I have found a lot of abstracts today dealing with psychiatric non-adherence to medication: factors and solutions. Here is one of them and the link to get the full paper itself. It is a pdf freebee from Science Direct at the bottom of the post. Once I read the paper I will have more comments.
Medication adherence is crucial in psychiatry, especially for chronic disorders. Both clinician and patient share responsibility for adherence, which is rarely an all-or-none phenomenon. For psychiatric drugs, non-adherence rates are approximately 40–60%. Such non-adherence explains much of the difference between drug efficacy and effectiveness, as demonstrated by higher relapse rates in non-adherent patient groups. Thus, non-adherence impacts profoundly on clinical and economic burdens for health services. During clinical assessment, predictive factors of non-adherence should be considered, including: a prior history of non-adherence; alcohol or substance misuse or where treatment is during an asymptomatic phase.
Similarly, drug dose and formulation polypharmacy, side effects and the therapeutic relationship also affect adherent behaviour.
Psychoeducational interventions aiming to enhance adherence focus primarily on imparting knowledge, rather than on attitudinal and behavioural change, and have proved largely ineffective. Individual psychological interventions are more effective as they specifically target the patient’s beliefs and attitudes concerning the illness and medication by utilizing cognitive–behavioural or motivational interviewing techniques.
Compliance therapy combines all of these. All clinicians should routinely use simple adherence-enhancing techniques, particularly as dedicated resources for specialist interventions remain rare. Moreover, in an attempt to further reduce the adverse clinical and economic impact of non-adherence, it is imperative that patients are given the opportunity to have their personal individual perspectives adequately heard.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B82Y7-4PN7KJV-4&_user=10&_coverDate=09%2F30%2F2007&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=849f29cf71a299db513642dc3ab73594#
Friday, September 14, 2007
Wednesday, September 12, 2007
An Abstract That Makes You Go Duh
I have read a couple of interesting abstracts over the last few days but this one just struck me as a "duh, of course" finding. I am all for research in developing countries, and for studies regarding technology for health promotion and medication adherence - I mean I work for a healthcare technology company that is focused on medication adherence - BUT this study just seems a little unnecessary and the findings a little weak for me to digest. I would like to know how much it cost and who had the bright idea to do this. Was an all expense trip to Peru part of the reasoning?
I am probably just a little miffed because when I read the title I was pretty excited to see the paper - but when I read the abstract, I was disappointed. This must of been how my 6th grade teacher felt about my book report on The Old Man and the Sea: a man went fishing and caught a fish.
Here is the provisional abstract for you to decide from BMC:
Access, use and perceptions regarding Internet, cell phones and PDAs as a means for health promotion for people living with HIV in Peru
Background:
Internet tools, cell phones, and other information and communication technologies are being used by HIV-positive people on their own initiative. Little is known about the perceptions of HIV-positive people towards these technologies in Peru. The purpose of this paper is to report on perceptions towards use of information and communication technologies as a means to support antiretroviral medication adherence and HIV transmission risk reduction.
Methods:
We conducted a qualitative study (in-depth interviews) among adult people living with HIV in two community-based clinics in Peru.
Results:
31 HIV-positive individuals in Lima were interviewed (n = 28 men, 3 women). People living with HIV in Peru are using tools such as cell phones, and the Internet (via E-mail, chat, list-serves) to support their HIV care and to make social and sexual connections. In general, they have positive perceptions about using the Internet, cell phones and PDA for HIV health promotion interventions.
Conclusions:
Health promotion interventions using information and communication technology tools among people living with HIV in resource-constrained settings may be acceptable and feasible, and can build on existing patterns of use.
I am probably just a little miffed because when I read the title I was pretty excited to see the paper - but when I read the abstract, I was disappointed. This must of been how my 6th grade teacher felt about my book report on The Old Man and the Sea: a man went fishing and caught a fish.
Here is the provisional abstract for you to decide from BMC:
Access, use and perceptions regarding Internet, cell phones and PDAs as a means for health promotion for people living with HIV in Peru
Background:
Internet tools, cell phones, and other information and communication technologies are being used by HIV-positive people on their own initiative. Little is known about the perceptions of HIV-positive people towards these technologies in Peru. The purpose of this paper is to report on perceptions towards use of information and communication technologies as a means to support antiretroviral medication adherence and HIV transmission risk reduction.
Methods:
We conducted a qualitative study (in-depth interviews) among adult people living with HIV in two community-based clinics in Peru.
Results:
31 HIV-positive individuals in Lima were interviewed (n = 28 men, 3 women). People living with HIV in Peru are using tools such as cell phones, and the Internet (via E-mail, chat, list-serves) to support their HIV care and to make social and sexual connections. In general, they have positive perceptions about using the Internet, cell phones and PDA for HIV health promotion interventions.
Conclusions:
Health promotion interventions using information and communication technology tools among people living with HIV in resource-constrained settings may be acceptable and feasible, and can build on existing patterns of use.
Pfizer Follow-up /Other Blogs
I am so behind on reading other blogs and postings that I failed to see others have written more in-depth and critical blogs about the Pfizer study I wrote about in my last post.
It has been pointed out to me that Dr. Showalter at AlignMap felt my post was "lacking in the kind of embittered cynicism characteristic of the AlignMap perspective." And by pointed out, I mean I read it on his blog.
He offers a much deeper analysis of this "study" as well as better comments on his blog dated 09.08.07: http://alignmap.com/category/blog. (I promise one day I will learn how create the best links and pictures and all of that).
I appreciate his experienced take on the Pfizer press release and his embittered criticism of the pharma industry spinning this study. I am slowly getting a handle on how to properly interpret the different "findings" and "studies" funded by pharmaceutical companies.
Dr. Rost also rips pharma reporters and Pfizer on his Question Authority site. This is not new for him considering he is a former Pfizer VP and whistleblower. I think he is somewhat full of himself but I will not go into right now.
There is a funny blog that started a few days ago that just rips into Rost and his QA blog, as well as his new gig as writer for BrandweekNRX - plus the blatant self-promotion of himself, the ranking of his blogs and his novels: http://pharmayobbosphere.blogspot.com. I don't know if it is serious or not since the tone is quite funny, and the blogger himself is quite full of himself.
Self promotion is important, but to a point. When that promotion gets in the way of what you are supposedly presenting/representing in your blog/space/whatever. i.e. Question Authority, I assume, wants to question the authority of the pharma industry. There is a blurb from Fortune that says Rost is the "drug industry's most annoying - and effective - online scourge."
There is a sidebar where you can buy his novel - everyone has to make money.
His post from 9/11 is a Daily Show Clip parody. Very Funny. Then a listing of top medblogs, then a piece about a woman banned from smoking in her garden, followed by a promotion about Rost being involved in a Senate investigation regarding taxing big pharma.
9/10: Mentions he is getting suggestions to do pharma related postings on NRX and post things on his own blog for "regular readers". Followed by a map showing how America is #1 in our minds, a clip about a beer scooter, and two pieces about the best blogs.
9/8: States that is time for a change and that he is tired of pharma blogging - but has to do if for work on brandweekNRX. Then cites Pharmalot as doing a better job (which it is) of reporting real news.
9/7: A posting of a hand shadow show from YouTube.
9/6: A posting about the best pharma sites.
Doesn't this signal that it is time for Dr. Rost to put Question Authority to pasture? He could keep the url: perterrost.blogspot.com - and just have it to promote himself.
That is my recomendation - but I have only had 450 or so visitors in 3 months - not the thousands Rost gets daily, so who really cares what I think?
To keep inline with what I present/represent: stay adherent to your medication regime - drugs don't work unless you take them.
It has been pointed out to me that Dr. Showalter at AlignMap felt my post was "lacking in the kind of embittered cynicism characteristic of the AlignMap perspective." And by pointed out, I mean I read it on his blog.
He offers a much deeper analysis of this "study" as well as better comments on his blog dated 09.08.07: http://alignmap.com/category/blog. (I promise one day I will learn how create the best links and pictures and all of that).
I appreciate his experienced take on the Pfizer press release and his embittered criticism of the pharma industry spinning this study. I am slowly getting a handle on how to properly interpret the different "findings" and "studies" funded by pharmaceutical companies.
Dr. Rost also rips pharma reporters and Pfizer on his Question Authority site. This is not new for him considering he is a former Pfizer VP and whistleblower. I think he is somewhat full of himself but I will not go into right now.
There is a funny blog that started a few days ago that just rips into Rost and his QA blog, as well as his new gig as writer for BrandweekNRX - plus the blatant self-promotion of himself, the ranking of his blogs and his novels: http://pharmayobbosphere.blogspot.com. I don't know if it is serious or not since the tone is quite funny, and the blogger himself is quite full of himself.
Self promotion is important, but to a point. When that promotion gets in the way of what you are supposedly presenting/representing in your blog/space/whatever. i.e. Question Authority, I assume, wants to question the authority of the pharma industry. There is a blurb from Fortune that says Rost is the "drug industry's most annoying - and effective - online scourge."
There is a sidebar where you can buy his novel - everyone has to make money.
His post from 9/11 is a Daily Show Clip parody. Very Funny. Then a listing of top medblogs, then a piece about a woman banned from smoking in her garden, followed by a promotion about Rost being involved in a Senate investigation regarding taxing big pharma.
9/10: Mentions he is getting suggestions to do pharma related postings on NRX and post things on his own blog for "regular readers". Followed by a map showing how America is #1 in our minds, a clip about a beer scooter, and two pieces about the best blogs.
9/8: States that is time for a change and that he is tired of pharma blogging - but has to do if for work on brandweekNRX. Then cites Pharmalot as doing a better job (which it is) of reporting real news.
9/7: A posting of a hand shadow show from YouTube.
9/6: A posting about the best pharma sites.
Doesn't this signal that it is time for Dr. Rost to put Question Authority to pasture? He could keep the url: perterrost.blogspot.com - and just have it to promote himself.
That is my recomendation - but I have only had 450 or so visitors in 3 months - not the thousands Rost gets daily, so who really cares what I think?
To keep inline with what I present/represent: stay adherent to your medication regime - drugs don't work unless you take them.
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."
More ADHD Adherence News
I picked this blip up from spiritindia.com, which calls itself "an amazing health tech site". I'll look into it more.
The Food and Drug Administration approved Alliant's Methylin Chewable Tablets and Methylin Oral Solution and the pediatric specialty pharmaceutical company said the goal is to increase compliance.
Dr. Lyndon Waugh of Emory University said children often have difficulty swallowing pills so the new offerings could help ensure they take their medication. It's estimated up to 26 percent of the general population has difficulty swallowing tablets and capsules and the percentage is considered higher for children.
ADHD is a brain disorder that causes children to exhibit inappropriate impulsivity or inattention. It is estimated that 7 percent of school-age children and 4 percent of adults suffer from ADHD, one of the most commonly reported behavioral problems.
My Comment
When I was young (34 now), I had the Flintstone chewable vitamins, as well as the St. Joseph's aspirin, so does this really come as a shock that kids have a difficult time with tablets and pills? Luckily I never suffered from ADHD or any deficit disorders, but hasn't that been the "easy" diagnosis for doctors for many years now? But 7% doesn't seem that high. Maybe I'm confused with ADD?
I know the parameters for diagnosing autism in children have gotten less stringent, raising the diagnosed numbers. But shouldn't ADHD be higher as well?
All I know if that anything pharma does to increase adherence is OK in my book.
The Food and Drug Administration approved Alliant's Methylin Chewable Tablets and Methylin Oral Solution and the pediatric specialty pharmaceutical company said the goal is to increase compliance.
Dr. Lyndon Waugh of Emory University said children often have difficulty swallowing pills so the new offerings could help ensure they take their medication. It's estimated up to 26 percent of the general population has difficulty swallowing tablets and capsules and the percentage is considered higher for children.
ADHD is a brain disorder that causes children to exhibit inappropriate impulsivity or inattention. It is estimated that 7 percent of school-age children and 4 percent of adults suffer from ADHD, one of the most commonly reported behavioral problems.
My Comment
When I was young (34 now), I had the Flintstone chewable vitamins, as well as the St. Joseph's aspirin, so does this really come as a shock that kids have a difficult time with tablets and pills? Luckily I never suffered from ADHD or any deficit disorders, but hasn't that been the "easy" diagnosis for doctors for many years now? But 7% doesn't seem that high. Maybe I'm confused with ADD?
I know the parameters for diagnosing autism in children have gotten less stringent, raising the diagnosed numbers. But shouldn't ADHD be higher as well?
All I know if that anything pharma does to increase adherence is OK in my book.
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