AlignMap In Cites

Do IMF loans lead to higher rates of tuberculosis?

Wed, 23 Jul 2008 15:07:38 -0500

Do IMF loans lead to higher rates of tuberculosis? : Sydney Spiesel in the July 22, 2008 edition of Slate Magazine discusses a new paper that argues a nation’s health declines upon accepting an IMF loan. “In all of the countries under scrutiny, as IMF loans increased, so did tuberculosis death rates. For every 1 percent increase in credit, the TB mortality rate climbed by 0.9 percent. The longer IMF loans lasted, the greater the rate of tuberculosis deaths: Every extra year of money was associated with about a 4 percent increase in deaths.” The reason? “The stringent conditions attached to IMF loans often lead to cutbacks in employing [public health] workers [responsible for implementing DOTS].” An interesting read about a counterintuitive result.

Why Games Matter: A Prescription for Improving Health and Health Care

Tue, 22 Jul 2008 11:44:23 -0500

Why Games Matter: A Prescription for Improving Health and Health Care: Winners of the 2007 Why Games Matter competition sponsored by Changemakers in partnership with the Robert Wood Johnson Foundation. The first place winner, Freedom HIV/AIDS - Mobile Phone Games to create HIV/AIDS awareness in Asia and Africa, is directly related to compliance but several of the games are intriguing and worth at least a quick review.

AlignMap In Cites is active again.After a lapse caused by the...

Mon, 21 Jul 2008 22:49:04 -0500

AlignMap In Cites is active again.After a lapse caused by the illness and, finally, the death of a loved one, my posting here will begin again this week.

Kinda.

All authors, whether writing novels, movie scripts, doctoral dissertations, limericks, advertising copy, pornography, epic poems, or blog posts, require two elements: time and money.

Creating and maintaining a non-revenue web site about patient compliance is gratifying as all get-out but unless I can finagle a scam to rake in some bucks from these idiosyncratic displays of literary semicolon-wielding scribblings, HTML manipulation, and footnoted snarkiness, I face the joy-draining prospect of earning an honest dollar.

Although I intend to write about patient compliance, the extent, focus, and format of this effort are up for grabs.

Credit Due Department: The nifty AlignMap word cloud atop this post was generated by The Wordle Web Site

Little Devices That Could: Making sure you eat your Wheaties...

Sun, 01 Jun 2008 12:54:51 -0500

Little Devices That Could: Making sure you eat your Wheaties (and take your meds) Well written article with minimal jargon that neatly explicates the differences between what the author labels “pillbox technology” that relies on the honor system and “detection-and-monitor” technologies, such as Exhale’s breathalyzer, that can detrmine whether or not the specified medication entered the body, thus confirming compliance or noncompliance.

Postcard Mailings Drive More Smokers to Quit Lines

Sun, 01 Jun 2008 04:57:45 -0500

Postcard Mailings Drive More Smokers to Quit Lines: [Summary of O’Connor RJ, et al. Using direct mail to prompt smokers to call a quit line. Health Promot Pract 9(3), 2008.] Excerpt: O’Connor and colleagues mailed postcards promoting the services of a New York smoking cessation quit line and offering a two-week free starter kit of nicotine patches to the homes of 77,527 smokers, at an average mailing cost of 35 cents per household. Smokers randomly received one of two versions of the postcards: one version described the benefits of the nicotine patch and the other dispelled fears about the health risks of the nicotine patch. The findings appear in the July issue of the journal Health Promotion Practice. “Between 1 percent and 4 percent of smokers who received an unsolicited mailing about the quit line responded to the card,” O’Connor said. The study found that in the 15-day period following the mailing, call volume increased 36 percent — from an average of 139 calls per day before the mailing to 189 calls afterward. In addition, smokers who called because they had received a postcard were more likely to request free nicotine patches, a finding that suggests, “The mailing promotion successfully communicated the availability of free nicotine medications to those who received it,” the authors say.

Bonkers Institute: The patient is cheating himself More...

Wed, 28 May 2008 19:22:34 -0500

Bonkers Institute: The patient is cheating himself More self-serving compliance ads from Pharma depicting patients as cheaters

Oops: One in 20 patients want to kill doctor

Wed, 28 May 2008 19:18:12 -0500

Oops: One in 20 patients want to kill doctor: Excerpt: The survey questioned 800 Americans who were in pain, undergoing physical rehabilitation or seeking legal compensation for disability to find out their attitude towards their GP. The researchers from the University of Miami, Florida, found that just over 1 in 20, or five per cent, admitted feeling like they wanted to murder their physician.

Bonkers Institute: Notorious drug evaders Wrong-headed ad...

Wed, 21 May 2008 21:21:38 -0500

Bonkers Institute: Notorious drug evaders Wrong-headed ad designating mental patients notoriaoud Drug Evaders

Small Prescription Price Increases Dramatically Affect Patient Adherence to Treatment

Thu, 08 May 2008 04:31:32 -0500

Small Prescription Price Increases Dramatically Affect Patient Adherence to Treatment: Excerpt: Dr. Jalpa Doshi and colleagues from the University of Pennsylvania looked at data from the Veterans Affairs Medical Association (VA) covering prescription and office visit information since 2002, when the VA instituted a $5 increase in the required copayment rate for 30 day prescriptions. After discovering trends that seemed to suggest that fewer patients were taking their medicines as prescribed, the team focused their research on the 24 months prior to the rate increase and the 24 months immediately following the rate increase. When compared to “category 1” veterans (who have no out of pocket fees for any medical services), all patients who experienced the increase had a declining rate in appropriate medication use after the $5 increase. Even more, the decrease was directly related to the increased cost, even though the actual cost was small. Overall, in the group of patients who had their copay rise by $5, the number of people taking their medications as prescribed fell by about 20%.

Controlled Trial of Directly Administered Antiretroviral...

Tue, 06 May 2008 21:12:59 -0500

Controlled Trial of Directly Administered Antiretroviral Therapy Abstract: Directly administered antiretroviral therapy (DAART) can improve health outcomes among HIV-infected drug users. An understanding of the utilization of DAART—initiation, adherence, and retention—is critical to successful program design. Here, we use the Behavioral Model to assess the enabling, predisposing, and need factors impacting adherence in our randomized, controlled trial of DAART versus self-administered therapy (SAT) among 141 HIV-infected drug users. Of 88 participants randomized to DAART, 74 (84%) initiated treatment, and 51 (69%) of those who initiated were retained in the program throughout the entire six-month period. Mean adherence to directly observed visits was 73%, and the mean overall composite adherence score was 77%. These results were seen despite the finding that 75% of participants indicated that they would prefer to take their own medications. Major causes of DAART discontinuation included hospitalization, incarceration, and entry into drug-treatment programs. The presence of depression and the lack of willingness to travel greater than four blocks to receive DAART predicted time-to-discontinuation.

Semi-Hiatus at AlignMap In Cites

Tue, 06 May 2008 07:06:35 -0500

Given the dearth of recent posts to AlignMap In Cites, this is, I suppose, a clarification rather than a notification.

A convergence of family and business responsibilities, the illness of a close friend, and some relatively minor but time-consuming healthcare issues of my own make routine updating of this miniblog as well as AlignMap.com impossible.

The most likely scenario for the immediate future has me sporadically and unpredictably posting items when the opportunity arises.

My hope is to return to my original 3-5 posts per week schedule when the current tempests are quelled.

"Is lying to doctors destined to be a thing of the past?"

Thu, 24 Apr 2008 17:08:53 -0500

“Is lying to doctors destined to be a thing of the past?”

- High-Tech Treatment Adherence « Jessica Land

Patient responding to news of adherence monitoring device. Excerpt: Terrifying because, well, it might mean I have no way out of taking the drugs. If you’re non-compliant, doctor’s can “fire” you as their patient. Hence the reason many lie. For those who do fess up about their bad practices, there are endless reprisals from the physician. Again, a good reason to lie.

"Getting people to do the things they need to do to keep themselves healthy is tricky."

Tue, 22 Apr 2008 08:20:13 -0500

“Getting people to do the things they need to do to keep themselves healthy is tricky.”

- Star-Telegram.com: | 04/21/2008 | Disregarding doctors’ orders The quote in the heading may be my favorite of all the declarations made about improving patient compliance. My second favorite, also from this article, is No one wakes up and says, “Yes, today is a good day for a colonoscopy.”

In addition to offering great quotes, this piece is one of the best articles on noncompliance I’ve seen in the lay press. While it is not all-inclusive, it does also offer outstanding advice for patients coping with a difficult medication regimen (e.g., taking meds that produce severe side-effects). Heck, it’s even inspirational.

"A breath-monitoring device … allow[s] patients to participate in a type of virtual DOT..."

Tue, 22 Apr 2008 08:04:16 -0500

“A breath-monitoring device … allow[s] patients to participate in a type of virtual DOT [directly observed therapy] from home.”

- [Note: Source is Press Release.] Scientists test device to track medication adherence in patients with HIV/AIDS Excerpt: The researchers developed the adherence monitor by incorporating minute amounts of an alcohol into a gel capsule. The additive, called 2-butanol, is one of many GRAS — Generally Recognized as Safe — compounds approved by the Food and Drug Administration for use in foods. “We wanted (patients) to swallow a chemical and have it transform into something else that’s easy to monitor,” said Matthew Booth, Ph.D., an assistant professor of anesthesiology at the UF College of Medicine and an investigator in the study. “When it hits the stomach lining and liver, an enzyme converts the alcohol to a gas that can be measured in the breath. To determine how well the byproduct could be detected, six healthy volunteers swallowed empty pills in which the capsules contained trace amounts of 2-butanol. After five to 10 minutes, the scientists could measure the volatile byproduct in the volunteers’ breath using a small detector. The scientists say their device could also be used to monitor medication adherence in patients with other communicable diseases, such as tuberculosis. It is encouraging that the biological and chemical elements of the adherence system work as predicted. We were able to conclusively show who swallowed the capsules containing the 2-butanol. With further optimization, we are optimistic the device will perform very well,” said Donn Dennis, M.D., the Joachim S. Gravenstein professor of anesthesiology at the UF College of Medicine and an investigator in the study. The researchers say the device may prove equally helpful for monitoring adherence in clinical trials.

"Often, the difficulty with “compliance” with health care recommendations is unconscious even to..."

Sun, 20 Apr 2008 08:17:37 -0500

“Often, the difficulty with “compliance” with health care recommendations is unconscious even to those having the problems.”

- Albany Democrat Herald: Integrative primary care watches wellbeing Quote is from article author, Dr. Mary Ann Wallace. Excerpt: To make the lifestyle and behavioral changes often needed for our state of health, we must pay attention to the many components that go into our choices and decision making. For example, a number of years ago, while working as an epidemiologist for the State Health Division, we were struggling with a tuberculosis outbreak in one of the downtown Asian districts. It was not until a nurse made a home visit that we uncovered the fact that nobody was taking their medicine. True to their culture, the patients arrived every month at the TB clinic to pick up their medication and politely answer all the questions asked of them. And also true to their culture they, without disagreeing with the health professionals, then took their medicine home and put it in their cupboards — along with the rest of the accumulated unopened bottles. Why? It was the wrong color. In their cultural belief, different types of illnesses required certain color medication.

"Despite being more depressed, women were still more likely to take their medications."

Fri, 18 Apr 2008 19:52:45 -0500

“Despite being more depressed, women were still more likely to take their medications.”

- Poststroke Depression Does Not Decrease Women’s Compliance With Medications

After a stroke, women are more likely to become depressed and have poorer quality of life than men, but depressed men are more likely to stop taking their stroke-prevention medications, a new study found. Excerpt: It’s important to recognize that women are more likely to be depressed and to have poor quality of life after a stroke,” lead author Cheryl Bushnell, MD, associate professor of neurology at Wake Forest University School of Medicine, in Winston-Salem, NC, said in an interview with Medscape Neurology & Neurosurgery. “But we’ve been focusing on women recently, and I don’t think we fully understand what’s happening in men. If they’re deciding they don’t need their medications, that’s a problem.”

Computer feedback can help with lung disease

Wed, 16 Apr 2008 10:24:50 -0500

Computer feedback can help with lung disease: Excerpt: A computer feedback system can help patients with chronic obstructive pulmonary disease (COPD) breathe better and improve their exercise capacity, according to a report in the American Journal of Respiratory and Critical Care Medicine. … ” Patients with COPD frequently practice pursed lip breathing, which prolongs exhalation, We thought if patients could have some visual feedback (with a computer system), we could teach them to do this better.” The visual feedback system …monitors patients’ breathing during exercise. As the patient breathes, the speed and depth of breathing is presented graphically on the computer monitor along with set goals for inhaling more slowly and exhaling more completely. …

Testing at the end of the trial showed that patients who trained with the feedback system were able to exercise longer than those in the other groups. Such patients also increased their exhalation times to a greater extent than other patients and they were the only group to reduce the over-inflation of the lung that occurred during exercise.

SOURCE: American Journal of Respiratory and Critical Care Medicine, April 15, 2008.

"The strong effects in this research suggest that in the context of limited resources, patient..."

Sun, 13 Apr 2008 08:25:53 -0500

“The strong effects in this research suggest that in the context of limited resources, patient adherence to chronic disease regimens can best be achieved by improving health professional-patient communication and by insuring that patients believe in the necessity and efficacy of treatment, and have adequate support for adherence. Screening for, and reducing, patient depression and family conflict likely can improve patient adherence.”

- Patient Adherence: Lessons from Five Decades of Research. Report by DiMatteo based on “All empirical articles on adherence published in peer-reviewed, English language journals from 1948 through 2002”

"Fixing Medicare to better reflect the medical conditions confronting seniors and providing..."

Sun, 13 Apr 2008 06:43:00 -0500

“Fixing Medicare to better reflect the medical conditions confronting seniors and providing incentives for the proper care of these patients is going to require much more change than just pressing for the full coverage of specific medications on a disease-by-disease basis”

- Strategies to Improve Medication Compliance by Medicare Beneficiaries — Wilensky 117 (10): 1252 — Circulation Quote derives from an editorial on the article referenced in the preceding AlignMap In Cites post. The author of the editorial (an economist) concludes “Low copayments for medically appropriate therapeutics are a fundamental part of value-based insurance. I support the concept. However, pressing for full coverage for specific pharmacotherapy classes on a disease-by-disease basis is not likely to be an effective way to fix the current program. The question is how to best move the current, fragmented, stove-piped system that characterizes Medicare to one that rewards physicians and institutions that provide high-quality cost-effective care to patients.”

I emphasize this conclusion because it is in keeping with my long held, redundantly reiterated stance that piecemeal attempts to enhance treatment adherence are not only intrinsically limited by the scope of that area of noncompliance but also because changes in one area of the healthcare system are likely to have unintended consequences elsewhere in the system that may reduce or even reverse whatever advantages the initial change might have wrought.

My only criticism of the editorial, in fact, is that its focus is restricted to healthcare needs of seniors and Medicare, which is yet another reiteration of the same problem of addressing the compliance issue piecemeal - only with larger pieces.

Cost-Effectiveness of Providing Full Drug Coverage to Increase Medication Adherence in Post-Myocardial Infarction Medicare Beneficiaries -- Choudhry et al. 117 (10): 1261 -- Circulation

Sun, 13 Apr 2008 06:17:48 -0500

Cost-Effectiveness of Providing Full Drug Coverage to Increase Medication Adherence in Post-Myocardial Infarction Medicare Beneficiaries -- Choudhry et al. 117 (10): 1261 -- Circulation:

Results (excerpt): In the model, post–myocardial infarction Medicare beneficiaries who received usual prescription drug coverage under the Part D program lived an average of 8.21 quality-adjusted life-years after their initial event, incurring coronary heart disease–related medical costs of $114 000. Those who received prescription drug coverage without deductibles or copayments lived an average of 8.56 quality-adjusted life-years and incurred $111 600 in coronary heart disease–related costs. Compared with current prescription drug coverage, full coverage for post–myocardial infarction secondary prevention therapies would result in greater functional life expectancy (0.35 quality-adjusted life-year) and less resource use ($2500). From the perspective of Medicare, full drug coverage was highly cost-effective ($7182/quality-adjusted life-year) but not cost saving.

Note that this estimate is based on an economic model rather than a study of actual patients.

Full Text (PDF)