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Daily Archives: February 1, 2016

Study: Doctors’ Texts Can Prod Patients To Take Drugs, But Questions Linger

A spoonful of sugar may make the medicine go down, but that’s hardly useful if a patient doesn’t remember to take it in the first place.

According to a new analysis, there could be a possible solution: text message reminders sent to patients’ phones from the doctor. Researchers found that texts could push people to do better at adhering to their drug regimens and, along the way, save the health system a fair bit of money.

The paper, published Monday in JAMA Internal Medicine, reviewed data from 16 studies, all of which explored whether mobile telephone text reminders sent to patients made them more likely to take their medicine. In total, the studies included in this meta-analysis tracked the behavior of almost 3,000 chronically ill patients, looking at how well they complied with medication regimens, and found the text messages had an impact.

Across the various studies, patients went from having a 50 percent rate of following through on medication to a nearly 68 percent rate.

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On its face, that looks like quite a jump. But readers should view the findings with a degree of caution, the authors noted. They pointed out that several of the studies they examined relied on participants to self-report how faithful they were with their prescription drugs. Since people often misremember or misreport this kind of information, that measure isn’t always the most reliable. In addition, the studies included in the analysis lasted on average about three months, though chronically ill people take their medications for years. Thus, the studies may not have accounted for whether patients eventually experience text message fatigue and consequently paid the reminders less attention. If that is the case, then text messages could initially be effective but, over time, lose their power in helping people take medicine.

“It’s one way to think just sending messages is simple, and people will like it,” said Robby Nieuwlaat, an assistant professor of epidemiology and biostatistics at Canada’s McMaster University in Hamilton, Ontario. “But they can also be irritating at some point if you don’t need it.”

That could be a factor, said Laurie Buis, an assistant professor of family medicine at the University of Michigan, who has also researched the subject. But it’s clear people want such reminders. “There is a lot of consumer demand for these types of interventions.”

The paper also compares studies from a host of countries. Two were based in the United States, but others were conducted in China, Spain and Kenya. Some texted patients every day. Others messaged them every week. Still others used strategies like aligning a text message with timing for when patients should take particular doses. Some sent patients reminders that had been personalized. Others didn’t. Those differences could introduce variables that made the texts more or less effective, or they could have introduced other considerations for which the analysis doesn’t account.

Taking medicine is, of course, important — especially for people with chronic conditions, like diabetes or high blood pressure. Chronically ill people are also often on multiple medications, which can be hard to track and easy to forget about.

That means if text reminders do work, they have “the potential to prevent major clinical events such as heart attacks, strokes and premature death,” study co-author Clara Chow wrote in an email. Chow directs the cardiovascular division of the George Institute for Global Health in Sydney, Australia.

Not taking medicine isn’t just bad for your health — it’s expensive, too. Experts estimate patients not complying with their drug regimens cost the United States between $100 billion and $289 billion each year. If text reminders do prove effective, they could offer an easy, low-cost tool to address that problem.

“Text-message based interventions can be delivered at low-cost, they can be easily scaled with computerized message management systems,” Chow said. “So they are likely to be cost effective in health care.”

But the issue of who pays for the text messaging also raises questions.

Texts are cheap to send, but they still aren’t free, Nieuwlaat said. He wrote a commentary analyzing the study. As researchers further probe how helpful they could be, doctors and patients need to think about who would pay for that kind of service and if it’s worth the investment.

“If it’s on the patient side, it has to be acceptable to the patient — maybe they pay a bit more for the text messaging they receive,” he said. If health systems or doctors subsidize text reminders, they’ll “have to think about whether they think it’s worth investing the money, considering the potential benefit.”

There also needs to be more research to better quantify how influential these messages could be, Nieuwlaat added.

For instance, researchers need to study more than just whether patients remembered taking their medicine, he said. Other questions, such as how often pharmacists refilled prescriptions and whether patients get healthier, would be powerful measures.

Meanwhile, even if text messaging is effective, it addresses only one reason people don’t take their medicine, Buis said. Text messages are a good reminder if you forget something, but people often don’t take medicine for other reasons — they can’t afford the drugs or they dislike particular side effects.

Plus, even if almost 70 percent of respondents ended up taking medicine, that isn’t everyone, she said, adding that a more comprehensive strategy is still necessary.

Though it isn’t enough alone, she said, “text messaging can help move the needle.”

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Viewpoints: Health Premiums Bust Wallets; Affordability Of Care, Access To Insurance Go Together

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State Highlights: California’s Revamp On Health Plan Tax Faces Bumps; Massachusetts To Use Untested Legal Theory to Challege Gilead

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A Last-Minute Reprieve For Some Consumers On California Exchange

Covered California, the state’s insurance exchange, announced Friday that it was extending its enrollment deadline until Feb. 6 for people who had officially begun the process of signing up by Sunday.

Exchange officials said they extended the Sunday deadline to accommodate a surge in enrollment in the previous week involving “tens of thousands” of consumers.

As of Jan. 27, the exchange reported that more than繉,000 new consumers had signed up for coverage during the third annual enrollment period, which is within the estimate of the exchange’s estimate of 295,000 to 450,000 new enrollees.

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“Will we hit the 450,000?” said Covered California Executive Director Peter V. Lee. in an interview with California Healthline Friday. “I’m not sure.  But have we got enough people in and will we continue to get enough renewed to have a very good risk pool? I’m very confident of that.”

“One of the reasons we have talked [enrollment] ranges is because every crystal ball is a cloudy crystal ball,” he said.

Most people who fail to sign up by the deadline face tax penalties of $695 per adult, plus $347.50 per child, up to a maximum of $2,085 for a family, or 2.5 percent of family income in excess of 2015 income tax filing thresholds.

After open enrollment ends, consumers may sign up only if they have a life-changing event such as getting married, having a child or moving. Enrollment in Medi-Cal, the government program for lower income people, is year-round.

With renewals and new enrollees, Covered California appears on track to have about 1.5 million enrollees, but the final tally in the weeks ahead will depend on how many people actually pay their premiums. In addition, the numbers churn as people leave the exchange for employer coverage, Medi-Cal or drop out altogether.

“The arbitrary numbers don’t matter,” Lee said. “What matters is the mix of people involved for the stability of premiums.”

Lee acknowledges that reaching more middle-class consumers who receive less in subsidies remains a challenge. Many consumers say health insurance remains unaffordable, but he said going without coverage is risky.

Lee said the enrollment process had improved significantly with time. “It’s getting smoother with fewer glitches and we are getting smarter each year.”

He cited more outreach in African-American churches and having church leaders talk about Covered California from the pulpit. He noted the shift to micro-targeting of the uninsured by census tracts — akin to a political campaign — and making sure there are insurance agents and storefronts offering enrollment in underserved neighborhoods.

One report to be released Monday suggested, however, that glitches remain in the enrollment process. Researchers from the California Health Care Foundation evaluated 42 consumers’ experiences in trying to enroll in, or renew, their insurance through Covered California’s website. (California Healthline is an editorially independent program of the foundation.)

Though the study sample was small, the researchers found that the consumers struggled to complete their applications online – despite improvements to the site in the past year. None were able to actually do so in the sign-up sessions monitored by researchers – even though some sessions lasted as long as two hours.

“Poorly designed” online forms and unclear questions related to income and household size frustrated users and led to mistakes that kept consumers from completing their applications, the researchers concluded.

Parts of the application process seemed like a bureaucratic nightmare: “New enrollees received multiple error messages because they had not followed the eight requirements for creating a valid password — even though the rules are not provided at the outset of the process.”

For one participant, “it took 10 minutes and seven attempts to create an acceptable password,” the researchers wrote.

Whether or not they faced difficulties, many consumers rushed to sign up as the deadline approached.

In San Jose, Jenna Santiago’s Friday was filled with appointments for people who wanted to sign up before Sunday’s deadline.

“I absolutely have been busier in the last week,” said Santiago, a community health counselor for Catholic Charities of Santa Clara County. Lately, she said she had been seeing five clients a day, rather than the five a week she helped when enrollment started Nov. 1.

Santiago said most of her clients just want to avoid the tax penalty.

“A lot of folks are surprised when they hear the amount,” Santiago said. “They don’t realize it’s going to be that high.”

Some would-be enrollees found themselves out of luck.

On Sunday, Anthony Johnson was disappointed to find that a Covered California kiosk that was supposed to be at the Valley Fair shopping mall in San Jose had disappeared.

He said he had visited a week earlier, but the people at the kiosk, representing an insurance agency, wanted him to come to their office during the week, when he was working.

Johnson, a 53-year-old Gilroy resident, said he had recently had returned with his family after a stint working in the Philippines, and he needed a few months of health insurance to tide his family over until he became eligible for insurance at his new job.

His new employer suggested he check out Covered California. But Johnson said he found it impossible to get through on the toll-free number and that it was too difficult to enroll online. (A reporter who tried the toll-free line Sunday also could not get through to an operator.)

Johnson said was particularly worried because his 13-year-old daughter, who had been exposed to tuberculosis in the Philippines, needed more medicine — at $900 a bottle — to prevent her from developing the active, contagious form of the disease.

“I’m just so frustrated,” said Johnson who added he would look at private insurance alternatives.

Otherwise, he said  “I guess we’re going to have to be uninsured until my job’s insurance comes through.”

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

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Viewpoints: Are Health Premiums Busting Wallets?; Affordability Of Care, Access To Insurance Go Together

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State Highlights: California’s Revamp On Health Plan Tax Faces Bumps; Ohio Medicaid Expansion Undercuts Nonprofit Hospitals’ Charity Care

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Republican Efforts Against Planned Parenthood In Texas Produce Few Results

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Cancer Moonshot Ignites Long-Simmering Firestorm Over Data Sharing

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Health Care Attacks Escalate As Candidates Make Final Push Before Caucuses

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Advocates’ Focus Turns To Enrolling Millions Of People Eligible For Medicaid

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