Archive for July, 2008

Telenursing Intervention Increases Psychiatric Medication Adherence in Schizophrenia Outpatients

07/30/2008 , 10:43 AM by Alex Sicre

And here is today’s medication adherence abstract from Journal of the American Psychiatric Nurses Association:

BACKGROUND:
Promoting medication adherence is a critical issue in optimizing both physical and mental health in persons with schizophrenia. Average antipsychotic medication adherence is only 50%; few studies have examined nonpsychiatric medication adherence. Psychosocial interventions with components of problem solving and motivation have shown promise in improving adherence behaviors.

OBJECTIVES:
This study examines telephone intervention problem solving (TIPS) for outpatients with schizophrenia. TIPS is a weekly, provider-initiated, proactive telenursing intervention designed to help persons with schizophrenia respond to a variety of problems, including adherence problems.

STUDY DESIGN:
The authors completed objective measures of adherence to psychiatric and nonpsychiatric medications in 29 community-dwelling persons with schizophrenia, monthly for 3 months.

STUDY RESULTS:
Persons receiving TIPS had significantly higher objective adherence to psychiatric medications throughout the study period, F(1, 20) = 5.47, p = .0298.

CONCLUSIONS:
Clinicians should consider using TIPS as an adjunct to face-to-face appointments to support adherence in persons at risk. J Am Psychiatr Nurses Assoc, 2008; 14(3), 217–224. DOI: 10.1177/1078390308318750

Two News Items That Tie Together

, 10:37 AM by Alex Sicre

So I have been looking at this Harris Poll Report that states “4% or an estimated 9M American adults believe that they or a family member have had confidential personal medical information either lost or stolen”, and trying to figure out if I know of anyone who this has happened to and if this is a low or high number.

The second round of figures: “about 7 in 10 (69%) of adults have either read or heard about medical records with personal health information being lost or stolen from doctor’s offcies, clinics, hospitals, health insurers, employers or government agencies”.

I definitely fit into this category, and it was even further reinforced with this article in the Atlanta Journal-Constitution about BCBS of Georgia sending out “an estimated 202,000 benefits letters containing personal and health information to the wrong addresses last week.” That seems like a big screw-up.

So what do people really think about privacy, health records and the advent of EHRs? I am going to pull a few quotes from each piece to state my point. HPR: when asked which medical records, computerized or paper may be lost or stolen more often, 47% state computerized records, with 16% for paper, and 23% think the same.

My conclusion, Americans do not trust electronic records. Further support: of the 69% who had heard about medical records being lost or stolen, 54% believed it was from electronic records.

Recent medical “breaches” have included Wellpoint, U of Miami, NIH, the Cleveland Clinic, CVS, – with over 50 breached from healthcare providers reported to the Identity Theft Resource Center in the first 6 months of 2008. I have heard of these companies. Aren’t they supposed to be the biggest and most secure in their fields?

BCBS of Georgia said the recent mix-up was caused by a change in the computer system that was not properly tested. Why would they implement a computer system without testing it, considering they are a HIPAA covered entity? Isn’t there a law and governmental regulations in place to protect this data? Oh yeah, that’s right, there is. Since HIPAA was fully implemented in 2003, very few fines have been assessed.

AJC: “This is very, very serious,” [state Insurance Commissioner John] Oxendine said. A person with knowledge of medicine or billing, for example, could determine if the patient was treated for cancer, HIV or fertility problems, he said….

…Rhonda Bloschock, a registered nurse in Atlanta, said Monday that she discovered EOB forms from nine other patients in a large envelope she received Friday from Blue Cross. “This is a serious privacy breach,” Bloschock said. Nurses and other hospital staff “jump through all sorts of hoops protecting people’s privacy,” she said….

…consumers have become more attuned to privacy issues, said Anne Adams, chief privacy officer for Emory Healthcare. “There is an expectation that their personal information is protected and not used inappropriately,” Adams said. But with the movement toward keeping health records electronically, there’s more potential for breaches to happen, Adams said.”

So going back to Google Health, Microsoft Health Vault and EMR, PHR vendors – will the American people trust their records online to these companies, GOOG and MSN not being HIPAA covered, when other companies cannot protect this data already? And those that can protect it, still have mechanical errors?

The eDrugSearch Top 100 Health Blogs and Phrase Cloud

07/29/2008 , 10:49 AM by Alex Sicre

I was watching my Twitter stream and saw a mention of a ““phrase cloud” postingof the 883 health and medicine blogs listed by eDrugSearch. I have seen the eDrugSearch Top 100 Health Blogs mentioned before on blogs, but have never really thought the Medication Non-adherence blog would ever get there. Here is the “phrase cloud” of the Top 100.

However, in reading this post and doing some research (thanks Twitter), I see there are actually 883 blogs that are the Top 100 list, so I am going to throw my hat into the ring. A handful of the blogs that I read are in the Top 100, with a handful of the blogs I really like and respect ranging between 300 and 600.

The question is, what does it say about your blog if you have a “high” ranking or no ranking at all? I don’t think it discounts what the author has to saw with a “high” ranking, however if a blog is in the top 20, more readers will flock to it, thus keeping the blog’s “low” ranking.

eDrugSearch has an algorithm that tracks the “popularity” of your blog based on various other website ranking systems. Here is the outline. If I spend some more time looking into figuring out how to get a higher rank, I might be able to move my number up, but what would be the point? More exposure equals more readers mean that more people will learn about the problems of medication non-adherence and hopefully realize that it is a serious problem that needs to be addressed. And that is the point of this blog, right?

I usually think that rankings and reviews should happen organically, however the more I read about blogging and social media, the more I realize there sometimes you need to be a little PR. Also, you have to register to have your blog reviewed, so here I go into the fray.

Mention in Brass and Ivory /Inside Health Media’s Blog List

, 10:47 AM by Alex Sicre

As a follow-up to today’s earlier post, I was looking at Technorati, which referenced the Medication Non-adherence blog in another blog. This time it was Brass and Ivory reporting on “Inside Health Media’s huge new blog directory gives PR pros an inside guide to influential bloggers covering health, medicine and fitness.”

So that is great for the blog, and I didn’t even know about it.

The Role of Cognitive Functioning in Medication Adherence of Children and Adolescents with HIV Infection.

, 10:45 AM by Alex Sicre

Here is today’s medication adherence abstract from Medline:

OBJECTIVE: To evaluate the relationship between cognitive functioning and medication adherence in children and adolescents with perinatally acquired HIV infection.

METHODS: Children and adolescents, ages 3-18 (N = 1,429), received a cognitive evaluation and adherence assessment. Multiple logistic regression models were used to identify associations between adherence and cognitive status, adjusting for potential confounding factors.

RESULTS: Children’s average cognitive performance was within the low-average range; 16% of children were cognitively impaired (MDI/FSIQ <70). Cognitive status was not associated with adherence to full medication regimens; however, children with borderline/low average cognitive functioning (IQ 70-84) had increased odds of nonadherence to the protease inhibitor class of antiretroviral therapy. Recent stressful life events and child health characteristics, such as HIV RNA detectability, were significantly associated with nonadherence.

CONCLUSION: Cognitive status plays a limited role in medication adherence. Child and caregiver psychosocial and health characteristics should inform interventions to support adherence.

Impact of Health Literacy on Health Outcomes in Ambulatory Care Patients: A Systematic Review

07/28/2008 , 10:51 AM by Alex Sicre

Here is your medication adherence abstract of the day from The Annals of Pharmacotherapy:

OBJECTIVE: To examine the relationship between low health literacy and disease state control and between low health literacy medication adherence in the primary care setting.

DATA SOURCES: The following databases were searched for relevant articles from date of inception to April 2008: The Cochrane Database of Systematic Reviews, Cumulative Index to Nursing & Allied Health Literature, EMBASE, Education Resources Information Center, PsycINFO, International Pharmaceutical Abstracts, and Iowa Drug Information Service. MEDLINE was searched from 1966 to April 2008. Key words included literacy, health literacy, health education, educational status, disease outcomes, health outcomes, adherence, medication adherence, and patient compliance. Additional articles were identified by reviewing reference sections of retrieved articles.

STUDY SELECTION AND DATA EXTRACTION: Studies using a validated measure of health literacy and performing statistical analysis to evaluate the relationship between health literacy and disease state control or medication adherence were evaluated.

DATA SYNTHESIS: Eleven evaluations, including 10 discrete studies, met eligibility criteria. Six studies evaluated the relationship between health literacy and disease state control, 3 evaluated health literacy and medication adherence, and 1 study evaluated health literacy and both outcomes. A quality rating of poor, fair, or good was assigned to each study based on the study question, population, outcome measures, statistical analysis, and results. Eight studies had good quality, 1 was fair, and 2 were poor. Two high-quality studies demonstrated statistically significant relationships with health literacy, 1 with disease state control and 1 with medication adherence. Limitations of the other studies included inadequate sample size, underrepresentation of patients with low health literacy, use of less objective outcome measures, and insufficient statistical analysis.

CONCLUSIONS: There may be a relationship between health literacy and disease state control and health literacy and medication adherence. Future research, with adequate representation of patients with low health literacy, is needed to further define this relationship and explore interventions to overcome the impact that low health literacy may have on patient outcomes.

Tobacco to Help Cure Cancer

07/25/2008 , 11:18 AM by Alex Sicre

came across an article on in-Pharma Technologist.com regarding a Stanford University study “described [as] the first-in-man Phase I safety trial of the tobacco-produced vaccines against follicular B-cell lymphoma.”

“In an ironic twist, researchers have shown that the tobacco plant, the cause of millions of cases of cancer, can be harnessed to produce personalised cancer vaccines.” Full Article here

I really have no comment save that is it more ironic than a fly in your Chardonnay, and it seems as if this might be a real break through for advancing the speed of vaccine growth.

EnrichMap: A Profile for Medication Non-Adherence

, 10:52 AM by Alex Sicre

Dr. Alan Showalter, leader of the AlignMap empire, has been working for many years in the field of medication non-adherence, and has developed a patient survey and compliance profile which can be found on EnrichMap.com .

Here is their statement of purpose from their website:

“EnrichMap focuses on proactively managing adherence to treatment regimen in clinical trials by identifying, prior to enrollment in the study, groups of patients based on their behavioral patterns pertinent to compliance and providing pragmatic, group-specific strategies to minimize unnecessary treatment failures caused by noncompliance and, in turn, reduce the consequent morbidity and mortality, research confoundments, delays, and financial waste.”

I took the plunge a few months ago and was delivered a very interesting report and “compliance assignment based on a national population PROFILE”. I apologize that it has taken me so long to post.

Based on my responses to the Emap questionnaire the results indicated compliance related characteristics in two groups, with nearly equal weight to both sets of traits. The Primary Compliance Group is “Sage & Satisfied”, the Secondary Compliance Group is “Security Seeking”. The report is two pages. I am going to summarize a few statements from the report, some of which I agree with, some not. My comments are in bold.

Sage & Satisfied
The most significant characteristic of individuals with the Sage and Satisfied Group is their confidence in and positive view of traditional healthcare. They trust their doctors and believe that trust is reciprocated by the clinicians’ genuine concern for their patients.This is TRUE.

As one might expect, they are more likely than average to evaluate any treatment they are receiving as successful and report few negative or adversarial experiences with healthcare professionals. They quietly embrace the notion that they bear a personal responsibility for implementing good healthcare practices. This is TRUE.

This group is more likely to monitor their own health, including participation in recommended screenings (e.g., mammograms and colonoscopies), and to take appropriate action upon discovering problems (e.g., promptly contacting their doctor). They are willing to make use of any medical specialty from dermatology to dentistry.This is TRUE.

The Sage and Satisfied are conscientious, concerned and educated. They are responsive to healthcare ideas that have become accepted as “common sense” or are endorsed by an authority. They read food labels, recycle, and avoid smokers. This is TRUE.

They are exceptionally active and are, in fact, the most heavily involved in all types of personal and social activities surveyed, whether intellectual and physical in nature. Sort of true. I play golf, tennis, swim and walk my dog. Somewhat social.

Unsurprisingly, the Sage and Satisfied also have the lowest incidence of self-destructive habits such as smoking and heavy use of alcohol. I stopped smoking 2.5 years ago.

Secondary Compliance Group: Security Seeking
Individuals in the Security-Seeking Group are second only to those from the Sage and Satisfied Group in demonstrating a positive view of physicians and healthcare. They have the strongest belief in the power of medication as a remedy (and in the power of medication to cause problems, especially if not used appropriately). This is TRUE.

Consequently, it is hardly surprising that these individuals maintain close relationships with doctors and agree with the importance of following medical directions. They rarely express concern or cynicism about the skill and integrity of clinicians. I am very cynical, but do believe that the doctor knows more than me. I do seek 2nd and 3rd opinions though.

Their only common complaint about the medical system, in fact, is the number of restrictions their third-party healthcare funding places on the services they receive.This is NOT TRUE.

Despite their fearfulness, members of this Group are not hypochondriac. They, in fact, perceive their health as being good. They are average in the frequency and variety of clinical interventions and in their use of non prescription medications and vitamins. They do read printed instructions. This is TRUE, but I do not take vitamins.

They neither demand excessive medical attention nor avoid seeking necessary help. The Security-Seeking Group is second only to the Sage and Satisfied in adhering to their doctors’ prescribed treatment. True to their defining characteristics, the Security-Seeking Group makes healthcare choices based on the overwhelming need to avoid risks.This is TRUE.

While attentive to their physicians’ instructions, they are reluctant to seek medical information. Even if the trusted clinician offers them written material, they mistrust it – or at least their own interpretation of it. As would be expected, these individuals avoid self diagnoses and novel medical methodologies. This is NOT TRUE.

Overall, the EnrichMap survey and profile are great tools to help a patient identify who they are and why they are non-adherent. No two patients are the same, so it is difficult to make a group and classify a patient in that group then expect all the characteristic to fit said patient. Sage and Satisfied pretty much nailed my medical behavior, whereas Security Seeking was a little off – but still 60% correct with my behavioral pattern.

If you are interested, the survey is free to take, and I would recommend visiting the site. FD: Dr. Showalter bribed me for this plug. No, his treatment of medication non-adherence with his blog posts and research has been an inspiration for me, and my blog. His humor abounds, while seriously addressing awareness and concern. I am glad he is back to blogging after a few months away.

The Darkside of Medication Non-adherence

07/24/2008 , 11:19 AM by Alex Sicre

This is a sad case of the dark side of medication non-adherence: prescription medicine abuse. This form of drug abuse has been gaining “popularity” over the last few years, the most serious cases involving OxyCotin, and well publicized by Hollywood Celebrity overdoses.

I found this article on WDAY Channel 6’s website from Fargo ND, taken from an AP story about a doctor who’s license was suspended for “sloppy handling of narcotics, letting assistants fill out drug prescription forms for patients, and accepting unused drugs from his patients and keeping them in an unlocked drawer.”

The whole situation sounds very fishy to me. Here is a patient profile and quote:

Chastity Woodbury, 32, of Fargo, said she was hit by a train when she was 5 years old and has been in several accidents, leaving her in chronic pain and depression. She said she needs medication to function. “No other doctor understands us,” Woodbury said. “Everyone looks at us as pain medication seekers, but Dr. Lee cares about us.”

And another patient quote: “Yes, the paperwork in his office is stacked on the floor, but I don’t go there for that,” said R.D. “Dick” Knutson. “I go there for help.”

I understand the need for patients with chronic pain to need medications, but when it turns to abuse, that is what it is: drug abuse.

Pre-Diabetes Needs To Be Treated

07/23/2008 , 11:22 AM by Alex Sicre

Here is a great article in the USA Today about pre-diabetes and preventative treatment. I am pre-diabetic and have a family history of diabetes, so I am a very aware of the escalating problems. I started monitoring my glucose levels 8 weeks ago, and so far I have not had any huge spikes.

Some takeaways from the article. Everything NOT in quotes are my comments:

“We, as endocrinologists, are saying we truly recognize a state of pre-diabetes, and I think the most important issue is that there is not one unifying point that defines it, says Daniel Einhorn, vice president of the American Association of Clinical Endocrinologists.”

This is somewhat troubling as it seems the only way to detect this condition is blood monitoring.

“In an early release of the new recommendations, members of the endocrinologist group agreed that diagnosing pre-diabetes should be based on more than the results of blood glucose tests, such as history of diabetes during pregnancy and family history of the disease. The group also decided that changes in ways of living, not medication, should be the first line of treatment in staving off diabetes.”

I am happy to hear that changes in diet and lifestyle is the first line of defense instead of medication. That being said, I am on tricor and niaspan for high triglycerides – but I have adjusted my diet.

“The guidelines recommend that people with metabolic syndrome — defined by three or more of the following: elevated triglycerides, a low HDL (the so-called good cholesterol), a high fasting glucose, a big waist circumference and high blood pressure — be considered at high risk for pre-diabetes, as well as women with prior gestational diabetes, people with a family history of type 2 diabetes and obese patients.”

Yeah, three for me: HT, Low HDL, and type 2 in family.

“The new guidelines also advise that primary-care physicians and specialists address cardiovascular problems such as blood pressure and lipid levels when diagnosing pre-diabetes. Though there was some debate at the conference over whether medication should be used to treat pre-diabetes, the final consensus is that certain drugs may have a place if diet and exercise do not bring down glucose levels first.”

Again, exercise and diet should be the first treatment. So often, medications are prescribed instead of naturally treating the problem. And yes, I am a hypocrite, but my levels were so high, my doctor thought it best that I take medication until my levels drop to “safe” level – which I should accomplish at the end of July – then go off the meds.

With childhood obesity at an all time high (1 in 3 are obese or at risk), and diabetes following suit, something must be done. CT Senator Chris Dodd is proposing a task force and a Childhood Obesity Bill, so hopefully pre-diabetes and diabetes will be addressed.

One service that has helped me with resources and has provided me with a forum to discuss pre-diabetes and ask questions is TuDiabetes, a diabetes social network founded by the Diabetes Hands Foundation. Here is my profile. FD: Diabetes Hands Foundation has been offered to join Intelecare’s pro bono Enlighten Together Program like Diabetes Sisters.

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