Envisioning 2.0

This interesting article provides information on how pharmaceutical companies are marketing to minority populations.  The author of this article notes that NitroMed’s BiDil marketing efforts have had mixed results.  However, my recent interview with Dr. Keith Ferdinand reveals that BiDil’s dosing schedule and generic competition may be  the key reasons the drug is not doing well.

A new study suggests that blacks don’t trust doctors . . . This study has interesting implications for the healthcare disparities debate.

Kate Steadman’s got more on this story.

at a health wonk’s blog . . . The Health Business Blog.  Click here to view it.

Race-based medicine, or the practice of treating people differently based on their racial and ethnic background, has long been a subject of interest to healthcare providers, public health practitioners, communicators and others. Now, with the introduction of BiDil, the first medication approved for the treatment of a condition in a specific race (African Americans), the topic is once again gaining increased attention.

Given the intense interest in this subject, I am conducting a series of periodic interviews with physicians, executives from medical societies, communications experts and others. Each interview subject provides his or her unique perspective on race-based medicine, which I then publish on this blog. Please click here to read the other interviews in this series.

Interview Subject: Dr. Keith Ferdinand

About Dr. Ferdinand: Dr. Ferdinand is a clinical cardiologist, and was Medical Director of Heartbeats Life Center in New Orleans, Louisiana prior to Hurricane Katrina. He is currently Chief Science Officer of the Association of Black Cardiologists, Past-President and member of the Louisiana State Board of Medical Examiners; Past-President of the Orleans Division of the American Heart Association; and Past-Chairman of the Board of the Association of Black Cardiologists, Inc.

Dr. Ferdinand also serves on the advisory board of the African American Heart Failure Trial (A-HeFT) trial. A-HeFT is the first major clinical trial to test the effectiveness of a heart failure medication in a targeted population. The study investigated the response to BiDil added to standard treatment in self-identified African Americans with advanced heart failure.

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I’ve posted the final version of my blogposium entry on the Clinical Informatics Wiki. You can view it by clicking here.

Thanks to all those who commented on the article.

Health Wonk Review #5

Welcome to the fifth edition of the Health Wonk Review. This growing bi-weekly carnival is designed to highlight the best health policy-related blog posts of the previous two weeks. It was inspired by the work of Nicholas Genes who founded the weekly medical blog gathering, Grand Rounds.

After much cajoling and sucking up, I was able to convince the estate of the late, great Albert Einstein to provide some archival photos for this edition of the Review. It turns out that Einstein predicted that the Health Wonk Review would one day spring into existence and had someone photograph him writing pithy statements about health policy on his trusty blackboard. These photos appear below for your viewing pleasure.

Technology/IT

Calling All Bloggers: Dmitriy Kruglyak of The Medical Blogging Network was tapped to speak at the 2006 Consumer Directed Health Care Conference and Expo, taking place this May about the impact of blogs on consumer driven healthcare. In this post he issues a call for case studies of bloggers who are using this technology to take more responsibility for their healthcare. Click here to learn more and to submit a case study.

Blogposium and Consumer-Driven Healthcare: Jack Mason has gathered together a number of healthcare bloggers to participate in the first Blogposium, a three-day virtual conference designed to add content to the Clincial Informatics Wiki. In this post, Trapier Michael of Marketplace.MD schools readers on the history of consumer-driven healthcare.

The Virtual House Call: Dr. Paul Grundy, IBM’s Well-Being Director, introduces a new service CIGNA has launched, Physician webVisits, which will enable some California patients to access a type of “virtual house call” for non-urgent health issues. Yet another service that will help patients navigate this new world of consumer-driven healthcare.

The Business Of Healthcare

Healthcare vs. Health Insurance: At InsureBlog, Bob Vineyard explains the difference between health *insurance* and health *care,* and looks at how providers often get stuck by both systems.

The Gulf Between Words & Action: Dr. Roy Poses highlights the actions of the Leapfrog Group’s member companies, which are providing generous retirement benefits to managers while cutting health plans of other retirees.

TBTAM Issues A Warning: The Blog That Ate Manhattan warns that pharmaceutical companies are using the Together Rx program to gather sensitive health information and use it for marketing purposes.

Ending The War Between Clinicians & Finance Folks: Hospital Impact brings up an age-old hospital management issue: why clinical and financial leaders constantly butt heads, and what one CFO did to bridge the gap at his hospital.

Wal-Mart Offers Health Insurance, What Does This Mean?: Kate Steadman of Healthy Policy takes a look at Wal-Mart’s recent announcement that it will loosen the eligibility requirements for part-time workers to obtain health insurance.

Politics, Policy and Economics

MA Health Reform Knowledge: Tapped From The Source: John McDonough, who leads Healthcare For All, Massachusetts’ leading consumer health advocacy group, introduces his organization’s blog. He says: “We cover MA health reform like a glove, and if folks want an up close and personal look at the dynamics of this new MA health reform law, we suggest our site.” This post was based on his advocacy coalition’s fast analysis of the reform law hours before the final legislative vote. This is just one example of many health reform posts to be found on his group’s blog, A Healthy Blog. (Side note: McDonough is also featured in my recent report on healthcare blogs.)

Will The Real HSA Fan Please Stand Up?: Matthew Holt of The Health Care Blog wonders what the HSA fans really mean, and asks if the real HSA fans will please stand up. Meanwhile, he describes his own surreal Dickensian trip through the individual insurance market at Spot-on in a Tale of Two Underwriters.

You Can Do It — If You Try: Marcus Newberry of Fixin’ Healthcare describes a project in Finland that demonstrates how a determined, well-conceived public health intervention influences health related lifestyle and population risk factors and leads to reduced disease rates and improved health.

Cato Dead Wrong On Mass Plan: David Williams of the Health Business Blog talks about why the new Massachusetts health care plan is a whole lot better than the Cato Institute would have you believe.

We Want Transparency . . . Except In Medicare: Joe Paduda of Managed Care Matters talks about a contradiction that “could only arise from inside the Beltway.” He says: “The Bush Administration is avidly promoting consumerism as the cure for health care’s ills, yet refuses to release provider outcomes data from Medicare databases, citing an apparently weak prohibition against such disclosure.”

Malpractice Law Needs Fixing: This post from Jason Shafrin of Healthcare Economist reviews two academic papers which analyze the incidence of malpractice suits in the United States. The papers find that 3-5% of all hospitalizations are due to doctor error. It is surprising, however, to see that that only 3% of people who do suffer a negligent iatrogenic injury sue their doctor. Further, since so few people who suffer negligent injuries sue, over half of the caseload in the court system today is due to frivolous malpractice lawsuits.

Beyond Category

Finally, we end this edition with a few posts that are “beyond category.”

The WTC and Worker’s Comp: The World Trade Center Health Registry is currently tracking some 71,437 people who worked at ground zero, and while health effects are expected to take 20+ years to be fully evident, deaths from respiratory diseases are surfacing. Julie Ferguson of Workers Comp Insider discusses the limitations of workers compensation in addressing these and other toxic exposures.

Bloggers: Let’s Link Up: Dr. Steve Beller of Curing Healthcare presents a proposal for linking communities of healthcare blogs with wikis. Dr. Beller’s idea is to organize a community of blogs and wikis focused on helping to solve the healthcare crisis through news feeds, conversations and knowledge-sharing that increase people’s understanding, spark innovation, provide decision-support, and mobilize grass-roots efforts.

That’s it for this edition of the Health Wonk Review. I hope you enjoyed it. Joe Paduda at Managed Care Matters will host the next event. Be sure to visit the Health Wonk Review Web site to learn more about this event and submit a post.

at Fat Doctor.

As some of you know, I’m hosting this week’s edition of the Health Wonk Review. To submit a post, please click here. Submissions are due at 9:00 a.m. tomorrow.

I will post the next edition on April 20.

Following is my contribution to an innovative project Jack Mason of HealthNex has started. It is called Blogposium, a “three-day collaboration of healthcare bloggers to expand the Clinical Informatics Wiki.”

Please help us make this effort a success by making comments and providing edits to each entry. You can find additional Blogposium submissions at the following blogs:

• Christina’s Considerations: Regional Health Information Organizations
• eHealth: Integration of Personal Health Records and Electronic Medical Records
• EMR and HIPAA: Electronic Medical Records and Biometric Integration
• HealthNex: Biobanking, Patient Experiential Data and Genetic Privacy Issues
• HITsmit: e-MAR Systems
• HIT Transition: RHIO Startup Funding and Finance
• Marketplace.MD: The Consumer-Driven Health Care Movement
• medmusings: Mobile Access to EMR/EHR/PHR for Providers and Patients
• Usemed: Ongoing and Completed EHR, CPOE and CDS Implementation Projects

My entry, focusing on the impact of SMS and blogs on the patient-provider relationship is below.

SMS, Blogs and the Patient-Provider Relationship: Enhancing Communication, Improving Treatment Outcomes

The healthcare provider-patient relationship is one of our most valued and important connections. This is true across a range of countries and cultures. For example, according to a 2003 study presented at the World Medical Association, people ranked their relationship with their physician as second only to their connection with family members.[1] Another study indicates that people want their physicians to have good communications skills, to be accessible and to partner with them to help them achieve good health.[2]

Unfortunately, patients and medical professionals face significant obstacles to building strong, positive relationships. One barrier is time. Many medical professionals complain that they have limited time to address all of their patients’ needs during a visit. Another challenge is behavior, specifically patient noncompliance with medication and missed appointments. It is difficult for providers to build rewarding connections with noncompliant patients or those who do not show up for sessions.

Fortunately, patients and medical professionals have access to a number of inexpensive and easy-to-use technologies that they can use to enhance communication, increase compliance, limit no-shows and improve treatment outcomes. This article focuses on how two of them, text messaging and blogs, can improve the patient-provider relationship and medical management.

Definitions: Text Messaging and Blogs

Text Messaging (SMS)

Short Message Service (SMS) or text messaging is a mobile phone technology that enables people to send and receive text messages (usually no longer than 160 characters) to cell phone or computer users.

Blogs

Blogs are Web sites containing an archive of content in reverse chronological order.[3] Over the past decade, blogs have increased in popularity because they enable people to publish content to the Web without having a great deal of technical expertise.

SMS and the Patient-Provider Relationship

As indicated above, two significant barriers to the development of a positive patient-provider relationship is noncompliance and patient no-shows. Evidence is building that SMS may be an inexpensive and efficient way to solve both of these problems.

Reducing Missed Appointments Using SMS

Missed appointments are a significant problem in many countries, especially in Britain. It is estimated that patient no-shows cost the National Health Service (NHS) about £575 million annually.[4] Some studies suggest that SMS may help reduce the rate of missed appointments. For example, a trial conducted at London’s Homerton Hospital indicates that SMS helped reduce missed appointments at the institution’s Department of Sexual Health by eight percent.[5]

Improving Compliance and Treatment Outcomes with SMS

As medical professionals are all too aware, it is very difficult to monitor patients to ensure they comply with therapy. Using SMS may be one way to increase patient compliance and improve treatment outcomes.

A study published in early 2006 in the journal Sexually Transmitted Infections indicates that patients who receive text messages may be more likely to seek treatment. Patients using SMS took less time to get treated (an average of nine days versus 15 for those not receiving text messages) and used fewer staff resources.[6]

In the United States, healthcare providers have been using SMS to help patients take an active role in their diabetes treatment. In one study, researchers used a text messaging service called “Sweet Talk” with teenage patients. Each day the patients received a reminder to take their medication. Patients that received text messages felt that their treatment was much improved and had better control of their blood glucose levels.[7]

These studies indicate that SMS may help patients have more productive and rewarding relationships with their healthcare providers because they will be more likely to show up for appointments, comply with therapy and have better treatment outcomes.

Blogs and the Patient-Provider Relationship

In 2005, Harris Interactive reported that 117 million Americans regularly turn to the Internet for healthcare-related information.[8] This statistic indicates that the Web has become an important tool for people seeking to become educated about medical conditions.

The Internet is also having an impact on the patient-provider relationship. Traditionally, patients have viewed providers as their primary source of healthcare information. With the advent of the Internet, patients no longer relied primarily on healthcare providers for medical information. They began to gather medical content from the Web and share it with healthcare providers.[9] Today, a significant proportion of medical information available on the Internet is published on blogs and other sources of consumer-generated content (i.e., bulletin boards, podcasts).

With increased education, patients began to feel more comfortable partnering with healthcare providers rather than relying on them to make the majority of medical decisions.[1]

Blogs enhance the provider-patient relationship because they enable both parties to apply and share highly relevant medical information. Blogs can also improve relations between medical professionals and patients by:

- Facilitating Patient-Provider Communication: Blogs can provide an opportunity for patients to ask anonymous questions of providers about how to identify and manage medical conditions. Providers can use blogs to educate patients and direct them to credible sources of healthcare information. However, patients should always be warned that a blog is no substitute for professional, customized medical advice.

- Enhancing Patient Therapy: Some healthcare providers are prescribing blogs to patients as a part of their therapy.[9] They ask patients to use blogs to relate their experiences and share information and insights with others.

- Informing Providers About Best Practices: Patients and healthcare providers can both benefit from the careful application of evidence-based medicine and best practices. Blogs can be a good source of detailed information about how to manage common and rare medical conditions. One example of a good “treatment” blog is Clinical Cases and Images, which physicians at Case Western Reserve University maintain.

Drawbacks

While blogs and SMS have the potential to improve the patient-provider relationship, there are a few drawbacks to these technologies:

- Patient Privacy: Before the use of SMS becomes widespread in patient care, healthcare providers will have to determine ways to preserve patient privacy. With blogs this is less of a problem, as people can post content anonymously.

- Lack Of Data: While investigators have conducted a number of studies examining the benefits of SMS on patient care, additional information is required. Moreover, there has been no systematic review of healthcare blogs to determine if they have a positive impact on the patient-provider relationship or treatment outcomes.

- Access Issues: While SMS technology is available in most parts of the world, many do not have regular access to the Internet. The digital divide between and within countries may hamper the widespread adoption of blogs by medical professionals and patients globally.

References

1. Magee, M. Relationship-Based Health Care in the United States, United Kingdom, Canada, Germany, South Africa and Japan. in World Medical Association Assembly September 11 2003. Helsinki, Finland
2. Anonymous, Future Of Family Medicine: Selected Quantitative and Qualitative Research Findings. 2002, Future of Family Medicine Leawood, Kansas.
3. Anonymous. Blog. 2006 February 16, 2006 [cited 2006 February 19]; Available from: http://en.wikipedia.org/wiki/Blogs.
4. Atun, R. and S. Sittampalam, A Review of the Characteristics and Benefits of SMS in Delivering Healthcare, in The Role of Mobile Phones in Increasing Accessibility and Efficiency in Healthcare. 2006, Vodaphone Group. p. 18-28.
5. Dyer, O., Patients Will Be Reminded of Appointments by Text Messages. British Medical Journal, 2003. 326(7402): p. 1281.
6. Menon-Johansson, A.S., et al., Texting Decreases the Time to Treatment for Genital Chlamydia Trachomatis Infection. Sexually Transmitted Infections, 2006(82): p. 49-51.
7. Anonymous, A Text a Day . . . , in The Economist. March 25, 2006. p. 95.
8. Anonymous. Number of “Cyberchondriacs” – U.S. Adults Who Go Online for Health Information – Increases to Estimated 117 Million. 2005 July 15 [cited 2006 March 19]; Available from: http://www.harrisinteractive.com/harris_poll/index.asp?PID=584.
9. Johnmar, F., The Emerging Healthcare Blogosphere: What Is It & Why Does It Matter? . 2006, Envision Solutions, LLC. New York, NY.

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Critics question Schering-Plough’s decision to specifically exclude African American patients from a phase II trial of its hepatitis C drug, SCH 503034.  See this article for more.

(Via The Bioethics Web log)