Tuberculosis - MIT Creates New Testing And Reporting System, Rewarding Patients Who Take Their Medicine

One of the biggest challenges in fighting tuberculosis is simply getting patients to take their medicine.


MIT students have come up with a possible solution: a new testing and reporting system that is easy for patients to use and offers economic incentives such as free cell phone minutes.


Tuberculosis kills an estimated two million people every year, and treating the disease requires a strict six-month regimen of antibiotics. If patients abandon the treatment early, the TB bacteria survive and can become resistant to first-line antibiotics.


"TB is a massive problem, and it's exacerbated by the fact that people have a lot of trouble staying on their meds," says Elizabeth Leshen, an MIT sophomore majoring in biological engineering and member of the team, known as "X Out TB."


The students' plan, which has been field-tested in Nicaragua, combines a newly developed paper testing strip with a simple text message reporting system to ensure drug compliance.


The team's novel test strip takes advantage of new technology known as paper microfluidics. The strip is embedded with chemicals that react with metabolites present in the urine of patients who have taken TB medicine. When the chemical reaction occurs, the strip changes color, revealing a number.


Patients are given a device that dispenses one strip every 24 hours, and after they successfully take the test, they have about two hours to text the number on the strip to a central database that records that they have taken the drug.


Patients whose compliance rate is high enough receive free cell phone minutes. The team decided on cell phone minutes as an incentive because it's fairly easy to set up the reward system, and because most of the target patients have a cell phone already.


"It's really easy to tell cell phone companies to give someone extra cell minutes. You don't need a new infrastructure," says Leshen, who joined the team last fall.


Susan Murcott, who teaches D-Lab III: Dissemination, is advising the team. She says she's impressed with the innovation shown by the students.


"There are a lot of creative elements," said Murcott, a lecturer in civil and environmental engineering. "They've engineered a better urinalysis test, you don't have to send somebody out every day to check that patients are taking their medication, and there are these incentives built into the program."


The new system could be a breakthrough in monitoring patients in developing countries who don't live near medical centers, says Jose Gomez-Marquez, who joined the team while a grad student at Worcester Polytechnic Institute and is now directing MIT's Innovations in International Health initiative.


"Some of these people live six hours from the nearest health care center, so telling them that they have to come in every day to check if they're taking their medication is a non-starter," he said.


Gomez-Marquez, who is from Honduras, also believes the project will transform the relationship between patients and health care workers.


"Their lives are so hard already, and the last thing they need is to become an example of disappointment in another person's eyes," he says. "We're turning that around and rewarding them for doing good."


The project got started as part of the 2006-2007 Muhammad Yunus Innovation Challenge to Alleviate Poverty, which challenged students to find a way to get TB patients to take their medicine. The Yunus Challenge, part of MIT's IDEAS Competition, is sponsored by Mohammed Abdul Latif Jameel, benefactor of MIT's Poverty Action Lab.


The "X Out TB" team decided that simply reminding people to take their medicine is not enough-the best way to get people to comply is to offer them an incentive. Similar incentive programs have been launched in the United States.



"This is a universal concept that, given the right technology, we think can be applied just as effectively in developing countries as it can here," says Leshen.


The team plans to run larger field tests in Pakistan and Indonesia this summer, in conjunction with local hospitals.


Other members of the team are Minyoung Jang '07, Elizabeth Gillenwater '07, Aron Walker '07, Angela Kirby '07 and Jeffrey Blander, lecturer in the Harvard-MIT Division of Health Sciences and Technology.


By Anne Trafton, News Office


mit

GuildNet Will Expand Use Of AMAC's Remote Telemedicine System To Improve Patient Medication Compliance

GuildNet, a managed long-term care program that offers a community-based alternative to facility-based long-term care, announced that after a three month evaluation period, it has decided to make American Medical Alert Corp.'s (AMAC) MedSmart Medication Management System available to its members. Wanda Figueroa-Kilroy, GuildNet's Executive Vice President, notes "our members and their families report a great deal of satisfaction with the device and we saw evidence that the reminders helped to ensure medication compliance."


Frederic Siegel, AMAC's Executive Vice President said, "We are very pleased with the results of the pilot and excited that GuildNet has decided to make MedSmart an integral part of their medication compliance program. With MedSmart, we are not only simplifying complex drug regimens, but putting providers and caregivers in the driver's seat to address dosing errors and ensure timely refill."


The MedSmart® System organizes, reminds and dispenses the correct pills at the correct time from 1 to 6 times per day ensuring safe and appropriate medication use. Using a two-way communication modem, MedSmart uploads device and dispensing information on a daily basis to a secure, web portal for access by authorized individuals. If a dose is missed or medications are low, the system will promptly notify designated caregivers via text, voice or email message, allowing for early intervention and timely tray refill.

Studies Geared To Improving HIV Care And Prevention Supported By Federal Stimulus Funds

UCSF HIV researchers have received two NIH grants of $1 million each to study the use of web-based, patient controlled personal health records to improve health and HIV prevention outcomes for HIV positive patients.



Both studies are funded through the federal stimulus bill, The American Recovery and Reinvestment Act.



One study will look at using mobile phone text messages linked to a web-based personal health record to help HIV patients' adherence to pill-taking regimens.



"Patients participating in the study will not only be assisted with taking their HIV medications, but also with medications for conditions like diabetes and hypertension. At least half the patients we see in our clinic have at least one other chronic disease that requires medication to control. Our hypothesis is that using individualized text message reminders linked to personal health records will help patients better succeed in self-management of their multiple health challenges," said James S. Kahn, MD, professor of clinical medicine at the UCSF Positive Health Program at San Francisco General Hospital.



Two methods will be used to assess adherence to medication regimens in this project. Self-report of pill taking is one. A biological marker, measurement of antiviral drug levels in hair, is the other method used. A member of the research team, UCSF assistant professor of medicine Monica Gandhi, MD, MPH, has shown this method to be a better correlate of success in HIV viral suppression during treatment than other variables usually considered.



The other study will test the feasibility and acceptability of a web-based strategy that seeks to reduce drug and alcohol use and accompanying HIV risk behaviors and improve antiretroviral medication adherence by HIV positive patients.



The strategy is called SBIRT and consists of screening for drug and alcohol use, a brief intervention and referral to treatment. It has been shown to be effective in many populations in reducing drug and alcohol use but has never been used in a HIV primary care setting. With several studies showing a relationship between high HIV transmission risk behaviors and drug and alcohol use, effective administration of the SBIRT strategy could also reduce HIV transmission according to the project team.



The project will compare SBIRT delivered through a self-administered and web-based method using patients' electronic health records with SBIRT delivered through a provider-administered protocol during clinic appointments using an electronic health record system.



"We want to see if the SBIRT approach will work in this population and this setting to not only reduce drug and alcohol use but also succeed in reducing HIV transmission associated with substance use. We are hoping to find out whether patients are more open to responding to sensitive topics with a self-administered web-based approach than they are talking directly with their clinician," said Carol Dawson-Rose, PhD, MSN, RN, associate professor of nursing at the UCSF Center for AIDS Prevention Studies.



Both studies use HERO (Health Care Evaluation Record Organizer), a web-based electronic medical record system and research database developed by Kahn and T. Van Nunnery, a programmer/analyst at UCSF, and myHERO. Integrated with HERO, myHERO is a publicly-accessible personal health record enabling patients to access information online from their own medical record. This complete electronic health record system is secure, flexible, extensible, and is exportable to other clinical care venues.

Non-Compliance May Be The Cause Of 'Difficult-To-Treat Asthma'

Difficult-to-treat asthma often may have more to do with patients who do not take their medication as instructed than ineffective medication, according to researchers in Northern Ireland.



"[A] significant proportion of patients with difficult asthma are poorly adherent to inhaled and oral corticosteroid therapy," wrote principal investigator, Dr. Liam Heaney, of Belfast City Hospital.



The results of the study were published in the November 1 issue of the American Journal of Respiratory and Critical Care Medicine, an official publication of the American Thoracic Society.



"Defining the scale and identifying non-adherence in this population is important given currently available and other imminent expensive biological therapies," said Dr. Heaney.



Dr. Heaney and colleagues obtained data from almost 200 patients who were referred to a tertiary referral clinic that specializes in treating difficult asthma. To assess compliance with inhaled corticosteroid therapy (ICT), they compared patient prescription to the patient's actual refill usage. They used blood plasma prednisolone and cortisol levels to evaluate oral medication adherence.



Of the 182 consecutive patients, 35 percent filled fewer than half of their prescribed inhaled combination therapy (ICT), 21 percent filled more than they were prescribed and 45 percent filled between half and all of the medication they were prescribed.



Furthermore, in patients who were on a maintenance course of oral prednisolone, blood levels of cortisol and prednisolone showed that nearly half (45 percent) were not taking the medication as prescribed. In follow-up conversations with the researchers, most admitted that they were inconsistent in the use of their medications. Of the 23 patients who were non-adherent to their oral prednisolone, 15 - or 65 percent - were also non-adherent to their ICT.



"All subjects had initially denied poor medication adherence, and poor adherence only became apparent using a combination of surrogate and objective measures," said Dr. Heaney. "Of these patients who were referred for assessment and treatment of difficult asthma, many are actually not taking their treatment as prescribed, which would suggest an important first course of action in assessing difficult asthma may actually be verifying the patient's adherence to his or her treatment protocol. Determining whether the patient is taking medications as prescribed is of utmost importance before moving to more aggressive and expensive treatments. It is also crucially important in understanding true refractory disease and assessing responses to novel therapies, either in clinical trials or clinical practice."



Some patient characteristics were more strongly associated with nonadherence than others: women were less likely to be adherent than men, a finding that had been previously identified, but that Dr. Heaney cites as needing more investigation.



Another red flag may be a lower score on quality of life measures. Dr. Heaney and colleagues found that patients who filled fewer than half of their prescribed ICT scored significantly lower on the EuroQol and the Asthma Quality of Life Questionnaire. Furthermore, the number of prior hospital admissions within the past 12 months was significantly associated with non-adherence.



"In general, one might expect in more severe disease that a very poor asthma quality of life score suggesting high morbidity, would perhaps, result in better adherence, " said Dr. Heaney. "The same could be said for hospital admission, but the reasons for non-adherence are complex. However for clinicians, multiple hospital admissions should definitely flag probable non-adherence in difficult-to-treat cases."



"Non-adherence is a common problem, which is often hard to detect. In general, asking the patient or relying on clinical impression is useless, and objective or good surrogate measures should be utilized. However, we need to try and develop better objective tests for this problem, and we are currently looking at some novel techniques to do this," Dr. Heaney concluded.

Chance Of Heart Failure Hospitalization Impacted By Health Literacy

Being able to read and understand words like anemia, hormones and seizure means a patient with heart failure may be less likely to be hospitalized, according to a new study from Emory University School of Medicine. Findings were presented at the American Heart Association Scientific Sessions conference in Chicago.



The research, led by Emory cardiologist Javed Butler, MD, MPH, professor of medicine, Emory School of Medicine and director of Heart Failure Research at Emory Healthcare, involved the use of a simple test called the Rapid Estimates of Adults Literacy in Medicine (REALM-R).



"This study lends more insight about the importance of health literacy and the impact it has on a patient's participation in their care," says Butler, who also serves as the deputy chief science advisor for the American Heart Association. "We learned that below optimal health literacy is driven by low socioeconomic status and is associated with increased admission rates in patients with heart failure."



REALM-R is a word recognition test designed to assist medical professionals in identifying patients at risk for poor literacy skills and playing a role in predicting their ability to control a chronic condition like heart failure. Adults are asked to de-code or pronounce a short list of words. The test takes less than two minutes to administer and score.



Emory researchers administered the REALM-R test to 154 heart failure outpatients from January 2008 to July 2009. People with a score of 60 or lower (considered low or marginal) had a 55 percent higher rate of hospitalization for any reason.



Among the 154 patients, 30 had a low REALM-R score. People with annual family income less than $50,000, African-Americans, and people without a college-level education were much more likely to have a low REALM-R score (ten-fold, five-fold and five-fold, respectively). Gender was not linked to REALM-R score.



What doctors call "hard events" (death, urgent cardiac transplantation, or ventricular assist device implantation) did not increase based on low REALM-R score.



The interdisciplinary study was co-authored by Emory University cardiovascular nursing researcher Sandra Dunbar, RN, DSN, FAAN, FAHA and Vasiliki Georgiopoulou, MD, assistant professor of medicine, Emory School of Medicine who also presented the study at the meeting.

The 'Silent Killer' Severe Hypertension Is Still On The Loose

High blood pressure may be one of the top killers in the country, but you'd never know it by the way we're behaving, say scientists attending the annual congress of the Society for Critical Care Medicine (SCCM).



"Research shows that some 73 million people in the U.S. have high blood pressure, yet many of them don't even know it. And among those that do, a large number are not taking the medications they need to control it," says Dr. Christopher Granger, a cardiologist at Duke University Medical Center. "We've discovered that these patients are getting highly variable treatment. Moreover, we also found out that we aren't doing a very good job following up with these folks once they leave the hospital," he adds.



Granger and colleagues at nearly two dozen institutions around the country created a special registry to find out what happens to patients with acute, severe hypertension - those with blood pressure readings above 160/110 - when they come to an emergency department or critical care setting for treatment.



They found that although 90 percent of them already had a diagnosis of high blood pressure, about a quarter of them were not taking the medicines they were supposed to. The researchers also found that extremely high blood pressure was related to high complication and death rates. Many of the patients already had major organ damage and over six percent of them died in the hospital. Upon discharge, most of the patients were given prescriptions for at least two medicines, but 41 percent had to be readmitted within three months. What may be most unsettling, however, is the fact that the investigators could not find any evidence in the discharge records of about 60 percent of the patients that there had been any attempt to schedule a follow-up appointment for them.



"We are apparently turning large numbers of patients back out into the community without appropriate follow-up and care," says Granger. "Severe hypertension is a very common problem, but we really know very little about it. There is a huge need to improve care for these patients."



Dr. Solomon Aronson, an anesthesiologist at Duke, sees danger in high blood pressure from another angle. Aronson has spent years trying to discover the "sweet spot," or ideal range, of blood pressure during cardiac surgeries. Aronson led a team of investigators that analyzed over 3 million blood pressure readings in the records of 5238 cardiac surgical patients at Duke over a nine-year period They discovered that when patients' systolic blood pressure readings fell below 95 or went higher than 135, there was a greater risk of death within the following month, with the risk of death increasing with the amount and duration of the deviation from that range.



"This is the first time that anyone has determined the optimal range for blood pressure management during these procedures," says Aronson, who adds that different ranges might be more appropriate for other types of surgery.



Aronson says blood pressure management has become such a routine responsibility during surgery that physicians may have developed an attitude of "therapeutic inertia." "These data suggest that drifting off the road and onto the shoulder when you drive is not good for you. We're beginning to define the width of the road."



"We still have a long way to go before we can understand and successfully manage the subtle and complex effects that targeted blood pressure control has on overall health," he says. "Just because high blood pressure is a common problem doesn't mean that we know how best how to deal with it."







Both Aronson and Granger are paid consultants for The Medicines Company, which supported the creation of the new, acute, severe hypertension registry at Duke and is also developing an experimental drug for the management of high blood pressure.

Insured African-Americans More Likely To Use Emergency Room Than Other Insured Groups

Health insurance, and the access it provides to a primary care physician, should reduce the use of a major driver of health care costs: the emergency room.



Yet in a policy brief released today by the UCLA Center for Health Policy Research, researchers found that in California, privately insured African Americans enrolled in HMOs are far more likely to use the ER and to delay getting needed prescription drugs than HMO-insured members of other racial and ethnic groups. The research was funded by the California Office of the Patient Advocate.



It's not that African Americans fail to see their doctors, researchers say. In fact, of all HMO enrollees, African Americans were the most likely to report seeing a doctor in the past year, according to the authors of the brief, "African-Americans in Commercial HMOs Are More Likely to Delay Prescription Drugs and Use the Emergency Room."



Patient income and illness did not predict ER or prescription drug use either. Researchers found greater ER use and delays in getting prescription drugs even among African American HMO enrollees who were generally healthy and had higher incomes.



While the reasons behind the ER use and drug delays among African Americans are the subject of future research, lead author Dylan Roby, a research scientist with the UCLA Center for Health Policy Research, said the data suggests that the way health maintenance organizations or their contracted physicians provide care - and the way patients respond to that care - may create obstacles to timely primary care, as well as foster excessive use of the emergency room and delays in getting needed medications.



African Americans Depend on HMOs



More than two-thirds of insured African Americans in California are enrolled in HMOs (67.3 percent, or 1.35 million), compared with 64.7 percent (4.5 million) of insured Latinos and 51.6 percent (8 million) of whites.



Using data from the 2007 California Health Interview Survey (CHIS), researchers found that African American patients enrolled in commercial HMO plans were more likely to delay getting needed prescription drugs. Those enrolled in commercial Kaiser Permanente plans were more likely to use the ER, they said.



"It's troubling, because it suggests that even if you are insured and well-off, you still may not be getting the care you need," Roby said. "It also suggests that HMOs that are designed to provide preventive care and to make sure people have their medications are not able to do so."



Kaiser Permanente is the most popular HMO among African Americans, with one-fourth of all insured African Americans enrolled in the Oakland-based insurance carrier. Despite HMO emphasis on preventive care, however, more than a quarter (25.4 percent) of all privately insured African Americans enrolled in a Kaiser Permanente plan used the emergency room in the past year - in contrast to 14 percent of Asian American enrollees and 17.5 percent of Latinos.
















The reasons could range from the relative affordability of emergency-room services to the ease of accessing those services, Roby said.



"If it takes days or weeks to get an appointment with your doctor and just hours to be seen in the ER, people might make the easier choice, especially if it is convenient and affordable," he said. "On the other hand, if someone knows their local ER is overcrowded and expensive, they may be more likely to wait and see their own doctor."



Delaying Needed Medicine



Privately insured African American HMO enrollees also were notably more likely to delay getting needed prescription drugs. Prescription drug delays were about 10 percent higher for privately insured African Americans enrolled in non-Kaiser commercial HMO plans than for whites in comparable commercial plans.



Costs, geography and the pharmacy benefits offered by a given HMO may all inhibit the timely purchase of prescription drugs.



"We need to think about how the cost of prescriptions and delays in getting needed medications are compromising health status and quality of life," Roby said.



The research helps health advocates in California identify key health and health care issues for African American HMO members, said Sandra Perez, director of the California Office of the Patient Advocate. "This is the first step in understanding how HMOs can close the gaps in the quality of care and access they provide to their members."



Roby recommended an education campaign for both patient and provider that would address appropriate use of the ER and primary care services, as well as the importance of medication adherence and getting prescribed medications and refills.



"African American HMO members need to be empowered to find a doctor they are comfortable with, while health plans need to make a greater effort to connect patients with that doctor," Roby said.



The policy brief was supported by a grant from the California Office of the Patient Advocate as part of a targeted educational outreach program.

Better Muscle Control, Worse Side Effects In Parkinson's Drugs Tradeoff

Compared to older drugs for Parkinson disease, a newer class of medications called dopamine agonists might be better at preventing some of the disabling muscle control problems associated with the disease and its treatment, a new review of recent studies concludes.



However, patients who take dopamine agonists suffer from an increase in numerous side effects - from sleepiness to nausea to hallucinations in some cases - and are more likely to drop out of treatment than those who take the older treatment levodopa or no drugs at all.



"Patients taking dopamine agonists were more than twice as likely to quit treatment, suggesting that the side effects were severe enough to have a meaningful impact on patients' quality of life, outweighing the muscle control problems," said Rebecca Stowe of the University of Birmingham, the review's lead author.



The review of studies appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.



Parkinson's disease is a degenerative disease of the nervous system that can impair a person's movements and speech. Dopamine agonists, drugs that stimulate the production of the important neurotransmitter dopamine in the brain, are increasingly used as first-line therapies for the disease.



Levodopa, an older drug that can be metabolized in the brain to produce dopamine, is also used widely in Parkinson's treatment. However, patients who use levodopa over long periods can develop painful, distorting, involuntary muscle spasms and repetitive movements.



Stowe and colleagues reviewed 29 studies that included 5,247 patients who were in the early stages of Parkinson's disease and did not show any significant signs of muscle and movement problems. Some of the studies compared dopamine agonists only with levodopa, while some used a combination of dopamine agonists and levodopa.



There was no significant difference in the death rates between patients using dopamine agonists and those who did not take the drugs, the researchers found.



"Importantly, the review highlights that the balance of risks and benefits of dopamine agonists remains unclear," said Stowe, who called for further studies on patients' overall quality of life and the economic costs of the treatments.



Researchers are tracking another troubling effect of dopamine agonists - their potential link to impulsive behaviors such as uncontrolled gambling and hypersexuality. Dr. Joseph Jankovic, a Parkinson's disease and motor disorders expert at the Baylor College of Medicine, said dopamine agonists "play an important role in triggering these nonmotor symptoms" that appear in some patients with Parkinson's disease, particularly men and those who develop the disease as younger adults.







The Cochrane review disclosed that co-author Carl E. Clarke, of the University of Birmingham, has received funding from manufacturers of several of the drugs discussed in the review.



Stowe RL, et al. Dopamine agonist therapy in early Parkinson disease. Compared to older drugs for Parkinson disease, a newer class of medications called dopamine agonists might be better at preventing some of the disabling muscle control problems associated with the disease and its treatment, a new review of recent studies concludes.



The Cochrane Collaboration is an international non-profit, independent organization that produces and disseminates systematic reviews of health care interventions and
promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit cochrane/ for more information.

Some U.S. Residents Cut Back On Prescription Drugs To Save Money

The New York Times on Wednesday examined how, as "people around the country respond to financial and economic hard times by juggling the cost of necessities like groceries and housing, drugs are sometimes having to wait." An analysis conducted recently by IMS Health found that U.S. prescription drug sales in the first eight months of 2008 failed to increase for the first time in more than 10 years. In addition, Pfizer, the largest pharmaceutical company worldwide by sales, on Tuesday said that third-quarter U.S. sales decreased by 13% from a year earlier.

According to the Times, "many doctors and other experts say consumer belt-tightening is a big factor in the prescription downturn," and the trend "could have potentially profound implications." James King, chair of the American Academy of Family Physicians, said, "People are having to choose between gas, meals and medication." Timothy Anderson, a pharmaceutical industry analyst with Sanford Bernstein, said that the decrease in sales of prescription drugs is "most likely tied to a worsening economic environment."

In addition to the economic downturn, increased out-of-pocket costs for prescription drugs might have contributed to the decrease in prescription drug sales. An annual employer survey from the Kaiser Family Foundation and the Health Research and Educational Trust found that average copayments for prescription drugs on "preferred" lists established by health insurers increased to $25 in 2007 from $15 in 2000. The Medicare prescription drug benefit "doughnut hole," in which beneficiaries must cover the full cost of their treatments, also might have contributed to the decrease in prescription drug sales, as studies have found that many beneficiaries end treatment with medications when they reach the coverage gap.

The decrease in prescription drug sales also might have resulted from "adverse publicity about some big-selling medications" -- such as the cholesterol medications Zetia, marketed by Merck, and Vytorin, marketed by a joint venture of Merck and Schering-Plough -- and the shift of the allergy medication Zyrtec, marketed by Johnson & Johnson, to over-the-counter status, the Times reports (Saul, New York Times, 10/22).

Survey
In related news, CBS News reports on a new survey by the Kaiser Family Foundation showing growing numbers of Americans reporting problems paying medical bills. According to the survey, 36% of residents have delayed medical care in the past year because of cost, 31% have skipped a test or treatment and 27% have decided not to fill a prescription. About one-third of residents said that they had problems with payment of medical bills, compared with one-fourth in 2006, and almost half said that a family member has delayed or cut back on needed care due to cost, according to the survey.














Sherry Glied, a health economist at Columbia University, said, "When people cut back on preventive care they're really cutting back on their own lives and health and the quality of their lives in the long run" (LaPook, "Evening News," CBS, 10/21).

The October Kaiser Health Tracking Poll: Election 2008, the eleventh and final in a series designed and analyzed by the Foundation's public opinion research team, also examines voters' specific health care issue interests and perceptions of the major presidential candidates' positions on health care and reform. Full results are available online.


Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation.?  All rights reserved.




View drug information on Zyrtec.

Elderly Black Women More Likely To Maintain Hypertension Treatment If They Incorporate Spirituality, Study Finds

Elderly black women who use spirituality might be more successful adhering to a hypertension regimen, according to a study presented on Wednesday at an annual meeting of the American Heart Association in Orlando, Fla., HealthDay/U.S. News & World Report reports.

For the report, researchers from the University of Pennsylvania School of Nursing studied 21 black women who were an average age of 73 and participated in CMS' Program for All Inclusive Care for the Elderly. The participants had been diagnosed with hypertension for an average of 16.7 years and were taking an average of 3.3 hypertension medications. According to researchers, older blacks tend to have poorer adherence to hypertension regimens than younger blacks or whites.

All 21 women reported that they used a process identified as "Partnering with God to Manage My Medications," under which they took personal responsibility for managing their conditions and used spirituality as a resource to make health-related decisions, cope with medication side effects and stick to their treatment regimens.

Researchers said the findings suggest that incorporating patients' religious and spiritual beliefs into hypertension treatment might improve medication adherence (HealthDay/U.S. News & World Report, 11/7).


An abstract of the study is available online.


Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

The Role Of New Technologies In Enhancing Compliance To Be Discussed At 7th Annual Patient Adherence & Engagement Summit, October 19-20, Philadelphia

Peter Mansell reports on how compliance and personal monitoring technologies can help pharma firms better tailor their offerings to different patient groups.


New technology is the lifeblood of drug development. But there is also a parallel stream of technological innovation that addresses how drugs are taken, managed, and monitored in the marketplace. These technologies range from enhanced packaging and reminder messaging (MedivoxRx Technologies' Talking Prescription Bottle) to texts and e-mails to monitoring systems (Johnson & Johnson/Apple's Lifescan application for glucometer data) to 'smart' pills (from Proteus/Novartis) that keep tabs on a patient's response to therapy within the patient's own body.


These technologies are now being applied to address the long-standing compliance problem. Only around one-third of medicines are taken as intended, and this issue has taken on new urgency in light of cost pressures on healthcare systems and trends such as ageing, multiple drug regimens, and chronic disease management.


Full article.


eyeforpharma's 7th Annual Patient Adherence & Engagement Summit, (October 19-20, Philadelphia) will have an entire session on developments in patient relationship marketing and technology innovation. To find out more about the conference and to register to attend, visit: eyeforpharma/pcusa

The Majority Of Ulcerative Colitis Patients Are Not Compliant With Medications, CCFA Survey Finds

A new, large survey supported by the Crohn's & Colitis Foundation of America (CCFA) finds that 65 percent of ulcerative colitis (UC) patients are less than fully compliant with first-line therapies to treat their disease. The findings are significant because an earlier study found that patients less than fully compliant experience five times the number of disease flare-ups.



Respondents to the CCFA survey were taking a variety of aminosalicylates, medications which help relieve symptoms and inflammation for many UC sufferers, but which require multiple pills be taken two to four times a day. CCFA conducted the survey to gain a better understanding of patients' experiences with UC and these medications.



The most commonly reported reasons for non-compliance with medications were the dosing frequency, the number of pills and the inconvenience associated with the medication. Seventy-four percent of the 1,595 UC sufferers included in the survey experienced at least one flare-up of UC during the previous year. Flare-ups can involve heightened symptoms such as diarrhea, abdominal pain, loss of appetite, fatigue as well as complications such as anemia.



"The study shows that many patients struggle to comply with their current medication regimen because they have to take multiple pills throughout the day," said the survey report's author Edward V. Loftus, Jr., a gastroenterologist at Mayo Clinic in Rochester, MN. "And we know that when UC patients don't take their medications as prescribed, it can have a significant impact on their health and quality of life."



In addition to poor compliance with medication, the survey evaluated overall quality of life for those living with UC - 60 percent reported loss of bowel control, 49 percent reported decreased energy levels, 46 percent reported spending less time away from home and 37 percent reported involvement in fewer social activities.



"Lack of compliance with medication is a major challenge across a variety of disease states and has a huge impact on Americans' health and the cost of healthcare in our country," said Jonathan Braun, MD, PhD, chair of CCFA's National Scientific Advisory Committee. "The introduction of new treatments with more convenient dosing regimens will be an important step in helping UC patients to remain compliant with their medication, lower the frequency of flares and improve their quality of life," he added.







The survey findings were recently presented at the Advances in Inflammatory Bowel Diseases conference in early December, and were published in the December 2006 issue of Inflammatory Bowel Diseases, the official journal of CCFA.



About Crohn's Disease and Ulcerative Colitis



Crohn's disease and ulcerative colitis are painful, medically incurable illnesses that attack the digestive system. Crohn's disease may attack anywhere from the mouth to the anus, while ulcerative colitis inflames the large intestine (colon) only. Symptoms may include persistent diarrhea, abdominal pain or cramps, rectal bleeding, fever, and weight loss. Many patients require hospitalization and surgery. These illnesses can cause severe complications, including colon cancer in patients with long-term disease. Some 1.4 million American adults and children suffer from Crohn's disease or ulcerative colitis, with as many as 150,000 under the age of 18. Most people develop the diseases between the ages of 15 and 35.



About CCFA



The Crohn's & Colitis Foundation of America's (CCFA) mission is to cure and prevent Crohn's disease and ulcerative colitis through research, and to improve the quality of life of children and adults affected by these digestive diseases through education and support. More than 80 cents of every dollar the Foundation spends goes to mission-critical programs. CCFA consistently meets the standards of organizations that monitor charities, including the Better Business Bureau's Wise Giving Alliance (give/) and the American Institute of Philanthropy (charitywatch). For more information, visit ccfa/.



This survey was supported by CCFA. Funding for writing support was provided in an unrestricted grant by Shire Pharmaceuticals Inc, PA, USA.



Contact: Lisa Koen


Golin/Harris International

2008 BIO International Convention Draws Global Industry Leaders And Public Officials For Networking, Deal Making And Partnering

The 2008 BIO International Convention, produced by the Biotechnology Industry Organization (BIO), wrapped up with 20,108 industry leaders - a 36 percent increase from the last time the convention was held in San Diego, Calif. in 2001. Attendees hailed from 70 countries and 48 states, as well as 4,270 attendees and exhibitors from California.


"The 2008 BIO International Convention was a phenomenal success, bringing together thousands of leaders from industry, government, academia and other disciplines who are working to solve some of society's greatest challenges," said president and CEO of BIO Jim Greenwood. "I want to personally thank our many partners in San Diego, the region and throughout the industry who help make this event a success year after year."


"We've had a rewarding time as the local hosts of the 2008 BIO International Convention," said Joe Panetta, president and CEO of BIOCOM, the association for the Southern California life science community. "Not only has this convention raised the profile of our life science community globally, but its visibility has helped our friends and neighbors here in Southern California understand the impact and importance of this industry to their own lives."


The full Convention program included four full days with 175 breakout sessions, 21 educational tracks, more than 1,000 speakers, three keynote sessions, six Super Sessions and three CEO Forum sessions.


More than 6,000 business leaders met at the convention and participated in the Business Forum. More than 14,500 one-on-one partnering meetings were held - a new record - and a total of 1,500 companies participated in the Business Forum.


The all-star keynote line up included Gen. Colin L. Powell, Gov. Arnold Schwarzenegger (R-CA), and J. Craig Venter, PhD. In addition, Gov. Deval Patrick (D-MA); Former Gov. Jeb Bush (R-FL) discussed healthcare in an election year with moderator Neil Cavuto, Anchor & Managing Editor of Fox News Channel.


In addition, many high-profile VIPs attended the Convention with 10 governors and numerous international public officials, including The Hon. Lino Baranao, Minister of Science, Technology & Production Innovation, Argentina; Sen The Hon. Kim Carr, Minister for Innovation, Industry, Science & Research, Australia; The Honourable Dr. Ewa Bjorling, Minister for Trade, Sweden; and His Excellency Suwit Khunkitti, Deputy Prime Minister & Minister of Industry, Thailand, among many others.


The convention featured the largest gathering of biotech exhibitors in history, with more than 2,100 companies, 126 of which were new, and more than 208,000 sq. feet of exhibition space, the largest ever at the convention. The exhibition included more than 60 domestic, country and regional pavilions representing every aspect of the biotechnology industry.


Exhibitors were thrilled with their experience and interactions within the BIO Exhibition:


"This is our first year at BIO and we didn't expect this much attention," said Donna Lee from RNL, a Korean biotech company who was popular this week for giving out Croc® shoes at their exhibit booth. The company develops products for Buerger's disease, which affects the hands and feet. "This is a big show, so the Crocs just made sense," said Lee.















"This was a great Convention for us. We made lots of solid business contacts. It was well worth the trip," said Sue Doughty, coordinator for Louisiana Bio-Tech Pavilion.


"This was another highly successful trip to the BIO International Convention for the New Zealand delegation. We made very useful business contacts. We look forward to coming back next year," said Christine Ross, communications manager of New Zealand Bio.


The BIO International Convention is the world's largest annual event for the biotechnology industry. The 2008 Convention ran Tuesday, June 17 through Friday, June 21 at the San Diego Convention Center in San Diego, Calif. Next year's event will be held May 18-21, 2009 at the Georgia World Congress Center in Atlanta, Ga.


The BIO International Convention helps to support the association's programs and initiatives. BIO works throughout the year to create a policy environment that enables the industry to continue to fulfill its vision of bettering the world through biotechnology innovation. For more information on the global event for biotechnology, including program, registration, and housing information, please visit bio2008.


Check out BIO's events blog at bioontheroad and listen to podcasts on the convention at biotech-now.


About BIO


BIO represents more than 1,200 biotechnology companies, academic institutions, state biotechnology centers and related organizations across the United States and in more than 30 other nations. BIO members are involved in the research and development of innovative healthcare, agricultural, industrial and environmental biotechnology products. BIO also produces the BIO International Convention, the world's largest gathering of the biotechnology industry, along with industry-leading investor and partnering meetings held around the world.


bio



Upcoming BIO Events


BIO International Convention

June 17-20, 2008

San Diego, CA


Pacific Rim Summit on Industrial Biotechnology and Bioenergy

Sept. 10-12, 2008

Vancouver, BC


BIO Investor Forum 2008

October 29-31, 2008

San Francisco, CA


BIO-Europe 2008

November 17-19, 2008

Mannheim/Heidelberg, Germany

bio

CVS Caremark Research Finds Correlation Between Amount Of Patient Co-pay And Prescription Abandonment

A new study by Harvard, Brigham and Women's Hospital and CVS Caremark researchers has found a direct correlation between the amount of a patient's out-of-pocket co-pay and likely abandonment of the prescription, with patients having a co-pay of $50 almost four times more likely to abandon a prescription at a pharmacy than those paying $10. The study also found that e-prescriptions are 65 percent more likely to be left abandoned at a retail pharmacy by patients than are hand-written prescriptions.


The CVS Caremark-sponsored study published this week in the Annals of Internal Medicine is the first to systematically evaluate rates and predictors of prescriptions abandoned at the pharmacy.


"Sticker shock is an important driver of prescription abandonment," said lead author of the study, William Shrank, MD, MSHS, of Brigham and Women's Hospital and Harvard. Shrank said the study also outlines and validates a simple prediction rule that pharmacists can apply to help them assess whether patients are at risk to abandon their prescriptions.


"This research gives us new insight into an area of non-adherence that we did not have before and shows we have opportunities to change patient behavior," said Larry J. Merlo, president and chief operating officer of CVS Caremark. "We need to be more attentive to reasons why patients may be abandoning prescriptions and work to help them stay on their medications. We continue to be a strong proponent of e-prescribing because we recognize the benefits it can provide, such as improving the accuracy and quality of prescription delivery and reducing paperwork to make pharmacy care more efficient."


The team of researchers reviewed all prescriptions dispensed at CVS/pharmacy locations between July 1 and September 30, 2008. Of the prescriptions that were abandoned, more than half were never filled at any pharmacy, while some were filled at other pharmacies at a later date. The team concluded that the pharmacy industry would benefit from learning more about prescription abandonment, which they said is an addressable factor impacting patient adherence to their medication.


The researchers said the higher rate of abandonment for e-prescriptions appears to occur because patients with written prescriptions must proactively bring the request for medications to the pharmacy, while patients with e-prescriptions are not required to take any step to begin the prescription filling process. In addition, the rate of e-prescription abandonment appears high because pharmacies are able to track them as abandoned versus paper prescriptions that are never actually brought to a pharmacy.


The researchers said that if the 3.27 percent abandonment rate observed during the study period is applied to the 3.6 billion prescriptions filled at pharmacies in 2008, approximately 110 million prescriptions would be abandoned.


The researchers outlined a predictive model for pharmacists to apply to help them recognize likely candidates for abandonment that includes:
















-- Reviewing the individual's benefit plan and tiered co-pays. The study said cost is the strongest predictor of abandonment. The data shows a 1.4 percent prescription abandonment rate for patients with co-pays of $10 or less, a 3.4 percent rate for patients with co-pays between $30 and $40 and a 4.7 percent rate for patients with co-pays of $50.



-- Understanding past pharmacy behavior. Patients with first-fill prescriptions are three times more likely to abandon prescriptions than those who are re-filling their medication.



-- Identifying the age of the patient. Younger patients are more likely than older patients to abandon their medications.



-- Reviewing the drug class. The study found that opiates, anti-platelets and statins were the least likely to be abandoned, while insulin and proton pump inhibitors were more likely to be abandoned.


The prescription abandonment study is part of the CVS Caremark research effort aimed at better understanding how consumers interact with their pharmacy so that they stay adherent to their medications. The study is the work of CVS Caremark's previously announced three-year collaboration with Harvard University and Brigham and Women's Hospital to research pharmacy claims data to better understand patient behavior around medication adherence.


Past industry studies show one-quarter of people receiving prescriptions never fill their first prescriptions, and patients with chronic diseases such as diabetes and coronary artery disease adhere to their ongoing medication regimen about half of the time. Non-adherence to essential medications is a frequent cause of preventable hospitalizations and patient illness, with costs to the U.S. health care system estimated at about $300 billion annually.

Innovative Strategy Could Help People Follow Doctors' Orders, Take Medications

People who received daily text messages reminding them to apply sunscreen were nearly twice as likely to use it as those who did not receive such messages, a new study led by a UC Davis Health System dermatologist has found. Researchers hope their findings, which appear in the November issue of the Archives of Dermatology, will inspire other health-care providers to use text messaging to encourage healthy habits in their patients, such as taking prescribed medications properly.



"Our study showed that people do respond to reminders," said April Armstrong, director of the UC Davis Teledermatology Program. "Cell phones are a smart way to communicate regularly with patients because people take them everywhere."



Using technology people already have is a relatively inexpensive way for health-care providers to improve compliance and prevent disease - in this case, by encouraging the regular use of sunscreen to prevent skin cancer caused by the sun's harmful ultraviolet (UV) rays.



"At the start of the study, we did not know how people would react to getting text messages as reminders. But the measurable differences we found in behavior were encouraging and exciting and suggest that using common communication tools can sometimes reap substantial benefits and opportunities to improve health and health care," said Armstrong, who is also a UC Davis assistant professor of dermatology.



According to the National Cancer Institute, about one million new cases of non-melanoma skin cancer - the kind that begins in the non-pigment producing cells of the skin - are reported every year. Melanoma begins in pigment-producing cells, such as those that make up moles, and is comparatively rare. Fewer than 70,000 cases are reported in the U.S. each year.



A person's risk of developing skin cancer is related to lifetime exposure to UV radiation from the sun. Sunscreen may help prevent skin cancer. Dermatologists like Armstrong also recommend that people further limit exposure by avoiding midday sun and wearing sun-protective clothing.



Getting people to apply sunscreen, however, has proven difficult over the years. Only about 20 percent of adults in the U.S. report regular use of sunscreens, and many do not use sufficient amounts, according to the National Health and Nutrition Examination Survey. Armstrong and her colleagues developed the novel approach to increase sunscreen use.



For the current study, Armstrong, who was research fellow at Harvard University at the time, recruited 70 healthy people in the Boston area to participate in the study. The participants had to demonstrate that they could send and receive text messages on their cell phones. Armstrong and her colleagues gave each participant a bottle of sunscreen equipped with an electronic sensor that sends an electronic signal to a central computer each time the bottle was opened.
















Participants were randomly assigned to two groups and told to apply sunscreen daily. One group received a two-part text message every morning: a weather report and a message reminding them to wear sunscreen. The control group received no text messages.



"Our goals were to keep the messages short so that they could be read at a glance and to have a good hook," Armstrong explained. The first line of the message changed with the fall weather in Boston. The second line regarding sunscreen usage also changed daily and included messages like "Slap on some sunscreen" and "Sunscreen is your friend."



"We didn't want the people to get message fatigue," Armstrong said.



The study ran for six weeks. Researchers calculated the total number of days per week that people in the two groups applied sunscreen. They then determined the average daily adherence rate. Those who did not receive the messages had an average daily adherence rate of 30 percent, meaning they used sunscreen less than about one day in three. The group that received the messages had an average daily adherence rate of 56.1 percent.



Armstrong said she hopes that these results will encourage other health-care professionals to use text messaging in similar ways. Scientists, for example, have studied other strategies to improve patient adherence to physician recommendations, such as programs where nurses visit patient homes to help remind people to follow their doctor's orders.



"This study is a bit different," Armstrong said. "Our team showed that an inexpensive and convenient technology can result in behavior changes that could potentially improve a person's health."



Armstrong is now exploring how affordable, consumer-grade technologies might also be used to increase access to specialty medical care. She plans to study the effectiveness of follow-up care for patients with a chronic skin disease by comparing their outcomes from conventional medical office visits with those done online. For the online visits, patients will take digital photos of their skin conditions and send the images securely to a dermatologist, who will then e-mail treatment recommendations and prescriptions. Armstrong thinks the study could show that online care can be an effective way to improve patient access for some specialty services.

Medicare Prescription Drug Benefit 'Doughnut Hole' Prompts Many Beneficiaries To End Treatment With Medications

BusinessWeek on Wednesday examined how many Medicare beneficiaries enrolled in the prescription drug benefit do not take necessary medications after they reach the "doughnut hole" coverage gap, in which they must cover the full cost of their treatments. According to an analysis released by the Kaiser Family Foundation in August, 26% of Medicare beneficiaries who filled any prescriptions under the prescription drug benefit, or about 3.4 million, reached the coverage gap in 2007. The analysis also found that 15% of Medicare beneficiaries enrolled in the prescription drug benefit who were taking drugs for a variety of chronic diseases did not take their medications after they reached the coverage gap.

Tricia Neuman, a Kaiser Family Foundation vice president and director of the Medicare Policy Project at the foundation, said, "High drug costs are a barrier, but this is the first time we're seeing it documented so plainly," adding, "This raises concerns about the consequences for people with serious chronic conditions." Carolyn Clancy, director of the Agency for Healthcare Research & Quality, said, "There is a growing recognition that the doughnut hole is impairing people's access to medications."

Health care policy experts "believe that the next administration will be under pressure to address the doughnut hole, and both candidates have expressed some support for reforming" the Medicare prescription drug benefit, BusinessWeek reports. Democratic presidential nominee Sen. Barack Obama (Ill.) has proposed to allow the federal government to negotiate directly with pharmaceutical companies for discounts on medications under the Medicare prescription drug benefit, and Republican presidential nominee Sen. John McCain (Ariz.) has proposed that higher-income beneficiaries pay higher premiums under the program (Weintraub, BusinessWeek, 10/15).


Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation.?  All rights reserved.

Safety Impact Of Error Reports In Neonatal Intensive Care Not Known

Voluntary reporting of mistakes made while caring for very sick newborns is more effective than compulsory reporting, says research published ahead of print in the Fetal & Neonatal Edition of the Archives of Disease in Childhood.


But it is unclear what impact error reports have on improving the safety of this very vulnerable group of patients, say the authors.


The findings are based on an extensive trawl of research databases, showing published studies of incident reporting in neonatal intensive care.


When all the information was analysed in detail from the 10 relevant studies, it showed that errors in prescribing or administering drugs were the most common type of reported mistake.


Failure to follow procedures, insufficient attention paid to the task, poor record keeping and/or communication were all to blame.


Most of the studies indicated that voluntary reporting boosted the number of incidents filed compared with compulsory, punitive systems.


The rate of medication error reports was around 13 times higher in voluntary systems. Potentially harmful incidents featured in almost every study.


Changes were made to processes following the reports, but the guaranteed anonymity of voluntary systems prevented further detailed analysis of the causes of the mistakes.


And complex errors, such as failure to prioritise clinical tasks appropriately or carry out assessments, which could equally affect the outcome of care, are often not reported, because they are difficult to measure, say the authors.


"Assessing the impact of preventive strategies on patient safety remains a challenge," they comment. "Although voluntary reporting systems increase the number of reports, under reporting is still likely," they say.


And it is still unclear whether patient safety is improved on the basis of the available evidence, they conclude.


British Medical Journal

BMA House, Tavistock Sq

London WC1H 9JP

United Kingdom

bmj

Cost Of Heart Drugs Makes Patients Skip Pills, Putting Themselves At Risk

For more than 5 million Americans with heart failure, a critical step to better health is taking the medications they're prescribed. But many patients fail to do so, putting themselves at greater risk of hospitalization and even death. To date, studies have not fully answered why patients fall short when it comes to taking heart medicine. In a study appearing in the April issue of Mayo Clinic Proceedings, Mayo Clinic researchers found the drugs' cost is one of the biggest deterrents.


"We found patients weren't filling their prescriptions because of the expense," says Shannon Dunlay, M.D., Mayo Clinic cardiologist and lead author.


The study recruited patients from Olmsted County, Minn., and tracked their pharmacy records. Previous studies looked only at electronic prescription claims data, possibly missing drugs purchased with cash or not covered by insurance, Dr. Dunlay says. The 209 patients in the study, ages 60 to 86, were asked how often they missed doses or didn't take drugs at all, and why.


Researchers found that younger patients were slightly more likely to skip certain heart medications than older patients. Men were less likely than women to stick to certain drug regimens. Among patients who did a poor job following prescriptions, financial concern was the main reason: 46 percent reported that they had stopped taking statins or not filled a prescription because of cost, and 23 percent acknowledged skipping doses to save money.


Although 77 percent of patients in the study were eligible for Medicare, medication costs were still an important issue for some of them.


Dr. Dunlay emphasizes that heart failure patients worried about medication costs should tell their physicians. There often are lower-cost alternatives, she says.

Increasing ICS Compliance: The Voice May Be Recorded, But The Results Are Real

Automated phone calling may help physicians solve a perennial problem: patients who don't take medicine prescribed for chronic health conditions.



Researchers at the Kaiser Permanente Center for Health Research, in Portland, Oregon, tested an automated calling service designed to encourage patients with asthma to fill or refill their prescriptions for inhaled corticosteroids (ICS).



The research was presented on May 17 at the 105th International Conference of the American Thoracic Society in San Diego.



"The trial demonstrated a modest, but statistically significant, improvement in compliance," said William M. Vollmer, Ph.D., senior investigator at the center, who led the trial. "And even a small change in adherence can potentially produce a big public health benefit, especially when the disease is as prevalent as asthma."



According to the National Heart, Lung, and Blood Institute, about 22 million Americans have asthma, most need to take medicine daily for long-term control of the disease and ICS are the preferred medicines for gaining that control.



The 18-month-long trial involved approximately 8,600 members enrolled in the integrated health system in the Northwest United States and Hawaii. Member participants were randomized to usual care and to the phone calling system.



The study found that the calls increased estimated medication adherence two percent beyond the compliance of patients receiving usual care (40 percent versus 38 percent; p< .01). Among those 60 years of age and older, medication adherence rose four percent.



Dr. Vollmer's presentation at the ATS International Conference will focus on the study's primary outcome: medication adherence. Future analyses will assess the intervention's impact on healthcare utilization and quality of life, as well as the cost-effectiveness of the automated calling system.



The study used Kaiser Permanente's electronic medical records to identify who should be called and what message they should hear. One message was for those who had just become eligible for a refill. Another message targeted those who were past due for a refill. And a third message was designed for first-time users or those who had not had an ICS dispensing for at least six months.



The calls were short, typically lasting no more than two to three minutes. About 40 percent of calls made reached their target participant; messages were left for another 45 percent of calls.



While most of the calls were constructed around simple questions requiring a 'yes' or a 'no' response, Dr. Vollmer said the calls had "a lot of branching logic" to them. They were, for instance, able to explore level of symptom control and barriers to compliance.



For someone late in refilling his or her prescription, Dr. Vollmer noted that the computer might ask, "Many people with asthma don't take their controller medicines when they feel well. Is that ever true for you?" Those answering yes would then hear a brief message about the difference between relievers and controllers and why the latter should be taken every day.



Alternatively, Dr. Vollmer noted, the computer might ask if the participant's asthma wakes him/her up at night or interferes with daily activities. For someone who said yes, the computer might respond, "With regular use of ICS, this doesn't need to be the case."



During the call, participants could choose to refill their prescription through Kaiser's automated service. They could also choose to speak to a real person.



Part of the success of the calls, Dr. Vollmer noted, was how "natural" the voice of the caller sounded. Although those called were told they were speaking with a computer, the voice was a human one that captured the intonation and rhythm of speakers from the geographic areas of the HMO members.



Dr. Vollmer and his colleagues hope to conduct a similar study on patients with cardiovascular disease, reminding them to refill three different medications. In addition to phone message, the researchers are considering integrating e-mail messages into the automated outreach program. As Dr. Vollmer noted, "We want to be able to tailor the messages to fit the patient's preferred communication style."

Interrupting HIV Treatment Could Be Beneficial

Stopping antiretroviral therapy in HIV-infected patients from time to time could reduce the side effects and costs of the treatment, according to an article in The Lancet.



Though extremely effective at preventing AIDS, lifelong treatment with Highly Active Anti-Retroviral Therapy (HAART) is expensive and can lead to serious side effects, such as liver damage. Decreasing the time that patients receive HAART could solve these problems but interrupting therapy may increase the risk of the disease progressing. The virus may also become resistant to HAART if treatment stops and low concentrations of the drug remain in the body.



Bernard Hirschel (University Hospital of Geneva, Switzerland) and colleagues assessed whether taking scheduled breaks in HAART was as effective as giving patients treatment on a continuous basis. 430 patients with chronic HIV were either placed in a scheduled interruption group (284), where treatment was temporarily stopped depending on their immune response, or in a group where HAART was given continuously (146) for 22 months. The results showed that levels of resistance and control of the HIV virus were similar between the two groups. Certain side effects such as diarrhoea and nausea were also less frequent in this group, while minor manifestations of HIV, such as oral thrush, were more common.



Dr Hirschel concludes: 'The results provide reassurance about the one risk that was feared - development of resistance and loss of efficacy of treatment...Scheduled treatment interruptions lasting many months, with substantial drug savings, can be anticipated, particularly in patients whose immune systems were never damaged by HIV.







Contact:

B. Hirschel, Division des maladies infectieuses

HCUG, CH-1211 Gen?ve.

bernard.hirschelhcuge.ch



Contact: Joe Santangelo

Lancet

Changing Behavior Helps Patients Take Medication As Prescribed

Taking medication as the doctor prescribes is crucial to improving health. However, 26 to 59 percent of older adults do not adhere to instructions, according to a 2003 study published in Drugs and Aging. In a new study, researchers at the University of Missouri found that applying behavior changing strategies, such as using pill boxes or reducing the number of daily doses, can improve patients' abilities to take their medications as required.



"It is very important for physicians and nurses to move past educating patients about the need for medication and focus on teaching behavior strategies," said Vicki Conn, associate dean of research and Potter-Brinton professor in the MU Sinclair School of Nursing. "Implementing these strategies can help older adults take their medications, resulting in better health and well-being."



The Mizzou researchers found that behavior-changing strategies have a greater impact on medication adherence than reinforcing the importance of taking medication to patients. Effective strategies include reducing the number of doses taken daily, prescribing medications so they can be taken at the same time as other medications, and encouraging the use of pill boxes. Giving patients clear, easy to read instructions for the medications also proved to be effective.



There are many reasons older adults have difficulties with medications, Conn said. Vision changes can interfere with reading medication bottles, and arthritis can make it difficult to handle pills and containers. However, the majority of adherence problems are not related to physical health. For example, many people simply forget to take their medications.



"There are approaches to overcome almost all problems," said David Mehr, co-author of the study and director of research in the MU Department of Family and Community Medicine. "It makes a huge difference in patients' adherence and health if they have some type of organized system for taking medication."



Failure to take prescribed medications can result in costly health interventions, including expensive tests and unnecessary additional prescriptions, Conn said. An interest in medication adherence research has grown recently due to its low rates among the adult population. In this study, the researchers conducted an analysis of 33 trials to combine and relate the findings of previous research.



The study "Interventions to Improve Medication Adherence Among Older Adults: Meta-Analysis of Adherence Outcomes Among Randomized Controlled Trials" was published in the August issue of The Gerontologist.

African Reliance On Traditional Medicine For The Treatment Of HIV/AIDS

A paper by Aceme Nyika, published this week in Developing World Bioethics examines the reliance on traditional medicine by HIV/AIDS sufferers in Africa, due to the affordability of traditional medicine in comparison to orthodox medicine.


Despite recent calls for traditional medicine to be subjected to the same stringent regulations and ethical guidelines as orthodox medicine, traditional medicine is treated with relative laxity especially where ethical and regulatory issues are concerned.


Given that about 80% of Africans rely on traditional medicines, the author of the paper, Dr Aceme Nyika from the South African Centre for the AIDS Programme of Research in Southern Africa, warns that 'there are loopholes in the practice of African traditional medicine that have the potential to expose patients to harm.'


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