Comments on: ADHERENCE TO TREATMENT PLANS http://www.mikecritelli.com/2007/10/19/adherence_to_treatment_plans/ Mike Critelli's Blog Mon, 01 Dec 2008 18:02:50 +0000 http://wordpress.org/?v=2.3.3 By: mike critelli http://www.mikecritelli.com/2007/10/19/adherence_to_treatment_plans/#comment-1520 mike critelli Mon, 29 Oct 2007 15:35:49 +0000 http://www.mikecritelli.com/2007/10/19/adherence_to_treatment_plans/#comment-1520 <p>To Aimee Monroy Smith:</p> <p>You make a number of great points:</p> <p>• I agree that the disclosure on side effects of drugs is flawed. Part of the reason is that the disclosures are written by lawyers to comply with laws, regulations, and court cases. Like many notices and disclosures, they are designed to protect the institution doing the disclosing, not to get the reader or the patient to understand the message. As a broader matter, whether we are talking about investment disclosures, language on drug side effects, or disclosures in financial documents, we need to re-think what we are trying to accomplish.<br /> • You also are correct that the side effects of drugs are different for virtually every person. Over time, the pharmaceutical industry is moving toward “designer drugs” to customize drugs and dosage levels to individuals. That day cannot come fast enough for me, and, I think, many other people.<br /> • You are also correct that people stop taking drugs, particularly anti-biotics, when they feel better. Years ago, a very wise doctor, our medical director, Dr. Julian Levine, deliberately gave patients a 3-day dosage for pills and he scheduled follow-up appointments, when he treated a condition requiring anti-biotics. He understood that, after three days, without his intervention, patients would frequently stop taking medication. Second and third visits reduced non-adherence issues. Today, Medicare and insurance reimbursement plans make this kind of approach more difficult because of the low reimbursement rates for primary care physicians.<br /> • Your other point, the fact that individuals get multiple prescription and over-the-counter drugs from multiple pharmacies is absolutely on target. Pharmacy benefit managers like Medco are trying to make sure individuals concentrate their drug purchases in one place. Beyond that, the Dossia personal health record initiative, which I chair, is designed to consolidate all health interactions, including both prescription and over-the-counter drug purchases, in one patient-controlled record. There are many good electronic health record initiatives, like Aetna’s, Kaiser Permanente’s, AHIP’s, and the more recent announcement by Microsoft. All are excellent initiatives, but ours is unique in both striving to provide a lifetime, universal, and portable capability (“portability” refers to the ability of an individual to take the record with him or her when he leaves one of these organization’s networks), and to get data brought in from all the major pharmacies. </p> <p>Thank you for you thoughtful comments.</p> <p>-- mike</p> To Aimee Monroy Smith:

You make a number of great points:

• I agree that the disclosure on side effects of drugs is flawed. Part of the reason is that the disclosures are written by lawyers to comply with laws, regulations, and court cases. Like many notices and disclosures, they are designed to protect the institution doing the disclosing, not to get the reader or the patient to understand the message. As a broader matter, whether we are talking about investment disclosures, language on drug side effects, or disclosures in financial documents, we need to re-think what we are trying to accomplish.
• You also are correct that the side effects of drugs are different for virtually every person. Over time, the pharmaceutical industry is moving toward “designer drugs” to customize drugs and dosage levels to individuals. That day cannot come fast enough for me, and, I think, many other people.
• You are also correct that people stop taking drugs, particularly anti-biotics, when they feel better. Years ago, a very wise doctor, our medical director, Dr. Julian Levine, deliberately gave patients a 3-day dosage for pills and he scheduled follow-up appointments, when he treated a condition requiring anti-biotics. He understood that, after three days, without his intervention, patients would frequently stop taking medication. Second and third visits reduced non-adherence issues. Today, Medicare and insurance reimbursement plans make this kind of approach more difficult because of the low reimbursement rates for primary care physicians.
• Your other point, the fact that individuals get multiple prescription and over-the-counter drugs from multiple pharmacies is absolutely on target. Pharmacy benefit managers like Medco are trying to make sure individuals concentrate their drug purchases in one place. Beyond that, the Dossia personal health record initiative, which I chair, is designed to consolidate all health interactions, including both prescription and over-the-counter drug purchases, in one patient-controlled record. There are many good electronic health record initiatives, like Aetna’s, Kaiser Permanente’s, AHIP’s, and the more recent announcement by Microsoft. All are excellent initiatives, but ours is unique in both striving to provide a lifetime, universal, and portable capability (“portability” refers to the ability of an individual to take the record with him or her when he leaves one of these organization’s networks), and to get data brought in from all the major pharmacies.

Thank you for you thoughtful comments.

– mike

]]> By: aimee monroy smith http://www.mikecritelli.com/2007/10/19/adherence_to_treatment_plans/#comment-1519 aimee monroy smith Mon, 22 Oct 2007 19:22:14 +0000 http://www.mikecritelli.com/2007/10/19/adherence_to_treatment_plans/#comment-1519 Sometimes, I think the lack of or partial adherence to drug regiments occurs because people do not understand how their drugs are specifically affecting their bodies. In this age of WebMD and prescription drugs that are accompanied with voluminous listings of side affects, there still seems to be much confusion over the purpose of different types of drugs and whether these agents are actually helping. For example, I have often come across people who will stop taking their antibiotics because they start to feel better or will misunderstand the point at which they should start to feel better. I have also heard people express confusion over whether an over-the-counter drug can be used while taking an antibiotic. I have also heard someone express confusion over the difference between their four asthma drugs. Additionally, this type of confusion can intensify if an individual is on a number of drugs due to a chronic condition. It would seem that the role of the pharmacist could address some questions related to possible interactions between drugs, but the pharmacist is only able to discuss the drugs in his/her computer system. What happens when a patient chooses to fill a prescription drug at a different location? An answer may lie in electronic medical records to be carried by a consumer, but hopefully, a patient with complex health care needs and accompanying drug regiments has one physician managing the relationship between all of these things. There seems to be great potential for confusion and possibly adverse consequences from those who are beginning complex drug regiments or from the individual who is on a couple of prescription drugs including an antibiotic and an over-the-counter medication. With the FDA choosing to recommend pulling over-the-counter cold remedies for children under six, there obviously needs to be a different approach for assisting consumers with the management of drugs whether prescription or not. Sometimes, I think the lack of or partial adherence to drug regiments occurs because people do not understand how their drugs are specifically affecting their bodies. In this age of WebMD and prescription drugs that are accompanied with voluminous listings of side affects, there still seems to be much confusion over the purpose of different types of drugs and whether these agents are actually helping. For example, I have often come across people who will stop taking their antibiotics because they start to feel better or will misunderstand the point at which they should start to feel better. I have also heard people express confusion over whether an over-the-counter drug can be used while taking an antibiotic. I have also heard someone express confusion over the difference between their four asthma drugs. Additionally, this type of confusion can intensify if an individual is on a number of drugs due to a chronic condition. It would seem that the role of the pharmacist could address some questions related to possible interactions between drugs, but the pharmacist is only able to discuss the drugs in his/her computer system. What happens when a patient chooses to fill a prescription drug at a different location? An answer may lie in electronic medical records to be carried by a consumer, but hopefully, a patient with complex health care needs and accompanying drug regiments has one physician managing the relationship between all of these things. There seems to be great potential for confusion and possibly adverse consequences from those who are beginning complex drug regiments or from the individual who is on a couple of prescription drugs including an antibiotic and an over-the-counter medication.

With the FDA choosing to recommend pulling over-the-counter cold remedies for children under six, there obviously needs to be a different approach for assisting consumers with the management of drugs whether prescription or not.

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