AlignMap In Cites

Excerpt: To learn more about adherence, a team of researchers from Johns Hopkins and University of Pennsylvania Schools of Medicine gave glaucoma patients a prostaglandin eyedrop medication at no cost and monitored use with an electronic device. “Eighty-six of our 196 study patients (44 percent) took their medication less than 75 percent of the time. A combined analysis found the most important factors were age (younger and older patients were less adherent), African-American ethnicity, and poorer overall health.

Excerpt:

Key Points

• Little is known about first-fill adherence patterns of patients receiving first prescription for asthma medications; adherence is necessary to improveoutcomes in this patient population.
• This is the largest study of its kind to analyze characteristics of first-fill or no-fill for asthmamedications. Of the 2023 patients with asthma in this study, 78% filled their first-time prescriptions ithin 30 days, and 22% did not.
• Patient copay of <$12 (the mean) resulted in a higher first-fill adherence rate than a copay of >$12.
• Other variables affecting first-fill medication adherence rates included  therapeutic class and route of administration, as well as controller and reliever type of medications.

1. Antiretroviral Therapy Adherence, Virologic and Immunologic Outcomes in Adolescents Compared With Adults in Southern Africa. Nachega JB, Hislop M, Nguyen H, Dowdy DW, Chaisson RE, Regensberg L, Cotton M, Maartens G.  J Acquir Immune Defic Syndr. 2009 Mar 11.
2. Transportation Costs Impede Sustained Adherence and Access to HAART in a Clinic Population in Southwestern Uganda: A Qualitative Study. Tuller DM, Bangsberg DR, Senkungu J, Ware NC, Emenyonu N, Weiser SD.  AIDS Behav. 2009 Mar 13.
3. Determinants of non-adherence to subsidized anti-retroviral treatment in southeast Nigeria. Uzochukwu BS, Onwujekwe OE, Onoka AC, Okoli C, Uguru NP, Chukwuogo OI.  Health Policy Plan. 2009 Mar 10

Excerpt:According to a recent University of Missouri survey that looked at 11,000 scheduled patient visits, patients who suggested the most convenient time for an appointment were more likely to show up than when the scheduler suggested the appointment time. Usually the scheduler was trying to book patients in the way that was most organized for the practice. For example, they’d schedule the first patient who called at 8:30 am Monday; the next one at 9:00 am Monday, etc.

When patients suggested their own appointment time, they took into account transportation schedule, family commitments, and other factors. When they tried to adapt their circumstances to the scheduler’s appointment, they were more likely to miss the appointment.

Except: In the postreminder implementation phase, women who received the intervention were 1.51 times more likely to undergo mammography than those in the comparison group (95% confidence interval [CI],1.40 – 1.62), after controlling for demographics and clinic visits.

Latest Compliance Enhancement Device: Zen the Border Collie

Excerpt: Every clinically study has to address the issue of patient compliance but sheep can be particularly difficult to keep on a program. Leaping out of stalls, running through fences and the desire to stay with the flock at all costs can make maintaining compliance hard work!

… Patient compliance can be a real struggle but having a dog to help is not an option for most practices.

Predictive modeling has many implications for compliance enhancment.

Excerpts:

Most predictive modelers are heavily dependent on medical and pharmacy claims data. It is well known that not all claims are created equal; for example incomplete or inaccurate coding, bundling or up-coding, and lags in submission may occur. Relying on information from claims data alone for validation of risk can lead to inappropriate allocation of services and missed opportunities for impact. Integration of key non-claims driven information is necessary to adjust the predicted risk.

Considerations include:

• Beneficiary-provided information can be invaluable in identifying risks. Behavioral aspects of a beneficiary, such as self-confidence, perceived barriers and readiness for change, can have significant impact on a person’s ability to actively participate in management of their health.
• Chronically ill and elderly individuals are at a greater risk for isolation and depression. Offering free access to a Health Risk Assessment (HRA) for beneficiaries, either on a Web portal or via a mailed paper form, can assist in identifying individuals with potential socialization or depression identified risks.
• The literacy level of an individual can influence their health outcomes and risk. If a beneficiary cannot understand instructions or read educational materials given to them on managing their chronic medical conditions, the chance for compliance with treatment regimes is greatly reduced. Non-compliance increases overall risk of disease progression and less than optimal outcomes.

… Integration of key information from disparate sources provides a more comprehensive view of a beneficiary across the healthcare continuum.

System driven processes and integrated quality of care alerts/reminders facilitate efficient, consistent workflows designed to meet the complex needs of Medicare care management programs.

Ongoing monitoring of targeted interventions for at-risk and high-risk beneficiaries through analysis and reporting tools enables efficient, comprehensive identification of program trends, risks and opportunities.

… Predictive modeling can help programs working with Medicare beneficiaries focus on identification and stratification of individuals at highest risk for costs and adverse outcomes. Combining this information with non-claims based beneficiary information can facilitate successful care management strategies and interventions resulting in positive clinical and financial outcomes.