Tag Archives: adherence

Start using electronic data capture in clinical trials

A recent publication suggests that Electronic Data Capture systems, or EDCs, should be implemented in clinical trials. The EDC software can reduce the overall trial costs by an estimated $347,600 in a phase ll trial of 20 sites, 10 patients per site and a duration of 12 months plus data cleaning. See the table.

Forrester-Research-Paper-versus-EDC-cost-comparison1

Table: Forrester Research Paper versus EDC cost comparison.

In this example, monitor visits still costs $ 180,000. Vitaphone CTS provides solutions to make subjects monitor their vital signs at home. This can also enhance their trial compliance. Re-activity is a top priority to create better and more efficient clinical trials. The tools developed by Vitaphone CTS will send biosensor data immediately and thus ensure almost real-time data. Our medication adherence support system (MASS) stimulates the study subjects to take their study medication.

Remote monitoring and support enables pharmaceutical, biotechnology and medical device industries to focus on the development of the best drug or device.

Using telemonitoring solutions, investigators can improve patient safety. This might be achieved through faster notification of adverse events to the Principal Investigator, CRO or Sponsor. This will support earlier and better decision-making. Embrace technology.

Author: Indy Kavelaars

Source: Clinovo

 

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Infographic: Prescription drugs in the US

A great infographic about prescription drugs in the United States. Some highlights:

  • Prescription drugs account for 10 percent of the US health expenditures. Society must ensure that this money will be spent efficiently and effectively. To accomplish this, the level of medication adherence should be improved.
  • It’s not enough to register if a prescription is fulfilled. A control if and when medication has been taken by the patient is essential.
  • Patients with conditions like diabetes, hypertension and congestive heart failure benefit from taking prescribed medications; saving is $1.200 to $7.800 per patient annually.
  • 89.000 deaths prevented by high blood pressure medication.

Conclusion: medication adherence must be optimized. This is possible with a medication adherence support system or a prescription drug monitoring program!

 

Infographic Prescription Drugs Cost US

Infographic Prescription Drugs Cost US by Clarityway

Author: Indy Kavelaars @ Vitaphone Netherlands

Source: Clarityway

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Nog een reden om een medicatie ondersteuningssysteem te gebruiken

English version >

“Gegevens van de National Health and Nutritional Examination Survey (NHANES) van 2007 tot en met 2010 laten zien dat 77.9 miljoen volwassen in de Verenigde Staten (33.0%) hypertensie hebben.”[1]

Hypertensie is een serieus probleem met een grote impact op de gezondheidszorg. 81.5% van de onderzochten wist af van hun eigen, te hoge, bloeddruk waarvan er 74.9% ook voor werd behandeld. Van de individuen die een behandeling kregen, had 52,5% de bloeddruk onder controle maar 47,5% had de bloeddruk niet onder controle.

“Effectieve daling van bloeddruk is geassocieerd met een reductie van het cardiovasculair risico en met minder cerebrovasculaire accidenten en daaraan gerelateerde morbiditeit en mortaliteit. De meeste hypertensie patiënten (~75%) hebben combinatietherapie nodig en sommigen (~25%) hebben drie antihypertensieve middelen nodig om de bloeddruk voldoende te verlagen.”[1]

In de afgelopen decennia zijn de richtlijnen steeds meer geëvolueerd richting het aanbevelen van combinatietherapie. Combinatietherapie verbetert inderdaad het potentieel om de bloeddruk op tijd te beheersen, zonder de incidentie en complicaties te verhogen. Het is wel zo dat patiënten zich aan het complexere medicatie schema moeten houden. Complexere medicatie schema’s leveren een grotere kans op medicatiefouten op. Hierbij kunnen en moeten de apotheken, zorginstellingen, thuishulp, ouders en naasten helpen! Vitaphone ondersteunt zowel de patiënten als de omgeving op een eenvoudige wijze met de PICO.

Auteur: Indy Kavelaars @ Vitaphone Netherlands

Bron: [1] Meerderheid van patiënten behoeft meerdere antihypertensiva om streefbloeddruk te behalen

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Fighting non-adherence

In a comprehensive publication in US Pharmacist, the Director of US Pharmacy’s Clinical Services, Mr. Meece, concludes that pharmacist-based assessment and monitoring can result in improved adherence to medication; in this case to insulin therapy. Mr. Meece found studies that report positive effect of pharmacist interventions on treatment outcomes and adherence. Medication therapy management (MTM) is a service designed to improve collaboration among pharmacists, physicians and other healthcare professionals and enhance communication between patients and their healthcare team. Another tool is motivational interviewing (MI): a method for interacting with patients.

Although the results are (very) positive related to adherence, quality of life and healthcare costs (less hospitalizations), the pharmacist’s efforts to get these results are not the average activities in a pharmacy. It’s up to regulators to find the right incentives for pharmacists to use techniques like MTM and MI.

Nevertheless, this article stimulates companies like us to keep on supporting pharmacists with tools so they can further improve patient’s medication adherence!

Author: Rene Stenvert @ Vitaphone Netherlands

Source: Individualizing therapy for the patient with type 2 diabetes, US Pharmacist, September 2013

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Benchmark medication adherence

HIN (Healthcare Intelligence Network) has published a report of their benchmark which compares 104 healthcare organizations on how they are improving medication adherence in their populations. Complex patients are the most common targets of medication adherence programs (75 percent of the responds). The use of multi-dose blister packs has more than quadrupled in the last 12 months, from 7 to 29 percent. Hypertension has now replaced diabetes as the condition where healthcare organizations think medication adherence programs have the greatest effect, according to 61% of the respondents.

The figure below shows that most respondents think telephonic follow-up will work to improve Medication Adherence (MA). We, at Vitaphone, think a combination of different tactics is the best approach, with a medication adherence support system as basic tool.

When do efforts to improve medication adherence occur

When do efforts to improve medication adherence occur

Author: Indy Kavelaars @ Vitaphone Netherlands

Source: HIN Healthcare Benchmarks Medication Adherence

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Medication adherence significantly higher with multidose drug dispensing

“Multidose drug dispensing(MDD), also known as automated drug dispensing, is a sophisticated dosing aid that provides patients with robot-dispensed unit doses. All drugs intended for one dosing moment are gathered in disposable bags and labelled with patient data, drug contents and the date and time for intake.”1 This looks something like this:

PICO medication roll

PICO medication roll

“The number of community-dwelling MDD users in The Netherlands increased strongly in recent years till 360.000 in 2011.”1 A clinical study in the Netherlands demonstrated that through multidose drug dispensing, patients older than 65 years of age have a better medication adherence than patients with normally dispensed medication!

“The percentage of patients being adherent to all drugs was higher for MDD users (n = 119, 81%) compared with non-MDD users (n = 96, 58%, P < 0.001)”1

So patients who get their medication on a roll adhere 23% better to their medication. And interesting part of this study is that they also measured the knowledge of patients of their medicines. The result was that; “the percentage of patients with adequate knowledge was lower for MDD users (40%) compared with non-MDD users (79%, P < 0.001).”1 Patients using the MMD system know less of the individual medicine in that system, but the adherence is much better. The conclusion is: “Knowledge is only one of the many factors that could influence adherence. Forgetfulness and practical difficulties with medication management (e.g. removing medication from its primary packaging) might be more important barriers to adequate adherence in this specific group of older patients.”1 Within the group of MDD users, the knowledge of MMD drugs was low: “35%”1 while the knowledge of non-MDD drugs was very high “92%”1.

It’s a very nice study that shows that you don’t have to know anything about your medication to be adherent!

[1] Medication adherence and knowledge of older patients with and without multidose drug dispensing, by Henk-Frans Kwint, Glenn Stolk, Adrianne Faber, Jacobijn Gussekloo, Marcel L. Bouvy, published on http://ageing.oxfordjournals.org/ by Oxford University Press on 5 July 2013 in Age and Ageing 2013; 42: pages 620–626

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New guideline on the treatment of blood cholesterol

Some days ago, the 2013 American College of Cardiology and the American Heart Association(ACC/AHA) Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adult was published*. Although a difficult subject, I find the Guideline accessible (as non-physician) and clear in its conclusions. The Big Three, Normal-Weight, Regular-Exercise & Non-Smoking, are foundation for arteriosclerotic cardiovascular disease(ASCVD) risk reduction efforts.  And medical treatment is explained in Four Major Statin Benefit Groups. It’s clear that the strategy of High-intensity statin gains popularity, or better said: scientific proof. As an individual without clinical ASCVD or diabetes, I might have an estimated 10-year ASCVD risk of 7.5% or higher. If that’s the case, statins and I are a couple for the rest of my life. And my adherence to life style and medication regime is very important. Until now, the guidelines predict non-(medication)adherence if the LDL-C reduction is less than 50% from the untreated baseline (or something else causes this lack of success). I would suggest to implement a Medication Adherence Support System, especially because the person doesn’t feel sick and adherence plays such an important role in the results. And that result is to stay without any ASCVD events!

Author: Rene Stenvert @ Vitaphone Netherlands

ACC/AHA Guideline* : http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437738.63853.7a

10-Year ASCVD Risks: http://www.cardiosource.org/science-and-quality/practice-guidelines-and-quality-standards/2013-prevention-guideline-tools.aspx

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Adherence and oncology!

“Oral treatments are transforming cancer care, moving the administration of treatment from the hospital to the patient’s home. This is shifting the responsibility for managing medications from healthcare professionals to patients, making adherence an important consideration”, says Atlantis Healthcare.

An average non-adherence rate of 21% has been reported to oral anticancer treatments. It’s clear that a high level of adherence to oral anticancer treatments is required for successful treatment. In addition to the impact on health and survival, non-adherence to oral anticancer treatment has been associated with increased healthcare costs, including more visits to the doctor, longer and more frequent hospital stays.

Dr. Lina Elliasson, a health psychology specialist who has conducted research with cancer patients’ states: “We found that the most common reason for missing doses was simply forgetting. It is important to make patients aware of adherence aids that might be available to them, such as alarms or monitor dosing boxes.” She also finds that: “Most hospitals do not offer patients any adherence support and are not set up with the necessary protocols to manage patients taking oral cancer medicine. I guess most places have a leaflet about the importance of adherence but that’s it.”

There are some promising interventions to support adherence thought:

  • Implementation of strategies to detect, report and manage side effects;
  • Practical strategies such as pill boxes, reminder aids and strategies for planning around changes to daily routine, such as socializing, visiting friends or going on holiday;
  • Involve patients in decisions about their treatment.

We think the practical strategies like pill boxes and reminders in combination with the social element can work. This strategy needs to be implemented as a part of the complete care system, not as an add-on.

Author: Indy Kavelaars @ Vitaphone Netherlands
Source: Atlantis healthcare, Adherence Research by Vanessa Cooper. More information download the white paper “From hospital to home: the changing therapeutic area of oncology

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