Adherencia al tratamiento en asma - Antje-Henriette Fink-Wagner, PhD

Adherence to Treatment Adherencia al Tratamiento

Antje-Henriette Fink-Wagner, PhD

Executive Director Global Allergy and Asthma Patient Platform GAAPP

Antje-Henriette Fink-Wagner, 2012 1

Statement of Interest No conflict of interest!


– Status of Health Literacy as relevant issue to be adherent/ concordant

– Patient advocacy as 1st step to empower patients and to increase adherence/concordance for better patient compliance

– Integral meaning and consequences of compliance – Model of patient behavior – Integration of all stakeholders to change patient behavior

– Conclusion

Examples: – Physician – Nurse – Pharmacist – Insurance/funds

– Family and friends – Policy Makers – Pharmaceutical industry – Patient associations

Content or what you will take home from this presentation


– Literacy and misunderstanding prescription drug labels. Annals of Internal Medicine 2006 :

Take two tablets twice daily.

How many patients can follow this direction?

Health Literacy a precondition to achieve acceptable adherence/concordance


– Literacy and misunderstanding prescription drug labels. Annals of Internal Medicine 2006 :

Take two tablets twice daily.

How many patients can follow this direction?

Only 34 % of patients were able to accurately follow this!

Health Literacy a precondition to achieve acceptable adherence/concordance


Patient advocacy as 1st step to empower patients and to increase adherence/concordance for better patient compliance – Advocacy empowers patients

– Empowered patients are more willing to feel responsible for their therapy

– Patients who feel responsible want to understand therapy opportunities, which means they request education

– Educated patients are able to adhere to doctors‘ advice on a level of concordance

– Concordance will increase compliance

Patient advocacy will increase compliance


Source:

Reality of non-compliance Compliance is the main challenge for optimal treatment of patients in general


Source: N. Barber, J. Parsons, S. Clifford, R. Darracott, R. Horne; Qual Saf Health Care 2004; 13: 172-175, doi: 10.1136/ qshc.2003.005926

Still taking medication at 10 days (n = 226/239)

Still taking medication at 4 weeks (n = 171/197)

Adherent Non-adherent Partial non-adherence Complete non-adherence

159 (70%) 67 (30%) 49 18

128 (75%) 43 (25%) 26 17

Adherence to new medication: Patients‘ problems with new medication for chronic conditions


Source: F.A. Al-Eidan et al. J Clin Pharmacol 2002, 53, 163-171

Example Compliance with and without help taking medication in Hp eradication therapy


Valerie uses her spray twice daily – without any relief!

… without any problems?


Model of patient behavior Levendahl, et al. stated 1992:

Patients personal ideas about their illness are often organized around five components: – Identity – Timeline – Cause – Consequences – Control/cure

These can be thought of as the answers to five basic questions about the illness or health threat: – What is it? – How long will it last? – What causes it? – How will it/has it affected me? – Can it be controlled or cured?

People form a mental model or representation of the illness, which is made up of their answers to these questions.


Conclusion

How can patient behavior be changed

Physician


Physician Motivational interviewing: Ask open questions in Patient friendly language

What changes would you most like to talk about?

What have you noticed about…….?

How important is it for you to change…?

How confident do you feel about changing…?

How do you see the benefits

Source:

Physician


BMJ 2010

Physician

Physician Motivational interviewing Develop Discrepancy

– How does current behavior conflict with core values?

Minimize Unsolicited Advice – Patients overcomes their own obstracles – Dance not a wrestling match Support Self-Efficacy – Uncover and reinforce it

Usual Suspects – Express empathy – Good nonverbal listening skills – Be a problem solving partners


Physician Physician Never forget the WRITTEN action plan!

Red Zone: Stop! Danger!

Yellow Zone: Caution! Slow Down!

Green Zone: Go!


Conclusion


Nurse


Nurse Example: Nurse Phone Dialog doctor – patient – nurse triangle

COPD case management by National Jewish Medical and Research Center – Individualized by patient and physician – Driven by action plans from physician – Nurses handle calls based on

developed algorithms as kind of call center – Inbound and outbound calls

through Case Manager (nurse) – Physicians always notified – Can be done every 12 or 24 hours and will be less after few weeks Antje-Henriette Fink-Wagner, 2012 17

National Jewish Medical and Research Center COPD all plan members 12-month utilization data

0 Adult Days Missed from Work

n = 272

500

1500

ER Visits

n = 751

Hospitalizations

n = 751

Unscheduled Dr. Visits

n = 751

Oral Antibiotic Bursts

n = 746

1383

245 164

582

Baseline

7 to 12 Months p < 0.001 1000

756

-79.7% 281

-70.7% 48

- 48.2% 127

-58.9% 239

-45.1% 415

Source: Data provided by David Tinkelman, vice president Health Initiatives NJC, December 2002

Nurse Example: Nurse


Conclusion


Pharmacist


Pharmacist Example: Pharmacist

EFA Allergy Awareness Project 2011-2014: Pharmacists are the first Health Care Professionals seeing a patient on risk for allergies when asking for OTC products. Situation: People often “know” they have an allergy but do not go for proper diagnosis. Aim: Use pharmacists to motivate potential allergy patients to visit a doctor for proper diagnosis and therapy. Pilot project planed in Austria and Germany to proof positive role of pharmacists in 2013. Antje-Henriette Fink-Wagner, 2012 20

Pharmacist

Voilà – Amuse gueule!

Appetizer …


Conclusion


Insurance/ Funds


Source: Techniker Krankenkasse, 2005; www.tk-online.de

Example: Insurance/Funds Reminder service

Reminder service for preventive measures of members – Dental prophylaxis – Health check-up – Cancer prophylaxis – Preventive care for children and youths – Smoking cessation Telephone reminder or information by e-mail as requested by the member

Insurance/ Funds


Source: Techniker Krankenkasse, www.tk-online.de, Januar 2005

Example: Insurance/Funds Diagnostic information for members – After online entry of a diagnosis (often provided in codes only),

a diagnosis text is displayed in patient friendly language – including additional information, e.g. links to treatment guidelines

Insurance/ Funds


Source: Chest 2011

Insurance/Funds The impact of co pay costs on non adherence Insurance/

Funds


Rates of cost-related non-adherence (black bars) by monthly out-of-pocket inhaler costs in the Inhaler +/CPD+ group. There is a roughly linear increases in cost –related non-adherence as the out-of-pocket costs of inhalers increases (test for trend, P<.0001). Error bars represent SEM.

Conclusion


Family and

Friends


Example: Family and Friends Smoking cessation

“Feel free to say no”, an initiative of the European Union: Testimonials presents the friends of the target groups


Paul, hurry! You have to be at the doctor’s at eleven …

Memory function … Family

and Friends


Conclusion


Public/

Policy Makers


Policy Makers Health Literacy: a precondition to achieve acceptable adherence/concordance

Public Policy Makers


European Health Award October 2012 : • Survey of the HLS-EU CONSORTIUM

Source: HLS-EU CONSORTIUM (2012): COMPARATIVE REPORT OF HEALTH LITERACY IN EIGHT EU MEMBER STATES. THE EUROPEAN HEALTH LITERACY SURVEY HLS-EU , ONLINE PUBLICATION: HTTP://WWW.HEALTH-LITERACY.EU

About 12% of respondents have inadequate general health literacy, and more than one third (35%) problematic health literacy, thus nearly every second respondent shows limited health literacy, in the general sample. 8000 respondents from 8 countries.

Joint messages in as many countries As possible

Public World Awareness days

Public Policy Makers

Creates awareness about a special disease to patients, public and Policy Makers


Conclusion


Pharma- ceutical Industry



Example: Pharmaceutical Industry ZacPac

History 3 packages to eradicate Hp: PPI plus two different antibiotics (French triple therapy) Compliance friendly solution Development of ONE compliance-supporting medication package for all three drugs – Received the international award


Example: Technical Industry Helping Hand™

– Electronic tool offered by Bang & Olufsen

– Reminds patients to take medication correctly

– Helps patients to feel secure on level of compliance

– In use for 4 indications (CNS, cardiovascular, osteoporosis, immune suppression)

– Improves compliance from 45 – 80% and 95% of doctors believe patients benefit from it

– Increased persistence affects market shares (according to B&O)



Conclusion


Patient Associations


Patient Association European Federation of Allergy and Airways Diseases Patient Associations EFA – 32 Member organizations in 22 countries

– EFA Respiratory Allergy Awareness Project:

– Raise awareness of respiratory allergies (Rhinoconjunctivitis and

Allergic Asthma Rhinitis, Asthma) as serious chronic disease

– Call for

– Early identification of symptoms by target audience

– Early diagnosis and appropriate strategies including life style changes

and physical activities to manage and control allergic diseases to

– Avoid exacerbations of severe allergies



EFA Call to Action

– EU policy-makers are called to coordinate actions to

1) Increase the political recognition of respiratory allergies as a real and serious disease

2) Promote national programmes on respiratory allergies

3) Prioritize the management and control of respiratory allergies

4) Promote training in allergy for healthcare professionals to improve accurate and early diagnosis

5) Align healthcare and reimbursement policies, to support appropriate disease management

6) Improve indoor air quality

Invitation to sign the EFA Call to Action: http://www.efacallaction.net/sign.aspx Antje-Henriette Fink-Wagner, 2012

http://www.efacallaction.net/sign.aspx


Patient Association Global Allergy and Asthma Patient Platform

– 24 member organizations on all Continents – Sport Games for children with asthma to promote

adherence to sport for asthmatics (see first talk of this session)


Conclusion

Adherence / Concordance will improve as the sum of individual advocacy initiatives by all allied healthcare professionals and the patients themselves.


COMPLY – OR DIE

Thank You!


Adherencia al tratamiento en asma - Antje-Henriette Fink-Wagner, PhD

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