The tools are coming! The tools are coming! For a while now, tools to manage drug adherence have been developed, many designed to enable the patient to self-manage in the context of and in collaboration with the health care system from a specifically designed device or heavy application. Patient adoption, however, has been slow and the vision for self-management of drug adherence not yet reality. But recently from the budding Health 2.0 space, we are seeing tools built on more accessible web and mobile platforms that allow patients to manage when and where they want to with their mobile device (e.g. iPhone, Blackberry, cell phone). So, in much the same way many people’s lives have changed as a result of being able to use Facebook or Twitter, or read the Washington Post from their phones on the bus or out at lunch, patients who have previously required proximity to their home device or desktop to log medications taken can now not only track on their phone what they take from their pill box, but also take advantage of glow cap or smart label technologies that can technically interact with a phone-based mobile application.

It was one thing when the Brazilian government was sending text messages to remind women to take their birth control pills (which, by the way, has been highly effective), but we are in a new age of both passive and active patient engagement with mobile platforms. There are iPhone accessible apps like Polka and TheCarrot.com that enable patients to schedule and track their medications taken along with a number of other health topics including sleep, exercise and mood, among others. Medic8Manager provides an iPhone solution that goes a few steps deeper on drug adherence for managing scheduled medications with reminder functionality, refill tracking, missed dose alerts, as-needed meds and discontinued medications. A similar application in development from Informediq even uses the tagline, “enabling healthcare anywhere”. While some products are typically used solely by patients without involvement required from a physician or other caregiver, we are starting to see more user-friendly tools that originate from the physician-patient care process, while allowing for more consumer-friendly adherence tracking, a good example of which we are seeing from the new AdhereTx product. The next step in innovation can be seen from eMedMobile which facilitates a phone working with “smart labels” on prescription medication bottles that store drug data and send alerts to caregivers when a drug is missed.

What mobile drug adherence applications cannot do is change the character of the person using their phone for this purpose.

• Will we choose to tweet about our day, check the latest scores AND log our our Lipitor on our phone?
• Will we enter all of the drugs we take and their respective schedules into one of these applications or will we demand that that information be automatically downloaded from our doctor or pharmacy as part of the electronic prescribing process?
• Will we be more inclined to use these tools if we are doing so in tight coordination with our physician?

A growing number of technology companies are betting on the fact that mobility will enable flexibility and meet the patient where they are, providing enough value to help them change their drug adherence behavior to some extent. We are even seeing some products go the next level to provide incentives to patients like Health Honors, which uses a points-reward system that can be used on health-related awards like fitness equipment, co-payment discounts and other financial benefits. We, the broad “we”, are hopeful if not excited about the prospects for these tools to have a significant impact on adherence once and for all. Although time will tell, innovation in this area is both notable and promising.

Q: So, where should we start? You have been involved with founding a number of ground breaking biotechnology companies, life science research foundations, trade associations, philanthropic groups, and a whole host of public policy organizations.

A: I enjoy thinking ahead and trying to do the next new thing to advance science, biomedical research, and the business of patient-centered health care. I’m very impatient for change. I consider myself an unrepentant insurgent, renegade, and rabble rouser. I think that is the most powerful disruptive technology there is. That’s why I love the Disruptive Women in Health Care Blog.

But honestly, everything I do is in a lame attempt to keep up with my wife, Sharon F. Terry. She is one of the Disruptive Women Authors and a force of nature like the others here.

I have been burdened with the ability to visualize the dynamics of highly complex systems (like the health care enterprise) and make sense out of navigating or reorganizing aspects of the system to create new efficiencies. U.S. health care is the most inefficient and expensive system ever conceived of and implemented in the history of the planet. It is a wonderfully disturbing playground for a person like me. So, as a coping mechanism I have to create new organizations and social systems to help drive change and innovation.

I have been lucky to be associated with some really brilliant and creative people. For example, the great group who I worked with to start Genomic Health [NASDAQ: GHDX] and apply innovative clinical genomics to successfully change the standard of care for breast cancer in record time. I learned a ton from all the talented people there and from that commercial experience. It made me audacious about what was possible in the new era of optimized precision medicine, personalized medicine, technological innovation, and new approaches to health care delivery.

Q: So, why are you doing all these different things?

A: My kids made me do it! No, really they are the reason I do what I do today. A little over a decade ago, my two children were both diagnosed with a rare genetic disease a few days before Christmas. My wife and I were blown away. The diagnosis was traumatic. In hind sight, it was a seminal, life altering event. It had a profound effect on me as a man, a father, and a husband. At the time, I considered myself a failure at each. What could I do for my kids now? As a young Dad, I completely bought into the archetypal role of supporting, protecting and providing for my family. It was all I thought about. It gave me a clear purpose in life. So, after a few weeks of trying to cope with the emotional rollercoaster of my kid’s diagnosis, I decided to try to find a treatment intervention for their disease. That was the day I decided to do the improbable, potentially the impossible – tame a genetic disease. Take on the system as Just A Dad.

Q: What did you do next?

A: At the time, I was a manager at a large construction firm in Boston. I was involved with building the hospital, university, and biotechnology infrastructure of Boston and Cambridge through the 80s and 90s. I had a sense of the physical manifestation of health care delivery, drug development, basic research facilities, animal studies, and the emerging biotech boom that characterized that hotbed era in Genetown. So I needed to convert my experiential knowledge of what was above the ceilings and behind the walls to help my kids. So as a lay person I went about learning the science and medical lingo necessary to begin to understand how you would create a project management plan to tame a genetic disease.

I began to insert myself into places I was not qualified to be in. I encroached onto the world of scientists, researchers, and clinical investigators. I had unique access because these were “my” facilities. So after my work day in construction, I volunteered and joined prestigious research groups working from 6pm to 2am in the lab to learn alongside brilliant doctorial students. It was hands on learning about what genetic and basic biomedical research entails. My sleep habits were destroyed from then on. But, I also became absolutely fascinated with the new science of genetics and genomics. I got the sense that this technology and science would have irreversible effects on most things in the century ahead. I was only slightly correct. It has turned out to have a much larger impact. Genomics has shaped my career ever since.

Anyhow, we created a patient directed research foundation and we went on to organize an international biobank, patient registry, longitudinal studies, find the causal gene for my children’s disease. Patent it. Create and license clinical diagnostics. Create animal models. And finally launch human clinical intervention trials for the disease. It’s been an exciting few years.

We are now working at creating an industrialized system to tackle small molecule drug develop and clinical studies for rare and neglected diseases in a systematic way never attempted before. The next few years will be exciting too.

Q: You’ve done so many different things in the health care arena in such a short time, what’s the secret to your success?

A: My Mom says, I was just lucky… Thanks, Mom!
But I think it has a lot to do with trying to live life with a fearless attitude. Failure is an option, in some circumstances it is the most likely outcome. But I say, so what? I chose action and risk failure. I rush in and do things I think need to be done on things that matter. I have a belief, that if I’m always working to help alleviate human suffering and the burden of disease in this world then I want to make sure I’m exhausted at the end of each and every day. Hopefully I have a positive impact.

Q: What do you think about these achievements?

A: I’ve been blessed with wonderful and insightful children (excuse me, they are young adults now). Because of them I have become the person I am today. They helped me become a better Dad. That is the greatest achievement. We all traveled the world together to help organize the international disease community and help people around the globe. The most gratifying achievements have been helping various disease groups do the same thing; find genes, create diagnostics and therapies, as well as delivering services to patients in all kinds of circumstances. Helping folks do it faster and better than I did it. I can’t imagine doing anything else.

Q: What do you think your experiences mean for the future of health care?

A: I am Just a Dad. I got engaged as an advocate and information empowered lay person. I did nothing earth shattering. I just incorporated the emerging technologies that are available to most Americans –the internet, social networking, shared knowledge, the power of self organized groups and a desire to solve a problem. It’s a simple but powerful equation.

I believe as collective health literacy improves and the challenges continue to confront the financing and delivery of health care in this country there will be a catalyzing effect that will produce more empowered, disruptive men and women in health care.

If you are interested in an overview of our current series, please read my first post.

I invite you to take a look at our adherence posts–but don’t stop there.  Explore the archives and recent posts listed on the left hand side of the blog.  Read the bios of our authors and join in the conversation.

In recent weeks these blog pages have been filled with ways to support patients: reviewing insights about human behavior, the young, the old, reminder systems, games and team care. In fact, this series could have continued all month and we’d not have exhausted the ways in which patients are supported, encouraged and cajoled to be adherent.

Yes, we’ve dispensed plenty of sugar to make the medicine go down, but we’ve not proposed any “sticks” in the event it does not. Let’s face it; we’re not ready for the outrage in the public policy world if we seriously suggested that patients somehow should be held accountable.

In the private sector, some accountability-style policies exist (though not to my knowledge regarding medicines). For example, one major company warns employees that if they have an automobile accident requiring hospitalization and committed a moving violation or failed to wear a seat belt, they’ll be responsible for paying an additional $1,000 deductible. It’s a policy that requests responsible behavior in return for a benefit. I don’t sense that we’re ready for that same kind of “tough love” talk with patients. Not yet.

I liked Joyce Cramer’s notion of the “patient as willing partner” and wonder if we, as patients, sit at one side of the partnership table, what does “the other side” offer us?

In fact, it offers us a lot in the way of benefits, opportunities and “carrots” regarding our medication needs.

•  Availability. More medications are available today than ever before, brought to us by public funding and policies that underwrite the cost of basic biomedical research, science education and advanced graduate training. Public policies also provide intellectual property protection to those who successfully innovate to produce new medicine solutions and then – after a time – allow that intellectual property to be used by others to produce cheaper, generic copies of those once-innovative products.
•  Assurances. Medications are studied, reviewed and regulated virtually continuously, by regulatory agencies and major health care systems to assure safety, effectiveness and appropriate use. We can report side effects and are encouraged to do so. Those data are monitored and used to further improve pharmaceutical care.
•  Accessibility. Medications are more accessible than ever. There is a pharmacy – on average – at every square mile in the US, each one staffed by experts in the use of medications and the management of complex combinations of multiple products for those of us with multiple chronic conditions. These experts can generally tell “in a heart beat” if the side effect we suspect is the medication or the way we’re taking it. For those locations where the “on average” does not apply, mail order pharmacies fill the gap.  
•  Affordability. Medications are more affordable than ever. The range of generic and therapeutic substitution options allow clinicians and patients to consider the cost of medicines and to pick affordable choices for the vast majority of conditions treated today. Public and private sector coverage for medicines has never been better and every company has a patient assistance program for those who do not have coverage or cannot otherwise afford the medications.
•  Alternatives. In this chronic disease epidemic era a large share of the medications we take are intended to treat conditions that could have been prevented. Public policies have invested in understanding the drivers of preventable illness and educating us on everything from nutrition and exercise to stress management and back-injury prevention. Surely not everyone, but many people can practice the alternatives if they choose. 
•  Accountability. Those who develop, manufacture, prescribe and dispense medications are held accountable for their mistakes. A company that misrepresents the safety, efficacy or indications for their product is subject to legal sanctions and litigation. Clinicians who inappropriately prescribe or pharmacists who inappropriately dispense are subjected to similar consequences. Preventable errors in hospitals are reported and related care is not reimbursed.

Each of these is important and as patients we’d want nothing less. Can we legitimately ask for more? In some cases, yes.

Those with multiple or serious chronic conditions requiring some of the newest biotechnology solutions face great financial burdens. They can legitimately ask for relief. The same is true for people who suffer from cancer and some rare diseases with very expensive therapies. Then, there are those with currently incurable conditions; they can legitimately ask – if not for a cure – then at least for a treatment.  

In return for what we have been given, can something be asked of us as patients? I’d like to think so, but I know of none that would gain traction in today’s debates. Are we ready to suggest that the non-adherent hypertensive patient be charged more for heart attack or stroke care? I don’t think so.

Until we are, we may as well ramp up the “carrots,” so many of which have appeared in these pages, stop the handwringing about the cost of non-adherence and haul out our collective checkbooks.

Based on my personal experiences, I was very surprised to learn what an extreme problem drug adherence is to the health care system. It appears that many, many people are not listening to their health care professionals about taking their medicine as they should.

Before looking at possible solutions to this national epidemic, let’s identify a few reasons patients don’t take, or sometimes, even fill, their prescriptions. One common reason is a lack of understanding about the disease or diagnosis for which the prescription was written. Other reasons may be concerns about the drug’s effectiveness, fears related to medical side-effects, lack of belief that they can control the disease, or like me with the antibiotic, they stop taking the medication because they are feeling better and don’t realize the side effects of not taking all of the prescription. It seems to me that many of these reasons for non-adherence can be addressed if people were provided with more information about both their medical conditions and how their medications can be of benefit.

One possible emerging solution to this information/education problem is the application of healthy games – multimedia experiences that are fun and deliver health benefits. Healthy games hold the potential for many benefits, including improving health literacy, physical fitness, cognitive fitness, condition management and motivating behavior change (like increasing the likelihood of drug adherence).

iConecto, a company working to empower personal health and organizational performance though healthy games, gaming technologies and social media, has collected the largest database of healthy games for consumers and professionals. In addition, iConecto is tracking the evidence and experience of the benefits of these games. Currently, there are over 35 documented studies which show that well-designed games can help engage and empower consumers health behaviors leading to higher treatment regime adherence, better overall health, and more clarity in communication with others about their conditions. These clinical studies have focused on a variety of areas, including cancer, asthma, diabetes, cystic fibrosis, exercise/weight loss and brain games. This blog post will focus on a few examples related to improving drug adherence through the use of healthy games.

One of the more well-known healthy games is “Re-Mission“, developed by Hope Labs, a first-person shooter game where players shoot and kill cancer cells while learning about the efficacy of different forms of treatment. According to an August 2008 article in the journal Pediatrics, results from a randomized, controlled study found that playing Re-Mission improved adolescent and young adult cancer patients’ cancer-related knowledge, self-efficacy and adherence to their prescribed cancer treatment plan. In a “Re-Mission” study conducted by the University Medical Center Utrecht in the Netherlands, one group of cancer patient played “Re-Mission” while the other (control) group played “Indiana Jones and the Emperor’s Tomb” – a strictly entertainment game with a similar design and interface to “Re-Mission”. This study, which included 375 male and female cancer patients aged 13 – 29, showed that those patients playing “Re-Mission” had higher drug adherence to both antibiotics and standard chemotherapy drugs. The assumption made in the study is that by playing “Re-mission”, the patients learned more about their disease and how they could control it through medication and chemotherapy.

Similarly, two asthma-related multi-media games have demonstrated increased knowledge of asthma and decreased asthma symptom days (perhaps from better adherence to daily doses of inhaled corticosteroids). Games designed around diabetes (Packy and Marlon, Escape from Diab and Nanoswarm) have shown, or are in clinical trials to show, improved self-efficacy and self-management. In the Packy and Marlon study, the treatment group who played this game had a 77-percent decrease in diabetes and emergency and urgent care clinical visits. Another approach to gaming for kids with diabetes is Bayer’s Didget, and its precursor Glucoboy. These are two blood glucose meters designed for kids with diabetes. They interface with the Nintendo DS and reward children with diabetes if they measure and track their blood sugar levels. Blood sugar levels in the correct range will unlock fun games on the Nintendo DS. Initial evidence has shown that kids with diabetes are much more likely to measure their blood glucose levels with this innovative meter. Didget also connects users to an online community to add the benefits of social networking to good health behavior motivation. Bayer’s Didget is not yet available in the U.S. but more information is available on www.bayerdidget.com.

If we consider exercise a health prescription (and there are plenty of people not adhering to that prescription), there are many examples of exergames, like the Wii Fit and Dance, Dance, Revolution, that have shown when exercise is made “fun”, people show a greater physical exertion rate and greater long, term exercise program adherence. Games have also been shown to improve overall healthy behaviors – for instance improving eating habits, enabling smoking cessation and reducing stress.

Finally, when it comes to medication, you may have heard that “Laughter is the best medicine!” and I agree wholeheartedly that having fun is key to our physical, mental and emotional well being. It serves to reason then, that since games are fun, engaging and educational – they can be a great approach to help us adhere to the best medicine of all.

Poor medication adherence affects all of us in healthcare — it’s a problem that our entire industry is trying to tackle. By many estimates, more than 50% of patients aren’t taking their medications as prescribed. And that’s a real problem: it’s adding $177 billion in additional healthcare costs and contributing to sicker patients. Reports associate lack of adherence with 10% of hospital visits and 40% of nursing home admissions.

At McKesson, we’re trying a new approach. We’ve partnered with pharmaceutical manufacturers to sponsor programs that get community pharmacists involved in promoting medication adherence. Independent and small-chain pharmacies, including McKesson’s chain of Health Mart pharmacies, have a reputation for building strong relationships with their customers and delivering excellent service. By getting pharmacists to spend time counseling patients about their medications, we’re helping patients become more informed, more confident, and more motivated to adhere to their medication regimens.

In one of our first programs, the Pharmacy Intervention Program, we’ve trained hundreds of pharmacies in motivational interviewing and other key health behavior change techniques — asking patients open-ended questions and having a true discussion about the patient’s knowledge, feelings, beliefs, goals and expectations. This patient-centered approach to counseling helps pharmacists be as effective as possible in providing education and support to patients.

Here’s how it works: when patients come to pick up their prescription for one of the sponsored medications, the pharmacy’s computer system alerts the pharmacist or pharmacy technician that the prescription is eligible for counseling. Before the patient leaves the pharmacy, a pharmacist begins a conversation with him or her about the medication and provides the patient with literature to take home. Pharmacists are reimbursed financially for the 5 minute counseling time — something they ordinarily do for free — further encouraging them to take the time to promote patient adherence.

We’re already seeing incredible results from the program. In our pilot program this summer for two products, our pharmacists achieved a 24% increase in adherence (the number of patients returning for refills) for a smoking cessation therapy medication, and an average 38 % increase in adherence rates for a COPD medication. These are mind-blowing results, and the manufacturers with whom we’re working have taken notice. We’re all excited about the impact of this program and the results that community pharmacies may be able to achieve in driving medication adherence.

So many times in our healthcare system, a patient’s different care providers work in isolation to promote better outcomes. But programs like the one we’ve introduced at McKesson suggest that more collaboration and coordination — reinforcing common messages about conditions and medications from the physician to the pharmacy counter — can make a huge difference. We’re also seeing the real difference that strong relationships and quality, patient-centered discussions can have on a patient’s understanding of and loyalty to a therapy. These are things to keep in mind as we ponder how to address this very large issue our healthcare system faces with medication adherence.

This resulted in either missing medications, or taking them incorrectly, to simply becoming frustrated and not taking them at all.  This was especially true for my mother who was on 16 prescription and 6 over-the-counter medications when I decided to design a medication chart to assist her. That developed into a healthcare and medication  system, easy-to-use spiral notebook.  This can be seen on www.mymedmanager.com or on www.youtube.com/mymedmanager.

Medications can be very beneficial, but to get the most benefit, they must be taken properly.  Following instructions from the prescribing physician is extremely important, but reading and understanding the warning labels placed by the manufacturer is just as important.

For example, many people think if the warning label says, “take with food,” it is to prevent getting an “upset stomach.” Therefore, many will ignore that warning label and take it on an empty stomach because they believe they have stomachs “made of steel.”   What they may not realize is, in many cases, food helps to increase the absorption of the medication.  There are numerous examples of this type of confusion.

My experience with working with individuals has shown me that when using a tool such as the mymedmanager medication chart, the simple act of filling out the form after reading the instructions carefully on the bottle and warning labels affixed can make a huge difference in their adherence.

The next important step is for the patient to take their medication chart to all their physicians.  Ask them to review their meds and make a copy for their files.  Someday we will be able to retrieve things electronically, but for now, we must rely on the patient to know what they are taking and why.

Having the medication chart creates a team among the patient, the physician, and the pharmacist.  My mother always took her chart with her to the pharmacy before purchasing over-the-counter medications, and asked for advice.

In my opinion, pharmacists have the even more knowledge about medications than the prescribing physician because they deal with meds all day long; plus most pharmacies have the software programs that can check prescription drugs, including over-the-counter medications, herbals, etc., quickly to assist the pharmacist.  Their time is valuable, and I suggest we use their brains and not just their hands for counting out pills.

So, the best advice I can give to all readers of this blog is to make a complete list of your medications, indicate if you are allergic to any meds or foods, a list of who to contact in case of an emergency, and your insurance information. Keep a copy at home and one in your wallet.  The life you save may be your own.

Please visit www.mymedmanager.com and see if the notebook would be of benefit to you or someone you know.

The American Academy of Nursing working with the Agency for Healthcare Research and Quality has published practice guidelines for nurses working with the older adults in the community on the management of their medication. There are many risk factors that affect the individual’s adherence from physical ability to depression and beyond.

We know that nursing interventions and evidenced based transitional care innovations where an advanced practice nurse leads an interdisciplinary team can help the patient and their caregivers prevent non-intentional and/or intentional non-adherence of medications.

Both patient and financial outcomes are well served by these interventions that can help prevent costly nursing homes stays, hospitalizations, emergency room visits and improve the quality of life for patients and their families. Knowledge, understanding and support for these interventions should not be limited to any one profession regardless of the individual professional who actual delivers the specific service.

Patient and family education remains a critical factor in the complex process of medication management which has many phases and activities. More research is needed for specific interventions that work in self-management. A small amount of financial investment in the assessment and monitoring of individuals with multiple medication regimens seems like a wise investment and one that could all health professional along the way as they provide the individual with the right care at the right time.

Ms. Privor-Dumm spent years in the vaccine industry working for Wyeth, where she led a US team to launch Prevnar® and helped achieve unprecedented uptake of Pneumococcal Conjugate Vaccine. Following the successful US experience, she worked as Commercial Director for the Latin American countries to introduce pneumococcal and meningococcal vaccines and then as Senior Director for Commercial Operations in Europe, the Middle East, and Africa.  She also worked at GlaxoSmithKline as director for global commercial strategy for various pipeline projects.  After 18 years in industry, Ms. Privor-Dumm moved to the public sector to apply her expertise in accelerating decision making in the world’s poorest countries.

This is one of my favorite photographs from a recent trip to Nigeria. I love how happy this little girl is to be with her big brother, as he looks at her with that I-know-so-much-more-than-you attitude of all older siblings. It’s an interaction that could have taken in Philadelphia, Baltimore or Cleveland, but I took it when I was at the University College Hospital of Ibadan.

I was in West Africa to make a documentary on the impact of new vaccines and pneumonia prevention efforts in developing countries.  After years working at a pharmaceutical company where I was fortunate enough to launch these new vaccines, I realized that something was missing.  I was surprised to learn that the percentage of deaths due to pneumonia was so high (almost 1/5 of all post neonatal deaths).  Ninety-five percent of these deaths occur outside of the US, Europe and other industrialized countries, yet it was in the developed world where we did most of our business.  We often forget about children in the developing world.  We see pictures of desperate, hungry children and rationalize well, if I don’t do this one thing, something else will kill them anyway.  But all you need to do is travel to one of these countries to realize that children are the same all over the world.  You forget that they are still grappling with some of the diseases that have long been out of our minds for children in our country.

Pneumonia? Who would have thought that this is such a large problem for young children?  In fact, it is the illness that leads to the most deaths worldwide – over 2 million young lives lost every year, a child every 15 seconds.   We have access to pneumonia vaccines and antibiotics to treat – child deaths due to pneumonia are relatively rare in US and Europe.  These deaths unfortunately occur all too often in the developing world.

While at the hospital in Ibadan, I spoke with mothers waiting outside the vaccine clinic. Many of them hadn’t heard of pneumonia, although one mother had lost her daughter to the disease, or as she described it to me, a “cold in her bones.” What was so heartbreaking about her story was how easily it could have been prevented. For only $20 USD, her daughter could have been fully immunized against pneumonia with Hib and Pneumococcal vaccines, similar to those given to our children in the US, and while non-vaccine-preventable strains exist, an appropriate course of antibiotic treatment costs less than $1.00.

The mothers I met that day are not the only ones unfamiliar with pneumonia. Many global health leaders and donors are unaware of the magnitude of this disease or the full range of effective tools available to protect children. In an effort to overcome this legacy of neglect, global health advocates around the globe are banding together today to commemorate the first ever World Pneumonia Day. Our shared goal is to bring greater attention to this disease and to motivate policymakers and donors to control child pneumonia through the protection, prevention, and treatment strategies recommended by the Global Action Plan for the Prevention and Control of Pneumonia (GAPP).

We often see images of sick children losing the battle against poverty and disease, but I think one of the reasons I like this photo so much is that it reminds me of the joy a child’s recovery can bring. Pneumonia is a common and deadly disease, but it is stoppable. World Pneumonia Day is an important first step in making the leading killer of children a global health priority.

If you’d like to learn more about child pneumonia or what you can do to support World Pneumonia Day, please visit our website.

I’m more aggravated though about how some political circles have spooked the health reform debate.  It’s a perfect horror movie with serial killers of anything Obama, scare tactics aimed to torment and take advantage of citizens who are vulnerable and unlearned about a complex issue, and gangbangers of a majority party unwilling to compromise for bipartisanship.

Take for instance some of the absurd television and internet ads on health reform.  One ad claims that 300,000 women will die from breast cancer if health reform legislation is passed.  An online ad claims that in Massachusetts, you can go to jail if you don’t have the right health care insurance.

And vocal anti-reform providers are scaring people even more.  I participated in a recent panel discussion on health reform and afterwards, a businesswoman expressed fear of reform because a physician who had just worked to revive her 7 year-old niece from a deadly aneurism told her that her niece would have died had health reform been in effect because quality of care would be compromised.

“Government takeover,” “no choice,” and “death panels” are frightening concepts for most Americans.  Check out this sample of scary lies from the debate, courtesy of Politifact.com, an independent fact-checking website:

• Forty-five percent of doctors “say they’ll quit” if health care reform passes,” Glenn Beck.
• “President Obama . . . wants to mandate circumcision,” Rush Limbaugh.
• Seniors and the disabled “will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care,” Sarah Palin.
• The Baucus health care bill “could be used to ban guns in home self-defense,” Gun Owners of America.

And because I’m an equal opportunity blogger:

• “Insurers delayed an Illinois man’s treatment, “and he died because of it,” President Obama.

Research into this claim from our President revealed that the insurer’s decision was reversed and this man lived three more years.

It is so unfortunate that debate over something so vital to the well-being and moral fiber of our nation has become so stupid.  I’d like to get in on this tomfoolery though, so in the spirit of Halloween, health reform and the recent release of Michael Jackson’s rehearsal documentary “This Is It,” I’ve remixed the infamous Halloween theme song, “Thriller.”  Enjoy.

It’s close to Christmas Recess and something false is lurking on the Hill
Then on your TV screen, you see an ad that almost makes you shrill
You try to scream, but terror takes the sound before you make it
You start to freeze as horror looks you right between the eyes
They’ll make you be euthanized

‘Cause this is thriller, thriller night
And the Dems aint gonna save you from the rationing ‘bout to strike
You know it’s thriller, thriller night
They’re voting for your life inside a killer, thriller tonight

If only this health reform horror could disappear on November 1 like Halloween’s ghosts, goblins and dead dummies.

Alternate flavorings, formulations, and suspensions can help the medicine go down in children.  But what is the solution when taste is not the problem?  One approach we need to take is to put the young person center and first.  Talking past the child to the parents is a practice that continues today and even with many young adults patients.  If we want young people to succeed in self-medication management, they must be the drivers of their care.

Child-centered care:

 Psychoeducation: As soon as the child is able to participate, he needs to be educated about his condition and medication regimen so he understands what his happening to his body.  Participating in the decision-making process, e.g., whether to take the morning medicine after brushing teeth or at breakfast, protects the child’s autonomy and sense of control.

Contracts help in getting the young person to take ownership, and patient records are an age-old but effective method of monitoring adherence.  Children can check boxes on printed forms, manually or computerized; parents can help by incentivizing adherence with tokens or rewards.  Encouraging the child to share the record in the next medical visit further increases his autonomy – a critical issue when one loses the sense of control over one’s body.  Physician follow-up is critical to promoting adherence, e.g., counting pills, checking records.

Communication skills and understanding the young person’s perspective are key ingredients to building trust. A non-judgmental attitude along with a willingness to negotiate and temporarily modify medications can help a young person understand the need to adhere to a regimen.

Problems may surface when the child enters adolescence and considers engaging in risk-taking behaviors.  This is also the time to foster health self-management and start the transition process to adult-oriented health care.  As the teen matures, he must be educated and encouraged to learn about his condition and management. The physician should work with the family to develop a step-wise approach to increase responsibility, e.g., first succeed at level 1 for x months before moving up to level to 2.  For example:

1. Monitor patient-recorded adherence chart
2. Make doctor’s appointments and record on chart (physician visits are associated with adherence)
3. Order prescriptions and record on chart
4. Fill medication trays

Of course, parent buy-in is critical.  They need to be educated about the condition, medication, side-effects, costs, and they should be given a written strategy to manage medications.  In addition, a school-based team approach may be needed. Parents’ personal and cultural beliefs may impact their management.  Physicians need to appraise parents and keep communication channels open since medicating young people raises several concerns:

1. The lack of studies done in children and prescribing drugs off-label,
2. Hormonal changes in puberty effect on drug levels and health, and
3. Problems when titrating and weaning medications.

As children grow up and become self-sufficient, parents may need help in letting go and learning to taking risks with their child.

A simple technique that improves adherence is texting. Young people prefer this mode of communication: it is non-intrusive and short and sweet.  We used to prompt our daughter to take her medications by telling her in person or calling her by phone.  When I asked my daughter to text us after taking each medication dose, we witnessed a 95% improvement in self-managed adherence.  Plus, texting takes the nagging voice out of the equation, and one thinks twice before sending something negative in writing.

Young people with chronic conditions often feel isolated and say their healthy peers do not understand them.  Group psychoeducation or mentorship improves self-management and adherence, and it is financially smart.   A promising emerging practice is the use of transition coordinators and clinics to help young people with chronic medical conditions learn how to manage their own health and health care.

New technologies, e.g., health games, should be fast-forwarded to move them into implementation stage to help these young people gain control over medication adherence now.  These young people have much to gain by being in good health now and as they grow into adulthood and live their entire lives with a chronic condition.  Equally, they have much to lose from poor health status and its repercussions on their growth, development, education, social life, and quality of life.   A couple of projects in the making that I like:

1. Embeddable medication management device in teddy bears or backpacks for kids with cystic fibrosis.  Provides alerts to child and caregivers.
2. PHR application for teens to share and negotiate health care status and needs with providers.  Uses real time data: moods, music, photos.

These ideas and strategies are not rocket science.  They require a concerted commitment of time and energy, reimbursement, and financial investment.  Most of all, they require an attitude shift to make our young people with chronic medical conditions and disabilities a national priority.   These children and young adults are growing up quickly…

What are we waiting for?

If only it were an urban legend that senior citizens in the United States were cutting their physician-prescribed pills in half or ignoring their medications altogether in order to have enough money for food and utilities, but one doesn’t need academic studies to know that this kind of economically-forced non-adherence has too often been the case in our country.

After Congress passed the Medicare Modernization Act (MMA), creating the Part D prescription drug program, the Healthcare Leadership Council – an advocacy group comprised of chief executives of healthcare companies and organizations from all health sectors – literally took its show on the road. Having worked for passage of the MMA, we felt a responsibility to ensure that the new Part D program was implemented successfully and that seniors knew how to take advantage of the new benefit.

In community meetings across the country, I met with scores of elderly men and women who told me heart-wrenching stories of the hard choices they had to make between medications and other necessities, knowing they were putting their health at risk.

Has the Medicare Part D prescription drug program made a difference in drug adherence within this vulnerable population? The results are quite positive but they also show that further improvements remain necessary.

The impact of Part D on drug adherence among the elderly is unquestionable. A survey in April of this year by KRC Research (commissioned by Medicare Today, a coalition of local and national organizations we founded to provide reliable Part D information to seniors) found that three of every 10 Medicare beneficiaries reported that they are now taking medications that they had previously either skipped or rationed.

A more recent study published this week in the Journal of the American Medical Association, involving data collected over a three-year period from over 24,000 Medicare beneficiaries, found that 11.5 percent of beneficiaries skipped medications in 2006, after the drug benefit was introduced, compared to 14.1 percent in 2005. The study also found that 7.6% reported cutting back on spending for basic needs in 2006 to afford medications, compared to 11.1% doing so the previous year, before they had prescription drug coverage.

That’s significant progress, coming in just the first year of Part D implementation.

The JAMA study also showed, however, that the sickest beneficiaries, those requiring the most prescriptions, showed no improvement in their drug adherence. That data underscores the need for further improvement in the Part D program.

It can be presumed that many of those high drug spenders fall into the so-called “donut hole”, the spending gap within which Part D doesn’t cover prescription costs. Health reform bills working their way through Congress right now include provisions to cut in half those “donut hole” out-of-pocket costs. This would be a welcome change and one that presumably would strengthen drug adherence among less-healthy Medicare beneficiaries.

Focus needs to be given, as well, to the approximately two million Medicare beneficiaries who are eligible for low-income subsidies but are not enrolled in the prescription drug benefit program. Not only is intense community outreach necessary to help enroll these beneficiaries, but Congress should also take a look at the asset tests that may be keeping many economically-vulnerable seniors from the benefits they need.

We’re moving closer to the day in which economics ceases to be a barrier to drug adherence among the elderly, but there is still work to be done.

The following guest post — part of our Drug Adherence series — is by Elizabeth Sozanski, who is currently Senior Director, Global Brand Strategy, and is the former Adherence Leader for AstraZeneca. In that role, she was responsible for building the adherence strategy and initiatives in support of 5 largest brands; had a leading role in developing adherence-related partnerships with multiple healthcare partners; and served as the main interface to the organization for adherence best practices aimed at improving appropriate care and healthcare outcomes.

In the many years that I’ve been with the pharmaceutical industry, few issues have been both as divisive and unifying the way medication adherence has, all at the same time. It’s divisive because various stakeholders in the healthcare space each own a different—and often seemingly conflicting—component of this common yet complex problem. It’s unifying because not a single one of those stakeholders can solve the issue on their own. The unique opportunity this situation creates is that, to address this costly and serious challenge with the price tag of $100 billion each year, we all have to come together and work across our boundaries and individual interests.

When I talk about healthcare stakeholders, I certainly include the manufacturers, but also a whole host of other key players in the healthcare space: starting with patients, doctors and nurses, and including managed care organizations, insurance companies, employers, public health organizations, policy-makers and regulatory bodies such as the FDA or EMEA.

As manufacturers, our hope is that patients who use our medicines benefit from their full value by using them appropriately. As an industry, we put so much effort into discovering and developing new medicines for patients—the therapeutic benefit of these medicines is clearly compromised unless an appropriate doctor-prescribed regimen is adhered to.

There are as many theories as they are people as to why patients deviate from their doctors’ guidance, and choose to “prescribe” their own treatment regimen instead. I won’t go into them because they have been very well covered already in this debate.

So what can a manufacturer do to address the issue? While no pharmaceutical company can single-handedly remove all of the underlying issues which drive patient adherence (in fact, none of the other healthcare stakeholders can either), there are many things we can do as an industry, and even more we can do if we partner with others in this challenging mission.

There are three key areas where we can bring particular value to this challenging issue:

1. First and foremost, we have both the ability and the obligation to understand the needs of our patients—as individuals—and not as “numbers” or a “disease.” We can, and should be, helping patients in ways that are relevant to them. Through many years of research, we found that patients tend to follow certain adherence behavior patterns depending on their “healthcare personality.” This personality guides their actions, and tends to hold true regardless of the type of medicine or condition it treats. There are many excellent patient support programs offered by AstraZeneca, and by our industry peers. These programs (such as In Your Corner TM or Healthy Horizons TM), which usually offer the patient a combination of personalized reminders, education and information combined with some simple rewards, help keep adherence top-of-mind. Patients who participate in these programs typically stay more adherent to their prescribed treatment, especially if the offerings are relevant and tailored to their unique “healthcare personality.”
2. Second, as an industry with long-standing and important relationships with physicians, it is our job is to support them in clearly communicating the importance of therapy adherence. While the healthcare and adherence dialogue clearly belongs to the physician and their patient, there are tools that we can provide to make that interaction as strong as it can be. For example, during the starting phase (the first 4 prescriptions, or approximately 120 days), adherence drop-off is especially dramatic. A simple tool, such as SERVTM, which has been designed to work within the reality of a busy practice, can help the physician encourage their patients’ adherence, starting from the first prescription.
3. Third, we need to play an active role in addressing non-adherence in the broader context of public health, through coalition-type partnerships, public education, and policy forums. Because non-adherence has a profound impact on all healthcare stakeholders, it can be a well-recognized rallying point for all of us. Here again, there are many great examples of various parties coming together for this important common cause: a pharmaceutical company and a health plan building and testing a voice-activated reminder technology together; a national pharmacy chain and a manufacturer building a customized in-pharmacy counseling program for patients; a health literacy initiative between a pharmaceutical company and the American Academy of Family Physicians; a state working together with Medicaid and a manufacturer (Florida: A Healthy State program) on a broad health-improvement initiative including adherence.

With these examples to build on, there is no reason why we shouldn’t be able to rise above our individual interests and boundaries to address non-adherence. As manufacturers, we clearly own a component of the issue—as well as of the solution. But to really make a difference in this complex challenge, we must work together across the healthcare spectrum. With that approach, as the patients benefit, so will all of us.

Why are childbirthing centers in this country struggling to survive when they ought to be spreading? We know that they provide a wellness-model of pregnancy and birthing (as opposed to a disease model that hospitals have traditionally taken), use best practices in birthing, have excellent clinical outcomes, and save money. Staffed and usually managed by certified nurse midwives, childbirthing centers have been endorsed by the American College of Obstetricians and Gynecologists.

At the end of the Bush administration, someone in the Centers for Medicare and Medicaid Services realized that there was no mandate to pay these centers a “facility fee” that provided support for overhead. So, after years of paying this fee, CMS stopped paying it to childbirthing centers and now pays it only to hospitals.

The numbers I’ve seen suggest that a vaginal delivery in a hospital costs 5 to 6 times more than in a childbirthing center. Ruth Watson Lubic, one of the pioneers of the childbirthing movement, founder of the Family Health and Childbirthing Center in Washington, DC, and a Disruptive Woman, has estimated that using these centers for just Medicaid births could save the nation $1-2 billion each year.

As our nation struggles to figure out how to pay for reforming the insurance industry, we can start to reform health care delivery in affordable, quality ways by ensuring that all pregnant women have access to the childbirthing centers. For those who want to act now, you can sign a petition calling for restoration of the Bellevue Hospital center. Or learn more about legislation to require CMS to restore the facility fee to childbirthing centers.

2.2 million Americans suffer from AF, a condition that causes a 4 to 5 fold increased risk for stroke. What is worse is that 5% of those ages 65+ have AF.  Luckily, warfarin is an inexpensive, generic drug that, if taken consistently and with regular physician monitoring, can reduce the risk of stroke for AF patients.   However, compliance is a problem and as a result non-compliant AF patients remain at risk for stroke.

My group utilized a PRECEDE/PROCEED framework to conduct a hypothetical needs assessment and identify the underlying causes of the problem that our resulting intervention would address.  This framework provides a conceptual way of organizing multiple levels of factors that explain prescription regimen noncompliance and identify places where an intervention may be effective.  Utilizing our course textbook, Health Behavior and Health Education: Theory, Research, and Practice by Glanz, Rimer, and Viswanath, we found that examining the following factors was particularly important in explaining whether one is adherent:

• Predisposing factors – the motivation or rationale for behavior and include one’s attitudes, beliefs, preferences, skills
• Reinforcing factors – the reward or incentive for persistent behavior such as social support, modeling, peer influence
• Enabling factors – direct or indirect antecedents that allow motivation to be realized, including environmental and structural factors

We also used social cognitive theory, which focuses on the individual as a health behavior change agent, and its theoretical constructs.  In reviewing the literature, we found that elderly AF patients may:

• lack the self-regulation to remember to take their medication consistently or to organize taking this particular medication among others that need to be taken throughout the day
• have a weak self-efficacy belief and feel incapable of adhering to their prescription regimen
• lack incentive motivation and not see the link between adherence and good outcome expectations; if they take warfarin once or several times, they may not see an instant reward, feel different, or see that they have reduced their risk of stroke
• have facilitation difficulty in physically getting to their provider’s office for the required physician monitoring

In summary, we found that adherence is an individual behavioral issue with layers of causal factors (identifiable via social cognitive theory) and surrounded and impacted by environmental factors, which can be organized using the PRECEDE/PROCEED framework.  Although we designed a hypothetical intervention that addressed the predisposing, reinforcing, and enabling factors specific to warfarin compliance, these tools could also be used to examine adherence issues for other drugs.

Listed below you’ll find arguments for not having health insurance that I hear on a regular basis. As a broker, I’ve provided a reality check for individuals to consider before making their final decision.

1. It costs too much.

The reality: Should a catastrophic illness or injury occur, it would likely bankrupt most people who do not have health insurance. It’s the terrible fact of life in 2009. Medical care is incredibly expensive, and employers are increasingly less likely to be able to support an injured or ill employee. So if something happens to you, and you have not saved enough money to support yourself if you are unable to work, odds are good that you will be in debt for astronomic health care bills and, unfortunately, many of us would be hard pressed to ever climb out of that financial hole. Don’t be scared. Just think long and hard about that.

2. It does not cover all of the health care needs that I have now, or might have in the future

The reality: The truth of the matter is that a good health insurance broker can usually find a policy that covers most every medical problem that is likely to arise. There are also resources that can be used to supplement your plan. For instance, if you need discount drugs, it is possible to fill your prescription at Wal-Mart or in Canada. Need a flu shot? You can get one at your local pharmacy. My mother always told me, “where there is a will, there is a way.” I believe that to my core. You just need to be clever and work at solving your own problems.

3. The drug benefit is insufficient on most health care plans.

The reality: See above. And do remember, you are your own best health care advocate. The health insurance plans cover many things, but you need to do some legwork to get everything you want and need for your own care.

4. The process of finding the right health insurance is too complicated.

The reality: Honestly, it really is not. Think about the old adage — “How do you eat an elephant? One bite at a time.” The same applies to health insurance. People think that the process of understanding a policy is just too difficult, so they tend to shut down before they even try to take the time to comprehend it. Don’t give up too soon.

5. I have a specific health issue that was not covered satisfactorily in the past, so I’m not inclined to buy health insurance again.

The reality: Please realize that not all policies are the same. There is definitely one that is right for each individual. Plus, there are often state-run programs that can address most insurance needs. If you had an issue it is likely that someone else did too, so take solace in the fact that you are not alone.

6. I am healthy and do not need health insurance today.

The reality: That’s true. Until, of course, you do need it. You will. You are human. Humans get sick and often need to see a doctor. So please, do not be stupid. Protect yourself against what is more than likely to come. In the case of a catastrophic incident, this ignorant assumption cannot be undone.

7. Obama will help me get free insurance.

The reality: I cannot believe how many times I have heard this in the last few months. I am the first to admit that President Obama is doing his best, but please stay grounded in the facts. The U.S. government is not going to give everyone a free health insurance policy. Unless you are very poor, forget this as an option. Take care of yourself today and buy an affordable health insurance policy.

8. I want to wait until health insurance is cheaper.

Having been in this industry for more than two decades I can speak from experience that health insurance companies are not in business to help you. Insurance is not going to get any cheaper — at least, not any time soon. It is heretic to admit, but insurance companies do not make billions for their shareholders by helping the little guy. We are easy targets. We have no lobbying power, and they know it.

The bottom line: Be smart. Buy a health insurance policy that will at least cover you in case of a catastrophic event. Health Savings Plans are a good option, and more solutions are coming on the market. The bottom line is that if you take care of yourself, you won’t regret it.

In between classes, I have busied myself with all that the MPH program has to offer outside the classroom, as there is no shortage of activity competing for students’ every “free” moment.  For instance, I am part of a monthly health disparities journal club and am working with a professor on a book about Taiwan’s national health insurance system.  I am also now VP of Communications for Students Promoting HEalthcare REform (SPHERE), an organization spanning the school of public health and school of medicine whose goals are to assure that every person in the United States has the right to affordable, high-quality healthcare and to educate the Hopkins community.  So far the organization has had one event this year in which we heard from a panel that included representatives from Kaiser Family Foundation/The Commonwealth Fund, Johns Hopkins faculty, and local news radio, on the state of play in health reform.  We will be having other health reform educational events throughout the year and one major advocacy event in the spring.  As VP of Communications, I will be promoting events at the school, updating and enhancing our website, and possibly forming partnerships with other similar, local student groups.

I have also been fortunate to hear speakers from CMS Office of the Actuary, AHRQ, MD Department of Health and Mental Hygiene and have given one presentation of my own outside of class.  The Health Systems & Policies concentrators meet twice a month to discuss health policy issues and share experiences.  Since I worked in account management for a payer prior to the MPH program (and am pretty sure I am the only person in the current MPH class who comes from a payer background) I presented on Health Reform from a Payer perspective, which stirred quite a bit of conversation from peers who are primarily coming from provider and consumer advocacy backgrounds

In addition, although I’ve just begun the MPH program, I cannot believe it is already time to plan for post-grad, which is right around the corner (May 2010).  So far, I’ve ordered my Johns Hopkins business cards, started a soft search of organizations and firms involved in health reform, policy, and consulting related to access and affordability of care and quality of care issues.  I am also deciding on fellowships and whether to stay in the DC area for a bit or immediately return back to the Philadelphia area, where healthcare spending is among the highest in the nation.  I am also considering how to best spend the January break.  Options include going to India to do public health work with a group of Hopkins students, trying to get involved with a project locally, or simply taking some time to relax and rejuvenate with loved ones and friends (while the last option may be good for sanity’s sake it could also be a lost opportunity to do meaningful work).  I certainly welcome any thoughts or suggestions!

The following guest post on the subject of drug adherence is written by Joyce A. Cramer. Joyce is Associate Research Scientist at Yale University School of Medicine as well as President of Epilepsy Therapy Project, a 501-c-3 organization accelerating new therapies for people with epilepsy.

“Drugs don’t work in people who don’t take them” said former Surgeon General C. Everett Koop. While performing research on this topic since the 1980s, I have been continually surprised that the results are uniform: People take, on average, three-fourths of medication as prescribed¹. This has held true across many diseases and types of medications. There seems to be no consequence so severe that everyone with that disorder takes all doses (e.g., organ transplantation, epilepsy, asthma, etc.).

One of the first studies I published included extensive neuropsychological testing. It showed that not taking all doses does NOT relate to intelligence². There are numerous studies showing the ineffectiveness of health education. Many people get good scores on knowledge linking disease control/management with medication, but do not carry-through by taking all doses.

Interviewing lots of people led me to realize that the main reason is forgetfulness (on a daily basis or during a disrupted schedule). I then developed a simple system to teach people skills on HOW to take their medication. It consists of asking the person (a) what is the best time of day to remember a dose, and (b) what daily activity can you link this to as a reminder³? Typical responses are the best time is in the morning (ask to set a range of time, i.e., 7-8 am), and link it to making coffee, taking the dog for a walk, etc. Only the person who is taking the medication can select the most convenient time and the personalized cue. The “Cramer Method” does work, as demonstrated in several studies.

The system works only when the person has accepted the diagnosis and need for treatment.

On the medical side, I teach doctors to ask whether the person is willing to take the medicine, then proceed to teach them how to set time and personalized cues. Explain that if the first cue does not work well, select another cue.

I often hear that someone had an exacerbation of symptoms after missing doses or discontinuing treatment. Sometimes the same person has multiple episodes until the personal lesion is learned. That’s human nature. I do not look at medication adherence as a complex behavior mediated by psychological issues. Much of it is a straightforward personal commitment based on choice, coupled with acceptable tactics to do what is being asked. Diseases differ in requirements, ranging from one tablet daily for hypertension to diet, exercise and oral or insulin treatments for diabetes. People differ in their willingness to perform health-related tasks – changing over time based on other priorities in their lives⁴. Yes, people make choices for which they are responsible, both actions and inactions. The doctor can’t make it happen without a willing partner.

1. Claxton & Cramer. Medication compliance: the importance of the dosing regimen. Clin Therapeutics 2001; 23: 1296-1310.
2. Cramer et al. How often is medication taken as prescribed ? A novel assessment technique. JAMA 1989; 261:3273-3277.
3. Cramer & Rosenheck. Enhancing medication compliance for people with serious mental illness. J Nervous Mental Dis, 1999; 187: 52-54.
4. Cramer et al. Compliance declines between clinic visits. Archives of Internal Medicine, 1990; 150:1377-1378.

Imagine going to a grocery store where none of the items had prices, and when you got to the checkout the cashier couldn’t tell you your total. Instead, he offered to mail you a bill for an unknown amount.

Although that sounds ridiculous, it’s exactly how our nation’s health care system often operates, and Regence BlueCross BlueShield has created a short (45 second) video highlighting the absurdity of that very situation.

The video is part of Regence’s What’s the Real Cost campaign designed to challenge people’s thinking about how far reform needs to go. It also explores the way choices consumers make each day can impact health care costs. Be sure to check out the five questions consumers can ask to change health care.

As the nation’s oldest consumer organization, the National Consumers League has long worked to improve medication safety, patient education, and consumer education in the health community.  With planning funds from the Agency for Healthcare Research and Quality (AHRQ), NCL is spearheading a first-of-its-kind national education campaign to raise consumer awareness of the importance of good medication adherence.  As called for in the 2007 NCPIE report, a public-private education campaign to motivate patients to improve their medication-taking behavior should be a national health priority.

Since the campaign planning phase got under way just a little more than a year ago, we have worked around the clock to bring together a diverse and committed group of stakeholders interested in improving medication adherence.  From government agencies to health care practitioner professional associations, community health plans to national health plans, pharmaceutical manufacturers to consumer advocates, the list of supporting organizations tops 100 and continues to grow.

The campaign, which NCL anticipates launching publicly in the third quarter of 2010, aims to educate consumers through mass media, including many new social media tools.  The depth and breadth of involvement from stakeholders will help reinforce the messages to ensure that consumers are educated, engaged, and empowered as they manage their health.  The campaign has involved health care practitioners (HCP) from the start, and HCPs will play an active role in improving adherence as they engage their patients.

Because poor adherence is especially harmful to people with chronic health conditions, such as asthma and diabetes, the campaign will focus special attention on those populations.  More than 45 percent of, or 133 million, Americans are affected by at least one chronic condition, and employers are seeing billions of dollars lost to chronic-condition related absenteeism. Every dollar that goes toward improving patient adherence is money well spent, ultimately resulting in long-term savings for the consumer – saving the consumer and the health system $7 in medical costs for those with diabetes, $5 in medical costs for those with high cholesterol, and $4 in medical costs for those with hypertension.

To motivate consumers to adhere to their medications, they must first understand that they play a key role in the management of their own health conditions. As consumers–and their communities– become more aware of the importance of taking medication safely and appropriately, the campaign hopes to improve behavior and positively affect health outcomes.  We look forward to working with employers to help engage and empower their employees to manage their health, resulting in a healthier and more productive workforce.  We are also pleased to work with health care practitioners eager to educate their patients about the importance of medication adherence. Finally, we believe this major public health problem is getting the attention it deserves.

We welcome your support and involvement as we continue to raise awareness about the issue and the many ways in which we can address it.  Please contact me at sallyg@nclnet.org or 202-835-3323.