AlignMap In Cites

Excerpt: The [Obama] stimulus also targets programs with the greatest potential to improve the quality of primary care and extend it to a greater number of people. One such program is the Patient Centered Medical Home (PCMH), a work-in-progress since the late 1960s. Stated simply, PCMH is about forging tight partnerships between primary physicians, patients, and when desirable, family members. These alliances are supported by up-to-date, electronic record keeping, allowing doctors to track the progress of patients in their care on an ongoing, holistic basis. The PCMH approach takes aim at two primary goals in medicine. One, to manage disease through prevention. Two, to prescribe medication for problems-in-the-making before they can become acute.

Doctors’ unrestricted access to patient information is a PCMH keystone and an aspect of the concept especially relevant to pharma. According to some estimates, roughly 50% of patients on regular medication stop taking their meds after just one year. There are also a significant number of people who fail to fill prescriptions the first time due to their high costs or the perception that the medicine is unnecessary or will prove ineffective. This, in fact, is often a dangerous misperception well-illustrated in the case of hypertension. For many, the condition presents no obvious symptoms, yet untreated, high blood pressure can bring on fatal consequences.

“When the PCMH concept is embraced nationwide, it will have tremendously positive ramifications for both patients and the pharmaceutical industry,” says Edwina Rogers, executive director, Patient Centered Primary Care Collaborative, a Washington-based trade association and foundation for stakeholders in the medical home movement. “A large piece of the home movement is medication management and adherence to recommended pharmaceuticals. A required part of the model ensures prescriptions are filled, with a clinical pharmacist or caseworker monitoring the process.

Abstract—More intensive management can improve controlblood pressure (BP) in hypertensive patients. However, manywould posit that treatment intensification (TI) is not beneficialin the face of suboptimal adherence. We investigated whetherthe effect of TI on BP varies by adherence. We enrolled 819patients with hypertension, managed in primary care at an academically-affiliatedinner-city hospital. We used the following formula to characterizeTI: (visits with a medication change-visits with elevated BP)/totalvisits. Adherence was characterized using electronic monitoringdevices (“MEMS caps”). Patients who returned their MEMS caps(671) were divided into quartiles of adherence, whereas patientswho did not return their MEMS caps (148) had “missing” adherence.We examined the relationship between TI and the final systolicblood pressure (SBP), controlling for patient-level covariates.In the entire sample, each additional therapy increase per 10visits predicted a 2.0 mm Hg decrease in final SBP (P<0.001).After stratifying by adherence, in the “best” adherence quartileeach therapy increase predicted a 2.1-mm Hg decrease in finalSBP, followed by 1.8 for the “next-best” adherence quartile,2.3 in the third quartile, and 2.4 in the “worst” adherencequartile. The effect size for patients with “missing” adherencewas 1.6 mm Hg. The differences between the group with “best”adherence and the other 4 groups were not statistically significant.In this observational study, treatment intensification was associatedwith similar BP improvement regardless of the patient’s levelof adherence. A randomized trial could further examine optimalmanagement of patients with suboptimal adherence.

Excerpt:  Last year, AmeriGas Propane Inc. gave its employees an ultimatum: get their medical checkups, or lose their health insurance.

The nationwide propane distributor took the unusual step after facing years of steep increases in the cost of health coverage for its roughly 6,000 workers. The company’s work force was aging, and many employees had unhealthy habits—the average worker is 46, and around 44% are smokers. And people weren’t getting tests or preventive care that could help them avoid heart attacks, diabetes or cancer.

AmeriGas had tried a number of voluntary wellness programs to encourage healthy habits in its employees. But the company concluded that “optional programs just don’t work,” says Bill Katz, vice president for human resources.

Then, beginning last year, the company mandated that all employees would have to get physical exams, blood-pressure checks and cholesterol and blood-sugar tests. Women also were required to get Pap smears, and mammograms for those 40 and older.

Workers and their covered spouses would have a year to complete the tests, which are covered 100%, or lose their insurance. And they’d need to keep getting the checkups at least every two years in order to retain the health benefits.

From the post:

Medication compliance technologies
These technologies have monitoring, reminding, dispensing features and combinations thereof. Most of these technologies are stand-alone and are targeted at the seniors or the caregiver. Simple monitoring is offered by QuietCare. Intel and Oregon Health and Sciences University (OHSU) (www.orcatech.org/index.php) have prototypes of monitoring and reminding systems and Honeywell HomMed has a medication monitoring and reminding system as part of the telemedicine suite. The Med-eMonitor from Informedix (www.informedix.com) incorporates reminding and educational information/ instructions. The MD2 (www.md2.com) and CompuMed (www.compumed.com) products have the dispensing functionality but may require a professional caregiver to perform the loading and programming. Most products have usability/ user interface issues for elderly users. Many products can be found on the Internet (e.g. on www.epill.com).

These devices have the potential to improve health outcomes and reduce cost of care, and to provide peace of mind to informal caregivers, but are generally not reimbursable. There is some preliminary evidence of their effectiveness in improving medication compliance, but more objective evaluation studies, aiming to evaluate their impacts on health outcomes and the cost of care, are warranted.

Open communication, including adverse events, is key to transforming patient compliance to a useful concept.

The focus of this article is on the legal and practical aspects of noncompliane with only a passing glance at causes clinical management.

This study has been touted elsewhere  (not by the research team itself) as demonstrating that “E-mail reminders to exercise and eat healthy are effective in modifying behavior.”  (quote is from  E-mail wellness program encourages patient compliance, study finds)  The abstract indicates that the program is more than just reminders: “[ALIVE is] a 16-week e-mail program offered individually tailored, small-step goals; a personal homepage with tips; educational materials; and tracking and simulation tools.” It should also be noted that the data was gathered by self-report of the subjects.

” …  the transplant recipients receive a text message reminding them to take their anti-rejection medications. If they don’t respond to the text message, their adult caregiver will then receive a text message. Since taking anti-rejection medications at the same time every day is important for preventing rejection, and “I forgot” is the most common reason for missing medication, the new program is designed to provide a reminder to teen patients in a way that is user friendly. … A blood test is done that helps determine compliance with medication, … [and] rates of rejection episodes are counted. In this case, rejection episodes dropped from 12 in one year to 2 for patients in the program.”