Tina Ryman, MS
Senior Medical Writer
A recent article in the New York Times featured a cohort of AIDS survivors, now middle-aged, who are struggling with the so-called "late effects" of treatment. These long-term effects include kidney damage, diabetes, heart disease, thyroid disease, and arthritis─diseases more typically seen in people who are 10 to 20 years older. On one hand, these people are glad to be alive. But on the other, they're fearful about facing this unanticipated set of challenges.
Late effects are physical and psychological
Powerful treatments for life-threatening diseases can have similarly powerful long-term physical effects. Physical late effects of chemotherapy, for example, include cataracts, heart problems, infertility, liver problems, lung disease, osteoporosis, reduced lung capacity, and increased risk of other cancers. "Chemobrain" collectively refers to problems with memory, learning, and attention. Radiation therapy can cause dental problems, hypothyroidism, and intestinal problems.
Psychological late effects of treatment can be equally serious. While patients may initially celebrate surviving the disease and completing treatment, over time some begin to experience anxiety, depression, loneliness, and even guilt. Low self-esteem, poor body image, and loss of libido are also common. Some survivors have even been diagnosed with post-traumatic stress disorder. This makes sense considering the trauma of learning one has a life-threatening disease, the physical and mental suffering often caused by treatment, and the tendency of survivors to live in a state of hyper-vigilance to the threat of disease recurrence.
The need for patient education
As more and more people are living longer with life-threatening illnesses, there is a growing need to educate patients about making the transition from patient to survivor. It's a subject that can be easily overlooked during treatment, when just getting through each day is challenge enough. Patient education can help expand the patient-healthcare provider dialogue to include questions such as:
• What are the possible long-term effects of this treatment?
• What symptoms should I watch for?
• Which doctor should I see for my follow-up care?
• What kind of medical information should I keep on file?
• What follow-up tests will I need to have?
• What other services may be useful after treatment?
Creating a follow-up care plan
Patient education can also highlight the importance of creating a follow-up care plan. Follow-up care helps identify changes in the patient's health, as well as address any ongoing problems. It affords the patient and healthcare team the opportunity to monitor for any psychosocial effects that may arise after treatment. Follow-up care can also replace some of the valuable support patients received through regular contact with their healthcare team during treatment.
Individualized follow-up care plans take into account the specific disease and treatment. Patient education materials can include a follow-up action plan template for patients to customize with their healthcare provider. A good example is provided by the Minnesota Cancer Alliance. It can be downloaded at cancer.org.
Conclusion
Late effects and survivorship are important topics that can be addressed in both branded and unbranded formats. At Artcraft Health Education, we encourage our clients to provide this valuable education to patients. It can build stronger relationships for everyone involved. Find out what Artcraft can do for you.
For more information and resources, visit:
journeyforward.org
cancer.gov/cancertopics/factsheet/Therapy/followup
Friday, June 28, 2013
Monday, June 24, 2013
Adherence By The Numbers
Some people call it medication compliance, others call it adherence. Whatever you call it, not doing it is a huge problem for payors, providers, and patients. Here’s why:
A Practitioner Says:
“As a family physician, I see the negative impact nonadherence has on patients each day. I also see the positive impact that adherence to treatment protocols has and the improved quality of life many individuals experience as a result.” Rebecca Jaffe, MD
An Industry Spokesperson Says:
“Improving adherence for diabetes alone could result in more than one million avoided emergency room visits and hospitalizations every year, saving over $8 billion a year.” John Castellani, president and chief executive officer of the Pharmaceutical Research and Manufacturers of America (PhRMA)
An Academic Researcher Says:
“Increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments.” R. Bryan Haynes, MD, PhD
A Global Health Proponent Says:
“There is no single intervention strategy, or package of strategies that has been shown to be effective across all patients, conditions and settings. Consequently, interventions that target adherence must be tailored to the particular illness-related demands experienced by the patient.” World Health Organization
The Leading Patient Education Provider Says:
“We offer a complete range of educational materials and adherence aids, all custom tailored to the specific needs of a patient cohort. We provide patients with clear information and healthcare professionals with tools to facilitate one-on-one communication with patients.” Artcraft Health Education
Tom Savonick - Medical Writer
Wednesday, June 12, 2013
The Impact of Digital Tools on Health Education
Lisa Moss Calderwood, MA
Senior Medical Writer, Artcraft Health Education
Picture this. Your child has been diagnosed with high blood pressure, a chronic, potentially dangerous condition if not managed carefully. Your pediatrician prescribes a low-salt, low-fat diet, exercise, and a daily hypertension medication. Fine, you think. But how are you going to get Johnny—your 11-year-old, somewhat overweight child who loves playing computer games much more than playing outdoors—to comply?
As you’re waiting in the exam room on a follow-up visit, a nurse enters who takes his blood pressure and then gives him a tablet device to play with while you wait for the pediatrician. You watch with growing interest as your son quickly engages with a game on the tablet that teaches him about hypertension and challenges him to learn more in order to gain points. When the doctor comes in to discuss your son’s latest numbers, Johnny pipes up, “Oh yeah, that’s the systolic number! I know what that is.”
Meanwhile, his mother is given a web key to a website that she can visit on her own time that will give her support as she navigates the challenges of pediatric hypertension. The web key also has a link to the game so Johnny can continue playing it on his family’s tablet or mobile device. Not only that, the web key also has information about a clinical trial on pediatric hypertension that the family may consider joining.
If the nurse had given Johnny and his mother brochures—or just talked about blood pressure— would they have retained or applied the information as well?
Johnny may be more likely to adhere to his treatment plan if he understands his condition and his mother applies some of the tips for adherence that she learned on the website, or from a clinical trial. With the right application, in the right circumstances, and with clear content and design, successful patient outcomes may come down to the effective design of a versatile digital learning tool.
Digital Health’s Versatility
“Any time, any place, any pace” training using digital media is a practical and relevant form of education, whether on the Internet or an iPad, and whether for healthcare professionals (HCPs) or patients. There are thousands of health apps on iTunes and Google Play for phones or tablets. Topics range from understanding disease states and treatments, to coping with chronic conditions, symptoms, and side effects, not to mention popular trackers for medication adherence, diet, exercise, and more. PocketMD, a directory of hundreds of mobile apps created by pharmaceutical, biotech, medical device, and life science companies, offers free apps to patients and providers to download on their iPhones or Android devices. And that directory is just the tip of the iceberg.
Mobile health’s (mHealth’s) advantages of interactivity and immediacy may have potentially far-reaching implications for quality health outcomes. And not just in patient or HCP education. Fierce Biotech notes how “the power, versatility and ubiquity of mobile devices give them the potential to improve many (clinical) trial processes.” With patient recruitment and retention in clinical trials a major challenge, mHealth is providing some engaging solutions in this area as well.
Tracking the Effectiveness of Digital Tools for Health Learning
While research is unfolding about how patients learn using digital tools, the trend is clear: patient and HCP learning is not just going digital, it’s already there. Patients like Johnny are learning on tablets in the doctor’s office. Consumers download apps their doctor might prescribe or that they find on their own, creating their own e-health clouds. Pharmaceutical companies, providers, and other healthcare stakeholders are focusing on users’ demand for content to address their own agendas for marketing, training, and quality health outcomes.
Key to the effectiveness of these tools is an understanding of health literacy levels. According to a 2011 study performed by the Pew Internet and American Life Project, 59% of Americans use the Internet to search for health information. However, studies show that the reading level of these materials is not at the typical seventh- to eighth-grade level. The American Medical Association, the National Institutes of Health, and the US Department of Health and Human Services encourage patient education materials be written at as low as fourth- to sixth-grade reading levels. Digital tools for patient education must follow these health literacy principles to be effective.
ROI or ROE?
Technology in itself is not a solution for patient or HCP education, or assuring the success of a clinical trial. But when applications are devised that consider the users, the content, and the context of use, the likelihood of a positive return on investment (ROI) is increased. Or, as Sarah Ray, a research analyst for Cutting Edge Information, reports (Evolving Mobile Strategy Requires that Pharma Move Beyond ROI), “companies are now using return on experience (ROE) as a gauge of success.” ROE, with its focus on quantitative and qualitative measures, may be more applicable digital patient learning.
The trend is worth watching. AHE can help.
AHE Digital is at the forefront of digital patient learning combining health literacy principles; robust, cross-platform functionality; and stunning animations and design. AHE Clinical Trials offers traditional and digital media solutions for all phases of clinical development, from recruitment to follow-up.
Senior Medical Writer, Artcraft Health Education
Picture this. Your child has been diagnosed with high blood pressure, a chronic, potentially dangerous condition if not managed carefully. Your pediatrician prescribes a low-salt, low-fat diet, exercise, and a daily hypertension medication. Fine, you think. But how are you going to get Johnny—your 11-year-old, somewhat overweight child who loves playing computer games much more than playing outdoors—to comply?
As you’re waiting in the exam room on a follow-up visit, a nurse enters who takes his blood pressure and then gives him a tablet device to play with while you wait for the pediatrician. You watch with growing interest as your son quickly engages with a game on the tablet that teaches him about hypertension and challenges him to learn more in order to gain points. When the doctor comes in to discuss your son’s latest numbers, Johnny pipes up, “Oh yeah, that’s the systolic number! I know what that is.”
Meanwhile, his mother is given a web key to a website that she can visit on her own time that will give her support as she navigates the challenges of pediatric hypertension. The web key also has a link to the game so Johnny can continue playing it on his family’s tablet or mobile device. Not only that, the web key also has information about a clinical trial on pediatric hypertension that the family may consider joining.
If the nurse had given Johnny and his mother brochures—or just talked about blood pressure— would they have retained or applied the information as well?
Johnny may be more likely to adhere to his treatment plan if he understands his condition and his mother applies some of the tips for adherence that she learned on the website, or from a clinical trial. With the right application, in the right circumstances, and with clear content and design, successful patient outcomes may come down to the effective design of a versatile digital learning tool.
Digital Health’s Versatility
“Any time, any place, any pace” training using digital media is a practical and relevant form of education, whether on the Internet or an iPad, and whether for healthcare professionals (HCPs) or patients. There are thousands of health apps on iTunes and Google Play for phones or tablets. Topics range from understanding disease states and treatments, to coping with chronic conditions, symptoms, and side effects, not to mention popular trackers for medication adherence, diet, exercise, and more. PocketMD, a directory of hundreds of mobile apps created by pharmaceutical, biotech, medical device, and life science companies, offers free apps to patients and providers to download on their iPhones or Android devices. And that directory is just the tip of the iceberg.
Mobile health’s (mHealth’s) advantages of interactivity and immediacy may have potentially far-reaching implications for quality health outcomes. And not just in patient or HCP education. Fierce Biotech notes how “the power, versatility and ubiquity of mobile devices give them the potential to improve many (clinical) trial processes.” With patient recruitment and retention in clinical trials a major challenge, mHealth is providing some engaging solutions in this area as well.
Tracking the Effectiveness of Digital Tools for Health Learning
While research is unfolding about how patients learn using digital tools, the trend is clear: patient and HCP learning is not just going digital, it’s already there. Patients like Johnny are learning on tablets in the doctor’s office. Consumers download apps their doctor might prescribe or that they find on their own, creating their own e-health clouds. Pharmaceutical companies, providers, and other healthcare stakeholders are focusing on users’ demand for content to address their own agendas for marketing, training, and quality health outcomes.
Key to the effectiveness of these tools is an understanding of health literacy levels. According to a 2011 study performed by the Pew Internet and American Life Project, 59% of Americans use the Internet to search for health information. However, studies show that the reading level of these materials is not at the typical seventh- to eighth-grade level. The American Medical Association, the National Institutes of Health, and the US Department of Health and Human Services encourage patient education materials be written at as low as fourth- to sixth-grade reading levels. Digital tools for patient education must follow these health literacy principles to be effective.
ROI or ROE?
Technology in itself is not a solution for patient or HCP education, or assuring the success of a clinical trial. But when applications are devised that consider the users, the content, and the context of use, the likelihood of a positive return on investment (ROI) is increased. Or, as Sarah Ray, a research analyst for Cutting Edge Information, reports (Evolving Mobile Strategy Requires that Pharma Move Beyond ROI), “companies are now using return on experience (ROE) as a gauge of success.” ROE, with its focus on quantitative and qualitative measures, may be more applicable digital patient learning.
The trend is worth watching. AHE can help.
AHE Digital is at the forefront of digital patient learning combining health literacy principles; robust, cross-platform functionality; and stunning animations and design. AHE Clinical Trials offers traditional and digital media solutions for all phases of clinical development, from recruitment to follow-up.
Thursday, June 6, 2013
Transition of Care to the Pharmacy
Lynn Altmaier, BS, BSN, RN, MSc
Senior Medical Writer
As of January 1, 2013, the Affordable Care Act (ACA) requires health systems, including pharmacists and physician groups, to form accountable care organizations (ACOs) that work together to provide coordinated care for eligible Medicare Part D recipients. Pharmacists will be responsible for consulting with patients and their healthcare providers and conducting comprehensive medication reviews to optimize appropriate medication use. They have the education and experience to reduce medication-related problems and improve health outcomes through medication therapy management (MTM), health promotion, and education. They are also in a position to ensure the success of ACOs by mediating the use of medications, reducing medication-related adverse events, preventing hospital readmissions, and helping patients manage chronic conditions.
The Centers for Medicare and Medicaid Services recently approved Walgreens as the first pharmacy chain to be part of an ACO. Walgreens is partnering with physicians and hospitals to form ACOs in Florida, New Jersey, and Texas to help improve health outcomes, access, and convenience while lowering health care costs. Walgreens announced April 4, 2013 that it will be expanding services at its 360 Take Care Clinic locations to include diagnostic and treatment services for chronic conditions such as diabetes, hypertension, and high cholesterol. CVS, the nation's largest retail clinic chain with 620 MinuteClinic locations, also has plans to expand its primary care services to include chronic disease management. MinuteClinics are partnering with several large health systems, including Cleveland Clinic, UCLA Medical Center, and Indiana University Health to collaborate on disease management and patient education.
In addition to retail clinics, self-service kiosks that check vital signs and give advice about health and disease risk are being integrated into the market. Rite Aid has partnered with OptumHealth to deliver more cost-effective, "personalized" healthcare at the touch of a button. A person visiting a Rite Aid NowClinic can walk into a private room near the pharmacy counter, register online, answer a few questions about their health problem, and access free education or talk with a nurse via video chat at no charge. If a person wants to speak to a physician, he or she can pay with a credit card for a 10-minute visit and add additional time if necessary. Vitals such as blood pressure may be taken on an automatic cuff and communicated directly to the physician who might write a prescription, if appropriate, or refer the person to a local provider. The NowClinic, which initially started as an online system accessed from home, has expanded its in-store "virtual visit" kiosks to 22 states.
According to a RAND Health study, use of retail clinics increased 10-fold between 2007 and 2009.(1) And the number is expected to climb even higher after January 2014, when an estimated 30 million people who are currently uninsured get healthcare coverage under the ACA. With care initiated at retail clinics being 30% to 40% less expensive than similar care provided at a physician's office, and 80% less than care provided in an emergency room, retail clinics and self-directed care may not only be a means of convenient care, but an answer to our healthcare crisis.(2) A recent study found that the use of retail clinics was associated with a lower total cost of care, primarily due to lower medical expenses at physicians' offices and hospital inpatient care, and fewer emergency department visits.(3)
The U.S. Food and Drug Administration (FDA) is taking "self-service" to a new level with a recent proposal that would allow patients to use technology to evaluate their own health needs and obtain prescription medications over the counter at the pharmacy without ever seeing a physician. The FDA argues that many patients do not seek medical care or prescriptions for certain conditions because of the time and cost associated with seeing a physician and getting a prescription.(4) This new delivery model would allow some medications for chronic conditions, such as asthma and allergies, to be sold under "conditions for safe use." Criteria for conditions for safe use would be assessed using technology such as patient kiosks, remote diagnostic tools, and online questionnaires that determine a patients' needs and appropriate medications.
Janet Woodcock, MD, director of the FDA's Center for Drug Evaluation and Research, supports the proposal, stating "It is clear that there are now many interactive mechanisms that can step the consumer through the process of self-diagnosing and medication selection in a much more comprehensive manner than by them reading the drug fact box." Pharmacists would assist patients in determining their need for medications and help them verify their self-diagnosis. Diseases and conditions that require a confirmation of diagnosis or routine monitoring with diagnostic testing (eg, blood test for cholesterol levels or liver function tests) could be available in the pharmacy. Eric Juhl, director of federal public policy for the National Association of Chain Drug Stores, states "Pharmacists are not only qualified to help educate patients, they also are more accessible than any other health care professional due to the number of drugstores in the U.S. and their extended hours. They are experts in appropriate use of medications and are uniquely qualified to take on this new role."
Although the verdict is still out on how this transition of care to the pharmacy will impact the healthcare system, it is clear that there is an increased need for patient education at the point of care and tools to support continuity of care among providers. Pharmacists and retail clinics will need to be armed with educational resources to reinforce treatment plans, support adherence initiatives, and help consumers make decisions about their health care. Artcraft Health Education (AHE) has long been on the forefront of identifying the best solutions for patient education at multiple touch points. AHE understands the value of patient comprehension and retention in improving adherence and health outcomes. Whether it be a digital animation available at the touch of a kiosk button, take-home resources that simplify a medication regimen, or information about participating in a clinical trial, AHE can help.
References
1. Ashwood JS, Reid RO, Setodji CM, et al. Trends in retail clinic use among the commercially insured. Am J Manag Care. 2011;17(11):e443-e448. http://www.ajmc.com/articles/Trends-in-Retail-Clinic-Use-Among-the-Commercially-Insured. Accessed May 15, 2013.
2. Use of retail clinics rises 10-fold over two-year period. RAND Corporation. http://www.rand.org/news/press/2011/11/22.html. Published November 22, 2011. Accessed May 15, 2013.
3. Sussman A, Dunham L, Snower K, et al. Retail clinic utilization associated with lower total cost of care. Am J Manag Care. 2013;19(4):e148-e157. http://www.ajmc.com/articles/Retail-Clinic-Utilization-Associated-With-Lower-Total-Cost-of-Care. Accessed May 15, 2013.
4. Using innovative technologies and other conditions of safe use to expand which drug products can be considered nonprescription; public hearing. Department of Health and Human Services Food and Drug Administration. http://www.gpo.gov/fdsys/pkg/FR-2012-02-28/pdf/2012-4597.pdf. Published February 28, 2012. Accessed May 15, 2013.
As of January 1, 2013, the Affordable Care Act (ACA) requires health systems, including pharmacists and physician groups, to form accountable care organizations (ACOs) that work together to provide coordinated care for eligible Medicare Part D recipients. Pharmacists will be responsible for consulting with patients and their healthcare providers and conducting comprehensive medication reviews to optimize appropriate medication use. They have the education and experience to reduce medication-related problems and improve health outcomes through medication therapy management (MTM), health promotion, and education. They are also in a position to ensure the success of ACOs by mediating the use of medications, reducing medication-related adverse events, preventing hospital readmissions, and helping patients manage chronic conditions.
The Centers for Medicare and Medicaid Services recently approved Walgreens as the first pharmacy chain to be part of an ACO. Walgreens is partnering with physicians and hospitals to form ACOs in Florida, New Jersey, and Texas to help improve health outcomes, access, and convenience while lowering health care costs. Walgreens announced April 4, 2013 that it will be expanding services at its 360 Take Care Clinic locations to include diagnostic and treatment services for chronic conditions such as diabetes, hypertension, and high cholesterol. CVS, the nation's largest retail clinic chain with 620 MinuteClinic locations, also has plans to expand its primary care services to include chronic disease management. MinuteClinics are partnering with several large health systems, including Cleveland Clinic, UCLA Medical Center, and Indiana University Health to collaborate on disease management and patient education.
In addition to retail clinics, self-service kiosks that check vital signs and give advice about health and disease risk are being integrated into the market. Rite Aid has partnered with OptumHealth to deliver more cost-effective, "personalized" healthcare at the touch of a button. A person visiting a Rite Aid NowClinic can walk into a private room near the pharmacy counter, register online, answer a few questions about their health problem, and access free education or talk with a nurse via video chat at no charge. If a person wants to speak to a physician, he or she can pay with a credit card for a 10-minute visit and add additional time if necessary. Vitals such as blood pressure may be taken on an automatic cuff and communicated directly to the physician who might write a prescription, if appropriate, or refer the person to a local provider. The NowClinic, which initially started as an online system accessed from home, has expanded its in-store "virtual visit" kiosks to 22 states.
According to a RAND Health study, use of retail clinics increased 10-fold between 2007 and 2009.(1) And the number is expected to climb even higher after January 2014, when an estimated 30 million people who are currently uninsured get healthcare coverage under the ACA. With care initiated at retail clinics being 30% to 40% less expensive than similar care provided at a physician's office, and 80% less than care provided in an emergency room, retail clinics and self-directed care may not only be a means of convenient care, but an answer to our healthcare crisis.(2) A recent study found that the use of retail clinics was associated with a lower total cost of care, primarily due to lower medical expenses at physicians' offices and hospital inpatient care, and fewer emergency department visits.(3)
The U.S. Food and Drug Administration (FDA) is taking "self-service" to a new level with a recent proposal that would allow patients to use technology to evaluate their own health needs and obtain prescription medications over the counter at the pharmacy without ever seeing a physician. The FDA argues that many patients do not seek medical care or prescriptions for certain conditions because of the time and cost associated with seeing a physician and getting a prescription.(4) This new delivery model would allow some medications for chronic conditions, such as asthma and allergies, to be sold under "conditions for safe use." Criteria for conditions for safe use would be assessed using technology such as patient kiosks, remote diagnostic tools, and online questionnaires that determine a patients' needs and appropriate medications.
Janet Woodcock, MD, director of the FDA's Center for Drug Evaluation and Research, supports the proposal, stating "It is clear that there are now many interactive mechanisms that can step the consumer through the process of self-diagnosing and medication selection in a much more comprehensive manner than by them reading the drug fact box." Pharmacists would assist patients in determining their need for medications and help them verify their self-diagnosis. Diseases and conditions that require a confirmation of diagnosis or routine monitoring with diagnostic testing (eg, blood test for cholesterol levels or liver function tests) could be available in the pharmacy. Eric Juhl, director of federal public policy for the National Association of Chain Drug Stores, states "Pharmacists are not only qualified to help educate patients, they also are more accessible than any other health care professional due to the number of drugstores in the U.S. and their extended hours. They are experts in appropriate use of medications and are uniquely qualified to take on this new role."
Although the verdict is still out on how this transition of care to the pharmacy will impact the healthcare system, it is clear that there is an increased need for patient education at the point of care and tools to support continuity of care among providers. Pharmacists and retail clinics will need to be armed with educational resources to reinforce treatment plans, support adherence initiatives, and help consumers make decisions about their health care. Artcraft Health Education (AHE) has long been on the forefront of identifying the best solutions for patient education at multiple touch points. AHE understands the value of patient comprehension and retention in improving adherence and health outcomes. Whether it be a digital animation available at the touch of a kiosk button, take-home resources that simplify a medication regimen, or information about participating in a clinical trial, AHE can help.
References
1. Ashwood JS, Reid RO, Setodji CM, et al. Trends in retail clinic use among the commercially insured. Am J Manag Care. 2011;17(11):e443-e448. http://www.ajmc.com/articles/Trends-in-Retail-Clinic-Use-Among-the-Commercially-Insured. Accessed May 15, 2013.
2. Use of retail clinics rises 10-fold over two-year period. RAND Corporation. http://www.rand.org/news/press/2011/11/22.html. Published November 22, 2011. Accessed May 15, 2013.
3. Sussman A, Dunham L, Snower K, et al. Retail clinic utilization associated with lower total cost of care. Am J Manag Care. 2013;19(4):e148-e157. http://www.ajmc.com/articles/Retail-Clinic-Utilization-Associated-With-Lower-Total-Cost-of-Care. Accessed May 15, 2013.
4. Using innovative technologies and other conditions of safe use to expand which drug products can be considered nonprescription; public hearing. Department of Health and Human Services Food and Drug Administration. http://www.gpo.gov/fdsys/pkg/FR-2012-02-28/pdf/2012-4597.pdf. Published February 28, 2012. Accessed May 15, 2013.
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