The first publication of ABC Project

The ABC project (Ascertaining Barriers for Compliance) is funded by the European Commission within the Seventh Framework Programme for research and technological development. The first ABC Project article entitled Management of patient adherence to medications: protocol for an online survey of doctors, pharmacists and nurses in Europe has been published by BMJ Open.  At this tiem, it has been the largest survey of European healthcare professionals' medication adherence perceptions, beliefs and behaviours. 

The article can be accessed here. 

Predictors of Primary Medication Nonadherence

Fischer et al. Trouble Getting Started: Predictors of Primary Medication Nonadherence

The American Journal of Medicine 124(11);1081.e9-22

Abstract

Background

Patient nonadherence to prescribed medication is common and limits the effectiveness of treatment for many conditions. Most adherence studies evaluate behavior only among patients who have filled a first prescription. The advent of electronic prescribing (e-prescribing) systems provides the opportunity to track initial prescriptions and identify nonadherence that may have previously been undetected.

Methods

We analyzed e-prescribing data and filled claims for all patients with CVS Caremark (Woonsocket, RI) drug coverage who received e-prescriptions from the iScribe e-prescribing system in calendar 2008. We matched e-prescriptions with filled claims by using data on the drug name, date of e-prescription, and date of filled claims, allowing up to 180 days for patients to fill e-prescriptions. We evaluated the rate of primary nonadherence to newly prescribed medications across multiple characteristics of patients, prescribers, and prescriptions and developed multivariable models to identify predictors of nonadherence.

Results

We identified 423,616 e-prescriptions for new medications, with 3634 prescribers and 280,081 patients. The primary nonadherence rate was 24.0%. Several factors were associated with nonadherence to e-prescriptions, including nonformulary status of medications (odds ratio [OR] 1.31 compared with preferred medications; 95% confidence interval [CI], 1.26-1.36; P<.001) and residence in a low-income ZIP code (OR 1.23 compared with high-income ZIP code; 95% CI, 1.17-1.30; P<.001) Nonadherence occurred less often when e-prescriptions were transmitted directly to the pharmacy rather than printed to give to patients (OR 0.54; 95% CI, 0.52-0.57; P<.001).

Conclusion

24% of e-prescriptions for new medications were not filled. Our results suggest that interventions to address economic barriers and increase electronic integration in the healthcare system may be promising approaches to improve medication adherence.

To read more click here.

Free Medications Could Improve Adherence: MI FREEE trial

Eliminating drug copayments for patients following a myocardial infarction reduced vascular events without increasing overall costs for insurers in the prospective randomized MI FREEE trial.

Although the Post-Myocardial Infarction Free Rx Event and Economic Evaluation trial had only a "modest" impact on medication adherence and missed its primary end point, the findings were dramatic enough that study sponsor Aetna has announced it will waive copayments for its post-MI patients beginning January 2013, lead author Dr. Niteesh Choudhry said at the annual scientific sessions of the American Heart Association.

To read more click here: Internal Medicine News 

Patient Adherence: The Next Frontier in Patient Care

Each year, Capgemini publishes an in-depth analysis of a major life sciences issue. In their 9^th edition of Vision & Reality, entitled “Patient Adherence: The Next Frontier in Patient Care," they focus on patient adherence – or rather the lack thereof. There is growing recognition that non-adherence to prescribed treatment is a major public health issue. In the US, it is estimated that additional care for non-adherent patients results in more than $300 billion of unnecessary costs to the healthcare industry each year.

For pharmaceutical companies, improvement in patient adherence represents a significant revenue opportunity that is largely untapped today. In this report, they analyze the current state of patient adherence and the challenges and key success factors involved in improving it.

To read the full report please click here.

High tech tools: enhancing adherence with a car

Ford and WellDoc have collaborated on in-car accessibility to WellDoc's comprehensive cloud-based personalized solutions for those with asthma and diabetes through SYNC Services providing real-time patient coaching, behavioral education and medication adherence support based on their historic and current disease information.

Forms of medication non-adherence

The following is a brief overview of the different forms of medication non-adherence.


Primary non-adherence:

• failure to fill prescriptions.

Since primary adherence is based on refill rates, it represents the  maximum possible level of adherence. Thus, it may overestimate the patient's drug taking behaviour.

Secondary non-adherence:

• overuse,
• underuse,
• alteration of schedules or doses,
• premature discontinuation of drug therapy.

Non-adherence not only mean underuse of the prescribed medication, symptom-relieving drugs such as short term bronchodilators are often overused. 

A Droid based Medication Adherence Screening Tool

Medication Adherence Individual Review-Screening Tool (MedAdhIR) is a reliable and valid instrument for screening adherence and now it is available for android too. 

Novartis invested 50 billion in “smart-pill” technology

According to a report in the Economist, NOVARTIS, the Swiss pharmaceuticals giant invested $50 billion in Alcon (an American eye-care firm) and spent $24m to secure exclusive licences and options on drug-delivery technologies developed by Proteus Biomedical.  It made Novartis the biggest pharmaceuticals firm to embrace “smart-pill” technology.

Reasons for the deal:

• Proteus’ technology points to “a promising new strategy” for a “troubled” industry.
• Patents on many lucrative drugs are set to expire soon and most pharma companies have not discovered enough treatments to replace them.
• With an eye toward maintaining fiscal stability, some drugmakers are tinkering with the idea of selling ancillary services tied to their offerings — like Proteus’ advanced medication adherence.
• Medication adherence is a huge problem: One study pinpoints the costs of medication adherence-related, needless hospitalizations at costing $100 billion each year in the U.S.
• Leslie Saxon, chief of cardiology at the University of Southern California, thinks patients will clamor for more data about their own health.
• Governments, including the U.S., are beginning require drugmakers to first prove the efficacy of expensive new pills in practice as well as in theory, which might drive more of them to use technology like Proteus.

The Economist report also includes a metric from research from Kalorama, which predicts that sales of wireless health services will leap from $4.3 billion last year to $9.6 billion by 2012.

The above story is reprinted from materials provided by: www.economist.com , mobilhealthnews.com .

Pfizer wins the compliance enhancing packaging design's award in 2011

Pfizer Manufacturing Deutschland GmbH is awarded the HCPC Alliance Columbus trophy for compliance enhancing packaging design 2011.

 
At Fleming Europe's Pharma packaging & labelling compliance conference 2011, which took place in Barcelona on March 23rd and 24th, the HCPC Alliance¹ presented for the first time the Columbus Award for compliance enhancing packaging design. Innovative packaging solutions with elements to help patients to take their medications as prescribed were presented and the Columbus Award was given to the solution that, according to the jury, offered the most comprehensive support.

 

The Champix/Chantix wallet packaging portfolio, from Pfizer Manufacturing Deutschland GmbH is an answer to the question how to enhance compliance for products marketed on a global scale by customized packaging solutions. It provides a multi-dimensional solution for the essential product medication scheme, regional packaging requirements but also important prescription and reimbursement regulations.

Compliance delivered through an innovative packaging platform is a critical success factor due to the treatment regime:

• Patients needs to set a date to stop smoking

• Begin of treatment one week before that date

• Titration dose (day 1-3 0,5 mg once a day, day 4-7 0,5 mg twice a day, continuing weeks 1 mg twice daily for a total of 12 weeks).

The above story is reprinted from materials provided by http://www.hcpc-europe.net/.

Factors associated with adherence in patients with COPD

I'm pleased to inform you that my article "Factors Associated with Medication Adherence in Patients with Chronic Obstructive Pulmonary Disease" has been e-published by Respiration.

Factors Associated with Medication Adherence in Patients with Chronic Obstructive Pulmonary Disease.

Agh T, Inotai A, Meszaros A.

University Pharmacy Department of Pharmacy Administration, Semmelweis University, Budapest, Hungary.

Abstract

Background: Predictors of medication adherence are not well known in chronic obstructive pulmonary disease (COPD). It is therefore necessary to identify factors associated with adherence to improve the effectiveness of COPD management within real-world situations. Objectives: The goals of this study were to estimate adherence to respiratory medication and to identify factors related to adherence in COPD patients. Methods: This was an observational, cross-sectional study conducted on a sample of COPD outpatients. The following information was obtained: adherence to respiratory therapy (Morisky Medication Adherence Scale), age, gender, smoking status, COPD severity [Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage], lung function [post-bronchodilator forced expiratory volume in 1 s (FEV(1))], treatment regimen for COPD, COPD medication costs per month paid by the patient and health-related quality of life (EuroQol 5-dimension questionnaire). A multivariate logistic regression analysis was performed to identify the independent predictors of adherence. Results: Of the 170 participants (mean age 63.8 years, 41.8% male), 58.2% reported optimal adherence. Adherence to respiratory therapy was associated with age, current smoking status, number of respiratory drugs, number of daily respiratory drug doses and quality of life (p < 0.005). Adherence to respiratory therapy was not related to gender, GOLD stage, FEV(1) or COPD medication costs. Conclusions: Adherence to COPD medication regimens is poor. Less frequent dosing regimens could be an effective method to enhance adherence to respiratory therapy. Quality-of-life monitoring within clinical practice settings could facilitate improved medication adherence.

Copyright © 2011 S. Karger AG, Basel.

PMID: 21454953 [PubMed - as supplied by publisher]

Association between ethnicity and medication adherence

Medication adherence is a multidimensional phenomenon. It is occurred for a variety of reasons, such as disease-related, treatment-related and socio-economic factors etc.. But what about ethnicity? Is ethnicity related with adherence? Little is known about the association between these factors, however it would be important to identify factors related to adherence in order to develop more effective strategies that can improve medication-taking behavior. E.g. What about ethnic-specific approaches, are these needed to improve adherence?

Factors associated with medication adherence to oral hypoglycaemic agents in different ethnic groups suffering from type 2 diabetes: a systematic literature review and suggestions for further research.

Peeters B, Van Tongelen I, Boussery K, Mehuys E, Remon JP, Willems S.

AIMS: To synthesize knowledge regarding the different factors that may influence adherence to oral hypoglycaemic agents in different ethnic groups through a systematic review of the literature.

METHODS: Thirteen databases were searched and 1201 articles were screened by two authors independently from each other. Different quantitative study designs were included if the study population included at least one ethnic group other than White people, medication adherence was a dependent variable and a clear description was given of the method used to measure medication adherence.

RESULTS: Demographic, disease-related and treatment-related, socio-economic and cultural factors were associated with medication adherence in the populations that were studied. However, to synthesize results, the number of studies was too small and the included studies differed too much with respect to their study designs and the ethnic groups that were studied. We discuss several methodological challenges with respect to measuring medication adherence, measuring ethnicity and study designs that need to be resolved to make future studies comparable. We propose methodological improvements for future research.

CONCLUSION: Although medication adherence is an essential part of the diabetic regimen, little is known about the association between ethnicity and medication adherence and the underlying factors that could explain this association. More research is needed in which important methodological challenges will have to be faced.

New medical package offering improved opportunities for real-time adherence control - Stora Enso Pharma DDSi Wireless

Healthcare efficiency and patient treatment will take a major step forward when the new Stora Enso Pharma DDSi Wireless is made available to the healthcare and pharmaceutical industry at the Pharmapack 2011 exhibition and conference in Paris on 23-24 February 2011.

The Stora Enso Pharma DDSi Wireless package is based on conductive ink on a carton board based blister inlay, which is connected to a cellular module embedded in the package. This enables the tracking of one pill at the time on removal from the blister, whereby data is sent to the cellular module and then forwarded wirelessly, even instantaneously if required, using GSM or GPRS cellular networks, to electronic health record systems. This allows real-time tracking and intervention by a physician and also enables physicians to make timely changes to patients' medication.

The blister inlay connected to the cellular module in the Pharma DDSi Wireless is made of environment-friendly, recyclable carton board with no metal components. The cellular module is equipped with a chargeable battery enabling up to several months of lifetime without recharging.

The principal benefits derive from the numerous possibilities that this solution provides to healthcare service providers: sending voice-call reminders or text messages (SMS) to patients, or making personal visits when important prescribed medication has not been taken in time. Patients can also elect to have the data provided to relatives, pharmacists, physicians and healthcare providers so that they can treat the patient more effectively and intervene if treatment changes are required.

The above story is reprinted from materials provided by Stora Enso Pharma.

Integral medicine

Integral medicine /AQAL- All Quadrants All Levels/ observes medicine from four different dimensions: intentional, behavioral, social, and cultural. The integral medicine that is rapidly developing today is more than ”holistic” medicine. It integrates both ”conventional” medicine and ”alternative” medicine. Conventional medicine treats the illness and alternative medicine treats the person; but integral medicine goes one step further: it treats the illness, the person, and the physician. Integral medicine is a way to help patients more effectively and efficiently; but it is first a way to help the health-care professional handle pressing problems, such as compliance.

„An integrally informed medical practice changes the practitioner first; he or she can then decide which of the treatments-conventional, alternative, complementary, and/or holistic-that he or she wishes to utilize when practicing medicine with integrity. It may include adding new treatments, conventional and alternative; or more conscientiously referring patients to otherquadrant practitioners when an integral diagnosis so indicates. The only item that is constant in all of those is the transformed practitioner. It is the physician who is healed and wholed first, not merely by learning new and complementary techniques, but by inhabiting a new consciousness that makes room for new techniques; and how that integrity then expresses itself in an integrally informed medical practice might vary considerably.” Ken Wilber /developer of the AQAL approach/.

Compliance-enhancing interventions

Many studies have been published about strategies to improve compliance. Seventy-six compliance interventions were evaluated in the systematic review by Petrilla and Benner.

They divided the compliance-enhancing interventions in the following categories:

·         coordination of healthcare: improved linkages between primary care physicians, clinicians and other health professionals;

·         live consultation and education;

·         the changes of the therapy dose, dosage and packaging for the convenient drug taking;

·         patient education materials;

·         disease management programs by clinicians;

·         reminders: medication refill reminders delivered by mail or telephone;

·         self-monitoring;

·         social support programs;

·         and the combination of these interventions.

Common attributes of successful programs included simplified treatment regimens, facilitation of doctor-patient relationships, and patient education methods, clear up from their review.

Effective treatment need a good clinician-patient relationship. Spending time on patient education and answering patient's questions is worth the time. Patients should be educated about the most important features and complications of their disease. Compliance may be enhanced, if the medical check-up and the therapy is known by the patient.



Reference:

Petrilla, A.A., Benner, J.S.: Critical evaluation of interventions to enhance patient compliance with chronic medications. Value in Health, 2003, 6, 200.

Electronic pillbox for the Baby Boomer Generation

MedFolio developed a new innovative pillbox.

The features of the MedFolio device address the needs of patients, caregivers, and their healthcare providers. The unique built-in pill identification system is a portfolio of every medication stored in the device, thereby giving the patient/caregiver the confidence to engage in medication discussions with their healthcare providers.  In order to help patients in remembering to take the “right dose at the right time”, advanced medication reminder systems have been incorporated into the device. The device connects to a personal computer by USB and installed software allows the patient/caregiver to easily customize the device to their specific medication regimens and dosing times. The medication information stored into the memory of the device will initiate audio alert and visual lighting reminders from the device. Additionally, the software program will communicate with a secure website to offer the option of receiving electronic messaging reminders (e-mail and text message) for each scheduled medication dosing time.

Gaps between patients and physicians understanding of osteoporosis

The survey findings ‘The gaps between patient and physician understanding of the emotional and physical impact of osteoporosis’ have been published in Archives of Osteoporosis.

This multinational survey conducted on behalf of the International Osteoporosis Foundation (IOF) show clear disparities between patients’ and doctors’ perceptions of osteoporosis and its management.

The 13-country survey of 844 postmenopausal patients over 55 years of age and 837 doctors investigated gaps between patient and doctor understanding of the emotional and physical impact of osteoporosis; identified barriers to patient adherence; and sought to understand the ways in which osteoporotic patients can better share and obtain information about the management of the disease.

Key findings showed:

• Patients are not as well informed as they believe themselves to be
• Patients fear fractures and worry about their quality of life, but do not always adhere to treatment
• Doctors consistently underestimate their patients adherence to treatment
• Doctors underestimate patients’ concerns about fracture, the impact of osteoporosis on their quality of life and fear of dependency. 

Adherence and persistence to osteoporosis therapy is a serious problem, with studies showing that fewer than 50% of patients still take their prescribed medication after 1 year. This can be attributed to underestimation of personal risk, uncertainty of benefits versus risks of treatment, side-effects, and a belief in the efficacy of lifestyle measures alone. Patients who drop their prescribed treatment unknowingly leave themselves at high risk of fracture.

The survey also showed the willingness of doctors to support initiatives that would improve patient adherence to treatment: 80% of doctors surveyed would be willing to hand out educational materials to increase adherence and 76% would recommend patient programmes that encourage better communication on osteoporosis management.

"As this survey revealed, patient and doctor misconceptions exist on a number of levels," noted IOF CEO Patrice McKenney. "Community-based online support programmes have a great potential to fill these information gaps. They can help patients share their concerns, improve patient-doctor dialogue, allow patient-to-patient contact, encourage long-term adherence to prescribed treatment and help patients to maintain or improve quality of life."

The International Osteoporosis Foundation, in cooperation with national osteoporosis societies in four pilot countries (Austria, Germany, Sweden and Switzerland), is currently developing a novel community-based platform called 'OsteoLink'. 'OsteoLink' aims to improve communications and facilitate dialogue among patients and between patients and doctors, providing personal networking opportunities and new tools that respond to current unmet needs.

The above story is reprinted from materials provided by International Osteoporosis Foundation (http://www.iofbonehealth.org/news/news-detail.html?newsID=394).

Chip in the pill

Next-generation pills are being developed by scientists, the Los Angeles Times and the Financial Times report.

These high-tech pills are equipped with microchips, that report back exactly when, what kind of and how much medicine the patient has taken.

The main goals of these new devices are to help the patients adhere to their medication regimen and to improve adherence to medication in clinical trials.

Examples for the high-tech pills

Magne Trace

Investigators from Georgia Tech developed an electronic necklace that can detect magnetized pills as they pass through the esophagus. The necklace (or a patch attached to the chest) contains a magnetic sensor that could be used to detect when specially-designed medication containing a tiny magnet – three millimeters in diameter and about one millimeter thick – passes through the patient’s esophagus. The date and time the user swallowed the pill can be recorded on a handheld wireless device, such as a smart phone, carried on the user’s body. The information can then be sent to the patient’s doctor over the internet. The device can notify both the patient and the patient’s doctor if the prescribed dosage is not taken at the proper time.

Proteus

Proteus Biomedical and Novartis developed a specialized microchip which the company plans to add to pills. When a patient ingests a ”Proteus-pill”, their stomach acids activate the microchip, which then sends data such as heart rate, temperature, and body movements to a dermal patch via Bluetooth connectivity. This patch can then export the data to an EMR (electronic medical record), so that it can be accessed by the patient's doctors. Novartis will bring the "Proteus-pills" to market within two years.

  

ID-Cap 

The ID-Cap is a sticker that is developed by University of Florida electronic engineer Rizwan Bashirullah. The cap contains a microchip, antenna and acid sensor and it sends electronic signals through body tissue to a receiver, worn on the wrist. Bashirullah estimates that applying the microchips to medication would cost between 25¢ to $1.00 more per pill, and that a real-world product should be available within two years.