BI drug-adherence report targets specific strategies
INGELHEIM, Germany —What chronic healthcare challenge causes an estimated 125,000 needless deaths a year, threatens the health of millions of others and generates some $100 billion in additional health-care costs and absenteeism, with little progress shown by health providers to date on eliminating or reducing its causes or effects?
The answer, of course, is the stubborn and ongoing lack of adherence among patients to their own medication therapy. Despite numerous studies that attempt to track and improve patient behavior, and “despite the decades of research geared toward a solution to the problem of nonadherence, little headway has been made in reversing the trend,” noted a new report from Boehringer Ingelheim Pharmaceuticals.
“The effects of medication nonadherence are far-reaching, with potentially deadly consequences for some patients, and financial implications for the medical and pharmaceutical industries,” noted BI in its report. “Nonadherence has been likened to a chronic illness, and referred to as an epidemic, with no regard for gender, race, economics or education.”
In response, BI has developed a new tool for use by pharmacists and other health providers in the long campaign to boost patient adherence and compliance. The new approach, based on a detailed nationwide study of 1,015 adults ages 45 and older suffering from one or more chronic diseases, marks an effort by the pharmaceutical giant to give pharmacists a set of guidelines to help them target and affect individual patient behaviors, with the aim of improving each patient’s adherence to and compliance with his or her own prescription drug regimen.
BI calls this new, patient-targeted tool the Medication Adherence Profiling System. The company detailed the new approach in its “Boehringer Ingelheim Pharmacy Satisfaction 2009 Medication Adherence Report.” “The critical element and key differentiator of this study is in its end goal: an effective, patient-specific approach to identifying and administering interventions,” BI spokeswoman Cheryl Rodeheffer told Drug Store News. To that end, she noted, “the researchers developed a system of profiling patients and identifying strategies for adherence interventions.”
Those pharmacist interventions, the “Medication Adherence Report” noted, “should move an individual patient farther along the continuum toward medication adherence—and should do so in a way that fits simply and easily within the pharmacist’s daily workflow.”
Behind the MAPS approach lies a key finding reinforced by the BI study: that a one-size-fits-all approach to improving adherence and compliance is only partially effective. “Tools have been created to help identify a nonadherent patient, but without knowing the reasons behind the nonadherent behaviors exhibited, pharmacists and other healthcare providers are left on their own to identify adherence interventions that may help that patient,” BI noted in its report. “What is missing is a mechanism for understanding the reasons behind an individual patient’s nonadherent behavior, which will allow for the tailoring of interventions specifically for that patient.”
“Consequently, pharmacists are often left to indiscriminately utilize commonly available adherence tools—pillboxes, refill reminders and dosing schedules—for all patients,” the report added. “While these interventions may be effective for patients who have complicated dosing regimens or have memory barriers that cause nonadherence, they are not as likely to be effective with patients for whom other issues are at the forefront.”
BI’s objective is to go beyond the standard platform of refill reminders, etc., to boost adherence and compliance. Thus, the purpose of the study, the authors noted, “is to classify the attitudes of patients surrounding taking their prescription medication, therefore shedding light on the underlying reasons an individual patient may not be adherent.”
For purposes of its report, BI drew a distinction between adherence and compliance, but referred to the overall problem as one of adherence for simplicity’s sake. The authors defined adherence as “the act of filling prescriptions or refilling prescriptions on time.” Compliance was defined as “the act of taking medication on schedule, or taking medication as prescribed.”
Patients polled for the BI study reported a far higher incidence of noncompliance—58% of those surveyed admitted some degree of noncompliance—than nonadherence, at 16% of patients.
The MAPS tool still is in the testing and development stage, BI noted, but the “Medication Adherence Report” laid out “strategies and tactics” that the company said “are intended as a starting point for building a patient-specific arsenal of adherence tools.”
To better understand the reasons why individual patients failed to comply with their drug therapies, BI’s researchers developed a lengthy list of questions aimed at “profiling patients and identifying strategies for adherence interventions.” The reasons for noncompliance varied by patient and included everything from the cost or side effects of the medication prescribed to the communication skills of the pharmacist or technician intervening with the patient, confusion over the drug regimen or even the sense of self-worth exhibited by the patient, according to the report.
From that data, “a clearer picture…begins to emerge” of the factors that drive compliance or adherence, BI noted, “along with an array of adherence interventions that may be effective for an individual patient.” Some patients, for instance, may respond better to such financial incentives as reduced co-pays to boost their adherence, while others may benefit more from “supplementary communication efforts, such as offering screening services, mini-counseling sessions and other innovative approaches.”
Still others may respond more readily to hard data that demonstrate the efficacy and value of a particular medication. “Pharmacists may find that taking an educational, ‘facts and figures’ approach could drive adherence among patients who score highly in this dimension,” BI reported.
Another patient attitude that could weigh heavily on adherence is distrust of the health provider, or the sense that “healthcare providers are ‘not on their side,’” according to BI. That lack of trust, the company added, triggers the need to “heighten transparency” through the interaction between pharmacist and patient.
In all, BI defined 11 approaches pharmacists could take to improve individual patient’s adherence and compliance, based on a personal reading of each patient’s attitudes and profile. Those patient-specific intervention strategies include:
Enhancing communication between pharmacist and patient
Providing financial aid
Offering more “transparency” to reassure skeptical patients of the value and necessity of their medication therapy
Promoting an effective drug regimen
Practicing discretion and heightened sensitivity to help patients feel more at ease talking about their health or medications
Empowering the patient. “With these patients, pharmacists could reinforce the use of medication as a means of taking control of their condition,” the report noted
Confronting avoidance among patients who deny or fear their condition and its treatment
Demonstrating the efficacy of a medication
Allaying concerns for patients who may have difficulty swallowing pills or who “may worry that the medication is addictive.” Among the strategies pharmacists could use to deal with those concerns, BI noted, are asking open-ended probing questions, educating patients about flavorings or the availability of liquid or chewable medicines or practicing “active listening to show you understand the patient’s concerns.”
Continually reinforcing the importance of a patient’s staying on their medication, even after they feel better, through ongoing counseling, periodic appointments, positive reinforcement and other means, including the use of manufacturer or support group programs.
In its report, BI provided several examples of how different individual patients respond to each of those 11 strategies. The MAPS technique, noted the study, weights those strategies “by their degree of correlation to nonadherence, so that those dimensions most affecting a patient’s nonadherence are evident, allowing pharmacists to better prioritize and employ targeted, patient-specific adherence intervention strategies.”
“By identifying and weighting the dimensions that drive nonadherence in a specific patient, MAPS makes it possible to tackle the issue of nonadherence on a patient-by-patient basis,” the report noted.
Late-stage clinical trial results: MS drug is effective
ALISO VIEJO, Calif. Patients taking an investigational drug for multiple sclerosis fared better than those taking placebo, according to late-stage clinical results presented Friday at a neurology conference.
Avanir Pharmaceuticals said MS patients taking Zenvia (dextromethorphan and quinidine) in 30 mg/10 mg doses experienced a 11.9% greater reduction in pseudobulbar effect – an MS-related condition also known as PBA that causes sudden, uncontrollable episodes of laughter, crying and other emotional outbursts – than those taking placebo in a 12-week phase 3 trial, results of which the company presented at the 3rd World Congress on Controversies in Neurology in Prague, Czech Republic. Patients taking the 20 mg/10 mg dose did not do better than the placebo group.
“PBA represents an area of high, unmet medical need with no FDA-approved treatments currently available,” study presenter and trial steering committee member Daniel Wynn of the Consultants in Neurology Multiple Sclerosis Center stated. “Although the involuntary emotional outbursts of PBA cause considerable impairment for millions of individuals in the United States, it is under-recognized and commonly misdiagnosed.”
New report projects 12.6% increase of probiotics market
NEW YORK The two takeaways from this story are “the [U.S.] market is expected to grow at a rate of almost 14%” and “the early movers in the industry will benefit in terms of market share.”
That about describes the opportunity in a probiotic nutshell.
The rising interest in probiotics can be credited in part to Dannon’s Activia brand, a line of yogurts and yogurt drinks, which has been heavily advertised to the American consumer with the message that not all bacteria is bad for you — and in fact some bacteria taken on a regular basis can impart some pretty significant health benefits. That advertising message — that probiotics can be an important piece in a healthier-for-you diet — has been all the more reinforced as Bayer supports its probiotic Phillips Colon Health, and as Procter & Gamble rolls out its Align probiotic.
And the consumers already are core drug store shoppers. The ratio of women to men in search of a product delivering digestive benefits is about 2-to-1, according to industry experts. When women hit their 30s and 40s, that’s the point in their lives when they’re looking for a strategy in life to help them manage their digestive issues.