Return on Education™—Leveraging Patient Education to Improve Treatment Outcomes<br />Susan LaRue, RD,CDE, Clinical Educati...
Give us the next 30 minutes and we will…<br />Give you an introduction to Return on Education™—a framework you can use to ...
Return on EducationTM: Starts with a behavior-based approach for developing programs<br />3<br />Program<br />Development ...
Education Impact<br />Desired Action <br />And includes a Return on EducationTMframeworkfor evaluating the outcomes of the...
Case study: Effects of Patient Education Support Program on Pramlintide Adherence<br />
Acknowledgement<br />6/21/2011<br />6<br /><ul><li>This case study is based on the following publication:
Lorenzi GM, LaRue SM, Collins SE. Effects of a patient support program on pramlintide adherence. Clin Diabetes. 2011;29(1)...
We wish to thank the lead author, Gayle Lorenzi, RN, CDE, University of California at San Diego, for her expertise and con...
The numbers shed light on the product’s challenges<br />3<br />Patients taking pramlintide at meal times may already be ta...
Why did patients stop treatment?  Their answers revealed a need<br />6/21/2011<br />9<br />Lack of effectiveness (voluntee...
To develop our program, we started with the Return on EducationTMapproach<br />10<br />Program<br />Development and <br />...
Program objectives were based on behavior-change principles<br />Set realistic expectations at the beginning of treatment<...
Trying to take a walk in patients’ shoes (uncovering insights)<br />6/21/2011<br />12<br />Starting Pramlintide Therapy<br...
Realistic expectations
Hope for improvement
Adjustment period/need for flexibility
Insulin/appetite changes
Weight loss
Improved glucose levels, fewer fluctuations
Improved AIC
Perceived benefits of therapy
Increased sense of control of diabetes
Weight loss
Less insulin</li></ul>Motivators<br />Motivators<br /><ul><li>Additional injections
Side effects
Therapy disappointment
Impact of changes on family dynamics
Suboptimal dosing; fewer benefits realized
Life demands
Lack of healthcare provider support and education
Frustration: different routine and considerations
Unanticipated hyperglycemia
Injection burden and treatment complexity
Unexpected side effects</li></ul>Barriers<br />Barriers<br />
Behavior models provide a blueprint for program design <br />6/21/2011<br />13<br />Program designed using Social Cognitiv...
Designed for clarity by integrating health literacy principles <br />6/21/2011<br />14<br />“I have challenges accessing, ...
Applying the Return on EducationTMapproach to develop the program<br />15<br />Program<br />Development and <br />Refineme...
Starting Pramlintide Therapy<br />Maintaining Pramlintide Therapy<br />Starting Pramlintide Therapy<br />Maintaining Praml...
Realistic expectations
Hope for improvement
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HealthEd and Amylin EXL Digital Pharma West 2011

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"Return On Education" presentation by HealthEd and Amylin Pharmaceuticals, EXL Digital Pharma West 2011, San Francisco. Presenters: Susan Eno Collins and Susan M. LaRue

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HealthEd and Amylin EXL Digital Pharma West 2011

  1. 1. Return on Education™—Leveraging Patient Education to Improve Treatment Outcomes<br />Susan LaRue, RD,CDE, Clinical Education Specialist, Medical Relations and Information, Amylin Pharmaceuticals, Inc<br />Susan Eno Collins, RD, CHES, SVP, Health Education, HealthEd; Community Leader, SurroundHealth.net<br />
  2. 2. Give us the next 30 minutes and we will…<br />Give you an introduction to Return on Education™—a framework you can use to develop effective programs <br />Show you a case study where we incorporated the framework<br />Share the positive results we got<br />Hopefully, answer your questions<br />6/21/2011<br />2<br />
  3. 3. Return on EducationTM: Starts with a behavior-based approach for developing programs<br />3<br />Program<br />Development and <br />Refinement<br />Post (After Program Launch)<br />Pre (In Planning)<br />During (In Development)<br />Uncover Insights<br />Choose Behavior Model<br />Develop Objectives<br />Capture and Analyze Results <br />Launch<br />
  4. 4. Education Impact<br />Desired Action <br />And includes a Return on EducationTMframeworkfor evaluating the outcomes of the program <br />6/21/2011<br />4<br />Program/Business Impact<br />Customized based on program objectives<br />Examples include<br />Screening/diagnosis<br />Talking with HCP<br />Fill initial Rx<br />Take Rx as prescribed<br />Conversion<br />Use of device<br />Persuasion <br />(“This is important to me”)<br />+<br />Clarity<br />(“I understand and can apply what I am learning”)<br />+<br />Insight-driven content<br />(“This relates to me and my life”)<br />+<br />Reaction to tactic/program<br />(“This has been worth it. I have learned something new.”)<br />Program<br />Engagement<br />Reach<br />Frequency<br />Business<br />Length on therapy<br />Increased sales<br />Rep access<br />Health Outcomes<br />Symptom alleviation<br />HEDIS measurement<br />Function<br />Clinical measures<br />
  5. 5. Case study: Effects of Patient Education Support Program on Pramlintide Adherence<br />
  6. 6. Acknowledgement<br />6/21/2011<br />6<br /><ul><li>This case study is based on the following publication:
  7. 7. Lorenzi GM, LaRue SM, Collins SE. Effects of a patient support program on pramlintide adherence. Clin Diabetes. 2011;29(1):17-24.
  8. 8. We wish to thank the lead author, Gayle Lorenzi, RN, CDE, University of California at San Diego, for her expertise and contributions</li></li></ul><li>Pramlintide is taken as an adjunct to mealtime insulin<br />Analog of the hormone amylin<br />Hormone cosecreted with insulin by the beta cells in the pancreas<br />Deficient in people with type 2 and type 1 diabetes<br />Adjunct treatment for people with type 2 or type 1 diabetes who take mealtime insulin<br />Injectable<br />Taken prior to major meals <br />A major meal is >30 grams of carbohydrate or > 250 calories<br />Offers improved blood glucose control<br />Fewer blood sugar swings throughout the day<br />Added benefit of potential weight loss<br />6/21/2011<br />7<br />
  9. 9. The numbers shed light on the product’s challenges<br />3<br />Patients taking pramlintide at meal times may already be taking 4 shots of insulin a day<br />Pramlintide becomes 3 additional shots to integrate into a daily routine<br />50%1<br />Adherence to medicines across multiple chronic conditions, including diabetes<br />50% in 2 months2<br />About 50% of patients starting pramlintide discontinued therapy within 2 months<br />6/21/2011<br />8<br />Sources: <br />1. World Health Organization: Adherence to long-term therapies: evidence for action. Geneva, World Health Organization, 2003. <br />2. Data on file. San Diego, CA., Amylin Pharmaceuticals, Inc.<br />
  10. 10. Why did patients stop treatment? Their answers revealed a need<br />6/21/2011<br />9<br />Lack of effectiveness (volunteered)<br />Dosing regimen too complicated<br />Did not lose weight<br />Too expensive<br />Side effects (volunteered)<br />Additional injections required<br />Potentially 57% of reasons for discontinuation can be addressed with<br />additional education/realistic expectations<br />Source: <br />Adapted from Lorenzi GM, LaRue SM, Collins SE. Effects of a patient support program on pramlintide adherence. Clin Diabetes. 2011;29(1):17-24.<br />
  11. 11. To develop our program, we started with the Return on EducationTMapproach<br />10<br />Program<br />Development and <br />Refinement<br />Post (After Program Launch)<br />Pre (In Planning)<br />During (In Development)<br />Uncover Insights<br />Choose Behavior Model<br />Develop Objectives<br />Capture and Analyze Results <br />Launch<br />
  12. 12. Program objectives were based on behavior-change principles<br />Set realistic expectations at the beginning of treatment<br />Build problem-solving and communication skills<br />Increase sense of self-efficacy (“I can do this”)<br />6/21/2011<br />11<br />
  13. 13. Trying to take a walk in patients’ shoes (uncovering insights)<br />6/21/2011<br />12<br />Starting Pramlintide Therapy<br />Maintaining Pramlintide Therapy<br /><ul><li>Healthcare provider knowledge
  14. 14. Realistic expectations
  15. 15. Hope for improvement
  16. 16. Adjustment period/need for flexibility
  17. 17. Insulin/appetite changes
  18. 18. Weight loss
  19. 19. Improved glucose levels, fewer fluctuations
  20. 20. Improved AIC
  21. 21. Perceived benefits of therapy
  22. 22. Increased sense of control of diabetes
  23. 23. Weight loss
  24. 24. Less insulin</li></ul>Motivators<br />Motivators<br /><ul><li>Additional injections
  25. 25. Side effects
  26. 26. Therapy disappointment
  27. 27. Impact of changes on family dynamics
  28. 28. Suboptimal dosing; fewer benefits realized
  29. 29. Life demands
  30. 30. Lack of healthcare provider support and education
  31. 31. Frustration: different routine and considerations
  32. 32. Unanticipated hyperglycemia
  33. 33. Injection burden and treatment complexity
  34. 34. Unexpected side effects</li></ul>Barriers<br />Barriers<br />
  35. 35. Behavior models provide a blueprint for program design <br />6/21/2011<br />13<br />Program designed using Social Cognitive Theory<br />
  36. 36. Designed for clarity by integrating health literacy principles <br />6/21/2011<br />14<br />“I have challenges accessing, understanding, and using health information “<br />“One out of 3 Americans have basic or below basic health literacy skills”<br />Source: <br />National Center for Education Statistics.  The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. (NCES 2006-483). http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006483.<br />
  37. 37. Applying the Return on EducationTMapproach to develop the program<br />15<br />Program<br />Development and <br />Refinement<br />Post (After Program Launch)<br />Pre (In Planning)<br />During (In Development)<br />Uncover Insights<br />Choose Behavior Model<br />Develop Objectives<br />Capture and Analyze Results <br />Launch<br />
  38. 38. Starting Pramlintide Therapy<br />Maintaining Pramlintide Therapy<br />Starting Pramlintide Therapy<br />Maintaining Pramlintide Therapy<br /><ul><li>Healthcare provider knowledge
  39. 39. Realistic expectations
  40. 40. Hope for improvement
  41. 41. Adjustment period/need for flexibility
  42. 42. Insulin/appetite changes
  43. 43. Weight loss
  44. 44. Improved glucose levels, fewer fluctuations
  45. 45. Improved AIC
  46. 46. Perceived benefits of therapy
  47. 47. Increased sense of control of diabetes
  48. 48. Weight loss
  49. 49. Less insulin</li></ul>In-officestarter kit with demo video<br />Welcome kit with goal setting and wellness map <br />Newsletter with expert <br />and patient interviews<br />Motivators<br />Motivators<br />Share Your Story<br />Newsletters<br />Feedback survey<br />Co-pay card<br />Co-pay card<br />Outbound/inbound calls with nurses<br />24/7 Information and education<br />Outbound/Inbound calls with nurses<br />24/7 Information and education<br />Program design was mapped to insights…<br />6/21/2011<br />16<br /><ul><li>Additional injections
  50. 50. Side effects
  51. 51. Therapy disappointment
  52. 52. Impact of changes on family dynamics
  53. 53. Suboptimal dosing; fewer benefits realized
  54. 54. Life demands
  55. 55. Lack of health care provider support and education
  56. 56. Frustration: different routine and considerations
  57. 57. Unanticipated hyperglycemia
  58. 58. Injection burden and treatment complexity
  59. 59. Unexpected side effects</li></ul>Barriers<br />Barriers<br />
  60. 60. To create a holistic, integrated experience <br />6/21/2011<br />17<br />Starting Pramlintide Therapy<br />Maintaining Pramlintide Therapy<br />In-officestarter kit with demo video<br />Welcome kit with goal setting and wellness map <br />Newsletter with expert <br />and patient interviews<br />Share Your Story<br />Newsletters<br />Feedback survey<br />Co-pay card<br />Co-pay card<br />Outbound/inbound calls with nurses<br />24/7 Information and education<br />Outbound/Inbound calls with nurses<br />24/7 Information and education<br />
  61. 61. Outcomes of a Behaviorally Based Program<br />
  62. 62. Did the Return on EducationTMapproach work? <br />19<br />Program<br />Development and <br />Refinement<br />Post (After Program Launch)<br />Pre (In Planning)<br />During (In Development)<br />Uncover Insights<br />Choose Behavior Model<br />Develop Objectives<br />Capture and Analyze Results <br />Launch<br />
  63. 63. Education Impact<br />Return on EducationTMframework guided the evaluation plan<br />6/21/2011<br />20<br />Desired Action <br />Program/Business Impact<br />Persuasion <br />Behavior Change Model Metrics<br />Change in Knowledge<br />Change in Attitudes<br />Change in Skills<br />+<br />Clarity<br />Clear by Design<br />+<br />Insight-driven content<br />Tone <br />Relevance<br />Accuracy of Information<br />+<br />Reaction to tactic/program<br />Satisfaction<br />Appeal<br />Usefulness<br />Needs Met<br />Impact<br />Intended/Actual use of materials<br />Customized based on program objectives<br />Examples include<br />Screening/diagnosis<br />Talking with HCP<br />Fill initial Rx<br />Take Rx as prescribed<br />Conversion<br />Use of device<br />Program<br />Engagement<br />Reach<br />Frequency<br />Enrollment<br />Channel preference<br />Site visits<br />Business<br />Length on therapy<br />Increased sales<br />Rep access<br />Market expansion<br />Health Outcomes<br />Symptom alleviation<br />HEDIS measurement<br />Function<br />Clinical measures<br />
  64. 64. Program was relevant<br />75%: same or more vs. 11% less<br />Q: Would you like to have more, less or about the same: Information about organizing my medicines<br />6/21/2011<br />21<br />75% of respondents want the same or more level of information about organizing their medicines<br />Source: <br />Data on file. San Diego, CA., Amylin Pharmaceuticals, Inc.<br />
  65. 65. Program had high appeal<br />71% of respondents want the same or more tools for talking with their HCP<br />71%: same or more vs. 13% less<br />Q: Would you like to have more, less or about the same: Tools for talking with my HCP<br />Source: <br />Data on file. San Diego, CA, Amylin Pharmaceuticals, Inc.<br />
  66. 66. Program was useful<br />6/21/2011<br />23<br />Percentage of Patients<br />The same/longer duration of calls<br />The same/more frequent diabetes information<br />The same/more frequent contact<br />The same/more frequentnewsletters<br />Patients Wanted:<br />Source: <br />Adapted from Lorenzi GM, LaRue SM, Collins SE. Effects of a patient support program on pramlintide adherence. Clin Diabetes. 2011;29(1):17-24.<br />
  67. 67. Prompted patients to talk with their HCPs <br />Most respondents agree that the program helps them talk with their HCPs<br />Q: The Support Program has helped me talk with my HCP about my pramlintide treatment<br />Source: <br />Data on file. San Diego, CA, Amylin Pharmaceuticals, Inc.<br />24<br />
  68. 68. 6/21/2011<br />25<br />Percentage of Patients<br />Patients Reported:<br />High self-reported compliance and persistency<br />On and continuing therapy the first 3 months<br />Administration of maintenance dose<br />Dosing 2 or 3 times daily<br />Source: <br />Adapted from Lorenzi GM, LaRue SM, Collins SE. Effects of a patient support program on pramlintide adherence. Clin Diabetes. 2011;29(1):17-24.<br />
  69. 69. Improvements were demonstrated<br />6/21/2011<br />26<br />Patients in program were on pramlintide 50% longer relative to those not in program<br />Source: <br />Adapted from Lorenzi GM, LaRue SM, Collins SE. Effects of a patient support program on pramlintide adherence. Clin Diabetes. 2011;29(1):17-24.<br />
  70. 70. Program refinement based on analysis<br />
  71. 71. Using the Return on EducationTMapproach to refine<br />©2011 HealthEd Group, Inc.<br />28<br />Program<br />Development and <br />Refinement<br />Post (After Program Launch)<br />Pre (In Planning)<br />During (In Development)<br />Uncover Insights<br />Choose Behavior Model<br />Develop Objectives<br />Capture and Analyze Results <br />Launch<br />
  72. 72. Teachable moments shouldn’t be missed<br />Web enrollments make up 50% of enrollees and often occur outside of business hours of call center. <br />6/21/2011<br />29<br />Video-based FAQs feature call center nurse<br />Video on BRAND.com creates continuity and familiarity<br />
  73. 73. Educational game developed to address confusion about Major Meals<br />6/21/2011<br />30<br />Brand<br />Brand<br />Brand.<br />
  74. 74. One barrier and motivator still had to be addressed<br />6/21/2011<br />31<br />Starting Pramlintide Therapy<br /><ul><li>Healthcare provider knowledge
  75. 75. Realistic expectations
  76. 76. Hope for improvement
  77. 77. Adjustment period/need for flexibility
  78. 78. Insulin/appetite changes
  79. 79. Weight loss</li></ul>Motivators<br /><ul><li>Lack of healthcare provider support and education
  80. 80. Frustration: different routine and considerations
  81. 81. Unanticipated hyperglycemia
  82. 82. Injection burden and treatment complexity
  83. 83. Unexpected side effects</li></ul>Barriers<br />
  84. 84. A challenge and opportunity for you<br />
  85. 85. You can use the Return on EducationTMapproach to createa solution that promotes action and change<br />33<br />Program<br />Development and<br />Refinement<br />Post (After Program Launch)<br />Pre (In Planning)<br />During (In Development)<br />Uncover Insights<br />Choose Behavior Model<br />Develop Objectives<br />Capture and Analyze Results <br />Launch<br />
  86. 86. Education Impact<br />Desired Action <br />And evaluate your Return on EducationTM<br />6/21/2011<br />34<br />Program/Business Impact<br />Customized based on program objectives<br />Examples include<br />Screening/diagnosis<br />Talking with HCP<br />Fill initial Rx<br />Take Rx as prescribed<br />Conversion<br />Use of device<br />Persuasion <br />+<br />Clarity<br />+<br />Insight-driven content<br />+<br />Reaction to tactic/program<br />Program<br />Engagement<br />Reach<br />Frequency<br />Business<br />Length on therapy<br />Increased sales<br />Rep access<br />Health Outcomes<br />Symptom alleviation<br />HEDIS measurement<br />Function<br />Clinical measures<br />
  87. 87. This is a complicated recipe<br />6/21/2011<br />35<br />
  88. 88. What patients have to manage day to day can also be complicated<br />6/21/2011<br />36<br />“My Day”<br />
  89. 89. Retention ratesof different learning styles1<br />Hands On<br />90%<br />Within just a few minutes of leaving the doctor’s office, patients may remember less than 50% of the critical information the doctor shared.2<br />Discussion<br />60%-70%<br />Audiovisual<br />40%-50%<br />Seeing<br />HearRead<br />Digital solutions can help make learning more effective<br />37<br />10%-20%<br />5%-15%<br />HCP Office Visit<br />1. Adapted from Edgar Dale’s “Cone of Experience.<br />2. Davis TC, Williams MV, Marin E, Parker RM, Glass J. Health literacy and cancer communication. CA Cancer J Clin. 2002;52:134-149.<br />
  90. 90. Which can lead to positive health outcomes<br />6/21/2011<br />38<br />“My Health”<br />
  91. 91. Thank you! <br />Time for your questions<br />6/21/2011<br />
  92. 92. To contact us<br />Susan LaRue Susan.LaRue@amylin.com<br />Susan Eno Collins s.collins@healthed.com<br />To obtain a copy of this presentation, go to www.healthed.com<br />6/21/2011<br />40<br />

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