Jan
7
Patient Diaries–improve your treatment and outcomes
Filed Under Patient Adherence, Patient Satisfaction | Leave a Comment
Wayne Parsons, an injury attorney at the InjuryBoard.com, has a nice post about the value of keeping a diary. He recommends it to all his clients. He references an article on About.com written by independent journalist Betsy Lee-Frye.
There are actually two kinds of diaries that benefit patients. The first is a diary of the kind Mr. Parsons recommends. You record your condition, symptoms, side effects, medication plan, and etc. It provides good data for you to use when you’re talking to your doctor. For a good article on how diaries like this help you get better treatment, see for example, Use of a structured migraine diary improves patient and physician communication about migraine disability and treatment outcomes published at InterScience or A patient diary as a tool to improve medicine compliance published by SpringerLink.
The other kind of diary is a journal. Instead of recording symptoms and medications, you write about your response to any significant event in your life. Surprisingly, journals have been found to be very therapeutic. The best article I’ve seen summarizing the positive effects of journaling is Baikie & Wilhelm, “Emotional and physical health benefits of expressive writing”, Advances in Psychiatric Treatment vol. 11 (2005): 338-339.
Tim’s Takeaway: Patients would do well to take Wayne’s advice. Even if you don’t know how to write a diary, get started. An easy way is to google patient diary or pain diary. You’ll find lots of forms online.
Written by Tim Dawes - Visit WebsiteJan
2
Solution to MOH is Better Physician/Patient Communication
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Headaches from overuse of medications. It’s a problem with a growing global awareness according to a recent article in virtualmedicalcentre.com. “MOH is associated with severe disability, unmet treatment need and little clinical data to support current management strategies.” Left untreated, they can have a bigger impact than migraines. So says David W. Dodick, M.D., Neurology, Mayo Clinic in Arizona.
He was lead researcher on a study on medication overuse headaches (MOH) in eight countries.
The study concludes that the best strategy to address MOH is to prevent overuse of medications through effective physician/patient communication and careful withdrawal of the overused medications.
Tim’s Takeaway: One more piece of the mounting evidence that poor communication between patient and care is at the root of much of patient non-adherence. Companies that are rolling out patient information should consider whether patients and practitioners are having the kinds of conversations that put that information to good use.
Written by Tim Dawes - Visit WebsiteJan
2
Medication Errors for Almost 1 in 5 Kids with Cancer
Filed Under Medical errors, Patient Adherence | Leave a Comment
More and more patients are taking medication for cancer at home. While it’s nice that patients get to go home, it also means more errors with medication.
In a study of 1300 patients reported by Science Daily, 7% of adults and 19% of children had medication errors, often with harm to the patient.
You’ll notice that confusion over orders was a prime contributor to medication errors. The errors for adults included administration of incorrect medication doses due to confusion over conflicting orders. Examples of pediatric errors included parents giving the wrong dose or the wrong number of doses per day of medicines because of a caregiver’s confusion about instructions.
Better communications was cited as a key to alleviating the problem:
Written by Tim Dawes - Visit Website“Requiring that medication orders be written on the day of administration, following review of lab results, may be a simple strategy for preventing errors among adults, while most of the errors involving children may have been avoided by better communication and support for parents of children who use chemotherapy medications at home,” said Dr. Walsh.
Jan
1
Osteoporosis - Nonadherence to Treatment Can Cost $9K per Patient
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Here’s a nice bit of detective work done by Dr. Michael Kleerekoper who blogs over at Endocrine Today. He noticed an op ed piece in Sunday’s New York Times that quoted a source saying President-Elect Obama claimed he could save $80B a year by pushing preventive medicine. So, he set out to find examples of ways that preventive medicine could save the patient pain and the healthcare group money by reducing fractures.
He found three cases and lots of money at stake, as much as $9,000 per patient fracture.
The concluding sentence rings familiar with what we’ve seen in other areas of medicine.
Our next priority would seem to be improving patient adherence to therapy that prevents adverse health outcomes but does not make them feel better today.
Tim’s Takeaway: Dr. Kleerekoper identifies the central challenge. How do we communicate with patients so that they regularly take actions that work only in the long run. It’s not as futile as it might seem. In fact, there are case studies in marketing (Listerine and home security systems come to mind) where companies have had success doing this. It does take creativity though.
Written by Tim Dawes - Visit WebsiteDec
31
Non-Adherence and Medication Error: Are We Confusing the Two?
Filed Under Medical errors, Patient Adherence | Leave a Comment
The Tennessean is carrying an article by Dr. William Stead that seems thoughtful and well-intentioned, yet introduces confusion by conflating two important issues: patient non-adherence and medication error. Dr. Stead is associate vice chancellor for strategy and transformation and director of the Informatics Center at Vanderbilt University Medical Center.
He starts the article with some useful and provocative statistics:
Sixty-one percent of patients fear being given the wrong medicine. Over 150 million phone calls requesting clarification from pharmacists to physicians are made annually because of the difficulty in interpreting the prescription.
And then inexplicably puts not medication error, but patient non-aderence at the crux of the problem.
As many as 125,000 die annually from non-adherence to their medications.
Dr. Stead chronicles a careful process he carried out at Vanderbilt to clean up the medication errors. All the while continuing to mix together issues that would be better dealt with separately.
As an example, here’s his critique of e-prescribing:
e-prescribing is better thought of as nine smaller processes — deciding what to prescribe; creating the prescription; transmitting the prescription to the pharmacy; pharmacist-prescriber dialogue; dispensing; filing the claim; taking the medication; monitoring for effect and adverse effect and refilling the prescription.
Notice that the process has a variety of vulnerabilities from a variety of sources. Both deciding what to prescribe as well as the pharmacist-prescriber dialogue are vulnerable to lack of information about other medicines the patient is taking (a medication error). They’re also vulnerable to patients withholding issues about beliefs and lifestyle that could keep them from filling or taking their medicines (nonadherence issues). Transmitting the prescription to the pharmacy is a pure technology issue. Dispensing is open to human error. Monitoring for adverse effects is often hindered by lack of trust between the physican and the patient (a nonadherence issue).
Tim’s Takeaway: Dr. Stead raises important issues. And thanksfully he’s attacking his challenges with a critical eye. If we’re going to get to the bottom of the problems, we’ve got to separate them out according to their root causes. Otherwise, we’ll be dealing with a conceptual tangle.
Written by - Visit WebsiteDec
24
The Key to Patient Adherence to Complex Treatments
Filed Under Burnout, Patient Adherence | Leave a Comment
According to a whitepaper authored by Frost & Sullivan, it’s deep understanding. Targeted education (materials that take into account standard variables such as age, gender, and race) is no longer good enough. If you want patients to stay on their treatment regimens, you’ve got to understand their lifestyle issues, the benefits and risks they see as a result of taking the medication, and the specific barriers to compliance they face.
“Driving patients’ adherence to medication requires an emphasis on the patient’s individual barriers to compliance and persistency. The need for this tailored approach is critical for some chronic conditions such as asthma, hypertension, diabetes and osteoporosis that call for significant lifestyle changes, and have complex, long-term treatment regimens.”
In other words–tailored education is wired, targeted education is tired.
F&S’s prescription:
‘Pharmaceutical manufacturers should collaborate with physicians to assess the patient’s understanding of their illness and recommended therapy, communicate the benefits of treatment, assess the patient’s readiness to carry out the plan, and discuss any barriers to adherence that patients have.”
Here’s the problem, the discussions that Frost & Sullivan recommend are not the discussions that doctors (or nurses for that matter) are trained to have in medical school. And they require some modicum of skill and thought, and not for the reason you’d think.
It would be easy to believe that practitioners, as compassionate as they are, need to learn to tease tender insights from patients reluctant to reveal intimacies. Turns out, it often doesn’t work that way.
In a previous post, I mentioned a study published in the Archives of Internal Medicine this year that showed that physicians miss as much as 90% of the personal overtures offered by patients. Practitioners tend to steer the conversation away from personal issues that bear on adherence, and toward symptoms and diagnoses.
Tim’s Takeaway: This is great advice from Frost & Sullivan, and well researched. The challenge is making these conversations happen between patients and practitioners. Pharma can develop all the ultra-tailored info they want. If practitioners don’t respond when patients bring up problems, it’s just more trees cut down to create literature that never leaves the info stands in the doctor’s office.
Written by Tim Dawes - Visit Website