- CONDITION CENTERS
The creators of mHealthCoach, a tabletbased health coaching app, received a $25,000 cash award from Walgreens, the retail pharmacy chain announced in September. The developers also earned an hour with Walgreens Chief Information Officer Timothy Theriault to discuss how their tool supports the chain’s ambition to transform community pharmacies into health and wellness hubs.
The team demonstrated their disease management app before an audience of mobile health enthusiasts at the Health 2.0 conference, held September 26 and 27, 2011, in San Francisco, California. Colin Watts, chief innovation officer for Walgreens, said the app “could be easily incorporated into the pharmacy of the future,” enabling patients to access and interpret their health data with a professional’s guidance.
mHealthCoach came about as a result of Walgreens’ participation in the Health 2.0 Developer Challenge Program, launched in June at the Health Data Initiative Forum in Washington, DC. As part of the program, Walgreens issued a challenge to mobile developers: create a userfriendly app that aggregates public health data according to a patient’s specific condition, health concern, or location.
The app would be used as a counseling tool by Walgreens’ new Health Guides—trained facilitators who help people navigate pharmacies and the larger health care system. The chain’s ultimate goal is to equip every Walgreens Health Guide with a wireless tablet loaded with apps that interface with health data from a variety of sources, including the patient’s pharmacy and electronic health records.
The Health Guides are a cornerstone of Walgreens’ vision for the future of retail pharmacy. Explaining the prototype to attendees at the Health Data Initiative Forum, Walgreens Chief Executive Officer Gregory D. Wasson, RPh, said, “We really see this individual becoming a new health care provider and a liaison to our patients.” More information about the Walgreens Health Guide Challenge is available at http://phrmcyt.ms/r9aQ58.
Social Media Tied To Teens’ Drug Use
Parents and researchers agree: social networks are a double-edged sword for today’s teenagers. Although the sites offer an outlet for freewheeling self-expression and identity-building, a new survey finds they may also give “bad influences” more pull over teenagers’ decisions.
Spending time on sites like Facebook and Myspace increased teens’ risk of smoking, drinking, and abusing prescription and illegal drugs, according to the National Center on Addiction and Substance Abuse (CASA) at Columbia University. The 2011 results are the first in the annual survey’s 15-year history to examine social media’s impact on risk-taking behaviors.
Compared with those who don’t visit the sites daily, teens who do are 5 times likelier to use tobacco, 3 times likelier to drink alcohol, and twice as likely to use marijuana. The mass appeal of social networks means these risks apply to most US teenagers—70% of adolescents 12 to 17 years spend anywhere from a few minutes to several hours on the sites in a typical day.
In a statement accompanying the results, CASA Founder and Chairman Joseph A. Califano, Jr. said the “anything goes, free-for-all world of Internet expression” is to blame for rising substance abuse risks. The survey confirmed that many teenagers aren’t afraid to post pictures of themselves in compromising situations: 40% of all teens surveyed have seen shots of friends getting drunk, passing out, or abusing prescription or illegal drugs.
For many teens, the posts by their peers signal a direct source of drugs and alcohol, CASA found. Respondents who reported seeing them were more likely to say they could easily acquire marijuana, controlled prescription drugs, or alcohol in less than a day. They are also “much likelier to have friends and classmates who abuse illegal and prescription drugs,” the report stated.
The link between online photos and real-world abuse “offers grotesque confirmation of the adage that a picture is worth a thousand words,” according to Califano. He urged parents to monitor their childrens’ activities on social networks: “For better or worse, parents have more influence over their teen’s risk of substance abuse than anyone else.”
EHRS Linked To Pharmacies Boost Adherence
New evidence strengthens the case for electronic health records (EHRs) that streamline the nation’s fragmented health care delivery model. According to a study by Kaiser Permanente, chronic disease patients who are treated in an integrated health system that links EHRs to its own pharmacy are more likely to fill their prescriptions.
Primary nonadherence—a term for when patients don’t fill new prescriptions—is a costly problem that is inherently difficult to track due to inconsistencies in the records systems that process medication orders and pharmacy claims data. The potential of EHRs to shore up these gaps is also an opportunity to learn more about an at-risk group, said lead study author Marsha Raebel, PharmD.
“This group of people has historically been ignored because prescriptions were written on a piece of paper,” said Dr. Raebel, a pharmacotherapy researcher at the Kaiser Permanente Colorado Institute for Health Research and the University of Colorado School of Pharmacy. With better electronic prescribing practices, “we can find out which patients did not pick up their first prescription for medications they need,” she said.
The study examined pharmacy records of 12,061 patients who received care from Kaiser Permanente Colorado, an integrated health system. Dr. Raebel and colleagues found that primary nonadherence was 7% for blood pressure medications, 11% for diabetes medications, and 13% for cholesterol-lowering medications. Primary nonadherence in non-integrated systems can be as high as 22%, authors reported in the September 6, 2011, online issue of the Journal of General Internal Medicine.
A portion of that difference can be attributed to more accurate data— another benefit of integrated systems, the researchers noted. “Having electronic health record medication order entry linked to pharmacy dispensing information makes it much easier for clinicians and researchers to identify patients who are not getting their new prescriptions filled,” said Dr. Raebel.
A Microchip for Safer Drugs
The FDA, the National Institutes of Health (NIH), and the Defense Advanced Research Projects Agency (DARPA) are teaming up to create a chip that would quickly predict a drug’s toxicity before it is tested in humans, the NIH announced in September.
The $140 million project will be carried out through independent programs conducted by the 3 agencies, which have already begun soliciting proposals from industry, government, academic, and research organizations. According to NIH, “The chip will be loaded with specific cell types that reflect human biology” and will “allow multiple different readouts that can indicate whether a particular compound is likely to be safe or toxic for humans.”
NIH Director Francis S. Collins, MD, PhD, said the advanced technology is needed to accelerate the development of safe and effective medicines and eliminate a bottleneck in drug approvals. “Drug toxicity is one of the most common reasons why promising compounds fail,” she explained. “We need to know which ones are safe and effective much earlier in the process.”
Text4health Takes AIM at Tobacco Use
A government task force focused on mobile phones and public health launched 2 text-messaging services that target smoking. The programs, SmokeFreeTXT and QuitNowTXT, were hatched by Text4Health, an initiative of the US Department of Health and Human Services (HHS) that leverages HHS’ data to create libraries of texts containing evidence-based health information.
SmokeFreeTXT engages teens with questions and tips designed to help them ride out cigarette cravings. For example, one message reads: “What makes you wanna smoke? Stress? Boredom? Parties? Write down your top 3 smoking triggers. Knowing ur triggers is the only way to avoid them!” Pharmacists who provide smoking cessation counseling can encourage young adults to enroll for the free service at http://phrmcyt.ms/ mRX7vv.
Bigger plans are in store for the second program, QuitNowTXT. Now a library of smoking cessation tips, motivational messages, and facts, QuitNowTXT will become the foundation of an interactive service for patients in the United States and abroad.
Text messages are a perfect medium for implementing smoking cessation programs on a global scale, according to HHS Chief Technology Officer Todd Park.
“Text messaging is widely available, inexpensive, and allows for immediate delivery of cessation information,” said Park.
Pharmacy Clinics Give Physicians an Edge
Retail health clinics are an untapped source of data that could help physicians diagnose infectious diseases more accurately, a new study finds. By providing doctors with real-time, local information about which diseases are being treated, pharmacy-based clinics could help prevent false positives and missed cases, according to the study published in the September 2011 issue of the Annals of Internal Medicine.
To learn whether such data could influence patient care, researchers Andrew Fine, MD, MPH and Kenneth Mandl, MD, MPH, of Children’s Hospital Boston looked at strep throat—a disease that is frequently misdiagnosed and overtreated with antibiotics. When a patient’s symptoms suggest strep throat, physicians use an evidencebased symptom scale called the Centor score to decide whether or not a strep test is warranted.
For the study, Drs. Mandl and Fine designed a new, local measure of disease prevalance, called “recent local proportion positive” (RLPP). It describes the number of patients who tested positive for a disease in a specific area relative to the total number of patients tested in a given time period. The researchers tested RLPP using data on 82,062 patients who were treated for strep throat at CVS MinuteClinics located across 6 states.
Using RLPP to adjust Centor scores “could significantly impact a patient’s chance of having strep throat and, as a result, diagnosis and treatment,” according to a news release on the study. Given the 10.5 million patient visits that occur each year due to strep, the tool’s cumulative impact would be significant: 166,616 fewer patients treated with unnecessary antibiotics and 62,537 fewer missed cases of strep, the authors estimated.
The finding is a testament to the value of data-sharing and collaborative care, according to Andrew Sussman, MD, president of CVS MinuteClinic. “The work demonstrates how our clinics collaborate with other health care providers to improve individual patient care by accessing aggregate patient data and integrating efforts,” he said. PT