Patients Frequently Decline Insulin For About Two Years After Recommendation

MedicalResearch.com Interview with:

Alexander Turchin, MD, MS Director of Quality in  Diabetes in the Division of Endocrinology, Diabetes and Hypertension Brigham and Women's Hospital

Dr. Turchin

Alexander Turchin, MD, MS
Director of Quality in
Diabetes in the Division of Endocrinology, Diabetes and Hypertension
Brigham and Women’s Hospital 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Anecdotally, many clinicians report that their patients with diabetes frequently decline recommendations to start treatment with insulin. However, until now, there was no systematic information available on this phenomenon.

Our study has found that 30% of patients initially decline their healthcare providers’ recommendation to start insulin therapy. Patients who do ultimately start treatment with insulin, do it on average more than two years after initially declining it.

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Fixed-Dose Blood Pressure Medications Save Money In The Long Run

MedicalResearch.com Interview with:

Kalyani B. Sonawane, PhD Assistant Professor/ PhD Program Director Department of Health Services Research, Management and Policy College of Public Health and Health Professions University of Florida Gainesville, FL 32610

Dr. Sonawane

Kalyani B. Sonawane, PhD
Assistant Professor/ PhD Program Director
Department of Health Services Research, Management and Policy
College of Public Health and Health Professions
University of Florida
Gainesville, FL 32610

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Almost one-third of Americans have high blood pressure. Of those patients who are prescribed medication to control their blood pressure, about 30 percent have problems with side effects and nearly 50 percent will not have their blood pressure controlled within the first year of taking medication. In such scenarios, physicians have the option to either add a medication, such as fixed-dose combination, to the patient’s regimen or gradually increase a patient’s dose of their current drug to achieve blood pressure control; and gradually decrease the dose of their current drug or switch to a different drug to resolve side effects. Using healthcare claims data, we compared the economic impact of these alternative treatment modification strategies.

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Directly Observed Therapy Linked To Lower Mortality In Multi-Drug Resistant TB

MedicalResearch.com Interview with:
Dr. Jorge Salinas MD
Epidemic intelligence service officer
Division of Tuberculosis Elimination
Centers for Disease Control and Prevention 

MedicalResearch.com: What is the background for this study?

Response: Because multidrug-resistant TB (MDR TB) treatment regimens are less effective, more complex, and are more likely to have side effects that are difficult to tolerate than regimens for drug-susceptible TB, patients with MDR TB are at a higher risk of dying. Directly observed therapy (a therapy by which patients meet with a healthcare worker at a regularly scheduled time and place so the healthcare worker can observe the patient taking their TB medication) is recommended to treat all forms of TB disease, including MDR TB.

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More Work Needed To Ensure Compliance With High Intensity Statins After Heart Attack

MedicalResearch.com Interview with:

Robert Rosenson, MD Professor of Medicine and Cardiology Icahn School of Medicine at Mount Sinai New York

Dr. Rosenson

Robert Rosenson, MD
Professor of Medicine and Cardiology
Icahn School of Medicine at Mount Sinai
New York

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: High intensity statin therapy is underutilized in patients with acute coronary syndromes. In 2011, 27% of patients were discharged on a high intensity statin (Rosenson RS, et al. J Am Coll Cardiol).

In this report, we investigate the factors associated with high adherence to high intensity statin. High adherence to high intensity statins was more common among patients who took high intensity statin prior to their hospitalization, had fewer comorbidities, received a low-income subsidy, attended cardiac rehabilitation and more visits with a cardiologist.

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New Capsule Can Reside in Stomach and Deliver Drugs for Several Weeks After Single Ingestion

MedicalResearch.com Interview with:

C. Giovanni Traverso, MB, BChir, PhD Gastroenterologist and biomedical engineer Division of Gastroenterology at BWH Instructor of medicine at Harvard Medical School.

Dr. Traverso

C. Giovanni Traverso, MB, BChir, PhD
Gastroenterologist and biomedical engineer
Division of Gastroenterology at BWH
Instructor of medicine at Harvard Medical School

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We developed a drug delivery system capable of safely residing in the stomach for 2 weeks. Furthermore we demonstrated the capacity of the novel dosage form, in the shape of a star, to protect the drug from the acidic stomach environment and also slowly release drug over the course of 14 days.

We applied this new technology towards efforts targeting the elimination of malaria. Specifically, we focused on a drug called ivermectin that has been used to treat parasites but also has the benefit of being toxic to malaria-carrying mosquitos when they bite someone who has ivermectin in their system.

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Electronic Prescriptions More Likely To Be Filled By Patients

MedicalResearch.com Interview with:

Adewole S. Adamson, MD, MPP Department of Dermatology The University of North Carolina at Chapel Hill Chapel Hill, NC

Dr.Adewole S. Adamson

Adewole S. Adamson, MD, MPP
Department of Dermatology
The University of North Carolina at Chapel Hill
Chapel Hill, NC

MedicalResearch.com: What is the background for this study?

Response: As the United States has moved to increasing levels of electronic medical record keeping, electronic prescribing has become an important part of improving the quality of care and patient experience. E-prescribing increases co-ordination between pharmacist and physician and decreases prescription errors. However, it is less certain whether e-prescribing affects patient primary adherence to medications, meaning whether or not a patient will fill and pick up their medication at the pharmacy. Although it may seem intuitive that primary adherence would increase by removing the patient from the prescription-to-pharmacy routing process, there have been few studies directly comparing primary adherence of patients given traditional paper prescriptions versus e-prescriptions.

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Big Data Using Predictive Analytics Aims To Improve Medication Adherence

Neil Smiley

Neil Smiley

MedicalResearch.com Interview with:
Neil Smiley

Founder and CEO of Loopback Analytics

Editor’s note: Loopback Analytics mission is to “integrate data across a myriad of healthcare information systems to bridge the expanding gaps within the care continuum”. CEO Neil Smiley discusses the problem of medication adherence and possible means to address the issue.

MedicalResearch.com: What is meant by medication “adherence”? How big a problem does this represent in term of health care outcomes and costs?

Response: Medication adherence is the degree to which a patient is taking medications as prescribed. Poor medication adherence takes the lives of 125,000 Americans annually, and costs the health care system nearly $300 billion a year in additional doctor visits, emergency department visits and hospitalizations.

MedicalResearch.com: What can be done by health care providers, systems and pharmacists to improve medication adherence?

Response: There are many potential failure points after a prescription is written, that range from affordability, transportation, literacy, confusion over brand vs. generics, duplication of therapy. Many patients simply stop taking medications when they start feeling better or fail to refill chronic maintenance medications. Healthcare providers can improve adherence by anticipating and eliminating potential points of failure before they become problems. For example, high risk patients leaving the hospital are less likely to be readmitted if they get their prescriptions before they are discharged. Follow-up consultations by pharmacists can assist patients with side effects that may otherwise cause patients to abandon their treatment plan and provide patients with education on how to take medications correctly.

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Online Health Portals Linked To Better Adherence To Preventive Care

MedicalResearch.com Interview with:

Shayna L. Henry, PhD Postdoctoral Research Fellow Department of Research & Evaluation Kaiser Permanente Southern California

Dr. Shayna Henry

Shayna L. Henry, PhD
Postdoctoral Research Fellow
Department of Research & Evaluation
Kaiser Permanente Southern California

Medical Research: What is the background for this study? What are the main findings?

Dr. Henry: In this study, we analyzed the electronic health records of 838,638 Kaiser Permanente members in Southern California. We decided to conduct this study because Kaiser Permanente always strives to advance standards of excellence for care, and even with all the outreach resources available to health care providers and staff, gaps in preventive care still arise. It can be hard to get patients engaged in managing their preventive care, because there are so many tasks for them to keep track of – many of which don’t happen on a very regular basis. Online patient portals have been very useful at helping patients get more engaged in their care, but patients still have to make the first move, and put all the pieces together. Our tool, the Online Personal Action Plan (oPAP), puts our members’ health status and preventive and chronic care tasks in a single dashboard, and alerts them via email to their upcoming care needs, prompting them to log in, view their upcoming health care tasks such as annual vaccinations, tests and blood draws for chronic conditions, and routine cancer screenings, and make the necessary medical appointments to close those gaps in care. We wanted to better understand if having access to the oPAP tools was associated with a higher likelihood of taking care of those outstanding health care tasks in a timely manner.

We found that members who used oPAP were more likely to get a mammogram, Pap smear, receive colorectal cancer screenings, and more likely to complete HbA1c testing for diabetes within 90 days of their coming due compared to members who were not registered on our patient portal.   Continue reading

‘Heart To Heart’ Aims To Improve Adherence to HIV Medications

Marya Viorst Gwadz, Ph.D Senior Research Scientist Director, Transdisciplinary Methods Core Center for Drug Use and HIV Research (CDUHR) New York University College of Nursing New York, NY 10010 MedicalResearch.com Interview with:
Marya Viorst Gwadz, Ph.D

Senior Research Scientist Director,
Transdisciplinary Methods Core
Center for Drug Use and HIV Research (CDUHR)
New York University College of Nursing
New York, NY 10010

Medical Research: What is the background for this study?

Dr. Gwadz: HIV is a major success story in that the tolerability, convenience, and efficacy of antiretroviral medications have improved dramatically over the last decade. A number of years ago in the course of another research study with vulnerable individuals infected with HIV in New York City, and we noticed that a substantial proportion of study participants were medically eligible for HIV medications, and had access to medications, but had declined or stopped taking them. We then turned our attention to understanding why this is the case, that is, to identify the individual, social, and structural barriers that persons living with HIV/AIDS (PLHA) experience to antiretroviral therapy. We focused in particular on African American/Black and Latino/Hispanic PLHA, because the overall emphasis of our research group at the NYU College of Nursing is the development and evaluation of culturally targeted intervention approaches to address health disparities. Around 2011, studies of the “HIV cascade of care” began to emerge, which highlighted the problem of poor engagement in HIV care and antiretroviral therapy nationally. The ultimate goal of HIV treatment is viral suppression, but at present, the Centers for Disease Control and Prevention (CDC) estimates that we have achieved that goal with only 30% of PLHA.

Medical Research: What kind of intervention approach that emerged from these background findings?

Dr. Gwadz: We found that barriers to HIV medication are complex and multi-faceted for PLHA from African American/Black and Latino/Hispanic backgrounds. In particular, PLHA experience serious emotional barriers to the uptake of HIV medications, such as fear of side effects, stigma, and disclosure of HIV status. Further, high rates of substance use and mental health distress, and barriers to accessing services for these concerns, impede medication uptake. Moreover, PLHA who are wary of HIV medication tend to avoid HIV primary care, often because they do not want to feel pressured to take medications, or explain to their providers why they are not taking them. So poor engagement in HIV care, which is very common among PLHA, and low uptake of HIV medication are actually related problems.

With funding from the National Institute of Mental Health (grant #R34MH093352), and in collaboration with Mount Sinai Beth Israel and Mount Sinai St. Luke’s-Roosevelt Hospital Center, we developed a multi-component culturally targeted intervention grounded in the Motivational Interviewing approach that included three individual sessions, 12-24 weeks of patient navigation (as needed), up to five support groups with other PLHA who had declined medication, which were co-led by a “successful” peer who was engaged in HIV care and were taking HIV medication with good adherence. One novel aspect of the intervention was its focus on emotional barriers to HIV medication, and the program’s “no pressure, no judgment” stance, congruent with the Motivational Interviewing approach, was key to engaging participants into the study to talk about these difficult issues.

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Only 1/3 of High Risk Diabetic Patients Comply With Medications

Sameer Bansilal, MD, MS Asst. Prof.- Medicine and Cardiology Clinical Trials & Global Health Studies Icahn School of Medicine at Mount SinaiMedicalResearch.com Interview with:
Sameer Bansilal, MD, MS
Asst. Prof.- Medicine and Cardiology
Clinical Trials & Global Health Studies
Icahn School of Medicine at Mount Sinai

Medical Research: What is the background for this study? What are the main findings?

Dr. Bansilal: Our group has previously published data from FREEDOM, COURAGE and BARI showing that adherence to recommended therapies are low in diabetic (DM) patients. We have spent the last decade developing a potential solution to this- the Fuster-Ferrer polypill. This study was done to better inform the association between levels of medication adherence and long term major adverse cardiovascular events (MACE) in high risk diabetic patients.

We analyzed a U.S. health insurers’ claims data for 19,962 high risk diabetic subjects. Using proportion of days covered (PDC) for 1 year after first refill, we stratified patients as fully adherent (FA≥80%), partially adherent (PA ≥40- ≤79%) or non-adherent (NA <40%) and examined the associations with a primary cardiovascualr outcome measure of death, myocardial infarction, stroke and coronary revascularization. We found that only 34% participants were fully adherent to therapy. When compared to being non-adherent at 2 yrs follow up,, being fully adherent was associated with a 28% lower rate of MACE; being partially adherent was associated with a 21% lower rate of MACE. Efforts towards improving adherence in diabetic subjects may lead to substantial reductions in MACE.

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