-TB too, Prof. Ahmed said, adding however, that implementation will take time. “It could take anywhere from two to six months, I can’t be sure at this time,” he said.
The incidence of MDR-TB is equal all over the country, he added. “According to WHO reports, the incidence of the disease in Pakistan is somewhere around two to three percent. It is higher in more populated areas, and lower in relatively more affluent suburbs, where a lesser number of people share the same living space.”
The problem with the government sponsoring MDR-TB treatment is that the prognoses (results) of the treatment are around 50 percent, Prof. Ahmed said. “At the end of the day, looking at financial constraints, it is more feasible to spend that money on the first line of treatment, so that the disease is nipped in the bud.”
He did agree, though, that some level of coverage should be given to MDR-TB by the federal and provincial health departments.
KARACHI: Medication for Multi-Drug Resistant Tuberculosis (MDR-TB) is generally smuggled into Pakistan from parts of India, sources in the federal health department and medicine-vendors in Karachi told Daily Times.
MDR-TB is a “higher form” of TB, and is a lot more difficult to cure than regular TB, mostly because the bacteria in this case have become resistant to most drugs used in the first line of treatment for (regular) TB. Medication for regular TB is provided free by the government, under the WHO-sponsored DOTS programme, run by the National TB Control Programme (NTP).
MDR-TB develops mainly due to non-compliance with the first line of treatment, which lasts around six to eight months. A number of patients, however, stop taking medication after the first three months (around the same time that TB symptoms disappear). “The bacteria are still there, though. They just become dormant, which is why the symptoms disappear. People think they’re cured, and stop taking the medication. The treatment during the next few months, however, works towards killing these bacteria, so the disease doesn’t make a comeback,” doctors said.
Once a patient drops out mid-treatment, the disease comes back with a vengeance, in the form of MDR-TB. These bacteria are resistant to the first line of treatment, and a different combination of drugs has to be used to combat them. These drugs are extremely expensive in Pakistan. Treatment generally lasts around two- to two-and-a-half years, and the total cost of medication alone comes up to around Rs 200,000,” Sindh TB Control Programme director, Prof. Iqtedar Ahmed, said.
Moreover, even a patient who has never contracted TB before can contract the drug-resistant form of the disease, if infected directly by a person suffering from MDR-TB. Four major drugs are used to combat MDR-TB – Cycloserene, Oflobid (a wide-spectrum antibacterial), Pas, and Ethomid.
Each of these medicines costs less than Rs 10 in India. After being smuggled into Pakistan, however, the cost increases to between Rs 50 and Rs 75 per capsule. An MDR-TB patient is expected to take at least two of each daily for the duration of the treatment. The total cost of treatment depends on the combination of drugs being used – all four medicines are not used at the same time.
Interestingly three of the four medicines are also produced locally in Pakistan, “but they are produced by multi-national companies (MNCs), so the difference in cost isn’t much,” a shopkeeper at the Medicine Market in Katchhi Gali # 2 (behind M.A. Jinnah Road) told Daily Times. “MNCs have their own costs of production to look at too.” “Locally-produced” versions of Pas, however, cost Rs 375 for a box of 50 tablets (Rs 7 per tablet). Ethomid costs Rs 476.85 for a pack of 30 tablets (Rs 16 per tablet), and Oflobid costs Rs 115 for a pack of 10 tablets (Rs 11.5 per tablet).
A cheaper variant of Ethomid is sold under the trade name “Marbital.” These are available at Rs 175 for 100 tablets (Rs 1.75 per tablet). Both versions are “legal” – the more expensive Ethomid is produced in Lahore, while the cheaper Marbital is produced in Karachi.
Cycloserene is produced in Seoul, Korea, and is marketed by a firm in Karachi. It is available at Rs 59 for a pack of 30 tablets (Rs 2 per tablet).
These are the prices that are generally applicable. “Most of the time, the supply of the locally-produced medicines falls short in the market, and drugs smuggled in from India have to be used,” medicine-vendors said. “That is when prices shoot up. If a patient has to take these medicines for two years, he or she will find the cheaper versions readily available for merely three to four months out of a total of 24. The rest of the time, the patient’s family will have to search hard and long for even the Indian versions of the medicines. This is how the treatment costs for MDR-TB shoot up. The government should subsidise the production of these medicines, so they are readily available, at cheaper rates.”
Another factor pharmacy salespeople and owners brought up was the fact that the availability of these medicines in rural areas is next-to-zero.
The WHO has a programme for treating MDR-TB. This programme is referred to as DOTS+. It is yet to be implemented in Pakistan, however. “Right now, we are concentrating on implementing the DOTS programme completely. We have been advised by the WHO to not touch MDR-TB as a programme yet,” Sindh TB Control Programme director, Prof. Iqtedar Ahmed, told Daily Times. “Keeping our human resources, financial resources, and technical resources in mind, our first priority is the first line of treatment for TB (under the DOTS programme). Our next target is paediatrics (incidence of TB in children under the age of 12).”
The National TB Control Programme has started to work on a protocol for implementing a programme for MDR-TB too, Prof. Ahmed said, adding however, that implementation will take time. “It could take anywhere from two to six months, I can’t be sure at this time,” he said.
The incidence of MDR-TB is equal all over the country, he added. “According to WHO reports, the incidence of the disease in Pakistan is somewhere around two to three percent. It is higher in more populated areas, and lower in relatively more affluent suburbs, where a lesser number of people share the same living space.”
The problem with the government sponsoring MDR-TB treatment is that the prognoses (results) of the treatment are around 50 percent, Prof. Ahmed said. “At the end of the day, looking at financial constraints, it is more feasible to spend that money on the first line of treatment, so that the disease is nipped in the bud.”
He did agree, though, that some level of coverage should be given to MDR-TB by the federal and provincial health departments.
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