5 posts tagged “adherence”

Throwback Thursday: Dr. Steve Feldman speaks about psoriasis and medication adherence

Posted August 6th, 2015 by

In honor of Psoriasis Awareness Month, we’re throwing it back to January 2013, when we sat down with Steve Feldman, MD, PhD, and Professor of Dermatology, Pathology & Public Health Sciences at Wake Forest University School of Medicine. In his interview, he spoke about the challenges for psoriasis patients, as well as the treatment advances that may be ahead. We’ve reposted his entire interview below so you can learn about his research studies on patients’ adherence to topical treatments.

As the founder of DrScore.com, tell us how rating doctors online can improve medical care.

Doctors want to give their patients great medical care. Online ratings can help by giving doctors the feedback they need to know—from patients’ perspectives—such as what the doctor is doing well and what the doctor can do to enhance the quality of care in their practice. www.DrScore.com was designed to help facilitate that feedback while also giving patients a better picture—more transparency—of the quality of care physicians provide, something that wasn’t nearly so easy to do in the pre-Internet era.

What do you think about PatientsLikeMe’s data-sharing platform and openness philosophy?

PatientsLikeMe does a truly wonderful job taking advantage of the capabilities of the Internet to permit data sharing among patients so they can learn from one another. Another extraordinary accomplishment has been to develop ways to combine that data in order to better understand diseases and the benefits and risks of the treatments for those diseases. Openness is a terrific attribute in this Internet age. I am very optimistic about medicine and health care providers and think there’s nothing to hide (and if there were something to hide, it ought to be exposed)!

You’ve done extensive research around treatment adherence. What are the considerations for patients?

Well, as the former Surgeon General put it, medicines don’t work if patients don’t take them. Taking medicine isn’t easy, unless it is a habit. And when a patient starts to use a new medicine, taking it isn’t a habit. Patients forget their medicine, they may be fearful of their medicine, there are just all sorts of reasons why patients don’t always take their medications. I think coming up with a plan, a system, for remembering is helpful. (I keep my own pills in a seven-day dispenser on the dinner table, which works great for me except when my family goes out to eat).

If patients are fearful, they should have an honest discussion with the doctor about it. One thing is certain: patients should be honest with their doctors about how they use their medicines. It does neither the patient nor the doctor any good for the patient to tell the doctor one thing but do something else. If a doctor does prescribe a medicine that the patient thinks is too costly or too risky, the patient should let their doctor know. The doctor wants to know and may be able to change things.

We have a growing psoriasis community. What challenges do psoriasis patients face?

Psoriasis has a huge impact on patients’ lives. It affects how patients perceive themselves, how other people perceive the person who has psoriasis, and, in many cases, how someone with psoriasis thinks they are perceived by others. The lesions aren’t just unsightly; they can be itchy and painful. The condition is caused by an overactive immune system, which can also result in arthritis and increased risk of cardiovascular disease and depression. There are good treatments, but the treatments have their downsides: they may be costly, inconvenient, messy, and risky. One of the biggest challenges is getting educated about all the potential options. It isn’t easy.

In our forum, patients have been discussing whether diet can affect psoriasis. What’s your take?

Well, I don’t know of any particular dietary issues that have been definitively shown to affect psoriasis one way or the other (except perhaps that starvation temporarily improves the disease, probably by inhibiting the immune system). But if a particular patient finds some particular dietary issue that makes their psoriasis worse (or better), they should eat accordingly. Some patients tell me beer and/or wine makes their disease worse or that avoiding gluten has helped. The PatientsLikeMe platform may be helpful in compiling the experiences of many people to see if these are issues for individuals or could truly help patients in general.

Any thoughts on what’s ahead in terms of psoriasis management and treatment advances?

As our understanding of the immune system improves, scientists at drug companies will be developing newer and perhaps better ways of controlling immune diseases, including psoriasis. As our health care system changes to become more cost conscious, there may be greater reliance on low cost treatments, like generic creams and ointments for people with mild disease and more use of phototherapy for people with more severe involvement. And with better data collection—like with PatientsLikeMe—we may develop a better understanding of what works, what doesn’t work, and what risks and benefits our treatments have.

If you’re living with psoriasis, don’t forget to connect with the more than 5,000 members of the psoriasis community at PatientsLikeMe.

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Open Access for All: PatientsLikeMe’s Epilepsy Survey Results Now Published

Posted December 22nd, 2011 by

Last April, we had the honor of presenting the results of our epilepsy survey at the American Academy of Neurology (AAN) Annual Meeting.   In some of the key takeaways, we shared that 55% of respondents consider PatientsLikeMe “moderately or very” helpful in learning about the type of seizures they experience. 45% found it useful for charting seizures, and 30% felt they received better healthcare as a result. In addition, 27% each said that PatientsLikeMe was useful for managing side effects and for improving treatment adherence.  (Check out our press release for more on this survey, which we conducted with our partner UCB.  PatientsLikeMe and UCB launched the epilepsy community in 2010.)

A Sample Section from the Epilepsy Survey

Now, we’re pleased to announce that our full survey results have been published as an open access article in the scientific journal Epilepsy & Behavior.  This gives you and anyone interested in epilepsy the opportunity to dig deeper into our findings.  For example, another interesting discovery is that one in three epilepsy patients surveyed did not know a single other person with their condition.  That is – until they joined PatientsLikeMe.  Survey respondents reported the benefits of using an online community to find other patients like them, and strikingly, the more friends with epilepsy that users had in the online community, the more benefits they experienced from using the site.

Do you agree that having friends with the same condition – either online or offline – has affected your experience for the better?  Share your thoughts in the comments section.

PatientsLikeMe member pwicks


Hawaii 5-0: PatientsLikeMe at AAN 2011

Posted April 21st, 2011 by

Here at PatientsLikeMe, we are not only focused on helping patients improve their health outcomes, but also on the cutting-edge research that enables those improvements. That’s why we couldn’t imagine better news when we learned that all five of our academic submissions to the American Academy of Neurology (AAN) were accepted for exhibition at their Annual Meeting.

AAN Annual Meeting 2011

But then we received even more good news: AAN 2011 would be in Honolulu, Hawaii! So we packed our bags two weeks ago and headed to paradise.

As home to over 45,000 patients living with neurological conditions – including epilepsy, multiple sclerosis (MS) and Parkinson’s disease (PD) – PatientsLikeMe is a logical partner for the AAN. Here are some highlights from three of the five studies we presented at the Annual Meeting (click on the title to see the poster for each):

  • Patient-Reported Clinician Adherence to Epilepsy Performance Measures of Quality Care. Last year the AAN developed guidelines for doctors treating patients with epilepsy. Naturally, we wanted to know: do patients like you observe their doctors following these guidelines during office visits? According to our survey, most doctors do, but epileptologists and neurologists perform better than non-specialists. Fewer of you felt that your doctors discussed treatment safety and side effects enough with them.
  • PatientsLikeMe, an Online Community: Benefits for Patients with Epilepsy. Here’s something we bet you already knew: there’s value in finding other patients like you! In our survey of epilepsy patients, we learned that 55% of you consider PatientsLikeMe “moderately or very” helpful in learning about the type of seizures they experience. 45% found it useful for charting seizures, and 30% felt they received better healthcare as a result. 27% each said that PatientsLikeMe was useful for managing side effects and for improving treatment adherence.

Yes, the weather was lovely in Hawaii, but that’s not the only reason we wish you could have been there. Our biggest takeaway was that so many researchers, doctors and industry partners want to hear from patients like you! They are excited about the work we have accomplished together already, and they are full of ideas about more that can be done. We flew home feeling exactly the same way.

That’s why we hope you’ll keep sharing, keep taking surveys and keep telling us what you really think. Because your message is getting across!

PatientsLikeMe member pwicks PatientsLikeMe member agraham


How Patients Like You Use Your Treatments in the Real World (Cont’d)

Posted February 1st, 2011 by

Here is our second blog about the two recent studies published in the Journal of Medical Internet Research (JMIR) about how patients like you are actually using your treatments.

Study Two:  Treatment Adherence Barriers

Your doctor has likely told you that it’s best to take your medication as prescribed.  But in the real world, there are barriers that can prevent you from doing so.  How do you reduce those barriers so that your medication has optimal results?  That was the focus of our second JMIR study entitled “Use of an Online Community to Develop Patient-Reported Outcome Instruments: The Multiple Sclerosis Treatment Adherence Questionnaire (MS-TAQ).”

This investigation was carried out with our partner Novartis, and it addresses a problem that many of you in our MS Community have struggled with over the years:  the barriers to being adherent to your injected or infused disease-modifying therapies (DMT). By combining a review of the scientific literature with a systematic search through MS forum conversations, we first worked to identify the full spectrum of issues that stop patients like you from taking your treatments on time as prescribed by your neurologist.

Then, we used this information to construct a rating scale called the MS Treatment Adherence Questionnaire (MSTAQ), which MS patients like you can use to quantify how many doses you’ve missed in the previous 28 days and identify and measure the barriers that kept you from being fully adherent.  You can download a copy of the MSTAQ here.

study2
Significant differences in missed dose ratio for patients who reported missing a

dose in the past 28 days; 0.00 = fully adherent, 1.00 = missed every prescribed dose

The scientific literature was already well aware of issues such as forgetting to take a single dose or taking a “drug holiday” to avoid side effects, but the comments of patients like you in our MS forum highlighted some other significant influences. For instance, you have been sharing tips and tricks with one another for minimizing injection site reactions (e.g. using ice cubes), so we added a new section to the scale that asks you how many coping strategies you’ve used.

In doing so, we discovered that your score on the MSTAQ was positively correlated with how many doses of your treatment you missed that month.  But intriguingly, the number of coping strategies you used was negatively correlated.  In other words, the more coping strategies you use, the better you are at being adherent to your treatment.  By publishing these findings in an open-access journal and sharing this rating scale with the research community, we hope to help patients like you understand what’s driving your adherence in partnership with your physician.

As always, we are grateful to you, our fantastic patients, as your sharing makes these discoveries possible.  Your data (and even your words in the forum) are truly advancing the field of medicine and empowering other patients like you to live their best lives.

PatientsLikeMe member pwicks


Multiple Sclerosis: Sustaining Care, Seeking a Cure

Posted July 15th, 2010 by

cmsc-logoOur research team here at PatientsLikeMe carries out world-class research in collaboration with academic centers, commercial partners (see “how we make money“), and to help answer questions from our patients. We share our findings with the world through this blog, peer-reviewed publications, and by attending academic conferences like the Consortium of Multiple Sclerosis Centers (CMSC) annual conference. This meeting, now in its 24th year, is for neurologists, nurses, researchers, and other healthcare professionals involved in MS to share their knowledge, network, and form new research collaborations.

In collaboration with our partners at Novartis, our MS community recently participated in a research study exploring the reasons why people don’t always take their disease-modifying therapies as prescribed. Adherence to medication is a big issue in chronic conditions; although we all mean to take our meds as prescribed by physicians, good intentions can fall by the wayside when real life interferes with our plans! Decreased adherence could lead to less medication efficacy, more relapses, and a higher burden of disability for MS patients.

By exploring the messages posted in our vibrant MS forum, and carrying out a review of the scientific literature, we constructed a new questionnaire called the “MS Treatment Evaluation Questionnaire” (MS-TEQ) that sought to explore and quantify the barriers that get in the way of people taking their DMTs as prescribed. As part of the validation process we also showed the questionnaire to some local MS patients to ensure it was easy to understand. In December of 2009, we sent out an invitation to 1,209 carefully selected patients and asked them to complete the MS-TEQ. Within just two weeks, we had complete responses back from 442 patients, a 37% overall response rate.

cmsc-poster-snapshot

The MS-TEQ addresses three areas: 1) MS-TEQ Barriers: the barriers faced by patients that stop them from taking their meds as prescribed (e.g., forgetting), 2) MS-TEQ SEs:  the side effects they experience (e.g., injection site reactions), and 3) MS-TEQ Cope: coping strategies they use to try and cope with these side effects (e.g., using an ice cube to reduce pain and itching). Our analysis found that for every 10 points on the MS-TEQ Barriers scale, patients did not take 10% of their medication as prescribed. However, we also found cause for hope; every coping mechanism they used to try and ameliorate their DMT side effects had a positive effect of 4% on the proportion of their DMTs that they took as prescribed.

At the conference’s poster session, we got a lot of interest from attendees and gave away all of our handouts and copies of the questionnaire, so you might be seeing the MS-TEQ in a clinic near you any day now! Our hope is that the questionnaire will help patients and their healthcare providers to understand why someone is struggling to take their medication as prescribed, and to give them a way of measuring this over time. We are currently preparing a manuscript to submit to a peer-reviewed journal to share our findings with the rest of the academic community.

Do you have trouble taking your MS disease-modifying therapies as prescribed? Check out our treatment database. Thousands of our members have written evaluations of the drugs used in MS, including advice and tips on how to stay adherent to your medication to improve your outcomes.

PatientsLikeMe member pwicks