Furl http://www.furl.net/ http://backend.userland.com/rss http://www.furl.net/member/AlignMap.rss Furl archive. Sat, 05 Jul 2008 11:08:25 GMT http://www.furl.net/item/34211965/forward http://www.furl.net/item/34211965 Sun, 01 Jun 2008 18:03:33 GMT Enhancement of Compliance The recent development of detect-and-report technologies means that the jury is still out on whether the honor system works as well as active detection and reporting systems. We’ll stay tuned. 4 http://www.furl.net/item/33445514/forward http://www.furl.net/item/33445514 Wed, 07 May 2008 02:08:54 GMT Special Populations & Compliance: HIV Directly Observed Therapy Directly administered antiretroviral therapy (DAART) can improve health outcomes among HIV-infected drug users. An understanding of the utilization of DAART—initiation, adherence, and retention—is critical to successful program design. Here, we use the Behavioral Model to assess the enabling, predisposing, and need factors impacting adherence in our randomized, controlled trial of DAART versus self-administered therapy (SAT) among 141 HIV-infected drug users. Of 88 participants randomized to DAART, 74 (84%) initiated treatment, and 51 (69%) of those who initiated were retained in the program throughout the entire six-month period. Mean adherence to directly observed visits was 73%, and the mean overall composite adherence score was 77%. These results were seen despite the finding that 75% of participants indicated that they would prefer to take their own medications. Major causes of DAART discontinuation included hospitalization, incarceration, and entry into drug-treatment programs. The presence of depression and the lack of willingness to travel greater than four blocks to receive DAART predicted time-to-discontinuation. 4 http://www.furl.net/item/32972293/forward http://www.furl.net/item/32972293 Wed, 23 Apr 2008 03:11:59 GMT Enhancement of Compliance Patients receiving lisinopril in the daily-dose blister packaging (Pill Calendar) refilled their prescriptions on time more often (P = 0.01), had higher MPRs (P = 0.04), and had lower diastolic blood pressure (P = 0.01) than patients who had their medications packaged in traditional bottles of loose tablets. 3 http://www.furl.net/item/32950956/forward http://www.furl.net/item/32950956 Outstanding lay press article on patient noncompliance, including advice to patients facing difficult regimens Tue, 22 Apr 2008 13:37:23 GMT Enhancement of Compliance Basics Of Compliance Getting people to do the things they need to do to keep themselves healthy is tricky. 5 http://www.furl.net/item/32950018/forward http://www.furl.net/item/32950018 Note: Source is Press Release Tue, 22 Apr 2008 13:09:15 GMT Monitors Of Compliance A breath-monitoring device developed by UF scientists and Xhale could change that, allowing patients to participate in a type of virtual DOT from home. 4 http://www.furl.net/item/32825210/forward http://www.furl.net/item/32825210 Sat, 19 Apr 2008 00:57:11 GMT Prevalence & Persistance of NonCompliance After a stroke, women are more likely to become depressed and have poorer quality of life than men, but depressed men are more likely to stop taking their stroke-prevention medications, a new study found. 4 http://www.furl.net/item/32601023/forward http://www.furl.net/item/32601023 Based on review of "All empirical articles on adherence published in peer-reviewed, English language journals from 1948 through 2002 " Sun, 13 Apr 2008 13:29:49 GMT Basics Of Compliance The strong effects in this research suggest that in the context of limited resources, patient adherence to chronic disease regimens can best be achieved by improving health professional-patient communication and by insuring that patients believe in the necessity and efficacy of treatment, and have adequate support for adherence. Screening for, and reducing, patient depression and family conflict likely can improve patient adherence. 4 http://www.furl.net/item/32599331/forward http://www.furl.net/item/32599331 Editorial referencing article in preceding Furl post, "Cost-Effectiveness of Providing Full Drug Coverage to Increase Medication Adherence in Post-Myocardial Infarction Medicare Beneficiaries." Sun, 13 Apr 2008 12:02:41 GMT Economics & Compliance Low copayments for medically appropriate therapeutics are a fundamental part of value-based insurance. I support the concept. However, pressing for full coverage for specific pharmacotherapy classes on a disease-by-disease basis is not likely to be an effective way to fix the current program. The question is how to best move the current, fragmented, stove-piped system that characterizes Medicare to one that rewards physicians and institutions that provide high-quality cost-effective care to patients. 5 http://www.furl.net/item/32599269/forward http://www.furl.net/item/32599269 Note: based on statistical model rather than actual experience Sun, 13 Apr 2008 11:59:41 GMT Enhancement of Compliance Economics & Compliance We created a Markov cost-effectiveness model to estimate the incremental cost-effectiveness of providing Medicare beneficiaries with full coverage for combination pharmacotherapy compared with current coverage under the Medicare Part D program. Our analysis was conducted from the societal perspective and considered a lifetime time horizon. In a sensitivity analysis, we repeated our analysis from the perspective of Medicare. In the model, post–myocardial infarction Medicare beneficiaries who received usual prescription drug coverage under the Part D program lived an average of 8.21 quality-adjusted life-years after their initial event, incurring coronary heart disease–related medical costs of $114 000. Those who received prescription drug coverage without deductibles or copayments lived an average of 8.56 quality-adjusted life-years and incurred $111 600 in coronary heart disease–related costs. Compared with current prescription drug coverage, full coverage for post–myocardial infarction secondary prevention therapies would result in greater functional life expectancy (0.35 quality-adjusted life-year) and less resource use ($2500). From the perspective of Medicare, full drug coverage was highly cost-effective ($7182/quality-adjusted life-year) but not cost saving. 3 http://www.furl.net/item/32460207/forward http://www.furl.net/item/32460207 Wed, 09 Apr 2008 19:00:23 GMT Monitors Of Compliance Approximately two-thirds of the participants stated that the MEMS helped them remember to take their medications, 93% reported that the MEMS was easy to open, 85% did not find it stressful, and 75% liked the MEMS and used it everyday. One-third of patients preferred using a pillbox and 25% did not like traveling with the MEMS. Patients who stated that they used the MEMS every day, felt comfortable using it in front of others, and remembered to put refills in the MEMS had significantly better adherence over the study period than did those who disagreed (p ≤ 0.05). 3