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October 21, 2010 Volume VII, No. 16

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

In this week's issue, learn how yoga and exercise can play a role in disease management for fibromyalgia and breast cancer patients, respectively. Plus, learn how telephonic disease management can improve the health of rheumatoid arthritis patients.

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

This week's DM news:

Table of Contents

  1. Fibromyalgia & Yoga
  2. Breast Cancer Risk & Exercise
  3. Patient Activation Measure
  4. Measuring Medication Adherence
  5. What's the ROI from Health Coaching?
  6. 2010 Health & Wellness Benchmarks
  7. Telephonic Disease Therapy Management
  8. Healthcare Trends for 2011

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Yoga Alleviates Pain, Improves Function in Fibromyalgia Patients

Patients participating in a “Yoga of Awareness” program showed significantly greater improvement in fibromyalgia (FM) symptoms and functioning compared to patients on a standard FM care program, according to a study published in an issue of PAIN.

FM is a debilitating condition affecting 11–15 million individuals in the U.S. alone. FM carries an annual direct cost for care of more than $20 billion and drug therapies are generally only 30 percent effective in relieving symptoms and 20 percent effective in improving function. Standard care currently includes medications accompanied by exercise and coping skills approaches.

Given the much higher prevalence of FM in females (80–90 percent), researchers chose to include only women in this study. Fifty-three women at least 21 years of age participated. To be eligible, patients had to meet the following criteria: be diagnosed with FM by American College of Rheumatology (ACR) criteria for at least one year and be on a stable regimen of pharmacologic and/or non-pharmacologic treatment for FM for at least three months. The patients were randomized; 25 participated in the Yoga of Awareness program, while 28 received standard care. Yoga of Awareness is an innovative, comprehensive yoga program, which for the purposes of this study was tailored to address pain, fatigue, sleep disturbance and emotional distress in FM. Each Yoga of Awareness class included approximately 40 minutes of gentle stretching poses, 25 minutes of mindfulness meditation (e.g., awareness of breath, awareness of awareness itself), 10 minutes of breathing techniques (e.g., full yogic breath, breathing into sensation), 20 minutes of didactic presentations on the application of yogic principles to optimal coping, and 25 minutes of group discussions (e.g., experiences while practicing yoga at home).

After the yoga program was completed, both groups were assessed for fibromyalgia symptoms and functional deficits, overall improvement in fibromyalgia symptoms, physical tests of fibromyalgia symptoms and functional deficits such as tender points, strength and balance deficits, and a number of pain coping strategies. Following treatment, women assigned to the yoga program showed significantly greater improvements on standardized measures of FM symptoms and functioning, including pain, fatigue and mood, and in pain catastrophizing, acceptance and other coping strategies. Lead investigator James W. Carson, PhD, Oregon Health & Science University, and colleagues, observed, "The results suggested the yoga intervention led to a beneficial shift in how patients cope with pain, including greater use of adaptive pain coping strategies (i.e., problem solving, positive reappraisal, use of religion, activity engagement despite pain, acceptance, relaxation) and less use of maladaptive strategies (i.e., catastrophizing, self-isolation, disengagement, confrontation).”

“Although yoga has been practiced for millennia, only recently have researchers begun to demonstrate yoga’s effects on persons suffering from persistent pain,” commented Dr. Carson. “The Yoga of Awareness program stands in contrast to previous multimodal interventions with FM patients in that it integrates a wide spectrum of yoga-based techniques — postures, mindfulness meditation, breathing exercises, application of yogic principles to optimal coping, and group discussions... the findings of this pilot study provide promising preliminary support for the beneficial effects of yoga in patients with FM.”

To learn more about this research, please visit:

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Vigorous Exercise Dramatically Cuts Breast Cancer Risk in African-American Women

The risk of breast cancer in African-American women can be dramatically reduced with vigorous exercise, according to researchers at Georgetown Lombardi Comprehensive Cancer Center, and they say even moderate exercise has significant benefits. The study reveals a 64 percent drop in risk for women who vigorously exercise at least two hours a week.

Data regarding the association of physical activity and breast cancer has been equivocal and lacking for African-American women, say researchers, but many benefits of exercise are already known. “We know from other studies that being physically active can have benefits in other diseases that occur at high rates in African-American women, such as diabetes and hypertension,” said the researchers. “Four out of five African-American women are either overweight or obese, and so disease control is a particularly important issue for these women.”

For the study, 199 women from the Washington, DC metro area participated. Of them, 97 were recently diagnosed with breast cancer and 102 did not have a breast cancer diagnosis. The women completed a physical activity questionnaire that asked about their exercise in the past year that included walking and vigorous physical activity (e.g., running, aerobics, etc.). Responses were used to calculate a metabolic equivalent (MET) score (hours/week equals hours/week vigorous activity times 7 plus hours/week walking times 3). The MET score was then categorized as low, medium and high. A high score was indicative of more physical activity or more frequent exercise. African-American women who engaged in vigorous physical activity (more than two hours a week in the past year of her life) had a 64 percent reduced risk of developing breast cancer compared to those who reported little physical activity. Researchers say women who engaged in moderate exercise had a 17 percent reduced risk, compared to women in the low tertile.

“Several diet and exercise studies have been conducted in Caucaisan women, but there is limited information about diet and exercise in African-American women,” according to the researchers. “It is important to identify breast cancer risk factors in this population that can be modified because African-American women suffer from higher rates of mortality compared to white women. Also, African-American women with breast cancer tend to be overweight and have more chronic conditions at diagnosis compared to white women.”

To learn more about this research, please visit:

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Patient Activation Measure™ — How PAM Portends Behavior Change

There are many ways to administer the Patient Activation Measure™ (PAM) and many socioeconomic factors that influence its outcomes, explains Dr. Judith Hibbard, developer of the PAM and professor of health policy at the University of Oregon. Dr. Hibbard identifies the PAM scores that signal a behavior change and the value of adding patient activation assessment to a health improvement initiative.

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Measuring Medication Adherence

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Jan Berger, M.D., chief medical officer for Silverlink Communications, Inc.

Question: What quality of life tools do you use to measure medication and care plan adherence?

Response: Some people are using the Short Form (SF) as general quality of life tools. In other cases, they are utilizing diagnosis or disease-specific. I am a firm believer in utilizing a generalized tool. Even though you may not get down to the specifics that you do in a disease-specific tool, many of us have more than one condition at one time. Therefore, getting more general information is better. Whatever tool you utilize, make it more conversational. None of us like to feel like we are being grilled with question after question. Having a correct style in using the tools, while still using them as they are supposed to be used, is a finessed art.

Getting data from any source you can is very important. Whether it is claims data from the health plans and the insurers or patient self-reported data, quality of life data is patient-supported. The only place you are going to get it today is from the patient. From the employer, you are going to get information such as absenteeism. Presenteeism, which is work done while you are at your workplace, is mostly patient self-reported. People are not going to go to their employers and say, "Please only pay me 60 percent today because I didn’t give my all because I didn’t feel well." Another piece that is important in patient self-reported data is clearly articulating to the patient about privacy and how the information they give you will be used. You do not always need face-to-face contact with a person to get information such as blood pressure, which is not found in a claims form or from the employer. Technology can be successfully used to get this information. We have talked to a number of healthcare consumers who are more comfortable and more honest giving answers about barriers, blood pressure, medication adherence or quality of life to a technology partner. They don’t feel they will be yelled at or disappointed. This is a very good place to use technology because it is non-judgmental.

For more information on medication adherence, please visit:

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Medical Home Monitor tracks the construction of medical homes around the country and their impact on healthcare access, quality, utilization and cost. As providers and payors reframe care delivery, this twice monthly e-newsletter will cover the pilots, practice transformations, tools and technology that will guide healthcare organizations toward clinical excellence.

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What's the ROI from Health Coaching?

Despite the fragile economy — and perhaps because of it — health and wellness coaching programs are flourishing. We wanted to see what ROI was generated from health coaching programs.

Click here to view the chart.

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2010 Benchmarks in Health & Wellness Incentives Use

The use of economic incentives to drive engagement and results from wellness and prevention programs continues to proliferate. This executive summary captures responses of 139 healthcare organizations to HIN's second annual Health and Wellness Incentives Use e-survey administered in February 2010 on the focus, utilization and impact of health and wellness incentives, from types of incentives offered to methods for identifying individuals for incentive programs and reasons for providing incentives.

To download this complimentary white paper, please visit:

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Telephonic Disease Therapy Management Program Improves Health Outcomes for Rheumatoid Arthritis Patients

A new study shows for the first time that a telephone-based disease therapy management (DTM) program improves clinical outcomes for rheumatoid arthritis (RA) patients who are receiving injectable medication therapy. The study, published in the Journal of Managed Care Pharmacy, was conducted by Prescription Solutions.

Disease-modifying antirheumatic drugs (DMARDS) have been shown to be most effective for controlling RA, but for many patients, adhering to these medications is challenging. Some patients fear the self-injection required for many of the newer DMARDS and others complain of injection-site reactions or the drugs' high cost. Any or all of these factors can cause some patients to abandon their course of treatment. This has a significant impact on health outcomes and health costs.

Patients who enrolled in Prescription Solutions' DTM program received telephone consultations with a licensed pharmacist or registered nurse. During each telephone consultation, the pharmacist or nurse educated the patient about his or her medical condition, self-management skills, side-effects management and the importance of medication adherence and persistence. This DTM program was offered in addition to routine specialty pharmacy management services provided by Prescription Solutions, which include medication educational brochures, mail service medication delivery, refill reminders and access to a pharmacist 24 hours a day, 7 days a week.

Patients enrolled in the seven-month-long DTM program showed significantly higher adherence to their injectable RA medications compared with a control group of patients who received the same medications through community pharmacies and did not participate in the DTM program. Adherence is the extent to which a patient continues the mode of treatment recommended by the physician or healthcare professional. The average adherence rate for patients in the DTM program was 83 percent, compared with an average adherence rate of 60 percent for patients in the control group. These findings provide important insights into the benefits DTM programs provide in helping patients better manage their health.

Patients who completed the seven-month RA DTM program had improvements in physical functioning manifested by significant improvements in the SF-12 physical component and HAQ-DI scores (validated instruments to measure health-related quality of life and physical functioning). However, the study did not demonstrate improvements to SF-12 mental scores or work productivity. Work productivity results were available for only a small number of patients (only 18.6 percent of the study patients were employed), making it difficult to interpret these results.

Prescription Solutions routinely conducts scientific studies on various disease states as a way to use its clinical expertise to advance the practice of medicine and add to the scientific literature. This is a key element of Prescription Solutions' ongoing search for the most current, highest-quality evidence available to further its goal of continuously improving the cost-effectiveness of patient medications and drug treatment outcomes. The company's DTM programs are intended to help patients more clearly understand the importance of proper treatment for their disease, to more effectively manage their disease symptoms or medication side effects, and to provide support to help patients overcome other obstacles to improved health and proper care, such as addressing stress-related issues or financial hardship.

To learn more about this research, please visit:

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Healthcare Trends for 2011

Following this year's passage of the Patient Protection and Affordable Care Act, the real work of healthcare reform has begun. Learn how more than 30 fellow healthcare companies are preparing for 2011 by completing HIN's sixth annual survey on Healthcare Trends in 2011 by October 31. You'll receive a free executive summary of the compiled results, and your responses will be kept strictly confidential.

To participate in this survey and receive its results, please visit:

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