September 1, 2009

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Age of empowerment—from taking responsibility for taking medications to joining a clinical trial, you have the ability to change the face of healthcare for your generation and future ones.

 

BY JULIE DAVIS

As the cost of healthcare storms upward, it is hard not to be shocked by a statistic in a new report by the New England Healthcare Institute (NEHI), the independent, not-for-profit research and health policy organization dedicated to transforming health care for the benefit of patients and their families. Patients who do not take their medications as prescribed by their doctors cost the US healthcare system an estimated $290 billion in avoidable medical spending every year. NEHI’s research, contained in the new report, "Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease," notes that one third to one half of all patients do not take their medications properly.

Patients with chronic diseases, which affect more than half of all Americans, are particularly susceptible to spotty adherence practices. Likewise, medication persistence—the length of time a patient continues to take a prescribed drug—tends to be very low for those with chronic illness. And there are consequences for every one of us. Those who do not consistently take their medications often experience otherwise preventable worsening of their disease, unnecessary hospitalizations and additional medical risks. According to one study of diabetes and heart disease patients cited by NEHI, mortality rates among patients who did not adhere to their medications were nearly double the rates of those who took their medications as prescribed.

Among all patient groups, poor adherence poses an increased risk of hospital- izations due to poor health outcomes, resulting in significant excess costs. For example, among diabetes patients, those with low levels of adherence have almost
twice the total annual health care costs of those with high levels of adherence—
$16,498 versus $8,886. NEHI has identified the four most promising solutions for public and private policymakers to pursue in addressing the issue of medication adherence as part of health reform efforts, including:

• Creating health care teams: Although physicians play a key role in improving medication adherence, the complexity of the issue necessitates additional support through care teams incorporating nurses, pharmacists and other clinicians. These teams increase the number of checks on adherence as patients move through the health care system.
• Patient engagement and education: Counseling by primary care providers or pharmacists to ensure that patients understand the important role of their medication in improving their condition is critical to encouraging sustained adherence.
• Payment reform: Realigning reimbursement incentives would encourage providers to invest in resources such as counseling services that would improve patient outcomes by increasing medication adherence.
• Leveraging health information technologies: Secure, reliable and robust information flows via technologies such as electronic health records, e-prescribing and clinical decision support systems would give providers a full sense of a patient’s current medications, indicating whether a patient has filled or refilled a medication.

 

More than 26 million people across the world live with Alzheimer’s disease, and that number is expected to quadruple by 2050. In fact, it is the seventh-leading cause of death in the United States. Alzheimer’s disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, and may even inhibit the ability to carry out the simplest tasks. Researchers are continuously looking for
new treatments that may impact the course of the disease and ultimately improve the quality of life for people living with the disease.

This year on World Alzheimer’s Day, September 21, patients and caregivers are encouraged to join the fight against Alzheimer’s disease by learning about enrollment in clinical trials that may help researchers learn how to stop or slow the disease from progressing versus simply treating the symptoms.

Today, at least 50,000 volunteers are urgently needed to participate in more than 175 actively enrolling Alzheimer’s disease clinical trials in the U.S. According to the Alzheimer’s Association, research shows that people involved in studies tend to do somewhat better than people in a similar stage of their disease who are not enrolled, regardless of whether the experimental treatment works. Scientists believe this advantage may be due to the general high quality of care provided during clinical studies.

Caregivers may also experience unexpected benefits:

• Opportunity to talk regularly to Alzheimer’s experts who have lots of practical experience
• Receive valuable advice on the emotional and physical aspects of the disease
• Learn about support groups and other helpful resources

One clinical trial that is currently seeking participants is the ICARA Study. The goal of the ICARA Study is to learn if an investigational drug from pharmaceutical maker Elan, bapineuzumab, can help slow the progression of Alzheimer's. For more information about this trial, visit www.icarastudy.com or call 1-888-770-6366.
For more on the importance of taking part in clinical trials, visit the Alzheimer’s Association at http://www.alz.org/alzheimers_disease_clinical_studies.asp

 

A University of Leicester-led study may have uncovered the reason why beta-blockers are less effective at preventing stroke in older people with high blood pressure, when compared to other drugs for high blood pressure.

The research, carried out by Bryan Williams, professor of medicine at the University of Leicester, and his colleague Dr. Peter Lacy, has been published in the Journal of the American College of Cardiology and has been cited on the MDLinx.com site as currently the world's number one leading finding in its field.

Professor Williams' research shows that lowering heart rate in older people, as beta-blockers do, can have a potentially detrimental effect on central aortic pressures (pressures in the large arteries close to the heart).

He commented, "Such findings can help define the template for optimal treatment strategies and highlight why new methods to estimate central aortic pressures are providing new insights into the pathogenesis of cardiovascular disease and how new drugs can be tailored to limit the damage.”

This study used analysis of the pulse wave measured at the wrist to estimate pressures in the large artery near to the heart, in people with high blood pressure. It shows that reducing heart rate in older people with high blood pressure can result in a higher than expected pressure in the large arteries.

This may be the reason why drugs such as beta-blockers, a widely used drug to treat high blood pressure, have been shown to be less effective than other treatments at preventing stroke. In 2006, it was recommended that beta-blockers no longer be used as a routine treatment for high blood pressure because they appeared somewhat less effective than other types of blood pressure lowering drugs at reducing the risk of stroke, especially in older people.

Professor Williams, who is also consultant physician with the University Hospitals of Leicester NHS Trust, suggests that the present study provides important insights into the mechanism. "There is no doubt that by better understanding of how modern drugs work in reducing the risk of stroke and heart disease, we will be able to continually refine treatments for the future," he said.

Should patients taking beta-blockers stop them? Professor Williams emphasized, "No, they should definitely not stop them. Beta-blockers are prescribed for a number of medical conditions, including angina and heart disease and in this context they are very beneficial. The new study is specifically exploring the reasons why beta-blockers or other drugs that lower heart rate may be less effective at preventing stroke than some of the other drugs we use to lower blood pressure."

 

ELDER CARE NEWS: BEST OF THE WEEK

A round-up of articles and studies impacting the lives of seniors

VIRGINIA NEWS: "New cooking program aims to take the heat off of caregivers" by Shannon Humphrey (Daily Press [Newport News, Virginia], August 31, 2009).
http://www.dailypress.com/news/dp-local_cooking_0830aug30,0,7601001.story

 

"Mental diseases among elderly called 'our next epidemic’" by Don Markus (Baltimore Sun, August 31, 2009).
http://www.baltimoresun.com/news/maryland/howard/bal-md.ho.assisted31aug31,0,4597024.story

 

New gadgets prod people to remember their meds" by Scott Kirsner (Boston Globe, August 30, 2009).
http://www.boston.com/business/healthcare/articles/2009/08/30/new_gadgets_prod_people_to_remember_their_meds/

 

"Dialysis treatment in USA: High costs, high death rates" by Rita Rubin (USA Today [McLean, Virginia], August 24, 2009).
http://www.usatoday.com/news/health/2009-08-23-dialysis_N.htm

 

"Many diabetic foot amputations are preventable" by Lauran Neergaard(Associated Press via Boston Globe, August 25, 2009).
http://www.boston.com/news/health/articles/2009/08/25/many_diabetic_foot_amputations_are_preventable/

 

“High blood pressure linked to early memory problems," (Reuters Health, August 24, 2009).
http://www.reutershealth.com/archive/2009/08/24/eline/links/20090824elin025.html

 

VERMONT NEWS: "Budget cuts impact long-term care" by Nancy Remsen (Burlington Free Press, August 24, 2009).
http://www.burlingtonfreepress.com/article/20090824/NEWS03/90823009/Budget-cuts-impact-long-term-care-