AlignMap In Cites

Proteus - Proteus ingestible event markers (IEMs) are tiny,...

Mon, 21 Sep 2009 18:53:42 -0500

Proteus - Proteus ingestible event markers (IEMs) are tiny, digestible sensors made from food ingredients, which are activated by stomach fluids after swallowing. Once activated, the IEM sends an ultra low-power, private, digital signal through the body to a microelectronic receiver that is either a small bandage style skin patch or a tiny device insert under the skin. The receiver date- and time-stamps, decodes, and records information such as the type of drug, the dose, and the place of manufacture, as well as measures and reports physiologic measures such as heart rate, activity, and respiratory rate.

The IEM is manufactured on silicon wafers, and is extremely economical to produce, costing a few cents per sensor in large quantities.

And You Thought a Prescription Was Private

Mon, 10 Aug 2009 12:08:00 -0500

And You Thought a Prescription Was Private

What Does Health Care Reform Really Mean to American Fatasses? Part 3: Fat and Compliance

Wed, 05 Aug 2009 13:36:00 -0500

What Does Health Care Reform Really Mean to American Fatasses? Part 3: Fat and Compliance

"The Smart Patient will: (1) Know their medical history and is able to share it. (2) Will go out and..."

Wed, 05 Aug 2009 13:30:16 -0500

“The Smart Patient will: (1) Know their medical history and is able to share it. (2) Will go out and get a second opinion (3) Finds an advocate. (4) Know their medications and adhere to them. Medication knowledge and compliance is a big issue. We need better solutions to assist patients with this task.”

- From keynote speech by Mamet Oz at Aspen Health Forum. Good, Bad & the Ugly at the Aspen Health Forum

"So, while the rest of the country is debating the cost of health care, those of us providing health..."

Tue, 04 Aug 2009 21:14:54 -0500

“So, while the rest of the country is debating the cost of health care, those of us providing health care know compliance is key. We also know compliance is not always tied to cost.”

- The local MD: Cost or compliance?

"Informed consent is an opportunity to invite patients to participate in the decision-making process..."

Sat, 01 Aug 2009 11:17:35 -0500

“Informed consent is an opportunity to invite patients to participate in the decision-making process of care. It’s a long-term investment for doctors and patients.””

- Doctor and Patient - Treating Patients as Partners, by Way of Informed Consent

"Findings from the evaluation of this program suggest the potential value … of employing..."

Wed, 29 Jul 2009 10:09:00 -0500

“Findings from the evaluation of this program suggest the potential value … of employing incentives to encourage the use of comprehensive prenatal care and perhaps other preventive care measures”

- Prenatal Payments Could Improve Birth Outcomes

Precursors to Corneal Transplant Failure; Patients Who Skip Glaucoma Treatment

Sun, 26 Jul 2009 20:35:00 -0500

Precursors to Corneal Transplant Failure; Patients Who Skip Glaucoma Treatment:

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.

Lower Copay and Oral Administration: Predictors of First-Fill Adherence to New Asthma Prescriptions (PDF)

Sun, 26 Jul 2009 17:53:00 -0500

Lower Copay and Oral Administration: Predictors of First-Fill Adherence to New Asthma Prescriptions (PDF):

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.

3 HIV Treatment Adherence Articles

Sun, 26 Jul 2009 17:42:00 -0500

3 HIV Treatment Adherence Articles:

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.
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.
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

Best Ways to Deal With No-Shows

Tue, 21 Jul 2009 17:40:04 -0500

Best Ways to Deal With No-Shows:

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.

"I readily admit that over the years I did not comply with my blood pressure care. I took my..."

Mon, 20 Jul 2009 11:45:57 -0500

“I readily admit that over the years I did not comply with my blood pressure care. I took my medication about as routinely as people win the lottery. My diet consisted of anything that could be wrapped in waxed paper and balled up in a napkin when done. I exercised only options, and they usually consisted of how long to microwave something.”

- Don’t ignore dangers of silent killer

Reminder Program Boosts Mammography Rates

Fri, 17 Jul 2009 21:02:05 -0500

Reminder Program Boosts Mammography Rates:

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.

New Horizons in Patient Compliance : Canine Compliance Coordinator

Mon, 13 Jul 2009 17:47:00 -0500

New Horizons in Patient Compliance : Canine Compliance Coordinator:

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.

Use predictive modeling in Medicare populations

Thu, 09 Jul 2009 07:53:00 -0500

Use predictive modeling in Medicare populations:

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.

What Impact Will The ARRA Have On Pharma? [Enhancing Compliance Through Implementation Of Patient Centered Medical Home]

Thu, 09 Jul 2009 07:04:16 -0500

What Impact Will The ARRA Have On Pharma? [Enhancing Compliance Through Implementation Of Patient Centered Medical Home]:

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.

Intensifying Therapy for Hypertension Despite Suboptimal Adherence -- Rose et al., 10.1161/HYPERTENSIONAHA.109.133389 -- Hypertension

Thu, 09 Jul 2009 03:10:40 -0500

Intensifying Therapy for Hypertension Despite Suboptimal Adherence -- Rose et al., 10.1161/HYPERTENSIONAHA.109.133389 -- Hypertension:

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.

How One Company Pushed Workers Into Preventive Care - Mandated Participation In Wellness Programs

Wed, 08 Jul 2009 13:40:57 -0500

How One Company Pushed Workers Into Preventive Care - Mandated Participation In Wellness Programs:

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.

[Compliance] Technology and aging by category - Prime Time: A New Look At Aging

Mon, 06 Jul 2009 12:02:20 -0500

[Compliance] Technology and aging by category - Prime Time: A New Look At Aging:

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.

Finally, a Drug Company Embraces Social Media, AEs Included!

Sat, 04 Jul 2009 06:50:33 -0500

Finally, a Drug Company Embraces Social Media, AEs Included!:

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