AlignMap

One of my patient compliance alerts this morning linked to Drug Compliance: Barriers to Care at Endo Blog where I found the attractive chart atop this post along with a discussion of the data it displays. Those findings are summarized in this excerpt:

From my reading of the post, it appears that the focus is on extracting from the chart (and the article whence the chart originated) practical recommendations for diabetic patients to enhance their ability to follow their treatment regimens. And from that perspective, the post is on target. The author advises, for example,

I’ve issued similar suggestions to my own patients, after learning (the hard way, of course) not to assume that patients were not born with the knowledge that orders for prescription refills could not always be issued immediately nor could the pharmacy always immediately produce a bottle of pills.

So far, so good. But I do want to use this post as an example of the risks of summarizing a study’s findings too concisely or, as I suspect is the case here, to present that summary in a public forum with only one segment of the potential audience in mind.

The Alternative Interpretation

On tracking down the source of the chart from the legend on its lower left corner, I recognized the article, Barriers to Medication Adherence in Poorly Controlled Diabetes Mellitus,¹ as one I had previously read and, in fact, had referenced one conclusion, the link between difficulty reading the text of the prescription and poor control of diabetes as indicated by the A1c biological marker, in my own post, Check The Fine Print For Noncompliance - Part 1.

Excerpts from the study’s abstract follow:

The problem lies not in what was written about the study but in what was not written.

Specifically, the following information wasn’t available to those who read only the post about the study:

1. The patient population was selected in part because of their poor control of their diabetes, as signaled by A1c values of 9% and above
2. Data re adherence and the challenges to adherence were collected exclusively by self-report
3. As noted in the abstract, “Self-reported adherence was not related to A1c control,” but “Taking more than 2 doses of DM medication daily and difficulty reading the DM medication prescription label were significantly associated with higher hemoglobin A1c.”

Now, the absence of that information has little or no impact on the advice offered to patients in the post. And the phrase, “according to patients, … ,” does indicate the source of the information.

Nonetheless, that declaration of results, while hardly egregious, is problematic, as can be seen by comparing the statement as written to a more complete version of the information.

As written:

More complete version:

My contention is that those two versions may have significantly different impacts, at least on certain readers.

And that is the point: public blogs are - well, public. Posts can be read by, among others, patients, clinicians, reporters, elected officials hoping to find justification for public policy changes, students writing doctoral papers, nurses from Africa caring for HIV patients who deny they are infected, lawyers working the compliance angles on behalf of their clients, colleagues with points of view congruent with the content, colleges with opposing points of view, marketing folks from pharmaceutical companies, and other bloggers.

That is only a partial list of those who have contacted me after reading something at AlignMap.com; that list is also the reason I write - and urge other bloggers to write - with the assumption that their readers will come to their posts with an extraordinarily wide variety of experience with and knowledge of the topic and with an even wider range of motivations.


Footnotes

1. Peggy Soule Odegard and Shelly L. Gray, Barriers to Medication Adherence in Poorly Controlled Diabetes Mellitus, The Diabetes Educator, Vol. 34, No. 4, 692-697, 2008↩