On a personal note, I was diagnosed with a rare blood disease this morning. Unfortunately I forgot the name of the disease but will post again later when I know more about it. Perhaps start a new blog. It has something to do with a build up of iron in the blood.
I do not necessarily have this disease, but I have one of the genes that patients of this disease have. My MD mentioned homo and hetero genes - I have one but not two. It is something he wants to monitor every three months or so.
Point being: my doctor said this disease is fatal, but easily treatable - I just have to give a pint of blood twice a year or so.
Thus what should I do? Be non-adherent and DIE, or go to the doctor and extra two times a year and let him take some blood?
Tough question.
If there was two of me - based on the national non-adhrence numbers - one would die and the other would live.
I think I will choose to live.
Monday, September 24, 2007
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.
Wow I hit the 500 Mark!!!!
I am very excited for myself and hope that the people who have read this blog have learned more about medication adherence and realize it is a serious problem that needs to be addressed. $177 BILLION can be saved - well probably not all of it, but a fair amount can be saved if patients would properly take their medications as prescribed and caregivers have the means to properly medicate their wards.
The real number is probably a lot less as I visit my blog at least 10 times a week - and the counter has been up since July 10th - so that is about 115 visits by me alone!
In any case, I am here to inform and help if I can.
Stay adherent!
The real number is probably a lot less as I visit my blog at least 10 times a week - and the counter has been up since July 10th - so that is about 115 visits by me alone!
In any case, I am here to inform and help if I can.
Stay adherent!
Insulin Pen
This little blurb from KHTS Radio AM 1220, a Santa Clarita CA radio station. I do not have much to say about this at the moment, other than sounds good! I will look into this some more.
The new insulin pen, which was made available this month, combines the insulin cartridge and syringe in a single unit, making regular use more convenient, which doctors say decreases claims of hypoglycemic episodes, emergency room and physician visits, and overall treatment costs.
“The pen is a huge, huge benefit in the treatment of diabetes,” said Reza Bonabi, M.D., a Diabetalogist and chairman of the diabetes committee at Providence Holy Cross Medical Center. “The pen will reduce dosage error, is easy to administer, and will decrease the cost of treatment for both the hospital and patient.”
Won Chan Lee, Ph.D., Abbott Laboratories’ Associates Director of Health Economics, studied the effects of the new device. "As evidenced by the marked improvement in medication adherence rates, patients who switched to the insulin pen found that its convenience and ease of use gave them a new ability to self-manage their condition and a resulting freedom from complications and visits to the emergency room,” Lee said.
“But our study also demonstrated a true 'win-win' situation, for individuals with diabetes and for society as a whole, due to significant decreases in the costs associated with hypoglycemic events — events that can be kept at a manageable level or avoidable, as long as a patient adheres to his or her treatment."
Hospital employees also are less at risk at being pricked by a needle when using the pen to provide insulin to the patients, said Donna Ryan, Diabetes Department Coordinator at Providence Holy Cross Medical Center
The new insulin pen, which was made available this month, combines the insulin cartridge and syringe in a single unit, making regular use more convenient, which doctors say decreases claims of hypoglycemic episodes, emergency room and physician visits, and overall treatment costs.
“The pen is a huge, huge benefit in the treatment of diabetes,” said Reza Bonabi, M.D., a Diabetalogist and chairman of the diabetes committee at Providence Holy Cross Medical Center. “The pen will reduce dosage error, is easy to administer, and will decrease the cost of treatment for both the hospital and patient.”
Won Chan Lee, Ph.D., Abbott Laboratories’ Associates Director of Health Economics, studied the effects of the new device. "As evidenced by the marked improvement in medication adherence rates, patients who switched to the insulin pen found that its convenience and ease of use gave them a new ability to self-manage their condition and a resulting freedom from complications and visits to the emergency room,” Lee said.
“But our study also demonstrated a true 'win-win' situation, for individuals with diabetes and for society as a whole, due to significant decreases in the costs associated with hypoglycemic events — events that can be kept at a manageable level or avoidable, as long as a patient adheres to his or her treatment."
Hospital employees also are less at risk at being pricked by a needle when using the pen to provide insulin to the patients, said Donna Ryan, Diabetes Department Coordinator at Providence Holy Cross Medical Center
Friday, September 14, 2007
ePrescribing in Mississippi
You don't really think of Mississippi as being an early adopter of technology, but this article on FCW.com, states otherwise. My comments are below.
E-prescribing PDAs save millions for Mississippi Medicaid BY Nancy Ferris
Mississippi’s Medicaid program is saving about $1.2 million per month in prescription costs as a result of equipping 225 doctors with handheld e-prescribing devices.
State officials say the system not only reduces medication costs, it also increases the quality of care for patients. That's because doctors have access to patients’ recent medication histories and can avoid prescribing medicines that would interact with ones they are already taking.
In addition, doctors can find out whether patients are filling and refilling their prescriptions. This allows them to detect when patients’ continued poor health is due to noncompliance with the doctors’ treatment plans.
Prescribers who use the handheld devices write fewer prescriptions on average, state officials said, and those prescriptions are likely to cost the state less.
After 18 months of steady savings, the Mississippi Division of Medicaid is negotiating with its contractor to expand the e-prescribing program, officials said.
Besides cutting drug costs, the state is saving nearly $27,000 a month on hospitalizations avoided because the doctors are getting real-time alerts about drug interactions, they said.
The program costs the state about $35,000 per month, so the hospitalization savings come close to covering the cost of the handheld devices from Informed Decisions, based in Tampa, Fla.
Florida has launched a similar program, with comparable results.
Asked whether there was any negative aspect to the program, Mississippi officials said they knew of none.
“I can see which medications patients are taking regardless of who prescribed them. As a result, we are now able to keep comprehensive, up-to-date medication lists for all our patients,” said Dr. Kurt Bruckmeier, who cares for about 200 Medicaid beneficiaries through Pacific Physicians Services in Hattiesburg, Miss. “It has also helped identify drug abusers who would very likely have gone undetected were it not for our ability to evaluate the full scope of prescriptions they were taking.”
COMMENTS:
I think this is a fantastic program that will pay for itself over a very short time. ePrescribing and medication adherence go hand in hand - especially when it comes to refills. I am not familiar with pharmacy policy, but do they tell the MD when you do not refill a script? I don't think so. With all scripts and patient information linked up via these PDAs or hand tablets, MDs have all the info at their fingertips - as well as drug-drug interaction information to reduce ADRs.
The problems arise however when the technology fails and the MDs have no idea what is going on with the patient. I'm sure there are back-ups and colocation servers, but in Ol' Miss there could be flooding, hurricanes, fires, etc.... Also, as we have seen with Pfizer of the last couple of weeks, what happens when someone hacks into the system? Not that medical records of the elderly have that much value (no offense) but it is protected information that anyone can blast out over the internet or use to for blackmail (that might not happen but it could!).
This works into the EHRs that many tech companies, MDs and healthcare providers are trying to adopt. I like the idea, and use one on Revolution Health but at the same time I am wary about that information out there. Not that I have anything to hide, but I do not know who is looking at that information. Some techie who is performing a system analysis? They also capture what you are interested in, what medications you are on, etc.... which they can then use to market your "eyes" to advertisers.
Also health social networking sites which encourage you to sign up for chat groups and the like - all that information goes somewhere and is monetized somehow. Sorry for that little rant. These are all opt-in websites and have strict privacy policies and terms of use.
This of course would not happen with the proper EHRs and ePrescribing tools since they are covered under HIPPA and would be gross misconduct if that information was shared. So I encourage the technological advances - if you are heli-skiing in Canada and break your leg, the mountain MD with a handheld internet browser can see what meds you are on and your history of broken bones, your allergies, etc... And this makes for safe practices. Scuba diving in the Maldives and black-out from NO2 poisoning - same thing. When all medical records are computerized and on servers, it will be safer to get into an accident /life threatening situation!
Go forth Ol' Miss and show us the benefits of ePrescribing and adopt that new technology!
E-prescribing PDAs save millions for Mississippi Medicaid BY Nancy Ferris
Mississippi’s Medicaid program is saving about $1.2 million per month in prescription costs as a result of equipping 225 doctors with handheld e-prescribing devices.
State officials say the system not only reduces medication costs, it also increases the quality of care for patients. That's because doctors have access to patients’ recent medication histories and can avoid prescribing medicines that would interact with ones they are already taking.
In addition, doctors can find out whether patients are filling and refilling their prescriptions. This allows them to detect when patients’ continued poor health is due to noncompliance with the doctors’ treatment plans.
Prescribers who use the handheld devices write fewer prescriptions on average, state officials said, and those prescriptions are likely to cost the state less.
After 18 months of steady savings, the Mississippi Division of Medicaid is negotiating with its contractor to expand the e-prescribing program, officials said.
Besides cutting drug costs, the state is saving nearly $27,000 a month on hospitalizations avoided because the doctors are getting real-time alerts about drug interactions, they said.
The program costs the state about $35,000 per month, so the hospitalization savings come close to covering the cost of the handheld devices from Informed Decisions, based in Tampa, Fla.
Florida has launched a similar program, with comparable results.
Asked whether there was any negative aspect to the program, Mississippi officials said they knew of none.
“I can see which medications patients are taking regardless of who prescribed them. As a result, we are now able to keep comprehensive, up-to-date medication lists for all our patients,” said Dr. Kurt Bruckmeier, who cares for about 200 Medicaid beneficiaries through Pacific Physicians Services in Hattiesburg, Miss. “It has also helped identify drug abusers who would very likely have gone undetected were it not for our ability to evaluate the full scope of prescriptions they were taking.”
COMMENTS:
I think this is a fantastic program that will pay for itself over a very short time. ePrescribing and medication adherence go hand in hand - especially when it comes to refills. I am not familiar with pharmacy policy, but do they tell the MD when you do not refill a script? I don't think so. With all scripts and patient information linked up via these PDAs or hand tablets, MDs have all the info at their fingertips - as well as drug-drug interaction information to reduce ADRs.
The problems arise however when the technology fails and the MDs have no idea what is going on with the patient. I'm sure there are back-ups and colocation servers, but in Ol' Miss there could be flooding, hurricanes, fires, etc.... Also, as we have seen with Pfizer of the last couple of weeks, what happens when someone hacks into the system? Not that medical records of the elderly have that much value (no offense) but it is protected information that anyone can blast out over the internet or use to for blackmail (that might not happen but it could!).
This works into the EHRs that many tech companies, MDs and healthcare providers are trying to adopt. I like the idea, and use one on Revolution Health but at the same time I am wary about that information out there. Not that I have anything to hide, but I do not know who is looking at that information. Some techie who is performing a system analysis? They also capture what you are interested in, what medications you are on, etc.... which they can then use to market your "eyes" to advertisers.
Also health social networking sites which encourage you to sign up for chat groups and the like - all that information goes somewhere and is monetized somehow. Sorry for that little rant. These are all opt-in websites and have strict privacy policies and terms of use.
This of course would not happen with the proper EHRs and ePrescribing tools since they are covered under HIPPA and would be gross misconduct if that information was shared. So I encourage the technological advances - if you are heli-skiing in Canada and break your leg, the mountain MD with a handheld internet browser can see what meds you are on and your history of broken bones, your allergies, etc... And this makes for safe practices. Scuba diving in the Maldives and black-out from NO2 poisoning - same thing. When all medical records are computerized and on servers, it will be safer to get into an accident /life threatening situation!
Go forth Ol' Miss and show us the benefits of ePrescribing and adopt that new technology!
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