The Great American Health 2.0 Motorcycle Tour

11/05/2008, 10:11 by Alex Sicre

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!

Real Cost of Medication Non-adherence for Diabetics

10/31/2008, 09:10 by Alex Sicre

So I write about the importance of medication adherence on this blog, on Twitter and speak to people everyday about dangers of medication non-adherence and the affect it has on 50% of the patients in the US.

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.

Engage With Grace: One Slide Project

10/31/2008, 09:10 by Alex Sicre

Last week at Health 2.0, Alexandra Drane and Matthew Holt launched a movement asking everyone to take two minutes at the end of each presentation to show just one slide. The slide asks if you can answer for yourself and your loved ones 5 simple questions about what you want for care at the end of your or their life.

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.

What I Am Reading – Health 2.0 Conference Wrap-ups

10/27/2008, 09:10 by Alex Sicre

What a way to kickstart the week by finding out what I am reading today!

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!

Medication Adherence and Asthma Symptoms Abstract

10/27/2008, 09:10 by Alex Sicre

Today’s Medication Adherence related abstract comes from The HighWire Press. My comments are at the end.

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.

Following The Health 2.0 Conference

10/22/2008, 09:10 by Alex Sicre

Unfortunately am not able to attend this year’s Health 2.0 Conference in San Francisco, but I am monitoring it off and on via live blogs and Twitter for the following two days.

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!

Health 2.0, LLC Launches Health 2.0 Advisors

10/22/2008, 09:10 by Alex Sicre

One of the first announcements to come out of the Health 2.0 Conference is the formation of Health 2.0 Advisors, “an advisory service formed by four principals with national reputations at the nexus of health care and technology.”

From their Press Release:

“The mission of the new advisory service is to partner with clients to critically evaluate the continuing evolution of the Health 2.0 marketplace and how its tools and processes can maximize business value.”

“The firm is a joint venture between Health 2.0, LLC, and a team of four individuals: Matthew Holt, a Health 2.0 pioneer and co-founder of the Health 2.0 Conference; Brian Klepper, an expert in change dynamics in health care; Michael L. Millenson, an author, consultant and expert in quality of care and consumerism; and Jane Sarasohn-Kahn, a respected health economist and founder of THINK-Health.”

This is an amazing combination of talent in the Health 2.0 space and will certainly help large Health 1.0 organizations identify the value in adopting Health 2.0 technology.

Several critics have recently been complaining about the problems of monetizing Health 2.0 and signaling the end of the movement. Obviously with the 1000+ attendees at the Health 2.0 Conference (including Google, Microsoft, and Yahoo!), it doesn’t seem to be ending anytime soon!

Matthew has consistently advocated for larger healthcare organizations to adopt the technology of the smaller, more nimble emerging Health 2.0 companies. Hopefully Health 2.0 Advisors will help bridge the gap between what is not working in the current healthcare system and the new technology that can effect a positive change, improve outcomes and reduce costs.

“Across health care, a wave of innovation has begun in earnest,” said Holt. “For stakeholders in the health care industry, understanding Health 2.0 has become absolutely mission critical. At Health 2.0 Advisors, we’re about ROI and guiding our clients to unlock the tremendous value of Health 2.0.”

Well said sir! I wish them the best of luck with their new venture.

InfoMedics Announces New Patient Adherence Survey and Launches Adherence Driver™

10/21/2008, 10:10 by Alex Sicre

InfoMedics recently announced the results from a new survey examining the behaviors of patients on prescription medications. These results were presented at the 2nd Annual Digital Pharma Conference October 15th, and also coincide with the launch of InfoMedics Adherence Driver™, which they will demonstrate at the 5th Annual Patient Adherence & Persistence Summit USA at the end of this week on October 23rd.

Smells like Conference season, considering the Health 2.0 Conference launches tonight, and there are four more events on the horizon in the next two weeks!

While the results are not groundbreaking, they further reinforce the disconnect between patients and doctors regarding medication adherence.

1,017 responded to Zoomerang’s invite to participate in InfoMedics, Inc.’s 2008 “Following Doctor’s Orders: Patient Prescription Behaviors” survey. All had taken prescription medications, with no particular demographic breakdown.

Survey Says (my comments are in BOLD):

34% do not always fill a new prescription from their doctors; another 5 percent said they never fill those prescriptions.
The latest poll I saw was around 30% – getting higher, wonder if economy affected this answer? Probably too early.

46% said there is a chance they would not tell their doctor if they stopped taking a medication or decided not to fill a prescription. This is bad. Obviously if a doctor doesn’t know you are not taking your medication, they will not know how to effectively treat your ailment. Good thing there is blood work to determine medication levels.

67% forget to take their medication at times. Last figure I have from 2007 is 87% – so that is a pretty steep decline.

9% said they would keep taking a medication if they started feeling worse. Not a very engaged population number.

34% sometimes, often or always stop taking medication if they feel better. This number sounds low.

46% are careless at times when taking medications. Sound about right.

32% are always motivated to take a newly prescribed medication.Better than 30%!

When asked for multiple responses about where they go for medication information, 51 percent of respondents said they look to the Internet for this information; 49 percent said they ask their pharmacists and 37 said they ask their doctors.
This follows Manhattan Research’s Cybercitizen® Health v8.0 report that stated 53% of patients prefer to look online for health information.

Overall this survey is pretty representative of the current research, with a good indicator that adherence rates are not going above 50%. I am looking forward to seeing the whole survey when it is published.

AlignMap Betters My Robotic Posts

10/20/2008, 10:10 by Alex Sicre

As has happened in the past, Dr. Showalter from AlignMap has written a better and more thoughtful post about the future of robotic medication adherence assistance than I did last week.

Dr. Showalter’s post reminds me (as our emails about blogging have in the past) that I sometimes only “report” what I find, not adding anything of merit with my own thoughts, observations, etc….  Also that I do not add any visuals.
I thank Dr. Showalter for his great additions to my previous two posts regarding medication adherence and healthcare robots, as well as adding a personal real world context for the use of these aids.

He also referenced his own blog post about a Tamagotchi-style Pill Pet reminder that I never saw. It alerts patients when to take their pills and when to go to the MD. If the patient is not adherent, the Pill Pet get sicks and eventually dies. This aids adherence by hopefully making the patient care more about the health of a robotic pet than their own.

I will close with Dr. Showalter’s favorite compliance program:

1. RoboCop (Dr. RoboCop to you) presents the healthcare instructions.

2. RoboCop enhances compliance with his trademark line, which also serves as the Program’s slogan: “You have 20 seconds to comply.”

Of course it is cooler and has more effect on the AlignMap blog as he has visuals and audio!

Ryan Haight Online Pharmacy Consumer Protection Act to Become Law

10/17/2008, 10:10 by Alex Sicre

President Bush signed the Ryan Haight Online Pharmacy Protection Act(H.R. 6353) on October 15th making it a law. Congrats to this administration for seeing this act through.

Most people believe that online pharmacies are scams selling fake or illegal pills at high rates for ED, and oxycontin. With the passing of this law, hopefully more legitimacy will be given to online pharmacies in the public view.

Also helping to make online pharmacies more respected are Health 2.0 companies like eDrugSearch which “brings together the world’s most highly respected online pharmacies through a comprehensive, easy-to-use search engine.”

They vet all the pharmacies their search engine queries and also provide “up-to-the-minute price search, detailed drug information, and other advanced features that make it the premier portal for online prescription medication shoppers. Our advanced search features enable members to identify pharmacies with specific licensing requirements, third-party accreditations, Better Business Bureau memberships, and more.”

eDrugSearch’s founder, Cary Byrd, an impassioned advocate of safe online pharmacies, wrote a great summary of the Ryan Haight Online Pharmacy Protection Act’s provisions last month on his blog.

Here is the condensed version. Thanks again to Cary for for the succinct write-up.

- Amends the Controlled Substances Act to prohibit the delivery, distribution, or dispensing of controlled substances over the Internet without a valid prescription. Exempts telemedicine practitioners.

- Defines “valid prescription” as a prescription that is issued for a legitimate purpose by a practitioner who has conducted at least one in-person medical evaluation of the patient.

- Adds definitions to the Controlled Substances Act relating to online pharmacies and the issuance of prescriptions over the Internet.

- Imposes registration and reporting requirements on online pharmacies.

- Authorizes the Attorney General to issue a special registration under this Act for telemedicine practitioners.

- Increases criminal penalties involving controlled substances in Schedules II, IV, and V of the Controlled Substances Act.

- Authorizes states to apply for injunctions or obtain damages and other civil remedies against online pharmacies that are deemed a threat to state residents.

Patients have cited access to medications as being a barrier for medication adherence. If you have trouble getting your meds and affording them, look to online resources like eDrugSearch to provide you with the best prices and services that will deliver you scripts to your door.

I hate to sound like an advert, but with the economy the way it is, medications should not be sacrificed in this dire time, and there are less expensive alternatives than going to your local pharmacy. I am all for supporting small, locally owned businesses (we go to a druggist in Southport where my wife got penny candy as a girl), however one’s health and medication regime come first – if you cannot afford to pay for small town service, look for alternatives.

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