Real World Health Care Blog

Tag Archives: drugs

Are Shorter Doctor’s Office Wait Times Just a Phone Call Away?

Nobody likes to wait, especially at the doctor’s office. No one knows for sure what will happen to wait times, which average from about 16 minutes to just over 24 minutes nationwide according to Vitals – as 30 million more Americans obtain health care coverage under the Affordable Care Act. But it stands to reason that wait times could increase. Couple that with the looming shortage of primary care physicians, and time spent in doctors’ waiting rooms may become an even more precious commodity.

Linda Barlow

Linda Barlow

Patients who lack, well, the patience to wait may have a solution – one that is showing great promise to eliminate doctor visit copays and is available even to those without medical insurance. The free Urgent Care app from GreatCall Inc. is designed to give people 24/7 access to health care information anytime, anywhere. Launched in January, the GreatCall app rose to the top of the Google Play and App Store medical categories by mid-May.

Urgent Care is the only app that provides users with round-the-clock access – for a price of $3.99 per call – to a live, registered nurse with LiveCare Clinic who can escalate inquiries to a board-certified doctor for health-related advice, diagnosis and even prescriptions without an appointment. It also provides a medical dictionary and medical symptom checker tool.

Urgent Care empowers patients to make choices about how and where they receive medical consultation. For example, many access the app’s Interactive Symptom Checker feature to pinpoint various symptoms of common ailments they might initially find uncomfortable to discuss in person. The app also helps identify:

  • Possible causes of symptoms
  • When to self-treat
  • When to contact a medical professional

“With the costs of medical care rising, people are looking for other options to get access to quality health care,” said Aaron Amerling, Manager of Mobile Apps at GreatCall. “Urgent Care fills a very real need by giving anyone access to medical resources, as well as the ability to quickly connect to a nurse or doctor for less than the cost of a typical Starbucks beverage.”

Amerling notes that Urgent Care is being used by a wide range of people – from those seeking a Spanish-speaking nurse or doctor to those who have health insurance and are frustrated by sitting on-hold or waiting long periods for returned calls from their health care providers.

When asked whether apps like this undermine the authority of health care providers by placing too much control in the hands of patients, Amerling said, “When people have the ability to look up ailments online, they may find a myriad of potential causes and are unable to self-diagnose safely. That’s why we made the ability to access registered nurses and board-certified physicians for expert opinions an important component of Urgent Care.”

According to Amerling, the app has been so successful that the company is looking to add even more resources for patients, including:

  • Access to health news and videos
  • Drug information forums
  • Expanded medical libraries
  • A Spanish-language version of the app

Have you ever used Urgent Care or another app to obtain medical advice? If yes, how did you feel about the quality of care you received? If not, do you think you would ever use an app like this?

Categories: Access to Care

With a Little Help from My Friends, Family… And Apps

“Drugs don’t work in patients who don’t take them.” – C. Everett Koop, former Surgeon General

It was an idea born of near tragedy: an elderly, diabetic father who double-dosed on his insulin therapy and suffered a medical emergency. His two sons realized that if they were more involved in reviewing their father’s daily medication and insulin regimens, it could change his behavior for the better and help him get healthier.

MedicineCabinet (5)

Photos courtesy of NextGen Healthcare

So Omri and Rotem Shor co-founded the MediSafe Project, a free mobile app that makes it easier for families and friends to give the support needed to help their loved ones get healthier and integrate healthier behavior modification into their everyday lives. In the first four months after its launch, users reported medication adherence rates of 79 percent (82.25 percent for statins) – well above the 50 percent average medication adherence rate reported by the World Health Organization.

The MediSafe Project provides an easy-to-use interface – an interactive pillbox of sorts — over iOS and Android mobile phones. Users input information about their meds by typing their names or photographing their National Drug Code numbers. The system stores the correct pharmaceutical name, manufacturer and dosage, ensuring an error-free medication list in the event of a medical emergency. Users signify taking their meds by dragging pills from the virtual pillbox into a mouth icon, which “swallows” the pills.

Users receive alerts before medication courses are completed, allowing them to order refills in a timely manner. In addition to reminding users when it’s time to take their medication, the MediSafe Project sends alerts to selected family members, friends and caretakers when a loved one misses a dose. Users can also email a personalized list of adherence stats to their doctor, giving doctors better patient oversight between office visits. A prescription page feature lets doctors “prescribe” the MediSafe project to their patients to help better monitor medication adherence.

The impact of non-adherence on the outcomes of patients with cardiovascular diseases is one example that underscores why it is so critical to implement strategies and utilize technologies that improve medication adherence.

“Medication non-adherence is a problem that costs U.S. hospitals billions of dollars every year,” says Omri “Bob” Shor, CEO, MediSafe. “An American dies every nineteen minutes from skipping or taking medication incorrectly. Our goal is to help combat this problem and encourage healthy habits among users and their support systems with easy-to-use technology.”

The MediSafe Project isn’t the only app on the medication adherence scene. The free NextGen® MedicineCabinet app lets users create and update a list of medications, including dosing and schedule information, thus creating their own “personal” medication record.

Notifications are sent for each medication and users can confirm adherence. The app was designed, in part, to improve adherence and proper use of medication by enhancing patients’ understanding of how to correctly take their medication and to recognize adverse reactions. According to the company, it also equips health care professionals with all the relevant information they need, in a way they like to view it.

“Mobile patient engagement is at the forefront of today’s changing health care environment,” said Ike Ellison, executive vice president of business development for NextGen Healthcare, in a statement. “Providing consumer technology that encourages members to control and lead healthier lifestyles is a key factor in improving outcomes.”

Michael Paquin, vice president, business development for NextGen Healthcare, added “One of our users commented on the way that she was able to, for the first time, be able to share her medication lists easily with family, friends and all her physicians. It has saved this particular patient hours of time on a monthly basis.”

Technology-based solutions like the MediSafe Project and the NextGen Medicine Cabinet are among the latest patient-directed tools that improve medication adherence.

However, providers still play an important role in assisting patients in maintaining healthy behaviors like medication adherence. The American College of Preventive Medicine offers a SIMPLE approach on how providers can help their patients take their medications as prescribed.

Barriers to medication compliance abound, with memory issues, lack of support, and lack of education just being a few. What is behind these barriers? How can patient behaviors and motivations be changed?

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Categories: Access to Care

New Drug Delivery Options that Help the Medicine Go Down

David Sheon

David Sheon

The water cooler talk for us at RWHC is frequently about improving treatment adherence (a patient’s ability and willingness to take his or her medicine consistently, as directed).  OK, so we don’t have the most exciting water cooler discussions.  But this happens to be important – for all of us because when patients stay on treatment, they get better faster.  This is almost universally true, regardless of the therapeutic category.

In some cases, improving adherence not only saves the life of the patient, but it can benefit an entire community.  In HIV, for example, taking antiretrovirals not only helps the patient to manage his or her viral load (the amount of HIV circulating in the blood), but it also lowers that patient’s ability to transmit the virus to someone else.

Sometimes, adherence can be improved by using a different delivery system.  This is the first post in a series on how drug delivery helps adherence.

Remember the first time you took a breath strip that dissolved on your tongue? The technology was invented in the 1970s, but only since July 2012 have pharmaceutical companies been able to win marketing approval to put a drug on the strip.  Two products have been cleared by the FDA.

Zuplenz (ondansetron) oral soluble film is an anti-nausea and vomiting product used by cancer patients who experience nausea and vomiting as a result of receiving chemotherapy and/or radiation as well as for the prevention of postoperative nausea and vomiting.

“We know from market research that patients who are nauseated don’t necessarily like swallowing pills or using suppositories and that sometimes taking pills with water contributes to their nausea,” said John V. Aiken, M. Ed., Vice President, Corporate Operations, Marketing, and Training, Praelia Pharmaceuticals, Inc.  “Since launching the product in December 2012, a number of doctors are telling us that their patients prefer the dissolving strip.”

The second drug now available on an oral dissolving strip is Suboxone (Buprenorphine and Naloxone), from Reckitt Benckiser Pharmaceuticals Inc.  For more information on this product, click here.

If the dosing is standardized and absorption is as good as more typical drug delivery methods, we see only an upside in terms of patient adherence to oral dissolving strips.  Please tell us what you think.  Also, if you know of a new drug delivery option that you’d like to see us cover, let us know!

Filling the Financial Gap When Health Insurance Isn’t Enough

You can’t escape the headlines: rising expenses and high unemployment. And even for the employed, a sharp reduction in health benefits – coupled with a steep increase in out-of-pocket costs, including deductibles, copayments and coinsurance – is making access to life-saving and life-sustaining therapies out of reach for many Americans.

For some individuals and families, these out-of-pocket expenses can total thousands of dollars each month – much more than many folks earn.

When people in these circumstances need help, many turn to Patient Assistance Programs (PAPs), while others apply for financial assistance through independent non-profits such as The HealthWell Foundation. PAPs – which are offered by state governments or drug makers – are designed for those who cannot afford the cost of medication. Groups like Partnership for Prescription Assistance, NeedyMeds, RxAssistRxOutreach, and the National Center for Benefits (provided by the National Council on Aging), empower individuals to sort out their options and get connected to the PAP that’s right for them, sometimes even helping applicants fill out their paperwork.

What do all these organizations have in common? They focus on addressing the financial strains confronting individuals with health insurance who need important medical treatments but cannot cover their associated out-of-pocket costs and premiums.

Individuals like Marianne of Tarpon Springs, Florida, for example. For Marianne, living frugally her whole life didn’t help. Even though she had health insurance, paid all her bills on time, and once earned a good living as a librarian, the 70-year-old breast cancer survivor could not afford the medicine she needed to keep the cancer from coming back.

With no other alternatives to the $500-a-month life-saving medicine, the fixed-income senior citizen didn’t know where to turn. Until her doctors pointed her to the HealthWell Foundation.

Two years later, and thanks to the financial assistance she received from HealthWell, the still-healthy Marianne travels, cycles, and enjoys the life that continues to “delight and amaze” her.

“I am so fortunate,” she says. “I’ve always been glad to give back to others, and now that I’ve needed the help, I know just how precious it is to receive the kindness and compassion of others.”

Marianne is one of many Americans who benefit from organizations like HealthWell, which has provided copayment assistance to more than 164,000 patients since 2004. Without these critical funds, many of those living with chronic and life-altering illnesses would not have the treatments they need in order to live healthier lives.

No child or adult in the U.S. should go without health care because he or she cannot afford it.

How can charitable copayment assistance organizations partner with businesses, government and other stakeholders to achieve lower costs for health care treatment?

The HealthWell Foundation sponsors this blog.

Get the conversation going in the comments section.

Categories: Cost-Savings

Walgreens Unveils Solutions to Boost Medication Adherence

How can health professionals enable their patients to take medications more consistently as prescribed?

Personalized counseling from pharmacists and prescription refill reminders are two effective ways now shown to fuel better drug adherence, according to research from Walgreens presented March 15 at the World Congress Summit in Philadelphia.

Walgreens’ community pharmacy programs – in addition to successful intervention models – are equipping patients with powerful tools to self-manage their health.

One finding, for example, revealed that individuals receiving in-person counseling from their pharmacist saw 7.2 percent higher adherence than those with more conventional pharmacy care. Meanwhile, one of Walgreens’ pilot programs demonstrated that patients who receive prescription refill reminders (also called automated refill reminders or ARR) are more likely to consistently take medications for chronic conditions.

“In order to improve medication adherence among patients, providers need to understand the key challenges and contributors to non-adherence, and how to address them,” said Jim Cohn, Walgreen Co. spokesperson. “The research findings demonstrate how programs at the community pharmacy level designed to target common barriers to adherence, such as the challenge of learning a new medication therapy or simple forgetfulness, can significantly improve patient health and outcomes.  Ultimately, these types of pharmacy initiatives can help providers do their part to ensure more people get, stay and live well.”

Walgreens isn’t alone in recommending evidence-based approaches to enhance adherence outcomes. The Medication Adherence Project’s (MAP) 2010 Training Package also offers strategies for both providers and pharmacists that stress individualized patient engagement, with solutions that include writing 90-day instead of 30-day prescriptions, prescribing generics, communicating directly with providers, and more.

Securing increased medication adherence will not only go far in helping patients live longer and healthier, but will deliver considerable savings for the health care system too.

How do we know? Underscoring the benefits of adherence, MAP cites “lower disease-related medical costs” for diabetes and hypercholesterolemia in addition to related “reductions in health care costs.”

The New England Health Institute (NEHI) also provides compelling evidence in its October 2012 Issue Brief that reducing medication non-adherence, which contributes to hospital readmissions, helps lower hospitalizations and saves on associated expenses, noting: “One study found that one-third of adverse drug events resulting in a hospital admission were related to non-adherence. The aggregate cost of hospital admissions related to medication adherence has been estimated to be roughly $100 billion per year and estimates of the share of hospital admissions related to non-adherence are as high as 10 percent.”

Successful strategies generating increased medication adherence are clearly worth pursuing and replicating, both to strengthen the quality of health services and to lower the cost of care.

Now we want to hear from you. As a medical professional, what approaches do you incorporate to encourage patients to properly take their meds? If you’re a patient, what has worked for you?

Three Pillars of Health Care Success: Cost Savings, Prevention/Patient-Centered Care, and Access to Care

Welcome to www.RealWorldHealthCare.org, a blog dedicated to showing what’s working to  improve health care in the U.S.

Why are we talking about improving access to good medical care? Rising costs could bankrupt us, and most people need to do a better job of preventing illness. But digging deeper, you may be surprised to learn that almost 10 percent of the U.S. population (that’s 29 million Americans) can’t afford the health insurance copayments, coinsurances and deductibles required to cover out-of-pocket costs for necessary treatments of certain chronic and life-altering medical conditions. The situation is so dire that about 60 percent of the personal bankruptcies filed in the U.S. are due to medical expenses.

As we see every day in the news, patients are facing more obstacles in accessing affordable, quality care. As across-the-board cuts to health care programs are now taking effect with implementation of the sequester – along with projected layoffs to health providers across fields – available funds to cover the rising cost of care will be strained even further. Staying abreast of the latest proven solutions to the increasingly complex challenges of our health care system is more important than ever, for patients and providers alike.

We want our blog to be the go-to source for demonstrating what’s working in our health care system by focusing on three important pillars of health care success:  Cost Savings, Prevention/Patient-Centered Care, and Access to Care.

Cost Savings: No patient – adult or child – should go without health care because he or she cannot afford it. The first step to finding solutions to the increasing cost of care is enabling health care systems and health care professionals to share their practical knowledge with one another as well as the patients who often have to choose between paying their medical bills and putting food on the table. From paying for prescription drug copayments and deductibles to affording health insurance premiums, our Cost Savings posts will explore proven strategies to help patients and families reduce the financial strain associated with the rising price of care.

Prevention/Patient-Centered Care: What’s the first thing you think of when given the words “health care?” Most people think “trip to the doctor,” or “medication.” Our attention has to shift more aggressively to find ways to help people stay healthy. Seeing a dietitian could be vital for millions of Americans hoping to live healthier and longer. Annual lab work can find vitamin deficiencies. Sometimes very simple things, like removing carpeting from the home, can contribute to better cardiovascular health, resulting in increased life expectancy. It takes a village to care for a patient. Partnerships among practitioners, payers, patients and their families are crucial for ensuring that health care decisions are made in a way that respects patients’ needs and that patients have the knowledge and support they need to make reasoned decisions and participate in their own care. In our Prevention/Patient-Centered Care blog posts, we’ll focus on the many strategies available for staying healthy and recognize ways that patients are taking an active role in decision-making about treatment options.

Access to Care: We are so fortunate to live in a world where scientists are developing novel, breakthrough therapies. But those therapies can’t result in positive health outcomes if the patients who so desperately need them can’t access them. The evidence is clear: Proper medication compliance and adherence – consistently the right medication, at the right dosage, for the right patient – is essential to mitigating chronic disease. Continued and properly managed care and staying on treatment will be the focus of our Access to Care blog posts.

We’ll be sharing real-life examples of positive health outcomes in this space, and we encourage you to join in the dialogue. How would you tackle the problem of unaffordable health care? How can business and philanthropy work together to reduce the financial burden on patients? Have you or someone you know received help paying for needed therapies? Let us know in the comments section.

Categories: General