Posts Tagged ‘Science Daily’

Study Proves Lower Co-pays Equal Better Medication Adherence

01/09/2008 , 9:40 AM by Alex Sicre

Here is a piece about a study that I read yesterday in a bunch of places, but this has the most information from ScienceDaily’s website and adapted from materials provided by University of Michigan Health System. It is so concise that I really cannot comment on it, save a few things which are at the end of this post.

ScienceDaily (Jan. 8, 2008) — As 2008 begins, millions of Americans are having to dig deeper into their own pockets every time they refill a prescription or see a doctor.The reason? Higher co-payments that took effect January 1, as employers try to deal with the rising cost of health insurance by making employees and retirees pay more.

But a new study finds that instead of going up, co-pays should go down — at least for some people taking some drugs. Just by cutting a few dollars off the co-pay, the study suggests, employers could increase the chances that employees with chronic illnesses will take certain preventive medicines. And that could pay off in the long run, in the form of fewer hospitalizations or emergency room visits for employees with diabetes, high blood pressure, asthma and other conditions.

Specifically, the study showed that a major private employer significantly increased the use of important preventive medicines among its employees by automatically making some medications free, and slashing co-pays for other drugs by 50 percent. Meanwhile, another employer that kept its co-pays the same didn’t experience the same increase in use of preventive medicines.

The difference in medication use between chronically ill employees at the two companies was sizable — even though all the employees in the study were also enrolled in special programs designed to help them take control of their diseases.

The study is published in the January/February issue of the journal Health Affairs by a team led by University of Michigan and Harvard University researchers. It is the first rigorous, controlled trial of a concept called “value based insurance design.”

That concept, introduced in the late 1990s by members of the research team, is based on the idea that there should be few barriers standing between a chronically ill person and the medications that can keep them well enough to work and to avoid health crises and complications related to their disease. Even a barrier of a few dollars is enough to keep people from using the medicines they need the most.

“All research to this point has shown that individuals will not buy important medical services even if there’s a small financial barrier: $5 or even $2,” says senior author Mark Fendrick, M.D., of the U-M Medical School and School of Public Health. “This study showed that when you remove those barriers, people started using these high-value services significantly more. These results bolster the idea that health insurance benefits should be designed in ways that produce the most health per dollar spent.”

Fendrick and first author Michael Chernew, Ph.D., of the Harvard Medical School, co-founded the Center for Value-Based Insurance Design, based at U-M. They conducted the study with co-authors from ActiveHealth Management, which had been retained by both companies in the study to provide voluntary disease-management programs for employees and dependents with 32 medical conditions.

Members of GlaxoSmithKline’s Health Management Innovations division also took part in the study, which was supported by unrestricted funds from both GSK and Pfizer, Inc. The employers involved in the study have asked to remain anonymous. During the study period, ActiveHealth Management was acquired by Aetna, a major insurer, but there was no impact on the study.

The study involved more than 35,000 employees and dependents at the company where co-pays were reduced (Company A), and more than 70,000 employees and dependents at the other (Company B). All had regular phone contact with nurses in their disease management programs, who offered help based on each person’s test results, medication use, doctor visits and other health information.

The researchers looked at use of five classes of drugs: heart-protecting ACE inhibitors and angiotensin-receptor blockers; blood-pressure-reducing beta blockers; diabetes medicines including blood sugar-reducing drugs and insulin; cholesterol-reducing statins; and asthma-calming inhaled steroids.

In the study period, co-pays at Company A went from $5 to $0 for generic drugs, from $25 to $12.50 for name-brand drugs on the company’s preferred drug list, and from $45 to $22.50 for non-preferred name-brand drugs. Co-pays at Company B stayed around $29 for brand-name drugs and $16 for generics.

As part of the disease management program at both companies, people who weren’t already taking preventive medications related to their conditions were contacted automatically to let them know about the importance of those specific medications. At Company A, they were also informed of the reduced co-pays. For all Company A employees, the co-pay reductions were made automatically at the pharmacy.

In just one year, the appropriate use of the preventive medicines at Company A increased significantly in four of the five drug classes, with inhaled steroids for asthma being the exception. The increase in use of statins was more modest than the increases in use of ACEs/ARBs, beta blockers and diabetes drugs.

And, the results show that “nonadherence” — a term used to describe a situation when someone should be taking a medicine but isn’t — decreased between 7 percent and 14 percent, depending on drug class.

Chernew notes that the study was not designed to assess whether increased adherence to preventive drugs had a measurable impact on employees’ and dependents’ health, or their use of costly services such as hospitalization and emergency care.

“While future studies need to be done to actually quantify this specifically, there is considerable evidence that use of the classes of medication in this study will reduce the frequency of adverse clinical events and associated hospitalizations and ER visits,” he says. “We believe that tailoring co-pays to the individual patient can improve the efficiency of health care spending when applied to this type of high-value health service.”

The new data provide the first rigorous, controlled analysis of the impact of a “clinically sensitive” health benefit design. Previously, employers such as office-equipment maker Pitney Bowes and the city of Asheville, NC have reported increased adherence and decreased use of health services among chronically ill employees who had their co-pays reduced.

Meanwhile, other employers have launched their own such programs without waiting for a controlled study to convince them of the potential benefits. In fact, the University of Michigan is currently offering free or reduced-price medications and tests to more than 2,000 of its employees and their dependents who have diabetes.

That project, called MHealthy: Focus on Diabetes, is being managed by the Center for Healthcare Quality and Transformation and may produce its first data this year.

“When I told my mother about this study, she turned to me and said ‘I can’t believe you had to spend all that money to show that if you make people pay more for something they’ll buy less of it,’” says Fendrick. “But we needed to show with a carefully done study that if we did lower barriers that people would utilize these essential medical services more. And as always, my mother was right.”

In addition to Fendrick and Chernew, the study’s authors are Mayur Shah, Arnold Wegh, Stephen Rosenberg, and Iver Juster of ActiveHealth; Allison Rosen of U-M Medical School and School of Public Health, who is leading the analysis of the University of Michigan diabetes project; and Michael Sokol and Kristina Yu-Isenberg of GSK.

COMMENTS
As it has been proven in the past, lower co-pays = betters adherence. The question is, who is going to pay? Pitney Bowes is picking up the tab for their employees, but they have one of the best employer healthcare programs and they see the value. Since insurance companies are always trying to make more of a profit, with they cover more prescription costs and realize it will pay off in the future? See the Aetna post of last month.
My own experience with copays almost affected my adherence, but I know better. When we switched over to a HSA program my co-pays went up by a ridiculous amount – almost 500%. My wife and son were also on two medications plus my two, and we were spending about $400 a month! Luckily we switched over to a regular plan and they went back down to $20 a script. Point being, with any financial barriers, adherence suffers.

This study is almost like a “Duh, of course”, just like Dr. Fendrick’s mother said, but it is important for insurers and employers to realize that cost is definitely a part of medication adherence.

Stay compliant! Remember to take your meds.

Older is Wiser

10/24/2007 , 11:00 AM by Alex Sicre

From Science Daily dated 08.19.98 – just found randomly.

Remembering Your Medications: Older are Wiser

“Being too busy, not being old, is what leads people to make mistakes in taking their medications,” says Denise C. Park, a psychologist at the U-M Institute for Social Research who presented her findings this month at the annual meeting of the International Congress of Applied Psychology.

As the population ages, the problem of forgetting to take the pills your doctor ordered–the right number of the right kind at the right times–will affect more and more people who are trying to manage diabetes, depression, high blood pressure, arthritis and other chronic age-related conditions.

According to Park, the conventional view has been that as patients age, their medication adherence rates drop, just when their need to manage complicated medication schedules increases.

With funding from the National Institute on Aging, Park and colleagues carried out a study designed not only to learn who really is most likely to make mistakes, but also what kinds of errors occur and why they’re being made.
For eight weeks, the researchers studied 121 men and women between the ages of 34 and 84, all diagnosed with moderately severe rheumatoid arthritis.

“We selected that illness because we expected medication adherence to be very good,” says Park. “Taking the medications commonly prescribed leads to real relief from pain, stiffness, and other symptoms. And that gives people a strong motivation to take medications on schedule.” Participants in the study took four types of medication, on average.

At the start of the study, researchers tested all the participants to determine their levels of depression and anxiety, and to see what their attitudes were about arthritis and disease in general. They also asked how helpful participants thought it was to take the specific medications they had, and medications in general. Participants also went through a range of tests assessing their memory, recall and other measures of mental functioning.

Park and her colleagues developed the “Busy Life Style Questionnaire,” to measure the chaos and unpredictability in the daily lives of participants. Among the items were questions asking how often you have too many things to do each day to get them all done, how often you’re so busy that you miss scheduled breaks or rest periods, or stay up later than normal, and how often you follow other regular routines, including eating meals at about the same time each day, or engaging in regular activities at home, such as reading the paper, watching a particular television show, or talking with family members.
After these initial assessments, participants received the prescriptions they were taking in new containers, special bottles with caps containing tiny electronic monitoring chips that recorded exactly when the bottles were opened.

After eight weeks, all the participants turned in the new containers. The information in the bottle-cap chips was downloaded into a computer file and analyzed.

Overall, the researchers found a surprisingly high level of adherence. Nearly 40 percent of participants didn’t make a single medication error during the two months studied. Of all the mistakes that were made, more than 98 percent were errors of omission; only 1.2 percent took an extra dose.

Perfect adherence was more common among older than younger adults, Parks found. Fully 47 percent of those over the age of 55 made no mistakes, compared with only 28 percent of those between the ages of 34 and 54.

What usually led to mistakes was being too busy, Park notes. Being slightly unhappy also contributed, combined with the belief that taking the medication as prescribed may make you feel better physically but won’t make you feel any better emotionally.

“Being a very busy person is the single biggest risk factor we found,” says Park. “Having a life that’s overly full leaves little time to attend to health concerns.”

For doctors, the implications of the research are clear. “Consider prescribing simpler drug regimens for busy, middle-aged patients, not for older patients,” says Park.

For middle-aged people too busy to take care of their health by remembering to take their medications on time, Park suggests using memory aids like written reminders or beeping wristwatches.

Dermatology Problems with Compliance

07/17/2007 , 9:58 AM by Alex Sicre

Who would have though? It is a problem you see everyday and would want to cure, yet noncompliance still happens!

Patients Not Complying With Treatment A Universal Problem
Science Daily — Patients not complying with their dermatologic treatment is a universal problem that doctors need to address, according to Steven Feldman, M.D., Ph.D., from Wake Forest University School of Medicine in an editorial published in the current issue of Archives of Dermatology. He said non-compliance can explain why some conditions may seem resistant to treatment.

“Physicians must develop practical measures to improve patients’ compliance behavior: establishing strong, trusting physician-patient relations, choosing medications that can fit patients’ lifestyles, using patient education materials designed to motivate without overly stressing risks, and scheduling a follow-up visit shortly after initiating a new treatment,” writes Feldman, a professor of dermatology.

Feldman says that dermatology research studies that involve electronically recording patients’ usage of a treatment, without them being aware of it, show that non-compliance is more pervasive that previously estimated.
“Understanding that non-adherence to treatment is widespread is essential for addressing many of the difficult-to-manage skin disease dilemmas seen in dermatology,” Feldman said. “By addressing adherence, we can achieve better success for patients with psoriasis and other chronic skin diseases.”

Feldman says he has had personal experience with patient noncompliance. He had acne and wanted to see how well current anti-acne medications work. He planned to take a photo of the rash, put the medicine on once a day and then take a photograph one week later.

“I wanted to make sure I didn’t forget to apply the medication, so I put it on top of my toothbrush,” he said. “The first night I used the medication. The second night I managed to brush my teeth and still forget to put the medication on. The third and fourth nights I went out of town and forgot to bring the medication with me. And I tend to be on the obsessive compulsive side!”

Patient forgetfulness is just one part of the problem, he said. Sometimes, patients consider treatment the worst part of the disease. For example, scalp psoriasis may seem resistant to treatment, he said. Actually, psoriasis treatments probably work better on the scalp than on other areas of the skin, if patients would just apply the medication.
Rather than having patients continually try new treatments for scalp psoriasis, he suggests having patients try the treatment for three to four days.

“It is much easier to be compliant for three or four days than for eight weeks,” Feldman said. “After that, patients will know they have a treatment that works and will use it as needed to keep their scalp psoriasis under control.”
He said that when prescribing medications, physicians need to consider which form is most likely to be used. Many patients prefer pills over creams and ointments, he said. Another option is physician-administered treatments, such as injections, that will assure adherence.

Feldman says doctors shouldn’t be surprised by poor adherence to using creams and ointments in the home environment, especially involving pediatric patients. “Those of us who are parents will recognize how difficult it is to apply sunscreen or other topical agents to our own children,” he said.

In addition to considering the form of therapy that patients are most likely to use, Feldman said the patient-physician relationship is an important part of the equation. He said research shows that if patients are satisfied with their physician visit three days afterwards, they are more likely to report an improvement in their condition a month later.

“Patients who are more satisfied with their visit are more trusting of their doctor, worry less about adverse effects and use their medication more regularly,” he said. Feldman’s co-authors are Saba M. Ali, B.S., Robert T. Brodell, M.D., and Rajesh Balkrishnan, Ph.D., all with Wake Forest.

Note: This story has been adapted from a news release issued by Wake Forest University Baptist Medical Center.