AlignMap

The How To Fix Patient Compliance Now Series

This is the fourth in a series of posts offering  steps to improve the study of and communication about patient compliance.

These recommendations are simple and inexpensive; their implementation, in fact, is solely a function  of motivation on the part of those working in the field.

Finally, the benefits of these recommendations are magnificently  self-apparent.

Previous Steps follow:

1. Always provide context-pertinent definitions of Patient Compliance terminology
2. Differentiate between unintentional and intentional noncompliance
3. Support compliance claims

Don’t say “Adherence” when you mean “Brand Loyalty”

“Compliance,”¹ if it is to have useful significance as a term, cannot be used as code for “selling more medication X.”²

A helpful rule of thumb follows:

If an alleged Medication Compliance Program applies to only one drug  or one small group of drugs, all produced by the same manufacturer,  what you’ve got yourself there is not a Medication Compliance Program but a Brand Loyalty Program.

A Medication Compliance Program is concerned with all the medications in a patient’s regimen; eliminating or replacing a given medications from a patient’s regimen does not disqualify a patient from participation in a Medication Compliance Program.³

Again, I am enough of a believer in free market theory that I don’t seek to ban Brand Loyalty Programs for pharmaceuticals as long as the programs do not promote the inappropriate prescription or continuation of the medications on which they focus – and the intent of the Program (i.e., to sell more doses of Medication X) is made transparent to doctors and patients.

That one can certainly devise a lexicographical rationale for using “compliance,” “adherence,” and similar terms in association with Brand Loyalty Programs does not mitigate the ongoing confusion about the concept of compliance.

It’s simply a matter of clarity and trust.

1. In this post, “Compliance” and “Adherence” are used interchangeably↩
2. I hasten to add that I have no problem with the notion of selling more medication X. It’s one of my favorite pharmaceutical agents, useful for any number of ailments and almost devoid of side-effects. I object only to its marketing being confused with medication compliance.↩
3. The exception, of course, is a single-agent Medication Compliance Program that concerns treatment deemed so essential that its proper execution warrants special adherence protocols (e.g., DOT in the case of tuberculosis treatment).  One supposes that a Medication Compliance Program could also legitimately focus on a single given medication with inherent qualities, such as a particularly complex dosing schedule or overwhelmingly noxious side-effects, that rendered adherence especially difficult. I have, however, yet to find a Medication Compliance Program for a single drug that described its intent in that manner or its drug of focus in those terms↩

I have been unavailable most of this week and will be away a few more days. Consequently, there has been a paucity of posts lately, and it is unlikely that new posts will be published here until the middle of next week. I apologize for this and the other interruptions in blogging over the past six months. 2008 has proved a rough year so far.

I have, however, continued to add short posts to AlignMap In Cites, the Tumblelog version of AlignMap.com, which offers annotated links to web sites pertinent to treatment compliance. This might be a good time to check out that site.

Michelangelo's Temptation and Fall - from Sistine Chapel Ceiling

Increasing Ones Knowledgebase Is Not Without Risk

Treatment Adherence Data From Fields Beyond Healthcare

While I’ve previously written AlignMap posts about the value of alternative perspectives on patient compliance, most of the entries here focus on pertinent studies and review articles from the familiar genre of medical literature.

Readers interested in extending their thinking beyond the standard party line may find some of the material covered at AlignMap In Cites, the tumblelog companion to this blog, helpful.  The succinctly annotated links comprising AlignMap In Cites tend to be more catholic in content than AlignMap.com and often include information sources from outside the mainstream.

Moreover, thanks to the recent change in the AlignMap.com structure it now  easier for viewers on this site to follow AlignMap In Cites.¹ The section labeled “AlignMap In Cites Recent Posts” at the bottom of the column to the reader’s right is a list of links to the 10 latest posts at AlignMap In Cites.

The two most recent AlignMap In Cites posts  today, in fact, are examples of non-medical resources:² the first links to a review of Buyology By Martin Lindstrom, which examines how marketers, using magnetic resonance imaging scanners, record brain activity in minute detail, measuring how the products they are selling affect the brain’s pleasure centers while the second is a reference to Emerging Lessons, a WSJ article on “understanding the needs of poorer consumers,” which includes, by my reading at least, useful concepts for conveying information to patients with low healthcare literacy. Both of these have obvious implications that could affect how we understand treatment adherence.

Posting at AlignMap In Cites tends to happen in batches separated by fallow periods so I recommend following the titles here and checking out those that look helpful.

I’ll also be listing other nontraditional sources of information about patient compliance here at AlignMap.com in the future.

Bonus #1: Other AlignMap In Cites Posts

I’ll take this opportunity to explain that the content of AlignMap In Cites includes references such as those discussed above, connections to AlignMap.com posts,³ and many entries into what might charitably be called “Miscellaneous.” Among today’s recent posts group, for example, is a quote lifted from a medical student’s publically published blog, which evidences that political correctness has not completely eliminated the blatently obnoxious declaration and which reminds those of us grown perhaps a tad jaded to the basics of patient compliance that teaching the fundamentals to medical students remains an essential task.

Bonus #2: Heck Of A Guy Posts

Near the bottom of the column on the left is a list of links to the ten most recent posts at Heck Of A Guy, my personal blog, which has almost nothing to do with patient compliance other than the occasional post alerting readers there to AlignMap posts of general interest. The tag line at Heck Of A Guy is “A pastiche of posts, featuring song, dance, snappy chatter plus notes on prose, poesy, love, lust, life, and beyond,”⁴  which should clue in any blog reader that I have no idea, day to day, about the content of the posts I’ll publish. I recently published my 1000th Heck Of A Guy post, which included a list of random topics covered there:

• Leonard Cohen
• Anjani
• Ketchup decantation
• Recommendations for additional subtypes of quotation marks:Quid Pro Quotation Marks And 2 More Specialty Quotation Marks and Misquotation Marks & Quasi-Quotation Punctuation
• Love story Julie and I shared
• George Washington Carver 6 Posts (Link goes to first in series)
• The reaction of my hometown to the Gay Games Rowing Event being held here 5 Posts (Link goes to first in series)
• Broomcorn 2 Posts (Link goes to first in series)
• The proposed revision of The Seal Of McHenry County Illinois More Than 10 Posts (Link goes to first in series)
• Mom’s inventory  of Ozark tchotchkes Multiple Posts (Link goes to summary)

I know – I don’t understand why it’s popular either.

1. AlignMap In Cites has also transformed its look into one more easily read and one that is, well, way cool.↩
2. Quelle coincidence, eh?↩
3. The graphics featured in Robot Enhancement of Treatment Adherence, for example, were first displayed on AlignMap In Cites,↩
4. Until recently, the tag line was “If this has made just 1 person spew Pinot Noir through his or her nose, then it’s all been worth it … ,” which may be more indicative of the Heck Of A Guy tone.↩

In my perpetual efforts to catch up with my reading in the area of patient compliance, I came across two recent entries at Medication Non-Adherence, Another Home Robot to Improve Medication Adherence and Would You Trust Your Eldercare To A Robot?, discussing the development of robots to enhance adherence to treatment among the elderly.

Both posts are thoughtful, insightful, and provocative and I can wholeheartedly recommend both as worthwhile reading.

And yet, those entries inexplicably lack two vital components, which I feel obligated to proffer as a supplement of sorts to the efforts of my brother blogger. This response, by the way, has nothing to do with the failure of Alex Sicre, the author at Medication Non-Adherence, to acknowledgment my own posts on the topic of Compliance-enhancing Robots, including Cute, Cuddly Robot Pets Remind Elderly To Take Pills, …

and my extrapolation from that post, Upping The Ante In The Pill Pet Scenario.

No, if I were going to have hurt feelings – not that I do, mind you – it would be over the diss implicit in the failure to mention my development and promotion of The RoboCop Compliance Program.  Based on the percepts electronically implanted into the hemi-mechanical hero who was the prototype for the law enforcement robots featured in the RoboCop movies, the Program is simplicity itself:

1. RoboCop (Dr. RoboCop to you) presents the healthcare recommendations.
2. RoboCop enhances compliance with his trademark line, which also serves as the Program’s slogan (Click to hear RoboCop Treatment Adherence Slogan)
   [audio:complyx.mp3]

But enough of that. Let’s move along to …

Elements Missing From the Robot Posts at Medication Non-Adherence:

1. A Misanthropic, Wildly Speculative, Tangential Soliloquy

In the literature I’ve found, as well as the sources quoted in the two posts at Medication Non-Adherence, the focus (and often the exclusive focus) is on caring for the elderly. I assume that choice is predicated on two of the fundamental driving forces in contemporary society:

1. Greed: The elderly are a large and rapidly growing portion of the population, and there is an often referenced, albeit rarely articulated, generic commitment from the government to fund their care.
2. Responsibility abrogation: My own cohort is facing the increasing likelihood that our parents, if not already in need of assistance, will require extra help in the near future, and I certainly intend to do everything I can to assure that the next generation, including my two sons, shoulder their obligation to care for their elders. It is clear, however, that few of us face this task with enthusiasm. Dispatching a robot to care for Grampa James may be a tad less empathic than Jimmy, Jr helping out, but, hey, it’s better than being pushed onto an ice floe.

I would, nonetheless, suggest that other population segments might provide good candidates for such services. The example that comes to mind is my son who suffered a head trauma followed by a coma and a recovery period of 1-2 years. Especially during the rehabilitation period just after his return home from the hospital, he required constant monitoring. Although 90%+  of his behaviors were appropriate, he would unpredictably have cognitive lapses, one consequence of which was that his adherence to medication doses and schedules was erratic. A robotic companion would have eased the burden on me as his sole caregiver and would, I suspect, have been easily accepted by him. A number of other diagnostic and age groups might benefit as well.

Specialized robots for specialized populations.

Just a thought.

2. Photos You can’t tell your robots without a program.

These carebots from GeckoSystems Inc. cost: $19,950 each, including delivery and two-day training.

This video is from the same company, GeckoSystems Intl. Corp, showing CareBots providing healthcare support of elderly, in this case, it presents “One family’s reaction to a CareBot™ for their mother.”

The graphic below is found at Carebots & the good life, a site produced by the Philosophy Department of the University of Twente, which is one of the three participants in the 3TU.Centre for Ethics and Technology. They are “looking for a PhD student to work on the project “Carebots and the good life: An anticipatory ethical analysis of human-robot interaction in (health) care”.

Infanoid  (pictured below) is from CareBots Project (Robotic Platforms). Many other photos and movies of human-emulating robots can be found at this site

Graphics Note: The image atop this post is my adaptation of a scene from Lost In Space. The role of the patient is played by the nefarious Dr Smith. The caregiver robot is, of course, Robot from the show. As everyone knows, Robot is a Model B-9, Class M-3 General Utility Non-Theorizing Environmental Control Robot.

Check Out AlignMap's New Digs

In case you’re new to AlignMap or you’re a returning viewer with a rapidly deteriorating visual memory that can no longer retain an image overnight, this blog, until an hour or two ago was clad in a theme called “Phrixus Elements.”

Now, the AlignMap.com has, for the first time in its 2 year history, popped for new school clothes. The new duds are in the form of a theme called “Cutline 3-Column Split,” which you see before you now.

In addition, I’ve taken advantage of the required implementation of new codes to make other shifts in the graphics and some titles to emphasize my primary focus: transforming the current concept of patient compliance, treatment adherence, concordance, … to – well, to something useful. Those readers who have passed this way before may detect some of these nuanced changes.

Changing Themes

While Phrixus Elements and I have split up, the relationship was a fruitful one and the breakup was one of those “It’s not you, it’s me” sort of things. In fact, the look of the Phrixus Elements theme was a good fit for those long AlignMap posts. Cutline can be a bit distracting.

The change was occasioned by the need for a beefed up and updated infrastructure.

Because I had no clue about how web sites and blogs operated when I began, the AlignMap software code has been revised, jury-rigged, re-revised, and all but rendered inoperable by too many homemade fixes.

Cutline is, in comparison, squeaky clean and is capable of operating all manner of gizmos, gadgets, and whizbangs so you have that to gleefully anticipate.

Another advantage to using Cutline is that I’m familiar with it. Cutline is the theme for 3 other blogs I manage: Heck Of A Guy, LeonardCohenSearch, and EnrichMap.

Still, I suspect Cutline is an interim theme that will be replaced when a more content-congruent format is found.

Imperfection

- From Anthem by Leonard Cohen

If Leonard was right, then this is going to be one well lit web site for a while.

While I have already made a number of edits and the major functions seem to working, there are no doubt a bundle of flaws that haven’t become apparent yet. Email me if problems arise. I hope to have things calmed down in the next week or so.

The Trek Continues

Our family’s move has been more complicated and arduous than anticipated. One consequence has been a prolongation of the posting hiatus here at AlignMap.

I am hopeful posting will begin again next week and apologize for the delay.

Credit Due Department
The photo is from The University of North Carolina at Pembroke

On The Road Again

Barring (more) unforeseen events, da boyz and I should be moving to a new domicile in early September.

That means the next 2-3 weeks will be filled with the joys of packing, moving, discontinuing utilities at one site and starting them at another, sending change of address cards, …

Which means, in turn, that posting may be rare for a while.

But I will be thinking of you.

Credit Due Department
Photo: Moving The Cottage RaeA at Flickr

What Does SEEDIE Have To Do With Patient Compliance?

First, one needs to know that SEEDIE is the Society for Exorbitantly Expensive and Difficult to Implement EHR’s, an organization that defines itself as “a healthcare IT standards organization that is completely funded and operated by a select group of proprietary electronic health record vendors.”

Further, “Unlike independent, objective, professional organizations created to help medical professionals select and implement interoperable EHR solutions, SEEDIE promotes healthcare IT systems that play well in the sandbox if, and only if, it is in the best interests of a particular vendor.”

SEEDIE also offers levels of certification for vendors that is exclusively fee-based.

So, what does SEEDIE have to do with adherence to treatment? Well, it should be obvious by now but here’s a clue from the home page of the SEEDIE site that features the graphic atop this post:

That’s right – SEEDIE also has nothing to do with patient compliance. Heck, AlignMap.com doesn’t even register on the warm and fuzzy meter.¹

The home page for this organization can be found at ~ SEEDIE ~

Hey, give me a break – it’s my first day back on the blog and I never could resist a clever parody.

Footnotes

1. Should SEEDIE develop an affiliate web site program, however, I’d be willing to work on the warm and fuzzy thing.↩

After a prolonged hiatus caused by the illness and, finally, the death of a loved one, my posting on the AlignMap blog will begin again this week.

Kinda.

The Same But Different

All authors, whether writing novels, movie scripts, doctoral dissertations, limericks, advertising copy, pornography, epic poems, or blog posts, require two elements: time and money.

Creating and maintaining a non-revenue web site about patient compliance is gratifying as all get-out but unless I can finagle a scam to rake in some bucks from these idiosyncratic displays of literary semicolon-wielding scribblings, HTML manipulation, and footnoted snarkiness, I face the joy-draining prospect of earning an honest dollar.

Plus, as it turns out, I have a lot going on these days.

More about that later.

For now, I just want to alert readers that, while I intend to continue writing about patient compliance, the extent, focus, and format of this effort are up for grabs – or less colloquially, will evolve over time.

Credit Due Department: The nifty AlignMap word cloud atop this post was generated by The Wordle Web Site

In the preceding entry, Posting Suspended, routine blogging on and additions to this site were halted because of the illness of a loved one. That individual died yesterday. I trust readers will understand why I am not re-initiating work on the site immediately.

As it turns out, my long-scheduled annual vacation begins next week so the earliest date for the resumption of routine posting is sometime the week of June 26.

In the preceding post, I mentioned the illness of a loved one; unfortunately, this illness has become severe. Consequently, routine posting on AlignMap.com and AlignMap In Cites, as well as my personal blogs, will continue to be suspended. I will post any changes in this plan, including the resumption of blogging, here.

Given the dearth of recent posts to AlignMap, this is, I suppose, a clarification rather than a notification.

A convergence of family and business responsibilities, the illness of a close friend, and some relatively minor but time-consuming healthcare issues of my own make routine updating of this blog as well as AlignMap In Cites impossible.

The most likely scenario for the immediate future has me sporadically and unpredictably posting items when the opportunity arises.

My hope is to return to my original 3-5 posts per week schedule when the current tempests are quelled.