Adherencia al tratamiento en asma - Antje-Henriette Fink-Wagner, PhD
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Conferencia dictada en el XVII Congreso Latinoamericano de Alergia, Asma e Inmunología, Cartagena, 2012

Conferencia dictada en el XVII Congreso Latinoamericano de Alergia, Asma e Inmunología, Cartagena, 2012

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

  • 1. Adherence to TreatmentAdherencia al Tratamiento Antje-Henriette Fink-Wagner, PhD Executive DirectorGlobal Allergy and Asthma Patient Platform GAAPP Antje-Henriette Fink-Wagner, 2012 1
  • 2. Statement of InterestNo conflict of interest! Antje-Henriette Fink-Wagner, 2012 2
  • 3. Contentor what you will take home from this presentation – 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 Examples: – Physician – Family and friends – Nurse – Policy Makers – Pharmacist – Pharmaceutical industry – Insurance/funds – Patient associations – Conclusion Antje-Henriette Fink-Wagner, 2012 3
  • 4. Health Literacya 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? Antje-Henriette Fink-Wagner, 2012 4
  • 5. Health Literacya 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! Antje-Henriette Fink-Wagner, 2012 5
  • 6. Patient advocacy as 1st step to empower patients andto increase adherence/concordance for better patientcompliance – 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 Antje-Henriette Fink-Wagner, 2012 6
  • 7. Reality of non-compliance Compliance is the main challenge for optimal treatment of patients in generalSource: Antje-Henriette Fink-Wagner, 2012 7
  • 8. Adherence to new medication: Patients‘ problems with new medication for chronic conditions Still taking medication at 10 days Still taking medication at 4 weeks (n = 226/239) (n = 171/197) Adherent 159 (70%) 128 (75%) Non-adherent Partial non-adherence 67 (30%) 43 (25%) Complete non-adherence 49 26 18 17Source: N. Barber, J. Parsons, S. Clifford, R. Darracott, R. Horne; Qual Saf Health Care2004; 13: 172-175, doi: 10.1136/ qshc.2003.005926 Antje-Henriette Fink-Wagner, 2012 8
  • 9. Example Compliance with and without help taking medication in Hp eradication therapySource: F.A. Al-Eidan et al. J Clin Pharmacol 2002, 53, 163-171 Antje-Henriette Fink-Wagner, 2012 9
  • 10. … without any problems? Valerie uses her spray twice daily – without any relief! Antje-Henriette Fink-Wagner, 2012 10
  • 11. Model of patient behaviorLevendahl, et al. stated 1992: Patients personal ideas These can be thought of about their illness are often as the answers to five basic organized around five questions about the illness components: or health threat: – Identity – What is it? – Timeline – How long will it last? – Cause – What causes it? – Consequences – How will it/has it affected me? – Control/cure – 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. Antje-Henriette Fink-Wagner, 2012 11
  • 12. How can patient behavior be changed Physician Conclusion Antje-Henriette Fink-Wagner, 2012 12
  • 13. PhysicianMotivational interviewing: Ask open questions in PhysicianPatient 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 BMJ 2010 Source: Antje-Henriette Fink-Wagner, 2012 13
  • 14. PhysicianMotivational interviewing Physician 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 Antje-Henriette Fink-Wagner, 2012 14
  • 15. PhysicianNever forget the WRITTEN action plan! PhysicianRed Zone: Stop! Danger!Yellow Zone: Caution! Slow Down!Green Zone: Go! Antje-Henriette Fink-Wagner, 2012 15
  • 16. How can patient behavior be changed Nurse Conclusion Antje-Henriette Fink-Wagner, 2012 16
  • 17. Example: Nurse NursePhone Dialogdoctor – 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
  • 18. Example: Nurse NurseNational Jewish Medical and Research CenterCOPD all plan members12-month utilization data 1500 1383 Baseline 7 to 12 Months p < 0.001 1000 756 582 -45.1% 500 -79.7% -58.9% 415 281 - 48.2% 239 164 -70.7% 245 127 48 0 Adult Days Missed ER Visits Hospitalizations Unscheduled Dr. Visits Oral Antibiotic Bursts from Work n = 272 n = 751 n = 751 n = 751 n = 746Source: Data provided by David Tinkelman, vice president Health Initiatives NJC, December 2002 Antje-Henriette Fink-Wagner, 2012 18
  • 19. How can patient behavior be changed Pharmacist Conclusion Antje-Henriette Fink-Wagner, 2012 19
  • 20. Example: Pharmacist 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
  • 21. Appetizer … Pharmacist Voilà – Amuse gueule! Antje-Henriette Fink-Wagner, 2012 21
  • 22. How can patient behavior be changed Insurance/ Funds Conclusion Antje-Henriette Fink-Wagner, 2012 22
  • 23. Example: Insurance/Funds Reminder service Insurance/ Funds 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 memberSource: Techniker Krankenkasse, 2005; www.tk-online.de Antje-Henriette Fink-Wagner, 2012 23
  • 24. Example: Insurance/Funds Diagnostic information for members Insurance/ Funds – 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 guidelinesSource: Techniker Krankenkasse, www.tk-online.de, Januar 2005 Antje-Henriette Fink-Wagner, 2012 24
  • 25. 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.Source: Chest 2011 Antje-Henriette Fink-Wagner, 2012 25
  • 26. How can patient behavior be changed Family and Friends Conclusion Antje-Henriette Fink-Wagner, 2012 26
  • 27. Example: Family and FriendsSmoking cessation “Feel free to say no”, an initiative of the European Union: Testimonials presents the friends of the target groups Antje-Henriette Fink-Wagner, 2012 27
  • 28. Memory function … Family and Friends Paul, hurry! You have to be at the doctor’s at eleven … Antje-Henriette Fink-Wagner, 2012 28
  • 29. How can patient behavior be changed Public/ Conclusion Policy Makers Antje-Henriette Fink-Wagner, 2012 29
  • 30. Policy MakersHealth Literacy: a precondition to achieve acceptableadherence/concordanceEuropean Health Award October 2012 : Public Policy Makers• Survey of the HLS-EU CONSORTIUM 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. 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 Antje-Henriette Fink-Wagner, 2012 30
  • 31. PublicWorld Awareness days Public Policy Makers Joint messages in as many countries As possible Creates awareness about a special disease to patients, public and Policy Makers Antje-Henriette Fink-Wagner, 2012 31
  • 32. How can patient behavior be changed Pharma- ceutical Industry Conclusion Antje-Henriette Fink-Wagner, 2012 32
  • 33. Example: Pharmaceutical IndustryZacPac Pharma- History ceutical 3 packages to eradicate Hp: Industry 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 Antje-Henriette Fink-Wagner, 2012 33
  • 34. Example: Technical IndustryHelping Hand™ – Electronic tool offered Pharma- by Bang & Olufsen ceutical – Reminds patients to take Industry 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) Antje-Henriette Fink-Wagner, 2012 34
  • 35. How can patient behavior be changed Patient Associations Conclusion Antje-Henriette Fink-Wagner, 2012 35
  • 36. Patient AssociationEuropean Federation of Allergy and AirwaysDiseases Patient Associations EFA Patient Associations – 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 Antje-Henriette Fink-Wagner, 2012 36
  • 37. 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
  • 38. Patient AssociationGlobal Allergy and Asthma Patient Platform Patient – 24 member organizations on all Associations Continents – Sport Games for children with asthma to promote adherence to sport for asthmatics (see first talk of this session) Antje-Henriette Fink-Wagner, 2012 38
  • 39. Conclusion Adherence / Concordance will improve as the sum of individual advocacy initiatives by all allied healthcare professionals and the patients themselves. Antje-Henriette Fink-Wagner, 2012 39
  • 40. Thank You! COMPLY – OR DIE Antje-Henriette Fink-Wagner, 2012 40