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September 17, 2009 Volume VI, No. 18

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

In this issue of the Disease Management Update, you will discover how medication adherence impacts possible fractures and hospitalizations among women with postmenopausal osteoporosis. Our prevention story for this week takes issue with current methods of estimating the costs of federal health initiatives for preventing and managing chronic diseases. Also in this issue, a recent study answers the question of whether air pollution causes heart disease.

P.S. Beginning this week, I'm taking over the reins of the Disease Management Update. Please email your concerns and story ideas to me at jpapay@hin.com.

Your colleague in the business of healthcare,
Jessica Papay
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. Medication Adherence and Osteoporosis
  2. Can Air Pollution Cause Heart Disease?
  3. Improving Medication Adherence
  4. Home Visits for Heart Failure Patients
  5. Healthcare Trends & Studies
  6. Chronic Disease Costs
  7. Telehealth in 2009

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Medication Adherence Important Factor in Postmenopausal Osteoporosis Treatment

New research from Amgen Inc. highlights the links between medication satisfaction, adherence to therapy and fracture risk reduction among women with postmenopausal osteoporosis.

Data collected from the Prospective Observational Scientific Study Investigation Bone Loss Experience (POSSIBLE US™) study showed that women who were less satisfied with their osteoporosis therapy were more likely to discontinue or switch their therapy compared to women who were more satisfied. In this study, in which women self-reported their adherence to therapy, 25 percent reported discontinuation of their initial therapy within the first study year and an additional 7 percent reported that they switched from their initial therapy to another therapy. Women who were less satisfied with the convenience of their treatment were approximately 39 percent more likely to discontinue or switch their initial therapy, and women who were less satisfied with the effectiveness of their treatment were approximately 25 percent more likely to discontinue or switch.

Two retrospective analyses were conducted from a study that examined the impact of medication adherence on risk of fracture, hospitalization and healthcare costs among women initiating osteoporosis medication. The two analyses used medical and pharmacy claims from 32,573 women who initiated treatment on alendronate, risedronate, teriparatide, ibandronate or raloxifene in a large U.S. health plan. One analysis showed that patients with low adherence had a 20.4 percent higher risk of fracture than did patients with high adherence.

To learn more about this research, please visit:

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Can Air Pollution Cause Heart Disease?

Itís well known that measures such as exercise, a healthy diet and not smoking can help reduce high blood pressure, but researchers at the University of Michigan (U-M) Health System have determined the very air we breathe can be an invisible catalyst to heart disease. Inhaling air pollution over just two hours caused a significant increase in diastolic blood pressure, the lower number on blood pressure readings, according to new U-M research.

In the study, researchers hoped to identify which air pollutants are harmful and how the pollutants work to damage the cardiovascular system.

Ozone gases, a well-known component of air pollution, were not the biggest culprit. Rather, small microscopic particles about a 10th of the diameter of a human hair caused the rise in blood pressure and impaired blood vessel function, tests showed. The blood pressure increase was rapid and occurred within two hours, while the impairment in blood vessel function occurred later but lasted as long as 24 hours.

To learn more about this research, please visit:

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Improving Medication Adherence — Practical Strategies to Increase Patient Compliance

U.S. healthcare spends an estimated $177 billion on medication non-adherence annually — nearly 80 percent of the country's healthcare spending. And the pharmaceutical industry loses billions of healthcare dollars annually as a result of medication non-adherence. Thom Stambaugh, chief pharmacy officer and vice president of clinical programs and specialty pharmacy for CIGNA Pharmacy Management, discusses strategies for recovering some of this lost revenue, the challenges behavioral health patients bring to medication compliance and how CIGNA measures compliance in its population.

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How-toís of Home Visits for Heart Failure Patients

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Michele Gilbert, M.S.N., education coordinator of the heart failure team and pulmonary hypertension program at Hackensack University Medical Center.

Question: What are the components and goals of the home visits conducted by the heart failure team?

Response: We have spent a lot of time teaching our home care nurses to be astute observers. One thing the nurse will do is interview the patient regarding their health practices and understanding of the disease. We give patients basic educational information. When the nurse conducts the visit, she does a complete physical assessment, as well as an assessment of the patientís functional abilities. We use the Minnesota Living With Heart Failure Questionnaire, which addresses functional status for the patient. We use that at the first and last visits to ensure that the patientís functional status and ability to self-manage is improving. We find out what the patient has been eating and what theyíre doing. We get our baseline.

On subsequent visits, the nurse might empty the patientís pantry and show them how much sodium theyíve been eating. They ensure the patient understands where to find hidden sources of sodium. The nurse continues to assess the patientís progress. They will provide them with a daily system for weighing themselves and recording their weight. The patientís ability to self-medicate is also assessed. If they donít have a system for taking their medications, we provide one, such as a seven-day pillbox with four compartments.

For more information on reducing readmissions for heart failure patients, please visit:

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Estimating Costs of Federal Chronic Disease Prevention Programs

Current methods used to estimate the costs of federal health initiatives may not capture the full impact of steps to prevent and manage chronic disease, according to a study published on the Health Affairs Web site. The effects of prevention and treatment interventions on healthcare costs and the federal budget have been primary points of contention in the ongoing debate over federal health reform legislation. The new study, funded by the National Changing Diabetes Program at Novo Nordisk, Inc., suggests that well-designed interventions dealing with chronic illness could be more cost-effective than projected in some estimates to date.

The study authors present a new epidemiologically based model that projects federal costs for type 2 diabetes under different policy options. They argue that this model, and similar models for other chronic diseases such as heart disease, could be used to provide more accurate estimates of the long-term spending associated with diabetes treatment interventions. Currently the Congressional Budget Office (CBO) — which estimates or "scores" the costs of federal programs for Congress — and the Office of the Actuary at CMS — which projects Medicare costs on behalf of the administration — rely heavily on health economic or actuarial models. These models work well for most healthcare policies, but cannot capture the changes in disease progression found in a chronic disease like diabetes.

The researchers also argue that the 10-year budget window typically used by Congress may not be long enough to accurately assess the effects of many interventions addressing chronic disease. "For many chronic illnesses, and in the case of diabetes in particular, complications from the disease may not show up for many years. Thus, cost estimates covering only 10 years may capture the up-front costs of prevention and disease management efforts but not the long-term health and economic benefits of avoiding future complications," said coauthor Michael O'Grady, a senior fellow at the National Opinion Research Center (NORC) in Bethesda, Maryland and principal of O'Grady Health Policy LLC.

To learn more about this research, please visit:

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Telehealth in 2009

While rising healthcare costs fuel much of the healthcare reform debate, many healthcare organizations are turning to telehealth to lower costs and improve efficiencies while expanding patients' access to services. Complete HIN's Survey of the Month on Telehealth in 2009 by September 30 and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

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