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May 27, 2010 Volume VI, No. 52

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

This week's DM Update focuses on two aspects of healthcare for children. Discover new data on chronic medication consumption among children, and how parents feel about vaccine choice.

Our prevention story highlights the rising dependence on telehealth, answering the question of whether blood pressure can be controlled with home health monitoring. And our HealthSounds this week illustrates the benefits of remote monitoring of heart failure patients.

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

This week's DM news:

Table of Contents

  1. Chronic Medications & Children
  2. Vaccine Choices for Children
  3. Heart Failure & Remote Monitoring
  4. Pharmacists & Medication Management
  5. Case Management ROI
  6. Telehealth Benchmarks
  7. Home Health Monitoring
  8. Managing Care Transitions

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Childrens' Consumption of Chronic Medications on the Rise

In growing numbers, children across America are adding a dose of medicine to their daily routine. In 2009, drug trend for children — a measure of prescription spending growth — increased 10.8 percent, driven by a 5 percent increase in drug utilization and higher medication costs, according to the Medco 2010 "Drug Trend Report." The growth in prescription drug use among children was nearly four times higher than the rise seen in the overall population. A corresponding analysis of pediatric medication use found that in 2009, more than one in four insured children in the U.S. and nearly 30 percent of adolescents (10-19 year olds) took at least one prescription medication to treat a chronic condition; the most substantial increases were seen in the use of antipsychotic, diabetes and asthma drugs over the past nine years.

Type 2 diabetes medication use by juveniles increased 5.3 percent in 2009, the largest increase across all age groups, and higher than overall utilization growth of 2.3 percent. Since 2001, the number of children ages 19 and younger using these medications has risen more than 150 percent, with girls between 10 and 19 showing the greatest jump at nearly 200 percent. While growth in use of these treatments is substantial, the actual number of children using these drugs is still far less than is seen in adults.

The obesity epidemic may also be responsible for a higher prevalence of hypertension and gastroesophageal reflux disease (GERD) in youngsters. From 2001 to 2009, there was a 17 percent increase in the use of antihypertensives in children, with the greatest growth (29 percent) seen in boys ages 10-19. The number of children on proton pump inhibitors, used to treat heartburn and GERD, and in some cases prescribed for colic in infants, increased by 147 percent from 2001 to 2009.

Utilization and costs of behavioral drug treatments continue to rise in children. In 2009, 13.2 percent of the prescription drug benefit dollars spent on children went to attention deficit hyperactivity disorder (ADHD) treatments. However, the greatest spike in utilization growth last year was not seen in the youngest demographic but rather in adults aged 20-34 where use of these drugs rose 21.2 percent. Among the drugs that have experienced substantial gains in the pediatric population are atypical antipsychotics; traditionally used to treat schizophrenia, these drugs have more recently been prescribed for a variety of psychiatric disorders. The nine-year analysis revealed that the use of these treatments in children has doubled over that time period. While atypicals are still more prevalent among boys, the rate of growth (130 percent) was greatest in girls ages 10-19. Questions of safety did have a major impact on curbing antidepressant use in young people, dropping about 23 percent since 2004 when the FDA issued its strongest safety warnings on the risk of suicidality in children using these medications.

Respiratory drug use grew 5.0 percent for children in 2009 and was up 42 percent since 2001. Rising asthma rates accounted for much of the increase, as well as greater awareness of the disease and the importance of early intervention in controlling disease progression. This class of drugs was responsible for the highest proportion of net costs of medications among children. There was also a 46 percent spike in the use of antiviral drugs among children, by far the largest increase of all age groups and driven by the high incidence of H1N1 in the young. Children's usage was primarily responsible for the 9.0 percent rise in utilization for the overall population.

To learn more about this research, please visit:

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Majority Support Parental Vaccination Choice for Children, Rather Than Government Choice

A new Harris Interactive poll shows a majority of American parents believe they, rather than the government, should have the final say in which vaccines their children receive. The poll, commissioned by the Center for Personal Rights, queried 1,144 American parents of children age 17 years or younger about vaccination. Poll results indicate a majority of American parents, 52 percent, believe that "parents should have the right to decide which vaccines their children receive without government mandates."

The parents polled answered other questions consistently. Fifty-four percent of parents are "concerned that the pharmaceutical industry has undue influence over government vaccine mandates." Fifty-four percent agree that "the government should fund an independent scientific study of fully vaccinated vs. unvaccinated individuals to assess long-term health outcomes." Forty-eight percent of parents are "concerned about serious adverse effects of vaccines." This is slightly less than the results from a study published in Pediatrics magazine that found that 54 percent of parents are concerned about serious adverse effects. Forty-two percent of parents agree that "all children should receive 69 doses of 16 vaccines before age 18, as recommended by the federal government."

These parental views are broadly consistent across gender, age, income, number of children, educational levels and regions of the country. Notably, older parents, aged 35 and above (57 percent), are significantly more likely than their younger peers (47 percent) to agree that the pharmaceutical industry has undue influence on vaccine mandates. Single parents are more likely to agree than parents in two-parent families across the range of vaccination questions, perhaps reflecting their greater vulnerability to the risks from vaccination adverse events.

To learn more about this research, please visit:

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Reducing Heart Failure Admissions through Remote Health Monitoring

Remote monitoring of heart failure patients by Henry Ford Health System reduced expected all-cause hospital admissions for enrollees by 36 percent after six months of enrollment and a return of 2.3:1 vs. program costs, according to a September 2009 study. Dr. Randall Williams, CEO of Pharos Innovations, the developer of the Tel-Assurance® remote patient monitoring platform used in Henry Ford's medical home pilot, describes how the daily engagement of Medicaid beneficiaries in self-care health monitoring programs can help healthcare organizations avoid many of the challenges inherent in working with this frequently underserved population.

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Including Pharmacists on the Medication Management Team

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Dr. Beth Chester, senior director of clinical pharmacy services and quality at Kaiser Permanente Colorado.

Question: Why is it essential to include a pharmacist on the medication therapy management (MTM) team?

Response: MTM services can be performed by non-pharmacists; however, of all the healthcare professionals, pharmacists have the most in-depth training related to medications. Today's graduates must complete six years of college before they receive their doctor of pharmacy degree, and many go on to complete general or specialty residencies — extensive training that makes the pharmacist the most knowledgeable healthcare professional when it comes to optimizing medication use.

Several studies demonstrate that pharmacists in a variety of practice settings can improve clinical outcomes and sustain these improvements over time. Accrediting organizations such as the National Committee for Quality Assurance (NCQA) have begun to recognize pharmacists' expertise when it comes to medication review and reconciliation. Two of the newer HEDIS® metrics — one on medication reconciliation post-discharge and another for medication review in the elderly — only gives health plans credit when these activities are performed by a prescribing practitioner or a clinical pharmacist.

However, Kaiser has embedded primary care clinical pharmacy specialists in all of its primary care medical offices. They work collaboratively with physician-led teams to optimize drug therapy, particularly for chronic conditions. For the most part, Kaiser has one dedicated clinical pharmacy specialist for every eight to nine adult PCPs. In addition to providing MTM services to individual patients, our primary care clinical pharmacy specialists are members of multidisciplinary teams, service drug therapy consultants and educational resources, and participate in a variety of regional activities such as utilization management, quality improvement, guideline development and clinical research. Clinical pharmacy staff members are an informed, unbiased drug therapy resource for the team — eliminating the need for industry-sponsored resources such as pharmaceutical representatives.

For more information on medication management, please visit:

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Case Management ROI

An increase in healthcare case management programs is significantly influencing medication compliance, hospital readmission rates and healthcare costs. We wanted to see what return on investment has been generated by healthcare case management programs.

Click here to view the chart.

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2009 Telehealth Benchmarks — Wired for Access and Efficiency

How are healthcare organizations utilizing telehealth and telemedicine? How prevalent is remote monitoring, and which medical conditions are most often monitored? How has telehealth impacted levels of healthcare access, efficiency, cost and patient compliance? The Healthcare Intelligence Network set out to answer these questions and others during its 2009 Telehealth e-survey. This executive summary of responses from 134 healthcare organizations identifies emerging trends in the use of telehealth and telemedicine and offers a glimpse into a healthcare future where no patient is left behind because of a lack of access.

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Home Health Monitoring May Improve Blood Pressure Control

The use of at-home blood pressure monitors and Web-based reporting tools that connect clinicians and patients via the Internet appears to significantly improve patients' ability to manage their high blood pressure to healthy levels, according to research from Kaiser Permanente. The study, led by Kaiser Permanente Colorado in collaboration with the American Heart Association and Microsoft Corp., involved 348 patients with uncontrolled hypertension, ages 18-85 years.

As many as 73 million Americans have high blood pressure (hypertension), a leading predictor of heart disease. According to the American Heart Association, approximately 69 percent of people who have a first attack and 77 percent who have a first stroke suffer from elevated blood pressure levels. The participants were randomized to a usual care group or a home monitoring group. All patients had their blood pressure measured in the medical office at the start of the six-month study. The usual care group was managed in a typical model that involved checking blood pressure during office visits. The home monitoring group used an at-home blood pressure device that uploaded data to the patient's account in Microsoft HealthVault. At the time of entering the study, the participants opted into a Kaiser Permanente application that automatically transferred the home blood pressure readings to Kaiser Permanente's electronic disease registry. Kaiser Permanente's clinical pharmacists used the computerized registry to monitor readings and consulted with patients to adjust their antihypertensive medications based on proven protocols. Connected to HealthVault, patients were able to manage their data using Heart360, an online tool provided by the American Heart Association.

At the start of the study, the average systolic blood pressure was 149 mm Hg in the home monitoring group and 145 mm Hg in the usual care group. At six months, patients in the home monitoring group were 50 percent more likely to have their blood pressure controlled to healthy levels compared to the usual care group. Similarly, a significantly greater decrease in systolic blood pressure at six months occurred in the home monitoring group (-21 mm Hg) versus the usual care group (-9 mm Hg).

Health experts have long known that the current approach to managing hypertension has its shortcomings. Patients often don't comply with in-person visits and when they do, the measurements can be inconsistent or inaccurate. In light of these shortcomings, the American Heart Association recently began recommending home monitoring. However, prior research found that when patients used home monitoring, but were required to write down and call in results, blood pressure goals only slightly improved. This latest study provides an additional layer of automation and convenience by directly feeding the readings from the home blood pressure cuff to the patient's care team via sophisticated health IT tools.

To learn more about this research, please visit:

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Managing Care Transitions Across Sites

Tighter management of transitions in care — particularly for older adults with complex acute or chronic conditions — can help to close care gaps, avoid unnecessary hospitalizations, readmissions and ER visits, reduce medication errors and raise the bar on care quality. Please join the more than 85 organizations that have shared how they coordinate key care transitions by completing HIN's second annual e-survey on Managing Care Transitions Across Sites by May 31. You'll receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

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

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