A colleague of mine, Emily Stanziale, has started her own blog: Patient 2.0.
This blog chronicles her evolution as a patient in today's modern world, who uses both traditional and holistic methods for achieving better health. As with our Adherence 2.0 model, no patient is the same, and I can obviously say ditto for personal health blogs.
Over the last few months, she has suffered some ailments, and her doctor has had a difficult time deciphering what was wrong. This has lead her to re-examine her PCD's role, and search for answers. She is very honest with what she has been going through and well informed about the industry, as she works in pharma sales.
Please visit her blog to see her unique perspective on her own health, today's healthcare industry and Health 2.0. I hope you enjoy!
Wednesday, July 16, 2008
Improving medication adherence with a targeted, technology-driven disease management intervention
I found this abstract in NCBI: Pub Med from a BCBS of South Carolina study. The results definitely support our Adherence 2.0 model. The question is, should mail order pharmacies start sending refills if they are due? I know several pharmacies have auto-fill programs, but should there be a triggering mechanism that gets the refills out the door after a week?
I transfered a refill online at a big box retailer to check out their pharmacy services, and did not get around to picking it up for three weeks (I sent the refill early, and my wife had our second son the day after I sent the request). I went to pick it up, and the meds had been put back. They said it would be an hour wait, so I came back the next day.
I understand why they returned the meds, but there wasn't any contact to me - no one reached out. They had my email and telephone number, and I was signed up for their reminder program - but I received no notice. This not only lost the pharmacy money, but contributed to my non-adherence.
Would a community pharmacy have made a personalized call to let me know the script was sitting there? Should I have paid more for that service instead of opting for the "deal" at the big box? Should my health plan have been in the mix? These are all questions a patient has to decide for themselves, and the industry needs to think about.
From Pub Med:
Treatment adherence is critical in managing chronic disease, but achieving it remains an elusive goal across many prevalent conditions. As part of its care management strategy, BlueCross BlueShield of South Carolina (BCBSSC) implemented the Longitudinal Adherence Treatment Evaluation program, a behavioral intervention to improve medication adherence among members with cardiovascular disease and/or diabetes.
The objectives of this study were to 1) assess the effectiveness of telephonic intervention in influencing reinitiation of medication therapy, and 2) evaluate the rate and timing of medication reinitiation. BCBSSC applied algorithms against pharmacy claims data to identify patients prescribed targeted medications who were 60 or more days overdue for refills. This information was provided to care managers to address during their next patient contact.
Care managers received focused training on techniques for medication behavior change, readiness to change, motivational interviewing, and active listening. Training also addressed common barriers to adherence and available resources, including side effect management, mail order benefits, drug assistance programs, medication organizers, and reminder systems.
Overdue refills were tracked for 12 months, with medication reinitiation followed for an additional 3 months. In the intervention group, 94 patients were identified with 123 instances of late medication refills. In the age- and gender-matched comparison group, 61 patients were identified with 76 late refills.
The intervention group had a significantly higher rate of medication reinitiation (59.3%) than the control group (42.1%; P < 0.05). Time to reinitiation was significantly shorter in the intervention group, 59.5 (+/- 69.0) days vs. 107.4 (+/- 109) days for the control group (P < 0.05).
This initiative demonstrated that a targeted disease management intervention promoting patient behavior change increased the number of patients who reinitiated therapy after a period of nonadherence and decreased the time from nonadherence to adherence.
I transfered a refill online at a big box retailer to check out their pharmacy services, and did not get around to picking it up for three weeks (I sent the refill early, and my wife had our second son the day after I sent the request). I went to pick it up, and the meds had been put back. They said it would be an hour wait, so I came back the next day.
I understand why they returned the meds, but there wasn't any contact to me - no one reached out. They had my email and telephone number, and I was signed up for their reminder program - but I received no notice. This not only lost the pharmacy money, but contributed to my non-adherence.
Would a community pharmacy have made a personalized call to let me know the script was sitting there? Should I have paid more for that service instead of opting for the "deal" at the big box? Should my health plan have been in the mix? These are all questions a patient has to decide for themselves, and the industry needs to think about.
From Pub Med:
Treatment adherence is critical in managing chronic disease, but achieving it remains an elusive goal across many prevalent conditions. As part of its care management strategy, BlueCross BlueShield of South Carolina (BCBSSC) implemented the Longitudinal Adherence Treatment Evaluation program, a behavioral intervention to improve medication adherence among members with cardiovascular disease and/or diabetes.
The objectives of this study were to 1) assess the effectiveness of telephonic intervention in influencing reinitiation of medication therapy, and 2) evaluate the rate and timing of medication reinitiation. BCBSSC applied algorithms against pharmacy claims data to identify patients prescribed targeted medications who were 60 or more days overdue for refills. This information was provided to care managers to address during their next patient contact.
Care managers received focused training on techniques for medication behavior change, readiness to change, motivational interviewing, and active listening. Training also addressed common barriers to adherence and available resources, including side effect management, mail order benefits, drug assistance programs, medication organizers, and reminder systems.
Overdue refills were tracked for 12 months, with medication reinitiation followed for an additional 3 months. In the intervention group, 94 patients were identified with 123 instances of late medication refills. In the age- and gender-matched comparison group, 61 patients were identified with 76 late refills.
The intervention group had a significantly higher rate of medication reinitiation (59.3%) than the control group (42.1%; P < 0.05). Time to reinitiation was significantly shorter in the intervention group, 59.5 (+/- 69.0) days vs. 107.4 (+/- 109) days for the control group (P < 0.05).
This initiative demonstrated that a targeted disease management intervention promoting patient behavior change increased the number of patients who reinitiated therapy after a period of nonadherence and decreased the time from nonadherence to adherence.
Thursday, July 10, 2008
The President's Fitness Challenge
In response to a previous blog post, a colleague informed me that the President's Fitness Challenge is still around and is available online for adults.
How fit are you? Take the Challenge to find out.
How fit are you? Take the Challenge to find out.
Tuesday, July 8, 2008
Prescription Assistance Programs from Washington Post
I thought I had written about prescription assistance programs from major pharmaceutical companies in the past, but after reviewing my previous posts, I did not see any mention of them.
These PAPs are fantastic programs that basically give away medications or sell them at reduced costs for those patients who cannot afford to pay for them. Pfizer helped 1.1M patients last year with $800M worth of medications at wholesale pricing.
Here is the Washington Post Article from last week discussing PAPs and a not-for-profit web resource called NeedyMeds which connects patients to PAPs.
These PAPs are fantastic programs that basically give away medications or sell them at reduced costs for those patients who cannot afford to pay for them. Pfizer helped 1.1M patients last year with $800M worth of medications at wholesale pricing.
Here is the Washington Post Article from last week discussing PAPs and a not-for-profit web resource called NeedyMeds which connects patients to PAPs.
Cholesterol Drugs for Kids: New AAP Recommendations
I'm sure you have seen this blog by Tara Parker Pope by now or read about it from another news source, but I am a little slow coming back from vacation.
Cholesterol drugs for kids? I think this is a little ridiculous. When I was in grade school in the 80s, we had this thing called the President's Fitness Challenge (or Test?) - where all the students had to take this fitness test to see how you fared against the national average. That was only 25 years ago.
Do they still use this in schools? I agree testing for cholesterol is important, but how about diet and exercise instead of medicating children. We are so quick to medicate children for everything - can't concentrate, drug em, too fat, drug 'em. Shouldn't parents be a little more responsible in regards to their children's health?
I was diagnosed with high triglycerides and high cholesterol 14 months ago, and have been taking Tricor, and now Niaspan to lower my levels, and I have changed my diet. I am about 5 points from getting off the medications, luckiy, or the next step would have been a stain. From what I heave heard though, I wouldn't want to wish a statin on anyone, let alone a child.
This is a brief reporting on the AAP recommendation for cholesterol drugs for children from FirstWord by Bryan DeBusk:
The American Academy of Pediatrics on Monday announced new guidelines recommending cholesterol screening and treatment options for children. According to the new policy, patients over 8 years of age with high LDL concentrations should be considered for cholesterol-lowering drug therapy.
The organisation recommended that children and adolescents undergo cholesterol screening if they have a family history of high cholesterol or heart disease, an unknown family history, or risk factors such as obesity, high blood pressure or diabetes. Screening should occur between the ages of two and 10 years.
According to the new policy, patients over 8 years of age with high LDL concentrations should be considered for cholesterol-lowering drug therapy. Children under age 8 with high cholesterol should focus on exercise, nutrition and weight reduction, according to the AAP.
Stephen Daniels, a member of the AAP’s nutrition committee, said the guidelines are based in part on recent research demonstrating the safety of cholesterol-lowering drugs in children, and predicted that the new guidelines will result in long-term health benefits. “If we are more aggressive about this in childhood, I think we can have an impact on what happens later in life...and avoid some of these heart attacks and strokes in adulthood," Daniels suggested.
Previous recommendations from the AAP stated that cholesterol drugs should only be considered in children older than 10 years if they have not been able to lose weight.
Cholesterol drugs for kids? I think this is a little ridiculous. When I was in grade school in the 80s, we had this thing called the President's Fitness Challenge (or Test?) - where all the students had to take this fitness test to see how you fared against the national average. That was only 25 years ago.
Do they still use this in schools? I agree testing for cholesterol is important, but how about diet and exercise instead of medicating children. We are so quick to medicate children for everything - can't concentrate, drug em, too fat, drug 'em. Shouldn't parents be a little more responsible in regards to their children's health?
I was diagnosed with high triglycerides and high cholesterol 14 months ago, and have been taking Tricor, and now Niaspan to lower my levels, and I have changed my diet. I am about 5 points from getting off the medications, luckiy, or the next step would have been a stain. From what I heave heard though, I wouldn't want to wish a statin on anyone, let alone a child.
This is a brief reporting on the AAP recommendation for cholesterol drugs for children from FirstWord by Bryan DeBusk:
The American Academy of Pediatrics on Monday announced new guidelines recommending cholesterol screening and treatment options for children. According to the new policy, patients over 8 years of age with high LDL concentrations should be considered for cholesterol-lowering drug therapy.
The organisation recommended that children and adolescents undergo cholesterol screening if they have a family history of high cholesterol or heart disease, an unknown family history, or risk factors such as obesity, high blood pressure or diabetes. Screening should occur between the ages of two and 10 years.
According to the new policy, patients over 8 years of age with high LDL concentrations should be considered for cholesterol-lowering drug therapy. Children under age 8 with high cholesterol should focus on exercise, nutrition and weight reduction, according to the AAP.
Stephen Daniels, a member of the AAP’s nutrition committee, said the guidelines are based in part on recent research demonstrating the safety of cholesterol-lowering drugs in children, and predicted that the new guidelines will result in long-term health benefits. “If we are more aggressive about this in childhood, I think we can have an impact on what happens later in life...and avoid some of these heart attacks and strokes in adulthood," Daniels suggested.
Previous recommendations from the AAP stated that cholesterol drugs should only be considered in children older than 10 years if they have not been able to lose weight.
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