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When I finally agreed to attend this meeting I still was not sure that it was going to be the best investment of time and money – I am thrilled to say it was well worth both! In the past most meetings were a series of supplier commercials with some data sprinkled in. This meeting was just the opposite. AND, just as I was losing hope that the life sciences industry could truly put the patient at the center of its business decision-making my faith was renewed.

I will share some highlights here but kudos go to Q1 Productions for assembling a great group of attendees and putting together a solid agenda. I would like to see more opportunity for discussion and Q&A at this and other meetings but the Q1 staff were great hosts and we attendees made sure we spoke to who we needed.

You can see the entire agenda here – http://www.q1productions.com/rxpatientadherence/dayone.php#.UOw136Wl5Rs

Here are the highlights:

Almost every single speaker spoke about and shared real world examples of being patient/user centered while meeting or exceeding business objectives. It’s that “meeting or exceeding business objectives” part that, frankly, will enable this industry to work from this perspective.

KEY STAKEHOLDERS ROUNDTABLE DISCUSSION: ENHANCING PATIENT EDUCATION, ENGAGEMENT AND ADHERENCE – PANEL DISCUSSION

Peter Pitts, President
CENTER FOR MEDICINE IN THE PUBLIC INTEREST
ADVISOR TO OBAMA ADMINISTRATION FDA TRANSITION TEAM

Lack of patient adherence results in suboptimal patient outcomes , suboptimal physician outcomes, suboptimal performance for pharma. A focus on patient adherence can play a role in reducing medical errors, lowering healthcare costs. There is no magic bullet to adherence and compliance. Technology plays a role but it is not the only answer. Apps are at the nexus of safe use.

Kevin Cast, VP Strategy & Contracting
CURASCRIPT, INC, EXPRESS SCRIPTS

Predictive behavior and consumerology philosophy combined with Medco science focus. 

Pharma Going to CuraScript to maximize roi
Kevin , Physician office is not the place to manage adherence, does not know if patients are adherent or not
Pharmacy “rescue call” pharmacist finally reaching out to patient

John P Burke III, Policy Advisor
FDA

BUILDING ADHERENCE PROGRAMS TO ENHANCE PATIENT OUTCOMES
Marianna Bruno, PharmD, MPH, Director, Medical Outcomes Specialists 
Marianna Bruno, PharmD, MPH, Director, Medical Outcomes Specialists
PFIZER
Cynthia Ewel, PhD, Project Director
Previously with MEDCO RESEARCH INSTITUTE
Discussed the development of a pharmacist counseling program for smoking cessation. Pfizer pharmacists are trained on motivational interviewing and train other pharmacists in the field. Pfizer has a team of medical outcomes specialists detailing adherence.
ENGAGING CONSUMERS TO TAKE OWNERSHIP OF THEIR HEALTH
Eric Racine, PharmD, Vice President, Partners in Patient Health
SANOFI
The life sciences industry must collaborate. The days of self interest are over. The solutions are in the community. May 2012 held a meeting for advocates to start to tackle the problem of patient engagement – Sanofi expected 50 attendees but 100 actually attended. Groups can work together to support patient engagement. All this must be driven by patient insights. Make adherence a public health issue and stop advocating for our own self interests.
Heather L. Black, PhD, US Outcomes Research
MERCK
It’s about what happens in a patients life. What does patient engagement really mean? There is no single definition of patient engagement so tough to quantify. The reference for high quality patient engagement links back to the AHRQ Principles for the National Quality Strategy (NQS) – http://www.ahrq.gov/workingforquality/nqs/principles.htm
Six basic criteria:
Health literacy
Care provided to them and around them their involvement
Confident they can follow their treatment plan
Their role, they can be inspired to manage their health
Treatment plan can be done in real life
Reminder about this all everyday

Bottom-line – Patient adherence and health improvement takes place within the informal network, within the patient lives

 

STRATEGIES AND INITIATIVES FOR OPTIMALLY EDUCATING PATIENTS ENROLLED IN CLINICAL DRUG TRIALS

Dorothy L. Smith, PharmD, CEO & President

CONSUMER HEALTH INFORMATION CORPORATION

Dr Smith raised the issue of non-adherence as it relates to drug safety, that patient adherence is the hidden problem in many clinical trials. The general assumption is that patients are 95% compliant in clinical trials. Dr Smith’s research belies this assumption. Her research shows that patients are much less adherent then believed, therefore decisions about dosage are over estimated resulting in the possibility of over-dosing. A recent example is the FDA guidance regarding reducing the dose of zolpidem for women http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm334798.htm. For more information on the study “Patients in Clinical Trials May Be Putting the Public at Risk” please see this link http://www.consumer-health.com/press/2008/PatientsinClinicalTrialsMayBePuttingthePublicatRisk.php

TRANSFORMING YOUR STRATEGY TO MEET PATIENT NEEDS
Christy Brown Pharm.D., Director, Patient Engagement
GLAXOSMITHKLINE
Jessica Brueggeman RN, MPH, VP, Health Behavior Group
MICROMASS
The industry has to be more patient focused, must balance needs of patients and brands. Challenging GSK to look at business through a patient engagement lens.Behavioral sciences, behavioral models, empirical data on patient behavior. Engagement/ activation. Patient value framework, proprietary delivery model
Drivers– behavior, motivators, behaviors, trust, confidence/self efficacy, partnership
Behavioral approach, awareness, action, environmental
Delivery principles– health literacy, choice/personalization, process of care, customer service
Completed ethnographic research with patients, validated model with 2000 patients over four disease states
       Drivers, illness perceptions, control, partnership ….unengaged patient
       Use motivational interviewing, goal setting for small changes to see they have control/connection to their  own behavior

Micro Mass is helping GSK to embed this model across the organization in commercial and R&D areas
   Building capability in patient engagement over the course of years timing
   Aligning customer tools to engagement principles
Why should GSK become an agent of behavioral change? Question she gets all the time. (We say congrats to GSK for trying!)

UNDERSTANDING BEHAVIORAL ECONOMICS TO OPTIMIZE PATIENT DECISIONS
Sharon Glave Frazee, PhD MPH, Vice President, Research & Analytics
EXPRESS SCRIPTS, INC.
Express Scripts has invested in what they call “Health Decision Science” and “Consumerology”. They discussed behavioral economics and the intent-behavior gap- the intention of people vs what they actually do. We expect patients to act differently than other people. Reviewed the info graphic Cost of Nonadherence nonadherence can cover cost of ACA – http://lab.express-scripts.com/adherence/infographic-predicting-rx-nonadherence/
 We are asking people to change something they don’t even know is a problem
 Let’s put this into cost terms. According to the November 2012 Drug Trends Report – http://digital.turn-page.com/i/95262 – Specialty drug spend is 21% of all spend and outcomes are more costly if patients are nonadherent.  There is a lot of research being done in the St. Louis, MO based Express Scripts Research & New Solutions Lab. (This meeting was my first exposure to the Lab. According to the Lab’s website “we turn data into insights and insights into proven, practical solutions for our clients and patients. We’re interested in exploring innovations that improve health outcomes, reduce healthcare costs and drive out pharmacy-related waste.”)
Sharon went on to discuss the impact of co-pay cards on adherence rates. Lowering the co-pay actually only increases adherence rates by less than 5%. Source: Sedjo RL, Cox ER. Am J Manag Care. 2008;14(12):813-18. So, what does work? Here is a slide showing the rates of adherence improvement by tactic. 
Sharon summarized  the most effective tactic:
“a letter that combined authority (signed by doc), combined with loss aversion, (patients recognize what they will lose if they don’t adhere) is the most effective effort.
In addition, the Research and new solutions lab found some simple, cheap, and effective solutions:
  1. Messages on pill cap, call your doc, no refills, new Rx required” on a cap for last bottle, increased refill in time rate, closed 230,000 gaps in care over six months
  2. Behavioral science and actionable data, 2,3, 6.3% improvement with dose alert
There is no such thing as one size fits all, nothing works for everyone. Optimal adherence possible only with advanced understanding of behavior
ROUNDTABLE DISCUSSION: INNOVATIVE METHODS FOR
BUILDING PHARMACY & PHYSICIAN COLLABORATIONS TO ENSURE COMPLIANCE
 Gina Guinasso, JD, Director, Managed Markets
ACORDA THERAPEUTICS

Kevin Cast, VP Strategy & Contracting
CURASCRIPT, INC, EXPRESS SCRIPTS
Daniel Miller, PharmD, RPh, Health-Systems Pharmacy Manager
WALGREENS SPECIALTY PHARMACY
  •  Manufacturers are going to specialty pharmacy for adherence programs
  • Medication Possession Ratio (MPR) is the measure                                                                                                                                                                                                                                                                                   
  • Specialty pharmacy builds hubs to manage patients, track adherence , can do more meeting stuff within a hub

 

 

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