Today's medication adherence related abstract, "Supporting the Patient's Role in Guideline Compliance: A Controlled Study", comes from The American Journal of Managed Care, and even has a link to the full article.
Objective: Clinical messages alerting physicians to gaps in the care of specific patients have been shown to increase compliance with evidence-based guidelines. This study sought to measure any additional impact on compliance when alerting messages also were sent to patients.
Study Design: For alerts that were generated by computerized clinical rules applied to claims, compliance was determined by subsequent claims evidence (eg, that recommended tests were performed). Compliance was measured in the baseline year and the study year for 4 study group employers (combined membership >100,000) that chose to add patient messaging in the study year, and 28 similar control group employers (combined membership >700,000) that maintained physician messaging but did not add patient messaging.
Methods: The impact of patient messaging was assessed by comparing changes in compliance from baseline to study year in the 2 groups. Multiple logistic regression was used to control for differences between the groups. Because a given member or physician could receive multiple alerts, generalized estimating equations with clustering by patient and physician were used.
Results: Controlling for differences in age, sex, and the severity and types of clinical alerts between the study and control groups, the addition of patient messaging increased compliance by 12.5% (P <.001). This increase was primarily because of improved responses to alerts regarding the need for screening, diagnostic, and monitoring tests.
Conclusion: Supplementing clinical alerts to physicians with messages directly to their patients produced a statistically significant increase in compliance with the evidence-based guidelines underlying the alerts.
(Am J Manag Care. 2008;14(11):737-744)
MY COMMENTS
I am always pleased when another study confirms that patient messaging improves patient compliance. Especially with the rising cost of healthcare, every preventative step should be taken to ensure patients have the best data about their care and their risks.
It is troubling however that the patient messaging was in the form of letters that had a 10 business day delay from the doctor getting the notification "to allow physicians to contact their patients first, if they choose, or to indicate via fax or phone that there are clinical reasons why alerts do not apply (eg, an allergy not revealed by claims data)". This study did take place in 2006, and I am surprised they did not use email messaging as well.
Here is an exampled of the alert for the doctor:
Your patient is at least 55 years old, has claims evidence for diabetes, has an additional cardiovascular disease risk factor (eg, history of cardiovascular disease, dyslipidemia, microalbuminuria), and has no claims evidence for an angiotensin-converting enzyme (ACE) inhibitor. The American Diabetes Association recommends that, in these patients, with or without hypertension, an ACE inhibitor be considered to reduce the risk of cardiovascular events. If your patient fits this clinical profile, and if not already done or contraindicated, consider starting an ACE inhibitor and titrating the dosage as tolerated.
Here is an example of the patient alert:
• Our data show that you may have diabetes.
• If you have diabetes, it may help you to take a type of drug
called an ACE inhibitor.
• You may not be taking this drug.
• Ask your doctor if you should take an ACE inhibitor.
Now with that 10 day delay the doctor can reach out to the patient and suggest a medication. The reinforcement from the health plan helps the patient adhere with the doctor's recommendation. Same applies for screenings, diagnostic and monitoring tests.
This also raises the question: "My insurer told me to get this test or take this pill. If I do not do it, will they deny claims in the future?"
Would you have this fear if your health plan was monitoring your adherence based on claims data? Would you prefer a 3rd party to deliver these messages?
Please let me know your thoughts.
Thanks!
Showing posts with label Medication Adherence. Show all posts
Showing posts with label Medication Adherence. Show all posts
Tuesday, November 11, 2008
Phillips Develops The iPill
Sorry to have been off on posting over the last week. I came across this article in Reuters that I found interesting, and slightly scary. We want develop the best method for increasing medication adherence, but is this the way?
What do you think?
AMSTERDAM (Reuters) - Dutch group Philips has developed an "intelligent pill" that contains a microprocessor, battery, wireless radio, pump and a drug reservoir to release medication in a specific area in the body.
Philips, one of the world's biggest hospital equipment makers, said Tuesday that the "iPill" capsule, measures acidity with a sensor to determine its location in the gut, and can then release drugs where they are needed.
Delivering drugs to treat digestive tract disorders such as Crohn's disease directly to the location of the disease means doses can be lower, reducing side effects, Philips said.
While capsules containing miniature cameras are already used as diagnostic tools, those lack the ability to deliver drugs, Philips said.
The "iPill" can also measure the local temperature and report it wirelessly to an external receiver.
The company plans to present the "iPill" at the annual meeting of the American Association of Pharmaceutical Scientists (AAPS) in Atlanta this month.
The iPill is a prototype but suitable for serial manufacturing, Philips said.
(Reporting by Niclas Mika; Editing by Greg Mahlich)
What do you think?
AMSTERDAM (Reuters) - Dutch group Philips has developed an "intelligent pill" that contains a microprocessor, battery, wireless radio, pump and a drug reservoir to release medication in a specific area in the body.
Philips, one of the world's biggest hospital equipment makers, said Tuesday that the "iPill" capsule, measures acidity with a sensor to determine its location in the gut, and can then release drugs where they are needed.
Delivering drugs to treat digestive tract disorders such as Crohn's disease directly to the location of the disease means doses can be lower, reducing side effects, Philips said.
While capsules containing miniature cameras are already used as diagnostic tools, those lack the ability to deliver drugs, Philips said.
The "iPill" can also measure the local temperature and report it wirelessly to an external receiver.
The company plans to present the "iPill" at the annual meeting of the American Association of Pharmaceutical Scientists (AAPS) in Atlanta this month.
The iPill is a prototype but suitable for serial manufacturing, Philips said.
(Reporting by Niclas Mika; Editing by Greg Mahlich)
Monday, October 20, 2008
AlignMap Betters My Robotic Posts
As has happened in the past, Dr. Showalter from AlignMap has written a better and more thoughtful post about the future of robotic medication adherence assistance than I did last week.
Dr. Showalter's post reminds me (as our emails about blogging have in the past) that I sometimes only "report" what I find, not adding anything of merit with my own thoughts, observations, etc.... Also that I do not add any visuals.
I thank Dr. Showalter for his great additions to my previous two posts regarding medication adherence and healthcare robots, as well as adding a personal real world context for the use of these aids.
He also referenced his own blog post about a Tamagotchi-style Pill Pet reminder that I never saw. It alerts patients when to take their pills and when to go to the MD. If the patient is not adherent, the Pill Pet get sicks and eventually dies. This aids adherence by hopefully making the patient care more about the health of a robotic pet than their own.
I will close with Dr. Showalter's favorite compliance program:
1. RoboCop (Dr. RoboCop to you) presents the healthcare instructions.
2. RoboCop enhances compliance with his trademark line, which also serves as the Program’s slogan: "You have 20 seconds to comply."
Of course it is cooler and has more effect on the AlignMap blog as he has visuals and audio!
He also referenced his own blog post about a Tamagotchi-style Pill Pet reminder that I never saw. It alerts patients when to take their pills and when to go to the MD. If the patient is not adherent, the Pill Pet get sicks and eventually dies. This aids adherence by hopefully making the patient care more about the health of a robotic pet than their own.
I will close with Dr. Showalter's favorite compliance program:
1. RoboCop (Dr. RoboCop to you) presents the healthcare instructions.
2. RoboCop enhances compliance with his trademark line, which also serves as the Program’s slogan: "You have 20 seconds to comply."
Of course it is cooler and has more effect on the AlignMap blog as he has visuals and audio!
Friday, October 17, 2008
Ryan Haight Online Pharmacy Consumer Protection Act to Become Law
President Bush signed the Ryan Haight Online Pharmacy Protection Act (H.R. 6353) on October 15th making it a law. Congrats to this administration for seeing this act through.
Most people believe that online pharmacies are scams selling fake or illegal pills at high rates for ED, and oxycontin. With the passing of this law, hopefully more legitimacy will be given to online pharmacies in the public view.
Also helping to make online pharmacies more respected are Health 2.0 companies like eDrugSearch which "brings together the world’s most highly respected online pharmacies through a comprehensive, easy-to-use search engine."
They vet all the pharmacies their search engine queries and also provide "up-to-the-minute price search, detailed drug information, and other advanced features that make it the premier portal for online prescription medication shoppers. Our advanced search features enable members to identify pharmacies with specific licensing requirements, third-party accreditations, Better Business Bureau memberships, and more."
eDrugSearch's founder, Cary Byrd, an impassioned advocate of safe online pharmacies, wrote a great summary of the Ryan Haight Online Pharmacy Protection Act's provisions last month on his blog.
Here is the condensed version. Thanks again to Cary for for the succinct write-up.
- Amends the Controlled Substances Act to prohibit the delivery, distribution, or dispensing of controlled substances over the Internet without a valid prescription. Exempts telemedicine practitioners.
- Defines “valid prescription” as a prescription that is issued for a legitimate purpose by a practitioner who has conducted at least one in-person medical evaluation of the patient.
- Adds definitions to the Controlled Substances Act relating to online pharmacies and the issuance of prescriptions over the Internet.
- Imposes registration and reporting requirements on online pharmacies.
- Authorizes the Attorney General to issue a special registration under this Act for telemedicine practitioners.
- Increases criminal penalties involving controlled substances in Schedules II, IV, and V of the Controlled Substances Act.
- Authorizes states to apply for injunctions or obtain damages and other civil remedies against online pharmacies that are deemed a threat to state residents.
Patients have cited access to medications as being a barrier for medication adherence. If you have trouble getting your meds and affording them, look to online resources like eDrugSearch to provide you with the best prices and services that will deliver you scripts to your door.
I hate to sound like an advert, but with the economy the way it is, medications should not be sacrificed in this dire time, and there are less expensive alternatives than going to your local pharmacy. I am all for supporting small, locally owned businesses (we go to a druggist in Southport where my wife got penny candy as a girl), however one's health and medication regime come first - if you cannot afford to pay for small town service, look for alternatives.
Most people believe that online pharmacies are scams selling fake or illegal pills at high rates for ED, and oxycontin. With the passing of this law, hopefully more legitimacy will be given to online pharmacies in the public view.
Also helping to make online pharmacies more respected are Health 2.0 companies like eDrugSearch which "brings together the world’s most highly respected online pharmacies through a comprehensive, easy-to-use search engine."
They vet all the pharmacies their search engine queries and also provide "up-to-the-minute price search, detailed drug information, and other advanced features that make it the premier portal for online prescription medication shoppers. Our advanced search features enable members to identify pharmacies with specific licensing requirements, third-party accreditations, Better Business Bureau memberships, and more."
eDrugSearch's founder, Cary Byrd, an impassioned advocate of safe online pharmacies, wrote a great summary of the Ryan Haight Online Pharmacy Protection Act's provisions last month on his blog.
Here is the condensed version. Thanks again to Cary for for the succinct write-up.
- Amends the Controlled Substances Act to prohibit the delivery, distribution, or dispensing of controlled substances over the Internet without a valid prescription. Exempts telemedicine practitioners.
- Defines “valid prescription” as a prescription that is issued for a legitimate purpose by a practitioner who has conducted at least one in-person medical evaluation of the patient.
- Adds definitions to the Controlled Substances Act relating to online pharmacies and the issuance of prescriptions over the Internet.
- Imposes registration and reporting requirements on online pharmacies.
- Authorizes the Attorney General to issue a special registration under this Act for telemedicine practitioners.
- Increases criminal penalties involving controlled substances in Schedules II, IV, and V of the Controlled Substances Act.
- Authorizes states to apply for injunctions or obtain damages and other civil remedies against online pharmacies that are deemed a threat to state residents.
Patients have cited access to medications as being a barrier for medication adherence. If you have trouble getting your meds and affording them, look to online resources like eDrugSearch to provide you with the best prices and services that will deliver you scripts to your door.
I hate to sound like an advert, but with the economy the way it is, medications should not be sacrificed in this dire time, and there are less expensive alternatives than going to your local pharmacy. I am all for supporting small, locally owned businesses (we go to a druggist in Southport where my wife got penny candy as a girl), however one's health and medication regime come first - if you cannot afford to pay for small town service, look for alternatives.
Tuesday, October 14, 2008
Another Home Robot to Improve Medication Adherence
I found this blurb in the Journal of Telemedicine and Telecare about another home robot to improve medication adherence:
"We have developed a prototype home robot to improve drug compliance. The robot is a small mobile device, capable of autonomous behaviour, as well as remotely controlled operation via a wireless datalink. The robot is capable of face detection and also has a display screen to provide facial feedback to help motivate patients and thus increase their level of compliance. An RFID reader can identify tags attached to different objects, such as bottles, for fluid intake monitoring. A tablet dispenser allows drug compliance monitoring. Despite some limitations, experience with the prototype suggests that simple and low-cost robots may soon become feasible for care of people living alone or in isolation."
Like my previous post about the Carebot, this is pretty creepy, but it can be the future of home eldercare. Think of I, Robot. I do not see how this can work right now, unless a trust level is developed between the patient and the robot. I can imagine a patient ignoring the robot, unless the patient is already engaged in their medication regime, and needs the help to remember.
I'll be interested to see how this rolls out and how their clinical trials improve medication adherence.
"We have developed a prototype home robot to improve drug compliance. The robot is a small mobile device, capable of autonomous behaviour, as well as remotely controlled operation via a wireless datalink. The robot is capable of face detection and also has a display screen to provide facial feedback to help motivate patients and thus increase their level of compliance. An RFID reader can identify tags attached to different objects, such as bottles, for fluid intake monitoring. A tablet dispenser allows drug compliance monitoring. Despite some limitations, experience with the prototype suggests that simple and low-cost robots may soon become feasible for care of people living alone or in isolation."
Like my previous post about the Carebot, this is pretty creepy, but it can be the future of home eldercare. Think of I, Robot. I do not see how this can work right now, unless a trust level is developed between the patient and the robot. I can imagine a patient ignoring the robot, unless the patient is already engaged in their medication regime, and needs the help to remember.
I'll be interested to see how this rolls out and how their clinical trials improve medication adherence.
Friday, October 3, 2008
New Medication Adherence Blog
I discovered a new Medication Adherence blog called Medication Adherence Group 7. Almost as catchy as the title of my blog ;). It appears to be run by "Group 7, University of Texas at Arlington". UT of A also has a two other groups on Blogger: Group 12 and Calvino Saputra which also write blogs.
So far Group 7 have only posted a few posts which mention the causes of non-adherence and what you can do to help stay adherent.
I look forward to seeing how their blog develops.
So far Group 7 have only posted a few posts which mention the causes of non-adherence and what you can do to help stay adherent.
I look forward to seeing how their blog develops.
Tuesday, September 30, 2008
Text Messaging's Healthcare Applications
One of the topics I enjoy talking about in regards to Health 2.0 is the effect text messaging will have on healthcare. Intelecare already uses (and has used for 3 years) text messaging as one of the delivery methods for our patient /caregiver created medical adherence reminders. BJ Fogg at Stanford held a Texting4Health conference in February, where a number of uses for texting in healthcare were presented, such as texting for AIDS testing clinics, and a smoking cessation program. Other companies, such as WellSphere, are also using texts as way to transmit health related information - such as where you can find a health food store or gym in your immediate area.
I have been looking at trends in mobile advertising and text usage, but I didn't really think that it had reached this point.
According to eMarketer: "The average mobile subscriber in the US sent and received more SMS text messages than mobile telephone calls during Q2 2008, according to Nielsen. This was the second consecutive quarter in which the average number of text messages was significantly higher than the average number of phone calls."
This is simply outstanding. As you can see from the chart, it is not just the tweens and Millenials using texts. My X Generation still sends more texts, and the 56 + crowd even does it. The US is also still way behind the rest of the world.
Quick Story: In 1999 or 2000 I was on a ski trip with my half-brother, Ricardo, who grew up and lives in London. He was looking at his phone and punching buttons (he was 18 or so at the time). I asked what he was doing, and he said "texting my friends". I asked what that was, he explained, and I said "why don't you call them"? His answer was that it was simpler, cheaper, and he can do it on "the sly".
It took me up until last year to really embrace sending text messages. I started with simple texts like "running late" or "what are you up to", which led to more complicated answers to queries, directions, twitter updates, etc... Now instead of "call me" it is "text me".
The uses in healthcare, for me, are most readily available for tracking information like glucose readings (I think SugarStats uses this), blood pressure monitoring, etc... I don't think texting your physician will catch on so rapidly, but it can happen.
AJ Fortin has a great post from this spring: 101 Things to Do With A Mobile Phone in Healthcare.
What are other uses you can think of for texting in healthcare? Please add your comments!
I have been looking at trends in mobile advertising and text usage, but I didn't really think that it had reached this point.
According to eMarketer: "The average mobile subscriber in the US sent and received more SMS text messages than mobile telephone calls during Q2 2008, according to Nielsen. This was the second consecutive quarter in which the average number of text messages was significantly higher than the average number of phone calls."
This is simply outstanding. As you can see from the chart, it is not just the tweens and Millenials using texts. My X Generation still sends more texts, and the 56 + crowd even does it. The US is also still way behind the rest of the world.
Quick Story: In 1999 or 2000 I was on a ski trip with my half-brother, Ricardo, who grew up and lives in London. He was looking at his phone and punching buttons (he was 18 or so at the time). I asked what he was doing, and he said "texting my friends". I asked what that was, he explained, and I said "why don't you call them"? His answer was that it was simpler, cheaper, and he can do it on "the sly".
It took me up until last year to really embrace sending text messages. I started with simple texts like "running late" or "what are you up to", which led to more complicated answers to queries, directions, twitter updates, etc... Now instead of "call me" it is "text me".
The uses in healthcare, for me, are most readily available for tracking information like glucose readings (I think SugarStats uses this), blood pressure monitoring, etc... I don't think texting your physician will catch on so rapidly, but it can happen.
AJ Fortin has a great post from this spring: 101 Things to Do With A Mobile Phone in Healthcare.
What are other uses you can think of for texting in healthcare? Please add your comments!
Wal Mart and Caterpillar Team Up for No-Copays
I have said it in meetings, in emails and on Twitter: Wal Mart can revolutionize healthcare in this country. They have the power to change the way patients get and pay for their medications. Already, Wal Mart has changed the pharmacy industry by introducing their $4 generic drug program in the fall of 2006. This program made every pharmacy, from Target and CVS to Farmer Joe and Hannafords, also offer $4 generics to compete.
This program has saved Wal Mart customers $1 BILLION already. THAT is impressive.
One of the programs for aiding the US healthcare system and helping patients become healthier is employer /health plan sponsored lower co-pays and free medication for chronic diseases. This is not my original idea, as several companies have offered these services to their employees, but one that I fully support and believe will make a difference in medication non-adherence. As we know, forgetfulness is the #1 reason, with drug prices, side effects and drug education being the other factors that contribute to this pandemic.
Wal Mart and Caterpillar are taking this idea a step further by offering no co-pays for employees taking Tier-1 generics.
"Caterpillar Inc. and Wal-Mart Stores Inc. have embarked on a pilot drug program that could revolutionize the prescription drug industry, officials from both companies said Monday.
Select salaried and management employees of Caterpillar as well as its retirees and surviving spouses can get Tier-1 generic drugs filled for no co-payment at all Wal-Mart, Sam's Clubs and Neighborhood Market stores now through Dec. 31, 2009, as part of the program that began earlier this month.
The co-payment for the generic drugs is $5 at other pharmacies.
While about 70,000 Caterpillar employees are affected now, that could expand to include union-represented employees who opt into the company's HMO plan beginning Jan. 1, 2009, said spokeswoman Rachel Potts. Open enrollment begins in November."
I think this is another fantastic program and shows the real power Wal Mart has to influence the US Healthcare industry.
"The goal of the pilot program, on which Caterpillar and Wal-Mart negotiated for several months, was to remove unnecessary costs from the health care equation, said Todd Bisping, Caterpillar's pharmacy benefits manager.
It does that by eliminating the middle man, so to speak, in the pharmaceutical management process. Most companies contract with an outside pharmacy benefits manager to set rates on prescription drugs, rates co-payments are designed to cover to defray the company's costs.
Caterpillar negotiated directly with Wal-Mart on the rates, saving it money and enabling Caterpillar to then waive the co-payment for its employees and retirees, Bisping said."
You can read the full story from the Peoria Journal Star.
This program has saved Wal Mart customers $1 BILLION already. THAT is impressive.
One of the programs for aiding the US healthcare system and helping patients become healthier is employer /health plan sponsored lower co-pays and free medication for chronic diseases. This is not my original idea, as several companies have offered these services to their employees, but one that I fully support and believe will make a difference in medication non-adherence. As we know, forgetfulness is the #1 reason, with drug prices, side effects and drug education being the other factors that contribute to this pandemic.
Wal Mart and Caterpillar are taking this idea a step further by offering no co-pays for employees taking Tier-1 generics.
"Caterpillar Inc. and Wal-Mart Stores Inc. have embarked on a pilot drug program that could revolutionize the prescription drug industry, officials from both companies said Monday.
Select salaried and management employees of Caterpillar as well as its retirees and surviving spouses can get Tier-1 generic drugs filled for no co-payment at all Wal-Mart, Sam's Clubs and Neighborhood Market stores now through Dec. 31, 2009, as part of the program that began earlier this month.
The co-payment for the generic drugs is $5 at other pharmacies.
While about 70,000 Caterpillar employees are affected now, that could expand to include union-represented employees who opt into the company's HMO plan beginning Jan. 1, 2009, said spokeswoman Rachel Potts. Open enrollment begins in November."
I think this is another fantastic program and shows the real power Wal Mart has to influence the US Healthcare industry.
"The goal of the pilot program, on which Caterpillar and Wal-Mart negotiated for several months, was to remove unnecessary costs from the health care equation, said Todd Bisping, Caterpillar's pharmacy benefits manager.
It does that by eliminating the middle man, so to speak, in the pharmaceutical management process. Most companies contract with an outside pharmacy benefits manager to set rates on prescription drugs, rates co-payments are designed to cover to defray the company's costs.
Caterpillar negotiated directly with Wal-Mart on the rates, saving it money and enabling Caterpillar to then waive the co-payment for its employees and retirees, Bisping said."
You can read the full story from the Peoria Journal Star.
Wednesday, September 24, 2008
Interview With The Chief Scientist of Express Scripts from STLToday
Here is a quickie from the St. Louis Post Dispatch. It seems to be an interview with the Chief Scientist from Express Scripts, however it is just a series of questions and answers without any reference text. I do think these are interesting questions though, and really makes me think about mail order pharmacies.
Why aren't you doing it? The costs are reduced for 90 day supplies. It makes perfect sense to me, since I am on two maintenance medications, yet I still have not done it - why? I do not really know. I printed out the form, and then it sat on my desk for a week. I think I took it home, then it was put in a drawer and lost it. We have since changed health plans, so maybe I will look into it again.
Enjoy the Q and A:
Can you give a brief explanation of Express Scripts' Center for Cost-Effective Consumerism?
The center brings together leading experts in behavioral economics to gain an advanced understanding of human behavior applied to health care. The center uses this information to help bring about positive health behavior change one consumer at a time. Right now, we're focused on procrastination as one major obstacle to better behavior.
One of the center's recent studies found patients were more likely to take medications as directed when they received those medications through the mail. Can you discuss these findings?
The study found that medication compliance was about 8 percentage points higher at home delivery than retail in key therapy classes: diabetes, high cholesterol and high blood pressure. The study involved more than 70,000 patients followed for nine months, and the design was such that we are confident that the difference in therapy adherence was due directly to home delivery.
Do you know any reasons why patients receiving drugs through mail order are more compliant?
There are at least two issues. First, it's clear that some of the noncompliance is due to procrastination when it comes to getting refills. This leads to gaps in compliance because patients wind up not having their medications. Because home delivery offers 90-day supplies, there are fewer refills needed and thus fewer gaps.
Second, our data show that patients in home delivery are far more engaged; they call us more often, log in to our website more often and increasingly view us as a trusted partner. This helps us communicate more effectively with them about their care.
Why don't more patients choose mail order?
Based on our work with the center's advisory board, we think it's more about procrastination than an active decision not to use home delivery.
In the past, moving to home delivery meant filling out forms, calling the doctor for a new prescription written for 90-day fills, etc. Express Scripts has new programs that take almost all of that work off patients' shoulders, so we expect a lot more of them to take advantage of home delivery going forward.
What should employers and other health insurer purchasers do if they want to encourage their employees or members to use mail order?
Clearly, financial incentives are not enough to drive members to home delivery. In addition to making sure patients save money on their co-payments at mail, employers and insurers should work with a PBM partner that can address the issue of procrastination and communicate effectively with patients.
Why aren't you doing it? The costs are reduced for 90 day supplies. It makes perfect sense to me, since I am on two maintenance medications, yet I still have not done it - why? I do not really know. I printed out the form, and then it sat on my desk for a week. I think I took it home, then it was put in a drawer and lost it. We have since changed health plans, so maybe I will look into it again.
Enjoy the Q and A:
Can you give a brief explanation of Express Scripts' Center for Cost-Effective Consumerism?
The center brings together leading experts in behavioral economics to gain an advanced understanding of human behavior applied to health care. The center uses this information to help bring about positive health behavior change one consumer at a time. Right now, we're focused on procrastination as one major obstacle to better behavior.
One of the center's recent studies found patients were more likely to take medications as directed when they received those medications through the mail. Can you discuss these findings?
The study found that medication compliance was about 8 percentage points higher at home delivery than retail in key therapy classes: diabetes, high cholesterol and high blood pressure. The study involved more than 70,000 patients followed for nine months, and the design was such that we are confident that the difference in therapy adherence was due directly to home delivery.
Do you know any reasons why patients receiving drugs through mail order are more compliant?
There are at least two issues. First, it's clear that some of the noncompliance is due to procrastination when it comes to getting refills. This leads to gaps in compliance because patients wind up not having their medications. Because home delivery offers 90-day supplies, there are fewer refills needed and thus fewer gaps.
Second, our data show that patients in home delivery are far more engaged; they call us more often, log in to our website more often and increasingly view us as a trusted partner. This helps us communicate more effectively with them about their care.
Why don't more patients choose mail order?
Based on our work with the center's advisory board, we think it's more about procrastination than an active decision not to use home delivery.
In the past, moving to home delivery meant filling out forms, calling the doctor for a new prescription written for 90-day fills, etc. Express Scripts has new programs that take almost all of that work off patients' shoulders, so we expect a lot more of them to take advantage of home delivery going forward.
What should employers and other health insurer purchasers do if they want to encourage their employees or members to use mail order?
Clearly, financial incentives are not enough to drive members to home delivery. In addition to making sure patients save money on their co-payments at mail, employers and insurers should work with a PBM partner that can address the issue of procrastination and communicate effectively with patients.
Monday, September 22, 2008
Abstracts from Medline
Today I found several abstracts related to medication non-adherence, specifically these four that deal with measurement. All are from the HighWire Press out of Stanford.
Enjoy!
ONE: Testing the psychometric properties of the Medication Adherence Scale in patients with heart failure
OBJECTIVE:
Many factors may contribute to medication nonadherence in heart failure (HF), but no standard measure exists to evaluate factors associated with nonadherence. To fill this gap, we developed the Medication Adherence Scale (MAS) and tested its reliability and validity in patients with HF.
METHOD:
Questionnaire data were collected from 100 patients with HF at baseline using the MAS, and objective adherence data were collected for 3 consecutive months using the Medication Event Monitoring System.
RESULTS:
Principal component analysis yielded three factors that explained 63% of the variance in medication adherence: knowledge, attitudes, and barriers to medication adherence. Cronbach's alphas for these subscales ranged from .75 to .94, which supported their internal consistency. The Spearman rho correlation coefficients between the Medication Event Monitoring System and Knowledge, Attitudes, and Barriers scores were .25 to .31 (P < .05), demonstrating support for construct validity.
CONCLUSION:
These results support the reliability and validity of the MAS as a measure of knowledge, attitudes, and barriers of medication adherence.
TWO: Revision and validation of the medication adherence self-efficacy scale (MASES) in hypertensive African Americans
Study purpose was to revise and examine the validity of the Medication Adherence Self-Efficacy Scale (MASES) in an independent sample of 168 hypertensive African Americans: mean age 54 years (SD = 12.36); 86% female; 76% high school education or greater. Participants provided demographic information; completed the MASES, self-report and electronic measures of medication adherence at baseline and three months.
Confirmatory (CFA), exploratory (EFA) factor analyses, and classical test theory (CTT) analyses suggested that MASES is unidimensional and internally reliable. Item response theory (IRT) analyses led to a revised 13-item version of the scale: MASES-R. EFA, CTT, and IRT results provide a foundation of support for MASES-R reliability and validity for African Americans with hypertension. Research examining MASES-R psychometric properties in other ethnic groups will improve generalizability of findings and utility of the scale across groups. The MASES-R is brief, quick to administer, and can capture useful data on adherence self-efficacy.
THREE: Methods of assessing adherence to inhaled corticosteroid therapy in children and adolescents: adherence rates and their implications for clinical practice
Nonadherence to inhaled corticosteroid therapy is common and has a negative effect on clinical control, as well as increasing morbidity rates, mortality rates and health care costs. This review was conducted using direct searches, together with the following sources: Medline; HighWire; and the Latin American and Caribbean Health Sciences Literature database. Searches included articles published between 1992 and 2008. The following methods of assessing adherence, listed in ascending order by degree of objectivity, were identified: patient or family reports; clinical judgment; weighing/dispensing of medication, electronic medication monitoring; and (rarely) biochemical analysis.
Adherence rates ranged from 30 to 70%. It is recognized that the degree of adherence determined by patient/family reports or by clinical judgment is exaggerated in comparison with that obtained using electronic medication monitors. Physicians should bear in mind that true adherence rates are lower than those reported by patients, and this should be considered in cases of poor clinical control. Weighing the spray quantifies the medication and infers adherence. However, there can be deliberate emptying of inhalers and medication sharing. Pharmacies provide the dates on which the medication was dispensed and refilled. This strategy is valid and should be used in Brazil.
The use of electronic medication monitors, which provide the date and time of each triggering of the medication device, although costly, is the most accurate method of assessing adherence. The results obtained with such monitors demonstrate that adherence was lower than expected. Physicians should improve their knowledge on patient adherence and use accurate methods of assessing such adherence.
FOUR: Evidence-based Assessment of Adherence to Medical Treatments in Pediatric Psychology
Objectives:
Adherence to medical regimens for children and adolescents with chronic conditions is generally below 50% and is considered the single, greatest cause of treatment failure. As the prevalence of chronic illnesses in pediatric populations increases and awareness of the negative consequences of poor adherence become clearer, the need for reliable and valid measures of adherence has grown.
Methods:
This review evaluated empirical evidence for 18 measures utilizing three assessment methods: (a) self-report or structured interviews, (b) daily diary methods, and (c) electronic monitors.
Results:
Ten measures met the "well-established" evidence-based (EBA) criteria.
Conclusions:
Several recommendations for improving adherence assessment were made. In particular, consideration should be given to the use of innovative technologies that provide a window into the "real time" behaviors of patients and families. Providing written treatment plans, identifying barriers to good adherence, and examining racial and ethnic differences in attitudes, beliefs and behaviors affecting adherence were strongly recommended.
Enjoy!
ONE: Testing the psychometric properties of the Medication Adherence Scale in patients with heart failure
OBJECTIVE:
Many factors may contribute to medication nonadherence in heart failure (HF), but no standard measure exists to evaluate factors associated with nonadherence. To fill this gap, we developed the Medication Adherence Scale (MAS) and tested its reliability and validity in patients with HF.
METHOD:
Questionnaire data were collected from 100 patients with HF at baseline using the MAS, and objective adherence data were collected for 3 consecutive months using the Medication Event Monitoring System.
RESULTS:
Principal component analysis yielded three factors that explained 63% of the variance in medication adherence: knowledge, attitudes, and barriers to medication adherence. Cronbach's alphas for these subscales ranged from .75 to .94, which supported their internal consistency. The Spearman rho correlation coefficients between the Medication Event Monitoring System and Knowledge, Attitudes, and Barriers scores were .25 to .31 (P < .05), demonstrating support for construct validity.
CONCLUSION:
These results support the reliability and validity of the MAS as a measure of knowledge, attitudes, and barriers of medication adherence.
TWO: Revision and validation of the medication adherence self-efficacy scale (MASES) in hypertensive African Americans
Study purpose was to revise and examine the validity of the Medication Adherence Self-Efficacy Scale (MASES) in an independent sample of 168 hypertensive African Americans: mean age 54 years (SD = 12.36); 86% female; 76% high school education or greater. Participants provided demographic information; completed the MASES, self-report and electronic measures of medication adherence at baseline and three months.
Confirmatory (CFA), exploratory (EFA) factor analyses, and classical test theory (CTT) analyses suggested that MASES is unidimensional and internally reliable. Item response theory (IRT) analyses led to a revised 13-item version of the scale: MASES-R. EFA, CTT, and IRT results provide a foundation of support for MASES-R reliability and validity for African Americans with hypertension. Research examining MASES-R psychometric properties in other ethnic groups will improve generalizability of findings and utility of the scale across groups. The MASES-R is brief, quick to administer, and can capture useful data on adherence self-efficacy.
THREE: Methods of assessing adherence to inhaled corticosteroid therapy in children and adolescents: adherence rates and their implications for clinical practice
Nonadherence to inhaled corticosteroid therapy is common and has a negative effect on clinical control, as well as increasing morbidity rates, mortality rates and health care costs. This review was conducted using direct searches, together with the following sources: Medline; HighWire; and the Latin American and Caribbean Health Sciences Literature database. Searches included articles published between 1992 and 2008. The following methods of assessing adherence, listed in ascending order by degree of objectivity, were identified: patient or family reports; clinical judgment; weighing/dispensing of medication, electronic medication monitoring; and (rarely) biochemical analysis.
Adherence rates ranged from 30 to 70%. It is recognized that the degree of adherence determined by patient/family reports or by clinical judgment is exaggerated in comparison with that obtained using electronic medication monitors. Physicians should bear in mind that true adherence rates are lower than those reported by patients, and this should be considered in cases of poor clinical control. Weighing the spray quantifies the medication and infers adherence. However, there can be deliberate emptying of inhalers and medication sharing. Pharmacies provide the dates on which the medication was dispensed and refilled. This strategy is valid and should be used in Brazil.
The use of electronic medication monitors, which provide the date and time of each triggering of the medication device, although costly, is the most accurate method of assessing adherence. The results obtained with such monitors demonstrate that adherence was lower than expected. Physicians should improve their knowledge on patient adherence and use accurate methods of assessing such adherence.
FOUR: Evidence-based Assessment of Adherence to Medical Treatments in Pediatric Psychology
Objectives:
Adherence to medical regimens for children and adolescents with chronic conditions is generally below 50% and is considered the single, greatest cause of treatment failure. As the prevalence of chronic illnesses in pediatric populations increases and awareness of the negative consequences of poor adherence become clearer, the need for reliable and valid measures of adherence has grown.
Methods:
This review evaluated empirical evidence for 18 measures utilizing three assessment methods: (a) self-report or structured interviews, (b) daily diary methods, and (c) electronic monitors.
Results:
Ten measures met the "well-established" evidence-based (EBA) criteria.
Conclusions:
Several recommendations for improving adherence assessment were made. In particular, consideration should be given to the use of innovative technologies that provide a window into the "real time" behaviors of patients and families. Providing written treatment plans, identifying barriers to good adherence, and examining racial and ethnic differences in attitudes, beliefs and behaviors affecting adherence were strongly recommended.
Thursday, September 18, 2008
iGuard Medication Alerts
Do you know about iGuard? I never want to sound like a salesperson, but it is a great service "launched in 2007 as a startup venture funded by Quintiles Transnational...to promote better communication and research about drug safety." Huh? A little bit of hype, and you wonder, how are they going to do that?
On the surface, iGuard is a DDI checker, "a healthcare service that helps monitor the safety of your medications (including prescription drugs, over-the-counter drugs, nutritional supplements and herbal extracts)" like ePocrates, DoubleCheckMD and PharmaSurveyor, but has a lot of other benefits as well. FD I know and have spoken with representatives from all of these companies - and they all do more than just check for drug interactions. I am just placing them in this category for now.
I signed up for iGuard a few months back, seeing if there was any synergy with Intelecare and kind of forgot about it, as I know the drugs I take do not have any interactions with each other. A few days ago I was twittering about another Health 2.0 company, and a VP of Quintiles pinged me to ask if I had heard of iGuard. I replied I had an account and went back to look at it again.
Users add the medications they are taking, and their health problems to see if there are any side effects, and then can get information about said meds and conditions. The interface for the medications is very user friendly with Wikipedia content, prescribing info, indications, fact & figures, side effects, as well as charts based on other users on the same drug and feedback from other patients.
For Niaspan ER, the health information is very straight forward: "This product is used in the treatment of patients with high lipid levels (including cholesterol). It's exact mechanism of action is not well understood." I did not know that researchers and MDs did not know how Niaspan works! Learning already. My risk rating is 2, meaning no harmful long-term side effects or interactions. 2,630 patients using iGuard take Niaspan, 53% have side effects (flushing being the most common), 7.0 satisfaction score (mine is a 9), etc... Point being, lots of great information, and a anonymous comment board to post.
This is what got me thinking about them today however, an email from them that stated the FDA is stopping the import of medicines from Ranbaxy Laboratories due to the concerns they are not following US standard for good manufacturing practices. Here is part of the email:
"Although Tricor is one of the medications manufactured by Ranbaxy, drug shortages are not expected because, in most instances, there are enough other suppliers that can help meet demand for Tricor.
For more information, please visit:
http://www.fda.gov/cder/drug/infopage/ranbaxy/qa.htm
* * * *
WHAT DOES THIS MEAN?
This alert will have very little impact on most patients. However, you should be aware that your pharmacy may dispense Tricor manufactured by a different generic company the next time you get your prescription filled. The effectiveness and safety of generic medication is equal, but some tablets or capsules look different depending on the manufacturer. If your prescription ever looks different, it is always a good idea to ask your pharmacist why the tablets or capsules look different.
This alert is not related to any safety concerns with Ranbaxy products currently distributed in the United States. If you are using medicine covered by this alert you should continue to take it as directed - the risk of suddenly stopping this medication is likely to be greater than any risk associated with their manufacturing. If you have any additional questions about how this FDA alert affects your medications, please talk with your pharmacist."
I got this email at 7:45 pm last night, after I had "shut down" for the day - and stopped inputing information via the web. I read this around 11 pm and thought wow, this is great. Of course I could get this news with the information I read throughout the day, however it was presented to me before the news broke, and provided me with a calm, knowing that I would be OK with my Tricor.
On the surface, iGuard is a DDI checker, "a healthcare service that helps monitor the safety of your medications (including prescription drugs, over-the-counter drugs, nutritional supplements and herbal extracts)" like ePocrates, DoubleCheckMD and PharmaSurveyor, but has a lot of other benefits as well. FD I know and have spoken with representatives from all of these companies - and they all do more than just check for drug interactions. I am just placing them in this category for now.
I signed up for iGuard a few months back, seeing if there was any synergy with Intelecare and kind of forgot about it, as I know the drugs I take do not have any interactions with each other. A few days ago I was twittering about another Health 2.0 company, and a VP of Quintiles pinged me to ask if I had heard of iGuard. I replied I had an account and went back to look at it again.
Users add the medications they are taking, and their health problems to see if there are any side effects, and then can get information about said meds and conditions. The interface for the medications is very user friendly with Wikipedia content, prescribing info, indications, fact & figures, side effects, as well as charts based on other users on the same drug and feedback from other patients.
For Niaspan ER, the health information is very straight forward: "This product is used in the treatment of patients with high lipid levels (including cholesterol). It's exact mechanism of action is not well understood." I did not know that researchers and MDs did not know how Niaspan works! Learning already. My risk rating is 2, meaning no harmful long-term side effects or interactions. 2,630 patients using iGuard take Niaspan, 53% have side effects (flushing being the most common), 7.0 satisfaction score (mine is a 9), etc... Point being, lots of great information, and a anonymous comment board to post.
This is what got me thinking about them today however, an email from them that stated the FDA is stopping the import of medicines from Ranbaxy Laboratories due to the concerns they are not following US standard for good manufacturing practices. Here is part of the email:
"Although Tricor is one of the medications manufactured by Ranbaxy, drug shortages are not expected because, in most instances, there are enough other suppliers that can help meet demand for Tricor.
For more information, please visit:
http://www.fda.gov/cder/drug/infopage/ranbaxy/qa.htm
* * * *
WHAT DOES THIS MEAN?
This alert will have very little impact on most patients. However, you should be aware that your pharmacy may dispense Tricor manufactured by a different generic company the next time you get your prescription filled. The effectiveness and safety of generic medication is equal, but some tablets or capsules look different depending on the manufacturer. If your prescription ever looks different, it is always a good idea to ask your pharmacist why the tablets or capsules look different.
This alert is not related to any safety concerns with Ranbaxy products currently distributed in the United States. If you are using medicine covered by this alert you should continue to take it as directed - the risk of suddenly stopping this medication is likely to be greater than any risk associated with their manufacturing. If you have any additional questions about how this FDA alert affects your medications, please talk with your pharmacist."
I got this email at 7:45 pm last night, after I had "shut down" for the day - and stopped inputing information via the web. I read this around 11 pm and thought wow, this is great. Of course I could get this news with the information I read throughout the day, however it was presented to me before the news broke, and provided me with a calm, knowing that I would be OK with my Tricor.
Follow-up On Retail Clinics
As a follow-up to my post on retail clinics last Tuesday, here are two links to blog posts which explore the topic more extensively than I.
Jane Sarasohn-Kahn of Health Populi talks about the lower costs and better access of retail clinics but at the price of raising overall costs.
Thoughts from Lab Soft News on the subject.
Jane Sarasohn-Kahn of Health Populi talks about the lower costs and better access of retail clinics but at the price of raising overall costs.
Thoughts from Lab Soft News on the subject.
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.
Tuesday, September 2, 2008
Randomized Controlled Trial of a Pictogram-Based Intervention to Reduce Dosing Errors and Improve Adherence Among Caregivers of Young Children
Today's medication adherence related abstract comes from the Annals of Pediatrics & Adolescent Medicine.
See my COMMENTS at the end.
Objective: To evaluate the efficacy of a pictogram-based health literacy intervention to decrease liquid medication administration errors by caregivers of young children.
Design: Randomized controlled trial.
Setting: Urban public hospital pediatric emergency department.
Participants: Parents and caregivers (N = 245) of children aged 30 days to 8 years who were prescribed liquid medications (daily dose or "as needed").
Intervention: Medication counseling using plain language, pictogram-based medication instruction sheets. Control subjects received standard medication counseling.
Outcome Measures: Medication knowledge and practice, dosing accuracy, and adherence.
Results: Of 245 randomized caregivers, 227 underwent follow-up assessments (intervention group, 113; control group, 114). Of these, 99 were prescribed a daily dose medication, and 158 were prescribed medication taken as needed.
Intervention caregivers had fewer errors in observed dosing accuracy (>20% deviation from prescribed dose) compared with caregivers who received routine counseling (daily dose: 5.4% vs 47.8%; absolute risk reduction [ARR], 42.4% [95% confidence interval, 24.0%-57.0%]; number needed to treat [NNT], 2 [2-4]; as needed: 15.6% vs 40.0%; ARR, 24.4% (8.7%-38.8%); NNT, 4 [3-12]). Of intervention caregivers, 9.3% were nonadherent (ie, did not give within 20% of the total prescribed doses) compared with 38.0% of controls (ARR, 28.7% [11.4%-43.7%]; NNT, 3 [2-9]).
Improvements were also seen for knowledge of appropriate preparation for both medication types, as well as knowledge of frequency for those prescribed daily dose medications.
Conclusion: A plain language, pictogram-based intervention used as part of medication counseling resulted in decreased medication dosing errors and improved adherence among multiethnic, low socioeconomic status caregivers whose children were treated at an urban pediatric emergency department.
MY COMMENTS
I recently attended a webinar hosted by a medical education company. They write their brochures and outreach materials for a 5th grade reading level. The average for healthcare related educational materials is geared towards an 8th grade reading level, but they are now going lower. To me that is quite scary for patients whose caregivers might not understand their medical regime and the medications they administer. Glad to see there is a study that has proven the efficacy of "dumbing down" medication instructions.
See my COMMENTS at the end.
Objective: To evaluate the efficacy of a pictogram-based health literacy intervention to decrease liquid medication administration errors by caregivers of young children.
Design: Randomized controlled trial.
Setting: Urban public hospital pediatric emergency department.
Participants: Parents and caregivers (N = 245) of children aged 30 days to 8 years who were prescribed liquid medications (daily dose or "as needed").
Intervention: Medication counseling using plain language, pictogram-based medication instruction sheets. Control subjects received standard medication counseling.
Outcome Measures: Medication knowledge and practice, dosing accuracy, and adherence.
Results: Of 245 randomized caregivers, 227 underwent follow-up assessments (intervention group, 113; control group, 114). Of these, 99 were prescribed a daily dose medication, and 158 were prescribed medication taken as needed.
Intervention caregivers had fewer errors in observed dosing accuracy (>20% deviation from prescribed dose) compared with caregivers who received routine counseling (daily dose: 5.4% vs 47.8%; absolute risk reduction [ARR], 42.4% [95% confidence interval, 24.0%-57.0%]; number needed to treat [NNT], 2 [2-4]; as needed: 15.6% vs 40.0%; ARR, 24.4% (8.7%-38.8%); NNT, 4 [3-12]). Of intervention caregivers, 9.3% were nonadherent (ie, did not give within 20% of the total prescribed doses) compared with 38.0% of controls (ARR, 28.7% [11.4%-43.7%]; NNT, 3 [2-9]).
Improvements were also seen for knowledge of appropriate preparation for both medication types, as well as knowledge of frequency for those prescribed daily dose medications.
Conclusion: A plain language, pictogram-based intervention used as part of medication counseling resulted in decreased medication dosing errors and improved adherence among multiethnic, low socioeconomic status caregivers whose children were treated at an urban pediatric emergency department.
MY COMMENTS
I recently attended a webinar hosted by a medical education company. They write their brochures and outreach materials for a 5th grade reading level. The average for healthcare related educational materials is geared towards an 8th grade reading level, but they are now going lower. To me that is quite scary for patients whose caregivers might not understand their medical regime and the medications they administer. Glad to see there is a study that has proven the efficacy of "dumbing down" medication instructions.
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.
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!
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!
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.
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
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."
COMMENTS
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.
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."
COMMENTS
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:
CHANGE IN THE AIR
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.
COMMENTS:
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?
CHANGE IN THE AIR
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.
COMMENTS:
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.
Enjoy!
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.
Enjoy!
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