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 Nonadherence. Show all posts
Showing posts with label Medication Nonadherence. Show all posts
Wednesday, October 8, 2008
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.
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.
Tuesday, July 29, 2008
The Role of Cognitive Functioning in Medication Adherence of Children and Adolescents with HIV Infection.
Here is today's medication adherence abstract from Medline:
OBJECTIVE: To evaluate the relationship between cognitive functioning and medication adherence in children and adolescents with perinatally acquired HIV infection.
METHODS: Children and adolescents, ages 3-18 (N = 1,429), received a cognitive evaluation and adherence assessment. Multiple logistic regression models were used to identify associations between adherence and cognitive status, adjusting for potential confounding factors.
RESULTS: Children's average cognitive performance was within the low-average range; 16% of children were cognitively impaired (MDI/FSIQ <70). Cognitive status was not associated with adherence to full medication regimens; however, children with borderline/low average cognitive functioning (IQ 70-84) had increased odds of nonadherence to the protease inhibitor class of antiretroviral therapy. Recent stressful life events and child health characteristics, such as HIV RNA detectability, were significantly associated with nonadherence.
CONCLUSION: Cognitive status plays a limited role in medication adherence. Child and caregiver psychosocial and health characteristics should inform interventions to support adherence.
OBJECTIVE: To evaluate the relationship between cognitive functioning and medication adherence in children and adolescents with perinatally acquired HIV infection.
METHODS: Children and adolescents, ages 3-18 (N = 1,429), received a cognitive evaluation and adherence assessment. Multiple logistic regression models were used to identify associations between adherence and cognitive status, adjusting for potential confounding factors.
RESULTS: Children's average cognitive performance was within the low-average range; 16% of children were cognitively impaired (MDI/FSIQ <70). Cognitive status was not associated with adherence to full medication regimens; however, children with borderline/low average cognitive functioning (IQ 70-84) had increased odds of nonadherence to the protease inhibitor class of antiretroviral therapy. Recent stressful life events and child health characteristics, such as HIV RNA detectability, were significantly associated with nonadherence.
CONCLUSION: Cognitive status plays a limited role in medication adherence. Child and caregiver psychosocial and health characteristics should inform interventions to support adherence.
Monday, June 23, 2008
Aetna To Fund UPenn Medical Adherence Lottery Study
A UPenn SOM study funded by Aetna Foundation has an interesting take on using a lottery system to see if patients will be adherent to their medications. If a patient takes their pills, they have an opportunity to wine $100 a day. Full article at courant.com.
Friday, March 28, 2008
Med-eMonitor Improves HIV Medication Adherence, BUT Look at The Test Group
I picked this up from lifesciencesworld.com, but it was on the PRWire as well. SEE my comments at the end.
ROCKVILLE, Md., March 26 /PRNewswire-FirstCall/ — InforMedix Holdings, Inc. (OTC Bulletin Board: IFMX), announced that results presented by Dr. David Bangsberg, an internationally renowned expert on medical adherence, at the Third International Conference on HIV Adherence, showed that HIV+ patients using its Med-eMonitor™ “smart pillbox” that monitors medication and care plan adherence, achieved an average 89.5% medication adherence rate.
The Med- eMonitor “smart pillbox” is linked to the Med-eXpert™ software system that analyzes patient information and provides Web-enabled reports and urgent outbound alerts to caregivers when patients miss medication or suffer declining health.
Approximately 1.2 million people in the US are living with HIV, with an additional 40,000 becoming infected each year, costing the US health care system approximately $50,000-$75,000 per year per patient, or $50 to $75 billion in total annual costs.
Average adherence to HIV antiretroviral therapy is under 70%, and 20-33% of HIV-positive patients will miss at least one of their doses over any given 3-day period. Given that a 10% difference in adherence by individuals is associated with a doubling of viral load, and a 21% increase in the risk of progression to full-blown AIDS; based upon the statistics above Med-eMonitor/Med-eXpert offers the potential for a 40% decrease in the risk of an HIV patient developing full blown AIDS.
The challenging population of 76 patients that were enrolled in the program not only suffered from HIV infection, but frequently were also suffering from drug abuse and severe mental illness, and were near-homeless.
COMMENTS
As I always say, I applaud anything that encourages and enhances medication adherence. It am impressed by these raised adherence rates for HIV patients, but I think regular adherence rates are even lower. Here is my one question though, the sample group of 76 patients were near -homeless, and suffered from drug abuse and severe mental illness. This, to me, does not seem like an accurate test of the efficacy of Med-eMonitor™ - since it is in a controlled environment. I am not knocking the Med-eMonitor, but certain factors have to be in place to use it: #1 being a house to put it in, a fast internet connection, and a patient who waits for the machine to tell them when to take their pills.
With such a structured regimen as HIV medications, sometimes 10 - 20 medications a day, at certain times, one would have to be in front of the Med-eMonitor all day, waiting for the cue to take their meds. So how did the study go? Did the drug addicted, mental unstable near homeless stay in a shelter, rehab facility or mental institution and have their own Med-eMonitor programmed for them? Instead of the nurse coming around with their pills, it was the machine?
I will have to look further into this study to get a real understanding of it all. It just struck me as bizarre. If you are going to announce these results, maybe not mention that the patients were mentally ill, homeless drug addicts.
I still applaud the work and the use of Med-eMonitor and InforMedix for the software they have developed to increase medication adherence. I will have to look at AlignMap to see if Showalter has any comments.
ROCKVILLE, Md., March 26 /PRNewswire-FirstCall/ — InforMedix Holdings, Inc. (OTC Bulletin Board: IFMX), announced that results presented by Dr. David Bangsberg, an internationally renowned expert on medical adherence, at the Third International Conference on HIV Adherence, showed that HIV+ patients using its Med-eMonitor™ “smart pillbox” that monitors medication and care plan adherence, achieved an average 89.5% medication adherence rate.
The Med- eMonitor “smart pillbox” is linked to the Med-eXpert™ software system that analyzes patient information and provides Web-enabled reports and urgent outbound alerts to caregivers when patients miss medication or suffer declining health.
Approximately 1.2 million people in the US are living with HIV, with an additional 40,000 becoming infected each year, costing the US health care system approximately $50,000-$75,000 per year per patient, or $50 to $75 billion in total annual costs.
Average adherence to HIV antiretroviral therapy is under 70%, and 20-33% of HIV-positive patients will miss at least one of their doses over any given 3-day period. Given that a 10% difference in adherence by individuals is associated with a doubling of viral load, and a 21% increase in the risk of progression to full-blown AIDS; based upon the statistics above Med-eMonitor/Med-eXpert offers the potential for a 40% decrease in the risk of an HIV patient developing full blown AIDS.
The challenging population of 76 patients that were enrolled in the program not only suffered from HIV infection, but frequently were also suffering from drug abuse and severe mental illness, and were near-homeless.
COMMENTS
As I always say, I applaud anything that encourages and enhances medication adherence. It am impressed by these raised adherence rates for HIV patients, but I think regular adherence rates are even lower. Here is my one question though, the sample group of 76 patients were near -homeless, and suffered from drug abuse and severe mental illness. This, to me, does not seem like an accurate test of the efficacy of Med-eMonitor™ - since it is in a controlled environment. I am not knocking the Med-eMonitor, but certain factors have to be in place to use it: #1 being a house to put it in, a fast internet connection, and a patient who waits for the machine to tell them when to take their pills.
With such a structured regimen as HIV medications, sometimes 10 - 20 medications a day, at certain times, one would have to be in front of the Med-eMonitor all day, waiting for the cue to take their meds. So how did the study go? Did the drug addicted, mental unstable near homeless stay in a shelter, rehab facility or mental institution and have their own Med-eMonitor programmed for them? Instead of the nurse coming around with their pills, it was the machine?
I will have to look further into this study to get a real understanding of it all. It just struck me as bizarre. If you are going to announce these results, maybe not mention that the patients were mentally ill, homeless drug addicts.
I still applaud the work and the use of Med-eMonitor and InforMedix for the software they have developed to increase medication adherence. I will have to look at AlignMap to see if Showalter has any comments.
Thursday, December 6, 2007
My Health
In February of this year, I was diagnosed with high Triglycerides and high Cholesterol. Mostly hereditary - have you seen the Vytorin ads? - and somewhat my diet. My doctor put me on Tricor, and I have been pretty adherent. In July, I stopped taking it for two weeks while I awaited a new script but otherwise everyday.
My new doctor (my old MD went back to research) didn't know if Tricor was the right drug, so he sent me for blood work.
He gave me the results today.
The good news is that all my levels went down: Total 247, LDL 149, HDL 38 and Triglycerides 301. The bad news is my HDL went down 10 points (very bad considering this is the "good" cholesterol and 40 or higher is recommended). The LDL went down 50 points (very good 130 is recommended), and my total is only 47 points out of the top part of the spectrum. So I am feeling pretty good about myself. I still need to eat better, lose more weight and exercise more effeciently - but who doesn't?
The point to all of this - other than letting you all know about my health, which is top of mind in your lives - is that within two minutes of questioning, my MD asked if I had been taking Tricor regularly. I said yes, except for that two week period, and he said "Everyday?" And I said, "Yes, everyday." I was going to tell him that I am the Director of Corporate Development for a healthcare technology company that focuses on enabling medication adherence and that a get daily text, voice and email reminders, but I didn't need to get into it.
It then occured to me that if I said I was taking the Tricor (see White Coat Adherence) and was not, that all of his diagnosees would be off. If he thought the Tricor wasn't working (technically it would not be working because I would not be taking it), and prescribed something else - it could really mess up my system. I never really thought about medication adherence this way, only that by not taking your meds, your condition gets worse.
My MD was happy to see my numbers and my weight go down and he gave me a choice: keep losing weight, eat better and exercise and see what happens in three months, or do all of that and take another medication in conjunction with the Tricor. He wanted to make sure I would stay adherent to another medication. Putting me on Niacin would increase my pills to 4 a day (I am on another med in the morning and bedtime). 32 million people are on 3 or more medications. Plus, he gave me an antibiotic to take for 10 days to knock a sinus infection out which I have had for two weeks.
So now, my total pill count is at 5 pills, 4 medications.
The better news is the rare blood disease he was worried about only needs to be checked every three months. So there is more time at the lab for me. If I stay adherent to the Tricor and the Niacin, and loose more weight (he said 10 lbs), and eat better (I do have the occational french fry, and ice cream) - I should have all my levels in the right range and not have to take any medications.
This would be optimal.
So, I will set up more reminders for myself, get into the routine of taking a new drug and everything should be right as rain.
As long as there are not any horrible side effects - he mentioned hot flashes - and the drugs fall into my formulary. By my son's 1st birthday, I will be a new man!
My new doctor (my old MD went back to research) didn't know if Tricor was the right drug, so he sent me for blood work.
He gave me the results today.
The good news is that all my levels went down: Total 247, LDL 149, HDL 38 and Triglycerides 301. The bad news is my HDL went down 10 points (very bad considering this is the "good" cholesterol and 40 or higher is recommended). The LDL went down 50 points (very good 130 is recommended), and my total is only 47 points out of the top part of the spectrum. So I am feeling pretty good about myself. I still need to eat better, lose more weight and exercise more effeciently - but who doesn't?
The point to all of this - other than letting you all know about my health, which is top of mind in your lives - is that within two minutes of questioning, my MD asked if I had been taking Tricor regularly. I said yes, except for that two week period, and he said "Everyday?" And I said, "Yes, everyday." I was going to tell him that I am the Director of Corporate Development for a healthcare technology company that focuses on enabling medication adherence and that a get daily text, voice and email reminders, but I didn't need to get into it.
It then occured to me that if I said I was taking the Tricor (see White Coat Adherence) and was not, that all of his diagnosees would be off. If he thought the Tricor wasn't working (technically it would not be working because I would not be taking it), and prescribed something else - it could really mess up my system. I never really thought about medication adherence this way, only that by not taking your meds, your condition gets worse.
My MD was happy to see my numbers and my weight go down and he gave me a choice: keep losing weight, eat better and exercise and see what happens in three months, or do all of that and take another medication in conjunction with the Tricor. He wanted to make sure I would stay adherent to another medication. Putting me on Niacin would increase my pills to 4 a day (I am on another med in the morning and bedtime). 32 million people are on 3 or more medications. Plus, he gave me an antibiotic to take for 10 days to knock a sinus infection out which I have had for two weeks.
So now, my total pill count is at 5 pills, 4 medications.
The better news is the rare blood disease he was worried about only needs to be checked every three months. So there is more time at the lab for me. If I stay adherent to the Tricor and the Niacin, and loose more weight (he said 10 lbs), and eat better (I do have the occational french fry, and ice cream) - I should have all my levels in the right range and not have to take any medications.
This would be optimal.
So, I will set up more reminders for myself, get into the routine of taking a new drug and everything should be right as rain.
As long as there are not any horrible side effects - he mentioned hot flashes - and the drugs fall into my formulary. By my son's 1st birthday, I will be a new man!
Monday, September 17, 2007
Heart and Soul Study
Below is the Abstract from the Heart and Soul Study I found in The Archives of Internal Medicine current issue. Unfortunately I do not have a subscription, but I can see flaws in this study just looking at the methodology. I support studies like this in finding the root and causes of medication non-adherence, but self reporting has never been an acurate measure. See my comments below.
Background
Nonadherence to physician treatment recommendations is an increasingly recognized cause of adverse outcomes and increased health care costs, particularly among patients with cardiovascular disease. Whether patient self-report can provide an accurate assessment of medication adherence in outpatients with stable coronary heart disease is unknown.
Methods
We prospectively evaluated the risk of cardiovascular events associated with self-reported medication nonadherence in 1015 outpatients with established coronary heart disease from the Heart and Soul Study. We asked participants a single question: "In the past month, how often did you take your medications as the doctor prescribed?" Nonadherence was defined as taking medications as prescribed 75% of the time or less. Cardiovascular events (coronary heart disease death, myocardial infarction, or stroke) were identified by review of medical records during 3.9 years of follow-up. We used Cox proportional hazards analysis to determine the risk of adverse cardiovascular events associated with self-reported medication nonadherence.
Results
Of the 1015 participants, 83 (8.2%) reported nonadherence to their medications, and 146 (14.4%) developed cardiovascular events. Nonadherent participants were more likely than adherent participants to develop cardiovascular events during 3.9 years of follow-up (22.9% vs 13.8%, P = .03). Self-reported nonadherence remained independently predictive of adverse cardiovascular events after adjusting for baseline cardiac disease severity, traditional risk factors, and depressive symptoms (hazards ratio, 2.3; 95% confidence interval, 1.3-4.3; P = .006).
Conclusions
In outpatients with stable coronary heart disease, self-reported medication nonadherence is associated with a greater than 2-fold increased rate of subsequent cardiovascular events. A single question about medication adherence may be a simple and effective method to identify patients at higher risk for adverse cardiovascular events.
MY COMMENTS
I don't really like the number 75% as being a proper number for adherence. It should be 100%. Diabetics need to take their pills everyday or suffer problmes with their blood sugar. What if they only chose to take those pills five days a week and skip the weekend? Does that 75% sound OK to you?
Here's a surprising fact: if you do not take your medication, you are more than likely to have a heart attack. The national average for non-adherence is over 50% - it is astounding how they found the minority as the basis for their study. As far as I know, self reporting has never been an acurate gauge for a study.
Everyone feels guilty and will lie regarding non-adherent behavior regarding everything from flossing to diet to heart medication. Here, take these, they will save your life - oh jeez, yeah I know I was supposed to take them, but, you know, I forgot, so now I am in the hospital - but I did tell you I took them.
Patient education is an important factor, as well as side effects and financial costs when dealing with medication non-adherence. But most often, people forget and it is not in their behavior (especially with a new script) to be adherent to medication - although in this case I like compliant because if you do not take that medication, you will return the hospital and die.
Background
Nonadherence to physician treatment recommendations is an increasingly recognized cause of adverse outcomes and increased health care costs, particularly among patients with cardiovascular disease. Whether patient self-report can provide an accurate assessment of medication adherence in outpatients with stable coronary heart disease is unknown.
Methods
We prospectively evaluated the risk of cardiovascular events associated with self-reported medication nonadherence in 1015 outpatients with established coronary heart disease from the Heart and Soul Study. We asked participants a single question: "In the past month, how often did you take your medications as the doctor prescribed?" Nonadherence was defined as taking medications as prescribed 75% of the time or less. Cardiovascular events (coronary heart disease death, myocardial infarction, or stroke) were identified by review of medical records during 3.9 years of follow-up. We used Cox proportional hazards analysis to determine the risk of adverse cardiovascular events associated with self-reported medication nonadherence.
Results
Of the 1015 participants, 83 (8.2%) reported nonadherence to their medications, and 146 (14.4%) developed cardiovascular events. Nonadherent participants were more likely than adherent participants to develop cardiovascular events during 3.9 years of follow-up (22.9% vs 13.8%, P = .03). Self-reported nonadherence remained independently predictive of adverse cardiovascular events after adjusting for baseline cardiac disease severity, traditional risk factors, and depressive symptoms (hazards ratio, 2.3; 95% confidence interval, 1.3-4.3; P = .006).
Conclusions
In outpatients with stable coronary heart disease, self-reported medication nonadherence is associated with a greater than 2-fold increased rate of subsequent cardiovascular events. A single question about medication adherence may be a simple and effective method to identify patients at higher risk for adverse cardiovascular events.
MY COMMENTS
I don't really like the number 75% as being a proper number for adherence. It should be 100%. Diabetics need to take their pills everyday or suffer problmes with their blood sugar. What if they only chose to take those pills five days a week and skip the weekend? Does that 75% sound OK to you?
Here's a surprising fact: if you do not take your medication, you are more than likely to have a heart attack. The national average for non-adherence is over 50% - it is astounding how they found the minority as the basis for their study. As far as I know, self reporting has never been an acurate gauge for a study.
Everyone feels guilty and will lie regarding non-adherent behavior regarding everything from flossing to diet to heart medication. Here, take these, they will save your life - oh jeez, yeah I know I was supposed to take them, but, you know, I forgot, so now I am in the hospital - but I did tell you I took them.
Patient education is an important factor, as well as side effects and financial costs when dealing with medication non-adherence. But most often, people forget and it is not in their behavior (especially with a new script) to be adherent to medication - although in this case I like compliant because if you do not take that medication, you will return the hospital and die.
Thursday, September 6, 2007
Pfizer Funded Study Says: Don't Stop Taking Your Lipitor!
This story was covered by many news outlets, but this reprint comes from FirstWord which is a pharma newsletter. I was really surprised that the non-adherence rates were higher for those patients that switched off the Lipitor. I would think that the patients would stop taking Lipitor or switch medications, and continue on the generic - not stop all together. Probably a little twist from Pfizer in reporting - or the generic did not prove any significant results and the Lipitor was too expensive? We all know the most common reasons for switching medication is cost - as exhibited here - and DTC advertising.
The heart attack rate really doesn't surprise me considering it is sometimes dangerous to change one's drug routine in the middle of treatment. No, I do not work for Pfizer.
Pfizer: Study results suggest switching from Lipitor to simvastatin raises cardiovascular risks
by Daniel Beaulieu
Data from an observational study suggest that patients who switched from Pfizer’s Lipitor (atorvastatin) to simvastatin experienced a 30-percent increase in the relative risk of major cardiovascular events, compared with those who remained on Lipitor, according to Pfizer. The study, which was funded by Pfizer, was presented at the European Society of Cardiology Congress and will also be published in The British Journal of Cardiology.
As part of the retrospective analysis, researchers analysed a UK database that included records on 11 520 patients who took Lipitor for at least six months between October 1997 and June 2005, including 2511 patients who were switched to simvastatin, and 9009 patients who remained on Pfizer’s drug. The findings showed that there was a 43-percent increase in the risk of major cardiovascular events including heart attacks, strokes, and certain types of heart surgeries, for those who switched to simvastatin compared with those who remained on Lipitor. However, there was no difference in all-cause death between the two groups.
A secondary analysis demonstrated that patients who changed drugs were more than twice as likely to discontinue treatment, compared with those who stayed on Lipitor. Reasons for why treatment was discontinued were not available from the database, Pfizer indicated, adding that reasons for switching from one drug to the other were also not available. Furthermore, Pfizer explained that patients in the study were not randomised to each arm, which limits the significance of the findings.
According to lead author Peter Jan Lansberg, many physicians are switching patients to simvastatin because US insurance companies and European governments are under pressure to reduce costs. Lansberg remarked that "it's not beneficial to have a universal switch to cheaper statins. We need to make a distinction between patients who benefit from generic statins and high-risk patients who need a more aggressive therapy."
The heart attack rate really doesn't surprise me considering it is sometimes dangerous to change one's drug routine in the middle of treatment. No, I do not work for Pfizer.
Pfizer: Study results suggest switching from Lipitor to simvastatin raises cardiovascular risks
by Daniel Beaulieu
Data from an observational study suggest that patients who switched from Pfizer’s Lipitor (atorvastatin) to simvastatin experienced a 30-percent increase in the relative risk of major cardiovascular events, compared with those who remained on Lipitor, according to Pfizer. The study, which was funded by Pfizer, was presented at the European Society of Cardiology Congress and will also be published in The British Journal of Cardiology.
As part of the retrospective analysis, researchers analysed a UK database that included records on 11 520 patients who took Lipitor for at least six months between October 1997 and June 2005, including 2511 patients who were switched to simvastatin, and 9009 patients who remained on Pfizer’s drug. The findings showed that there was a 43-percent increase in the risk of major cardiovascular events including heart attacks, strokes, and certain types of heart surgeries, for those who switched to simvastatin compared with those who remained on Lipitor. However, there was no difference in all-cause death between the two groups.
A secondary analysis demonstrated that patients who changed drugs were more than twice as likely to discontinue treatment, compared with those who stayed on Lipitor. Reasons for why treatment was discontinued were not available from the database, Pfizer indicated, adding that reasons for switching from one drug to the other were also not available. Furthermore, Pfizer explained that patients in the study were not randomised to each arm, which limits the significance of the findings.
According to lead author Peter Jan Lansberg, many physicians are switching patients to simvastatin because US insurance companies and European governments are under pressure to reduce costs. Lansberg remarked that "it's not beneficial to have a universal switch to cheaper statins. We need to make a distinction between patients who benefit from generic statins and high-risk patients who need a more aggressive therapy."
Tuesday, August 21, 2007
Old and Unused Meds for Fuel!
I have to look into this when I have the time, but it sounds pretty neat and a good way to use unfilled and returned medication. The article repeats the facts from the NCPIE report and uses some local stats that I am not including - just the mention of these programs from the Waldo County Citizen:
Prescriptions: Alternative Fuel by Patrick Walsh
I was surprised to read in a recent Associated Press article that a company called Capital Returns was generating electricity from burning outdated or recalled prescription drugs. These are unused drugs from pharmacies and manufacturers. With 28 percent of the “returns market,” this company was able to generate enough electricity to power 220 homes last year. The company figures that only about 1 percent of unused or recalled drugs are returned, but that 1 percent has a value of $4 billion to $5 billion.......
.....The lack of compliance, coupled with the lack of a system for consumers to return unused drugs, led to an innovative program being developed by the Maine Benzodiazepine Study Group and the Center on Aging at the University of Maine.
Funded by the Federal Environmental Protection Agency, the project will provide for return of drugs by mail and proper disposal. The EPA is involved because the prevailing practice of “flushing” unused drugs has caused a negative impact on water quality.
Unused drugs also have been diverted to the black market and represent a source for youth drawn to what they see as a “safe” drug alternative to illegal street drugs.
In looking at youth substance-use issues, we have heard about “pharm” or “Skittles” parties where youth as young as middle school age take their chances on prescription drugs dumped in a bowl. These may come from the family medicine cabinet and may be designed to control blood pressure, blood sugar, for pain management or who knows?In a related item, a bill presented to the Maine Legislature this session that would have outlawed any pharmaceutical advertising that made a false claim or “contains language recommending that viewers, listeners or readers ask physicians about any specific prescription drug” was declared dead May 17.
So we will continue to hear “ask your doctor” on every other ad during the evening news. And as a result, some of us may end up with very expensive medications that we don’t want and that could end up as fuel to generate electricity.
Now, consider that Waldo and Knox counties share the highest rate of drug prescriptions written in Maine — one per person, or more than 50,000 per year in each county — according to an analysis by the State Prescription Monitoring Program.
Prescriptions: Alternative Fuel by Patrick Walsh
I was surprised to read in a recent Associated Press article that a company called Capital Returns was generating electricity from burning outdated or recalled prescription drugs. These are unused drugs from pharmacies and manufacturers. With 28 percent of the “returns market,” this company was able to generate enough electricity to power 220 homes last year. The company figures that only about 1 percent of unused or recalled drugs are returned, but that 1 percent has a value of $4 billion to $5 billion.......
.....The lack of compliance, coupled with the lack of a system for consumers to return unused drugs, led to an innovative program being developed by the Maine Benzodiazepine Study Group and the Center on Aging at the University of Maine.
Funded by the Federal Environmental Protection Agency, the project will provide for return of drugs by mail and proper disposal. The EPA is involved because the prevailing practice of “flushing” unused drugs has caused a negative impact on water quality.
Unused drugs also have been diverted to the black market and represent a source for youth drawn to what they see as a “safe” drug alternative to illegal street drugs.
In looking at youth substance-use issues, we have heard about “pharm” or “Skittles” parties where youth as young as middle school age take their chances on prescription drugs dumped in a bowl. These may come from the family medicine cabinet and may be designed to control blood pressure, blood sugar, for pain management or who knows?In a related item, a bill presented to the Maine Legislature this session that would have outlawed any pharmaceutical advertising that made a false claim or “contains language recommending that viewers, listeners or readers ask physicians about any specific prescription drug” was declared dead May 17.
So we will continue to hear “ask your doctor” on every other ad during the evening news. And as a result, some of us may end up with very expensive medications that we don’t want and that could end up as fuel to generate electricity.
Now, consider that Waldo and Knox counties share the highest rate of drug prescriptions written in Maine — one per person, or more than 50,000 per year in each county — according to an analysis by the State Prescription Monitoring Program.
Monday, August 6, 2007
NCPIE Report
Yes, I have been very late in posting this. I appologize. The NCPIE report that is referenced in many articles around the country and in my last post can be found at http://www.talkaboutrx.com.
Dr. Allan Showalter at Alignmap is always up to date and I cannot express my thoughts about the report better than he at:
http://alignmap.com/category/blog.
Dr. Allan Showalter at Alignmap is always up to date and I cannot express my thoughts about the report better than he at:
http://alignmap.com/category/blog.
Tuesday, July 31, 2007
Another Article on the Horrible State of Medication Adherence
Here's an article that is on the wire. I looked for the study Neergaard references, however could not find it. There are some good nugets in here though:
Taking Our Meds? We Are Not Doing It Well
By LAURAN NEERGAARD
Associated Press – July 31, 2007
WASHINGTON
Consider it the other drug problem: Millions of people don't take their medicine correctly - or quit taking it altogether - and the consequences can be deadly.
On average, half of patients with chronic illnesses, such as heart disease or asthma, skip doses or otherwise mess up their medication, says a report being issued later this week that calls the problem a national crisis costing billions of dollars.
The government is preparing new steps to try to persuade patients and their doctors to do better.
But with contributors that range from too-hurried doctor visits to confusing pill bottles, there's no easy solution.
"We go into this with some humility," said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, which is planning what she calls an "in your face" campaign to improve medication adherence. "It's really pretty appalling how badly we do."
This goes far beyond the issue of affording prescriptions. Often people buy their drugs, but misunderstand what they're supposed to take, or how. Or forget doses. Or start feeling better and toss the rest of the bottle. Or skip doses for fear of side effects.
It's not just a problem of poverty or poor education. Even the rich and highly educated skip their medicine. Perhaps the most high-profile example is former President Clinton, who stopped taking his cholesterol-lowering statin drug and later needed open-heart surgery to avert a major heart attack. Statins offer significant heart protection, but about half of patients on statins quit using them within a year.
And remember the globe-trotting tuberculosis patient who was briefly quarantined in May after ignoring doctors' orders not to travel by airplane? He's out of the hospital now but, like all patients with hard-to-treat TB, must take his remaining antibiotics while health workers watch. So many TB patients skip their pills when they feel better - but before all the bacteria are wiped out - health departments now enforce what's called "directly observed therapy."
For most diseases, however, patients must choose to take their medicines. The new report combs a decade of research to conclude people generally do a lousy job.
Among findings from the nonprofit National Council on Patient
Information and Education:
Particularly at risk are people whose diseases are initially symptom-free. Although high blood pressure more than triples the risk of heart disease, for example, just 51 percent of patients stick with their prescribed antidote.
Also at high risk are the elderly, but adherence is a problem for all ages. As few as 30 percent of teenagers correctly take drugs to prevent asthma attacks, for example.
Dire consequences aren't always a deterrent. Among patients already blind in one eye from glaucoma, only 58 percent were protecting the other eye. Another study found that 18 percent of kidney transplant recipients weren't following instructions to prevent organ rejection.
Even doctors mess up, acknowledging in one study adhering to their own prescriptions just 79 percent of the time.
Poor medication adherence can cost an extra $2,000 a year for each patient in extra doctor visits alone, and it's associated with as many as 40 percent of nursing home admissions, even more costly.
Add preventable hospitalizations and premature death, and the report estimates that poor medication adherence could be costing the country $177 billion in medical bills and lost productivity.
Why is taking medicines correctly so tough? One reason is the general confusion surrounding drugs, said Dr. Ruth Parker of Emory University, a co-author of the new report who has studied the issue for the American College of Physicians Foundation.
When the pharmacy hands over your prescription, there are bunches of papers - stapled to the bag, outside the box, glued to the bottle - that all bear drug information, but often with different wording.
Bottles are covered in warning stickers - such as "Take with food" or "Swallow whole" or "Don't use with XYZ other drug" - in so many colors that Parker compares pill containers to Christmas trees.
What in that jumble should patients pay most attention to?
Then there's the wording. Parker recently helped test the seemingly simple instruction "Take two tablets twice daily." Did that mean a total of two, or a total of four? A third of patients who were deemed literate got confused. A more clear instruction would be: "Take two tablets in the morning and two tablets at night."
Beyond literacy, poor eyesight plays a role. Pill-bottle instructions are rather tiny.
Whatever the cause, Clancy hopes to make "take your medicine" a new priority. Her Agency for Healthcare Research and QUality is starting discussions with the new report's authors, the FDA and health groups about steps to do that. Options range from attention-grabbing ads about the dangers of misusing medicines to better drug labels.
Taking Our Meds? We Are Not Doing It Well
By LAURAN NEERGAARD
Associated Press – July 31, 2007
WASHINGTON
Consider it the other drug problem: Millions of people don't take their medicine correctly - or quit taking it altogether - and the consequences can be deadly.
On average, half of patients with chronic illnesses, such as heart disease or asthma, skip doses or otherwise mess up their medication, says a report being issued later this week that calls the problem a national crisis costing billions of dollars.
The government is preparing new steps to try to persuade patients and their doctors to do better.
But with contributors that range from too-hurried doctor visits to confusing pill bottles, there's no easy solution.
"We go into this with some humility," said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, which is planning what she calls an "in your face" campaign to improve medication adherence. "It's really pretty appalling how badly we do."
This goes far beyond the issue of affording prescriptions. Often people buy their drugs, but misunderstand what they're supposed to take, or how. Or forget doses. Or start feeling better and toss the rest of the bottle. Or skip doses for fear of side effects.
It's not just a problem of poverty or poor education. Even the rich and highly educated skip their medicine. Perhaps the most high-profile example is former President Clinton, who stopped taking his cholesterol-lowering statin drug and later needed open-heart surgery to avert a major heart attack. Statins offer significant heart protection, but about half of patients on statins quit using them within a year.
And remember the globe-trotting tuberculosis patient who was briefly quarantined in May after ignoring doctors' orders not to travel by airplane? He's out of the hospital now but, like all patients with hard-to-treat TB, must take his remaining antibiotics while health workers watch. So many TB patients skip their pills when they feel better - but before all the bacteria are wiped out - health departments now enforce what's called "directly observed therapy."
For most diseases, however, patients must choose to take their medicines. The new report combs a decade of research to conclude people generally do a lousy job.
Among findings from the nonprofit National Council on Patient
Information and Education:
Particularly at risk are people whose diseases are initially symptom-free. Although high blood pressure more than triples the risk of heart disease, for example, just 51 percent of patients stick with their prescribed antidote.
Also at high risk are the elderly, but adherence is a problem for all ages. As few as 30 percent of teenagers correctly take drugs to prevent asthma attacks, for example.
Dire consequences aren't always a deterrent. Among patients already blind in one eye from glaucoma, only 58 percent were protecting the other eye. Another study found that 18 percent of kidney transplant recipients weren't following instructions to prevent organ rejection.
Even doctors mess up, acknowledging in one study adhering to their own prescriptions just 79 percent of the time.
Poor medication adherence can cost an extra $2,000 a year for each patient in extra doctor visits alone, and it's associated with as many as 40 percent of nursing home admissions, even more costly.
Add preventable hospitalizations and premature death, and the report estimates that poor medication adherence could be costing the country $177 billion in medical bills and lost productivity.
Why is taking medicines correctly so tough? One reason is the general confusion surrounding drugs, said Dr. Ruth Parker of Emory University, a co-author of the new report who has studied the issue for the American College of Physicians Foundation.
When the pharmacy hands over your prescription, there are bunches of papers - stapled to the bag, outside the box, glued to the bottle - that all bear drug information, but often with different wording.
Bottles are covered in warning stickers - such as "Take with food" or "Swallow whole" or "Don't use with XYZ other drug" - in so many colors that Parker compares pill containers to Christmas trees.
What in that jumble should patients pay most attention to?
Then there's the wording. Parker recently helped test the seemingly simple instruction "Take two tablets twice daily." Did that mean a total of two, or a total of four? A third of patients who were deemed literate got confused. A more clear instruction would be: "Take two tablets in the morning and two tablets at night."
Beyond literacy, poor eyesight plays a role. Pill-bottle instructions are rather tiny.
Whatever the cause, Clancy hopes to make "take your medicine" a new priority. Her Agency for Healthcare Research and QUality is starting discussions with the new report's authors, the FDA and health groups about steps to do that. Options range from attention-grabbing ads about the dangers of misusing medicines to better drug labels.
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