Intelecare's Alex Sicre

When Intelecare decided to enter the social media space with its first blog entry in 2007, I was less than bullish on the idea.  I suppose it was just a fear of the unknown – a suspicion of the efficacy or usefulness of something I just didn’t understand.  But nearly 3 years later, Intelecare boasts a presence on Facebook and Twitter, is a biscuit away from launching various consumer-centric videos and a weekly Podcast (also available on YouTube) and, today, a resuscitated blog in honor of the man who started it all – Alex Sicre.

Alex was a thoughtful, poignant writer.  He loved research and, indeed, spreading the good word about all things he believed in.  His commitment to the idea that educating patients and caregivers through organic, grassroots approaches would result in better, more viable outcomes, was spot-on.  In the time since Alex’s passing in November 2008, he has left us a legacy of kindness and thought-provoking work as we continue the battle to increase medication adherence.

In the past year, Intelecare has broadened its member base and increased its work with managed care organizations, pharmacies and pharmaceutical companies.  Launched a completely overhauled user experience and continued to increase the number of patients using the Intelecare system – all during this volatile economic climate.  In that same time frame we lost touch with that grassroots philosophy that Alex championed to educate a community about the negative effects of non-adherence.  That ends today.

Alex’s work at Intelecare immersed him in the issues of non-compliance, but even he struggled with adherence to his medication regimen.  If medication adherence was difficult for someone like Alex, imagine how trying it can be for patients and caregivers whose busy lives pull them in multiple directions without a direct understanding of the ramifications of non-adherence?  Make no mistake about it, non-adherence is America’s biggest drug problem.

I am reminded of the statistics everyday:

• 1 out of every 2 people are non-compliant
• $300 billion in costs to the healthcare system with far reaching health and socio-economic implications
• $47 billion in hospitalization costs directly attributed to non-adherence

The statistics are daunting, but we can change them.  We can increase adherence and persistency.  At Intelecare, we believe our communications hub permits results based on a preference-based reminder.  Our approach to communications is paradigm-shifting that includes reminders but provides education, rewards and, ultimately, home delivery of medications with a click of a button.

Please join the entire Intelecare family in making this goal of increasing medication adherence a reality today.

I do not use Wikipedia regularly, however I find increasingly useful for trivial information, such as who is Lonelygirl15, since I missed all the YouTube ballyhoo.

I think UGC (user generated content) is fantastic, however I do not think it is always an authoritative source. With that in mind, I looked up the my favorite terms: medication adherence, medication non-adherence, medication compliance and medication non-compliance. The only listing was Compliance (Medicine).

From the Wikipedia entry:

“Compliance (or Adherence) is a medical term that is used to indicate a patient’s correct following of medical advice. Most commonly it is a patient taking medication (drug compliance), but may also apply to use of surgical appliances such as compression stockings, chronic wound care, self-directed physiotherapy exercises, or attending counselling or other courses of therapy.

Patients may not accurately report back to healthcare workers because fear of possible embarrassment, being chastised, or seeming to be ungrateful for a doctor’s care.

Causes for poor compliance include:
• Forgetfulness
• Prescription not collected or not dispensed
• Purpose of treatment not clear
• Perceived lack of effect
• Real or perceived side-effects
• Instructions for administration not clear
• Physical difficulty in complying (e.g. opening medicine containers, handling small tablets, swallowing difficulties, travel to place of treatment)
• Unattractive formulation, such as unpleasant taste
• Complicated regimen
• Cost of drugs”

The listing goes on to discuss “Adherence: An estimated half of those for whom medicines are prescribed do not take them in the recommended way. Until recently this was termed “non-compliance”, and was sometimes regarded as a manifestation of irrational behavior or willful failure to observe instructions, although forgetfulness is probably a more common reason. But today health care professionals prefer to talk about “adherence” to a regimen rather than “compliance”….”

And “Drug Compliance: It is estimated that only 50% of patients suffering from chronic diseases in developed countries follow treatment recommendations….”

And “Concordance: Concordance is a current UK NHS initiative to involve the patient in the treatment process and so improve compliance….”

Overall it is a great listing. Wikipedia (rather the authors & editors) address the causes, the percentage of patients who are non-adherent, and the differences between adherence and compliance and concordance.

I guess I will have to live the listing title: Compliance (Medicine).

What do you think?

AMSTERDAM (Reuters) – Dutch group Philips has developed an “intelligent pill” that contains a microprocessor, battery, wireless radio, pump and a drug reservoir to release medication in a specific area in the body.

Philips, one of the world’s biggest hospital equipment makers, said Tuesday that the “iPill” capsule, measures acidity with a sensor to determine its location in the gut, and can then release drugs where they are needed.

Delivering drugs to treat digestive tract disorders such as Crohn’s disease directly to the location of the disease means doses can be lower, reducing side effects, Philips said.

While capsules containing miniature cameras are already used as diagnostic tools, those lack the ability to deliver drugs, Philips said.

The “iPill” can also measure the local temperature and report it wirelessly to an external receiver.

The company plans to present the “iPill” at the annual meeting of the American Association of Pharmaceutical Scientists (AAPS) in Atlanta this month.

The iPill is a prototype but suitable for serial manufacturing, Philips said.

(Reporting by Niclas Mika; Editing by Greg Mahlich)

Objective: Clinical messages alerting physicians to gaps in the care of specific patients have been shown to increase compliance with evidence-based guidelines. This study sought to measure any additional impact on compliance when alerting messages also were sent to patients.

Study Design: For alerts that were generated by computerized clinical rules applied to claims, compliance was determined by subsequent claims evidence (eg, that recommended tests were performed). Compliance was measured in the baseline year and the study year for 4 study group employers (combined membership >100,000) that chose to add patient messaging in the study year, and 28 similar control group employers (combined membership >700,000) that maintained physician messaging but did not add patient messaging.

Methods: The impact of patient messaging was assessed by comparing changes in compliance from baseline to study year in the 2 groups. Multiple logistic regression was used to control for differences between the groups. Because a given member or physician could receive multiple alerts, generalized estimating equations with clustering by patient and physician were used.

Results: Controlling for differences in age, sex, and the severity and types of clinical alerts between the study and control groups, the addition of patient messaging increased compliance by 12.5% (P <.001). This increase was primarily because of improved responses to alerts regarding the need for screening, diagnostic, and monitoring tests.

Conclusion: Supplementing clinical alerts to physicians with messages directly to their patients produced a statistically significant increase in compliance with the evidence-based guidelines underlying the alerts.

(Am J Manag Care. 2008;14(11):737-744)

MY COMMENTS
I am always pleased when another study confirms that patient messaging improves patient compliance. Especially with the rising cost of healthcare, every preventative step should be taken to ensure patients have the best data about their care and their risks.

It is troubling however that the patient messaging was in the form of letters that had a 10 business day delay from the doctor getting the notification “to allow physicians to contact their patients first, if they choose, or to indicate via fax or phone that there are clinical reasons why alerts do not apply (eg, an allergy not revealed by claims data)”. This study did take place in 2006, and I am surprised they did not use email messaging as well.

Here is an exampled of the alert for the doctor:
Your patient is at least 55 years old, has claims evidence for diabetes, has an additional cardiovascular disease risk factor (eg, history of cardiovascular disease, dyslipidemia, microalbuminuria), and has no claims evidence for an angiotensin-converting enzyme (ACE) inhibitor. The American Diabetes Association recommends that, in these patients, with or without hypertension, an ACE inhibitor be considered to reduce the risk of cardiovascular events. If your patient fits this clinical profile, and if not already done or contraindicated, consider starting an ACE inhibitor and titrating the dosage as tolerated.

Here is an example of the patient alert:
• Our data show that you may have diabetes.
• If you have diabetes, it may help you to take a type of drug
called an ACE inhibitor.
• You may not be taking this drug.
• Ask your doctor if you should take an ACE inhibitor.

Now with that 10 day delay the doctor can reach out to the patient and suggest a medication. The reinforcement from the health plan helps the patient adhere with the doctor’s recommendation. Same applies for screenings, diagnostic and monitoring tests.

This also raises the question: “My insurer told me to get this test or take this pill. If I do not do it, will they deny claims in the future?”

Would you have this fear if your health plan was monitoring your adherence based on claims data? Would you prefer a 3rd party to deliver these messages?

Please let me know your thoughts.

Thanks!

Thanks to ScribeMedia for allowing me to embed this great video from David Kibbe, Director of the Center for Health Information Technology, American Academy of Family Physicians.

Dr. Kibbe hit the road earlier this year to produce (with Scribe) this documentary about Health 2.0. He rode his Honda Gullwing up and down the East Coast, interviewing some of the players in the H20 space, many of which I have blogged about. Included are interviews with the CEOs of MedHelp, Healthline, Hello Health, Patient’s Like Me, American Well and change:healthcare.

Two other interviews I enjoyed: New York Times Well blogger Tara Parker-Pope who doesn’t like the term Health 2.0 because it connotes a software package; and a CVS Minute Clinic RN who is not only providing patients with quick diagnoses in the pharmacy, but also encouraging and setting-up PHRs for them.

Google also makes an appearance in a quick conversation about, what else, Google Health.

Enjoy!

Recent Guidline research published by MedAdNews found that 6 in 10 Americans are now non-adherent to their medications. Now lets talk about what this really means in cost for diabetes patients and the strain medication non-adherence has on the US healthcare system.

The June 2005 issue of Medical Care, a journal by the American Public Health Association, published a study demonstrating that Diabetes patients who are highly compliant with their treatment programs have a 13% hospitalization risk for a diabetes-related problem, but patients with low compliance have more than twice the risk at 30%.

The same study stated the combined drug and medical costs for the most compliant patients average $4,570, which is almost 50 percent below the $8,867 cost for the least compliant group.

A recent report from the CDC states that diabetes rates are rising in the US. More than 23 million Americans have diabetes, with about 1.6 million new cases diagnosed among adults last year.

So currently, according to all these estimates, 13.8 M diabetics are non-adherent to their medication regimes, and cost the healthcare system $122 BILLION. With proper medication adherence, this figure can be reduced in half.

And this number is only going to go up, with almost 1M non-adherent diabetes added each year at a cost of $8.8 Billion.

And this is for one chronic disease.

There are several factors related to why patients are non-adherent to their medications and I do not mean to beat up on diabetics, but I just wanted to illustrate the real costs associated with not taking medications properly.

Matthew and Alexandra ask that you download the slide, start a viral movement, have these conversations and transform end-of-life care. To learn more visit Engage with Grace, where you can download the one slde, register for free, learn how to start the conversation and store your answers to the questions.

The questions are very morbid, but deal with an important issues: will your wishes be followed in the event of a terminal illness, do you have an advocate, where do you want to die, do you have a living will, power of healthcare attorney.

Visit the website, think about these questions, answer them and spread the word.

Thank you.

I know, it is very exciting – contain yourself!

There are still blog posts surfacing from last week’s Health 2.0 Conference, and I’m sure more to come:

- Matthew Holt, the co-founder, muses about his final thoughts and addresses criticism on the conference at The Healthcare Blog.

- Jane Sarasohn-Kahn from the Health Populi blog reflects on her personal experiences around the conference as a moderator, panelist and participant.

- A medical librarian’s review of the health search engines featured at the conference on the AltSearchEngines blog. Reading this has inspired me to once again revisit and tackle writing a post about the various health search engines and their results for medication non-adherence.

- Amy T from Diabetes Mine writes a brief post about her Health 2.0 experiences with a diabetes focus of course!

John from Chilmark Research did a great job of covering Health 2.0 and is now covering The Center for Connected Health’s 2008 Symposium. This Boston symposium also features a number of speakers who were at Health 2.0.

Alexandra Carmichael, from CureTogether, proposes an Open Source Health Research Plan.

Cary Byrd from eDrugSearch comments on a study that found higher drug costs in poorer neighborhoods.

John Halamka (who is a localvore) from Life As A Healthcare CIO writes about the ROI for EHRs.

Enjoy!

Brief-interval telephone surveys of medication adherence and asthma symptoms in the Childhood Asthma Management Program Continuation Study. BG Bender, A Rankin, ZV Tran, and FS Wamboldt

BACKGROUND: Although it is known that most patients do not consistently take controller medications every day, the impact of non-adherence on asthma control is not well documented.

OBJECTIVE: To establish the relationship between medication adherence and symptom control in adolescents and young adults with asthma.

METHODS: A total of 756 adolescents and young adults diagnosed as having mild to moderate asthma on entry into the original study underwent 6 monthly telephone interviews as an ancillary project to the Childhood Asthma Management Program Continuation Study. Participants were queried about medication use and symptom control within each 1-month interview window. Strategies adopted to improve self-report accuracy included use of repeated interviews, confidential reporting to staff unknown to the participants, and use of questions focused on recent behavior.

RESULTS: Only participants who were consistently on inhaled corticosteroids (ICSs) for the entire 6-month study interval were included. Three groups of patients were contrasted: those not on ICSs (n = 420), those on ICSs with high adherence (> or = 75% of medication taken, n = 90), and those on ICSs with low/medium adherence (< 75% of medication taken, n = 148). Participants in the low/medium adherence group reported, on average, less symptom control and more variability in wheezing, awakening at night, missed activities, and beta2-agonist use during the 6-month period, although most in this group perceived their asthma to be under good control.

CONCLUSION: Despite extensive patient education and support, diminished ICS adherence was frequent and undermined symptom control in this group of adolescents and young adults with mild to moderate asthma.

MY COMMENTS
This is another one of these, uh really? abstracts relating to poor medication adherence and lack of symptom control, but supports the fact that if you do not take your controller medications, you will not be able to control your symptoms.

My feelings about adolescents and asthma medication is that they will not take their ICS unless they are having an attack. Forgetfulness and stigma, I believe, are the two drivers of this non-adherence. It would have been nice if the researchers had added the question: “Why didn’t you take your ICS”?, but they will probably have to do another study to get this question answered.

The official Health 2.0 Conference blog is a little slow to update as all the contributors are currently making the event run smoothly, however I believe they will update it throughout the conference.

Craig Stoltz is posting on his Web 2. Oh…Really? blog as well as cross posting on The HealthCare Blog.

I was told the Ozmosis Community blog is also updating throughout the conference.

On Twitter, some people are using the “Health 2.0” tag others are using the “#health20con” tag. Either tag shows up in a Twitter Searchfor either term. You can even search for a product that is demoing or person who is speaking at the conference to see who is tweeting about them.

NOTE: You do not have to have a Twitter account to see these feeds or to search.

Others are not using tags, but providing great coverage:

Scott Shreeve from Crossover Healthcare, Mark Schrimshire, Unity Stoakes from OrganizedWisdom, Dr. Greene, Robert Hendrick from change:healthcare, and Carlos Rizo.

I apologize if you are also blogging or twittering and I do not mention you. Please comment if you want to be included and I will update at the end of the day to add your feed.

Thank you and enjoy the conference!

UPDATE: Bob Coffield compiled a RSS Feed and a Search Feed for all of the Twitter tags. Much easier to follow. Thanks Bob!