Texting for Diabetes @ Medicine 2.0’11 Stanford

For Medicine 2.0 (#med2) at Stanford this month, I am excited to be delivering a Research in Progress presentation of our study,  “Impact of Texting and Predictive Potential of Health Literacy on Medication Adherence in Type 2 Diabetes Mellitus”. The study, supported by the McKesson Foundation Mobilizing for Health grant program, aims to help a diverse and largely uninsured and underinsured population in South Florida improve adherence to the medications they take for type 2 diabetes mellitus. Our study intervention is designed as a simple series of text messages through treatment targeting one of the primary hurdles to optimal medication adherence – reminders. I will also be sharing our plan for integrating health literacy assessments and disease state knowledge into the clinic EHR as a means to provide more patient-centric counseling and support. Our hope is that we produce an effective intervention to improve health which is also low-cost and thus ultimately scalable. There are a lot of scary numbers being bandied about for diabetes such as its $174 billion annual cost and forecasts that as many as 1 in 3 Americans could develop diabetes by 2050; it would be massive if this contribution could assist in stemming the tide.

Beyond being surrounded by a great study team, I have also been fortunate that providers at our primary care clinic partners have become very enthused about the study. We actually amended our original protocol to account for the fact that physicians at other clinics within the Memorial Healthcare System approached us and volunteered to help recruit participants.

Over the years, Mednet and its offspring, the Medicine 2.0 Congress have been among the most ambitious, surprising, and practically beneficial conferences I’ve attended.  Every year I see new attendees from seemingly disparate areas and sectors that come and then find commonalities that produce stimulating discussions, research collaborations, business ventures, and even friendships. This year will continue that tradition with the pre-conference lineup at the Stanford Summit on September 16, 2011 and the two-day Medicine 2.0 conference proper that follows on September 17th and 18th.  I will be there to share our research to date and eager to participate in the other sessions. I hope to see you there too!

@kevinclauson

Pharmacy: Is there an app for you

The 45th Annual Meeting of the Florida Society of Health-System Pharmacists (FSHP) was held in Orlando during the weekend. Since it is a state organization conference, it is much smaller than gatherings like the ASHP Midyear Clinical Meeting. This allowed for a streamlined set of programming tracks and a more relaxed atmosphere. There were also some interesting individual sessions (and necessities) on medication errors, pain management, etc.  I particularly liked the presentation on “Cyberhealth”, which focused on issues with Internet Pharmacy. Additionally, I had the opportunity to present “Pharmacy: Is there an app for you” at the meeting.

@kevinclauson

 

Knowledge, Skills, and Resources for Pharmacy Informatics Education

The most recent issue of the American Journal of Pharmaceutical Education featured a Technology in Pharmacy Education section.  There is some really interesting reading in this section including, “Use of Twitter to Encourage Interaction in a Multi-campus Pharmacy Management Course” by @Brent_Fox.  Brent actually authored several articles including, “Knowledge, Skills, and Resources for Pharmacy Informatics Education“, which he wrote along with the newly installed Chair of the ASHP Informatics Section Allen Flynn, informatics luminary and frontliner Chris Fortier (@FortiPharm), and I.  With this article, we tried to summarize the baseline informatics knowledge that pharmacy students should possess upon graduation, framed within med use processes.  My hope is that it will be of real practical use to educators and others as specific recommendations are provided regarding activities and resources for class and curricular integration, rather than just observations made from 30,000 feet.  Also, as with all articles in AJPE, this one is open access (OA) in that it can be accessed free, full-text by anyone.

@kevinclauson

Source: Fox BI, Flynn AJ, Fortier CR, Clauson KA. Knowledge, skills, and resources for pharmacy informatics education. Am J Pharm Educ. 2011;75(5):Article 93.

Community pharmacists’ use of language access services

One of my pet interests is health literacy and its far-reaching impact on quality and access to healthcare.  The issues surrounding it can almost be insidious in nature.  Despite this, health literacy is typically only given superficial coverage in traditional training programs. 

Here in South Florida we have an especially diverse patient population with a higher than average percentage of those with limited English proficiency (LEP).  It’s pretty intuitive, but LEP patients are (unfortunately) more likely to encounter barriers to health care and are associated with poorer outcomes than non-LEP patients. 

In part to address this, there was actually an Executive Order mandating “meaningful access” be given to LEP persons for Federally-funded activities (what, you didn’t think ‘meaningful use/access’ was limited to EHRs and the like?).  Consequently, hospitals, clinics, etc. began incorporating translators and other language access services (LAS) as SOP (at least on paper) due to their receipt of Federal funding/payments.  However, a funny thing happened on the way to implementation in community pharmacies – much as those pharmacies and the healthcare professionals that staff them are treated differently than similar entities/professionals in our system of health care…this mandate has been treated more as a voluntary compliance issue.  What, if any, impact has this had on reimbursement or outcomes?  The jury is still out.  However, as a first step to methodically examine this issue, we conducted a national survey of availability and use of LAS in community pharmacies; the initial results of which have recently been published in the Journal of the American Pharmacists Association (JAPhA).

Pharmacist responses to the survey ranged from descriptions of widely advertised and seamlessly integrated interpretation (verbal) and translation (written) LAS services to the (rarely observed) attitude of ‘if they’re in our country they should speak English’.  Overall, we identified issues regarding awareness (e.g., about half of pharmacies with LAS capacities did not report making them known to patients), use of LAS (e.g., about 40% said they “never” used interpretation/translation tools), and workflow/time (e.g., a quarter of respondents said they simply lacked time to use LAS).  Alternately, there were encouraging signs as pharmacies that did apprise patients of LAS availability used a variety of methods including in-store direct notification, signage, flyers, and targeted mailings.  Additionally, more LAS products are becoming available such as Elsevier’s MEDcounselor Languages module, which advertises SIG translation and patient education materials in 14 languages.  Another gem that area pharmacists have started using (albeit moreso in AmCare clinic settings) is the free MediBabble iPhone app.  My understanding is that a future update will (ahem) include pharmacists in the introductions section. 

Unfortunately, our article “Community pharmacists’ use of language-access services in the United States” is behind a subscription wall, but I would be happy to answer any questions that I can.

@kevinclauson

Disclosure: A couple years ago we received a grant from one of the quadrillion companies Elsevier operates for an unrelated research study.  Inclusion of their product in this post is mostly due to timing (I just received an email about it), and should probably not be construed as a conflict of interest except for the most Mel Gibsonian of conspiracy theorists.  Separately, this JAPhA LAS study was funded by a NSU President’s Grant.  Going forward we are planning to study the LAS disconnect further, as well as possible solutions that may include tools such as automated LAS kiosks in pharmacies and online functionality as well as LAS availability notification via social media; funding source(s) TBD.

 

Source: Feichtl MM, Clauson KA, Alkhateeb FM, Jamass DS, Polen HH. Community pharmacists’ use of language-access services in the United States. J Am Pharm Assoc. 2011;51(3):368-72.

Pharmacist use of social media

The most recent hat tip for alerting me that one of my articles was published goes to @redheadedpharm, who also has one of the most thoughtful pharmacist authored blogs out there IMHO.  I should note that by drawing my attention to the article, TRP does not endorse the contents nor see eye-to-eye with me regarding pharmacists, pharmacy, or social media.  And that’s ok. I have to think no rational person just wants an echo chamber.  In fact, I may revisit the whole ‘landscape of pharmacist blogs’ in a future post if I can figure out a way to do so that doesn’t involve generating the hate e-mail and widespread snark that the AJHP article did.* 

In any event, I did want to share that the article I assisted Drs. Alkhateeb and Latif with is titled Pharmacist use of social media and was published in the International Journal of Pharmacy Practice.  As you can see to the left, this is a Short Communication and essentially provides a snapshot of social media use by pharmacists in West Virginia.  The most frequently used applications in this group of surveyed pharmacists included: YouTube (74%), Wikipedia (72%), Facebook (50%), and blogs (26%). Twitter (12%) and LinkedIn (12%) were also used by the respondents.  In a sense, it was a confirmatory study in that it verified some things we thought we knew about pharmacists and social media.  Some of the findings (e.g., 50% use of Facebook) were a little surprising.  Use of Facebook, in particular was examined a little more in-depth; only 15.8% indicated they used it for any professional purpose.  Usage patterns largely reflected those of non-healthcare professionals…these pharmacists used Facebook to keep in touch with colleagues, chat, upload pictures, etc. 

@kevinclauson

*It’s interesting how ‘hate e-mail’ can be a touchstone for publication topics.  The pharmacists blog study generated a dubious top 5 level volume of hate e-mail.  It was among the best written hate e-mail (which was oddly encouraging), but didn’t come close to the level produced after our Wikipedia paper came out.  To be fair, the sheer number of Wikipedia users and the widespread coverage** it received probably contributed to its you-are-as-bad-as-the-scientists-doing-research-on-puppies outrage. 

**Curious fact, of all the interviews I’ve done about our research over the years (e.g., New York Times, Wall Street Journal, CNN, BBC, NPR, New Scientist, etc.) the most hardcore fact-checkers were from Good Housekeeping and Fitness Magazine. Seriously.

Soapbox 2.0: Use of blogs by pharmacists

I saw a tweet by John @Poikonen that alerted me to the fact that a second article in as many weeks has been published on pharmacy and blogs.  Two pharmacy students (Justin Elkins and Chilla Goncz) and I authored “Use of blogs by pharmacists“, which appears in the new issue of the American Journal of Health System Pharmacy.  We identified all blogs that were pharmacist-authored, active (i.e. posts in the last 3 months), and written in English.  Blogs focused on pharmacy, but not written by a pharmacist were excluded.  Forty-four blogs were identified that fit those criteria.  We used the most recent 5 posts to assess the blogs based on six categories (e.g. practice based topics, identifying information, positive language, critical language, professionalism and miscellaneous). 

Most pharmacist blogs (68%) were written anonymously (versus 43% in Lagu’s study of physician and nurse blogs).  Pharmacist bloggers were equally represented by community (43%) and non-community settings (43%); the practice settings of the remainder were indeterminable.  These blogs most commonly used positive language to describe the profession (32%), other health care professionals (25%), and patients (25%).  Critical language was more commonly observed in descriptions of patients (57%); almost half of all posts contained profane or explicit language (48%). 

Most of the blogs (71%) contained mentions of pharmacologic therapies and current healthcare events (66%).  We also noted that 25% of these bloggers had a Twitter account (relative to 11% of the general population in the same timeframe per Pew).  Out of the 11 pharmacist blogs that were ranked by Technorati, all but two were primarily of a ‘ranting’ nature (e.g. Angry Pharmacist, Angriest Pharmacist, Your Pharmacist May Hate You).  Interestingly, the only two ranked, but non-ranting blogs were written by non-US pharmacists. 

Our full AJHP article lists all of the 44 blogs and while it is not open access, my hope is that via ASHP Connect and rapid response that this list of pharmacist blogs can be updated and curated using our article as a starting point.   

@kevinclauson

Analysis of pharmacy-centric blogs

We’ve seen analyses of blogs by physicians & nurses [1], medical bloggers [2], etc.  However, the excellent article “Analysis of pharmacy-centric blogs: Types, discourse themes, and issues” by Jeff Cain (@jjcain00) is the first analysis of pharmacy-centric blogs.  It appears in the the new issue of the Journal of the American Pharmacists Association and presents a balanced view of the pharmacy blogosphere.  It found that social media promotes transparency (except for authorship).  It also recognized that the degree of disinhibiton in the Web 2.0 world may have contributed to a substantial number of these blogs containing negative content about patients, pharmacy, and other healthcare professionals.  Cain and Dillon categorized 136 pharmacy-related blogs into: news, personal views, student oriented, career focused, etc.  Blog posts were also scored as positive (e.g. demonstrating empathy, supplying helpful drug information), negative (e.g. complaints, foul language), or neutral.  Cain and Dillon asserted that despite three of the top four blog themes being negative, these blogs likely had no real impact on the public perception of pharmacy as their readership “likely does not extend beyond the personal acquaintances of the bloggers and others in the profession”.  Overall, they found a variety of blog types with a preponderance of negative and derogatory posts.  Some primarily positive ones were identified as well.  The authors suggested the personal view blogs may be best used to educate student pharmacists and the profession about issues they will face.

@kevinclauson

[1] Lagu T, Kaufman EJ, Asch DA, Armstrong K. Content of weblogs written by health professionals. J Gen Intern Med 2008;23(10):1642-6.
[2] Kovic I, Lulic I, Brumini G. Examining the medical blogosphere: an online survey of medical bloggers. J Med Internet Res 2008;10(3):e28.

Stargazing at Digital Pharma East

I am really looking forward to the 4th Annual Digital Pharma East coming up on October 18th in Philadelphia.  In addition to presenting, I plan to do some major stargazing while I am there.  I don’t mean ‘star’ in the manner of the cult of celebrity.  I am defining stars as people who have something really valuable and/or interesting to say.  It feels a little mercenary to go with the express intent of cherry picking knowledge from experts given the themes around sharing – but I guess that’s just part of the allure.

I’m also very much looking forward to reconnecting with Berci Mesko (@Berci) who I have not seen in a couple years, talking shop with social media flag bearer Bryan Vartabedian (@Doctor_V) who will likely be pressed for time from Co-chairing the event, having a face-to-face chat with Phil Baumann (@PhilBaumann) whose mind works unlike any other I’ve encountered in this space, meeting Gilles Frydman (@gfry) who is the final piece of the ePatient trinity, as well as Shwen Gwee (@shwen) who has both tweet cred and does great work.

In addition to those folks, I may be most eager to see presentations by representatives from Comscore and Within3, along with Cluetrain Manifesto author Doc Searls and futurist Ian Morrison.  Needless to say, I am planning to see every single presentation on the final day, which is dedicated to mobile/mHealth.  The rest of the time, it’s just a question of which Stream.  Finally, I am curious to see how the unconference activities and #SocPharm sessions play out relative to previous HealthCamp events I’ve seen.

As for me, I’ll be presenting “Social Media Research: Partnering with Academia”.  The link to the slides on the Digital Pharma conference site will be provided here after the presentation and will be available beyond that at SlideShare as per.  I’m curious to see the reception given that the composition of the audience is pretty different than who I have been interacting with recently.  I definitely have a (relatively) longstanding interest in the subject as one of the first articles we published on the topic was “Legal and regulatory risk associated with Web 2.0 adoption by pharmaceutical companies” in the Journal of Medical Marketing.  We’ve also published several other studies on interactions between different healthcare professionals and representatives from Pharma.  Ultimately, I am banking on the fact that I actually do what I will be talking about and have some concrete takeaways for those interested in the topic.  I’m also optimistic that using an audience response system and building in time for discussion will help make it legitimately interactive.  We shall see.

Overall, I am looking forward to reconnecting and making new connections, planting the seeds for future research collaborations, and learning from area experts that are rarely available in this concentration.  I hope to see you there, hear your thoughts, or cross paths via #DigPharm (or whatever the hashtag ends up being)!

@kevinclauson

National Pharmacy Organizations Form eHealth Collaborative

It is encouraging when something brings all of the major pharmacy players together. In this case, it is the Pharmacy e-Health Information Technology Collaborative, and it is comprised of the Academy of Managed Care Pharmacy (AMCP), Accreditation Council for Pharmacy Education (ACPE), American Association of Colleges of Pharmacy (AACP), American College of Clinical Pharmacy (ACCP), American Pharmacists Association (APhA), American Society of Consultant Pharmacists (ASCP), American Society of Health-System Pharmacists (ASHP), National Alliance of State Pharmacy Associations (NASPA), and the National Community Pharmacists Association (NCPA).  It has also been announced that the Collaborative will have Tom Menighan, BS Pharm, MBA, ScD as Chair and Shelly Spiro, RPh, FASCP (@shellyspiro) as Director.   

The information volley from APhA seems to indicate the Collaborative will initially be focused on the electronic health record (EHR).  That makes sense for now given the mandatory nature of EHR adoption and the financial incentives and disincentives tied to its use.  I’m also heartened to see the formation of this group given the warning signs for pharmacy in the ‘meaningful use’ criteria (which will apparently undergo some minor revisions to “correct a few inconsistencies”).   My hope is that after the Collaborative tackles the admittedly daunting task of EHR implementation, that it turns its attention to other facets of eHealth in which pharmacy is underrepresented and lacks much of a voice.

@kevinclauson

Pharmacists’ duty to warn in the age of social media

Healthcare in general and pharmacy in particular, is still finding its way with social media.  One of the least developed elements of Health 2.0 remains the legal aspect.  A few years ago several of us starting discussing scenarios in which a legally valid pharmacist-patient relationship might be created based exclusively on Web 2.0 mediated interactions.  This discussion has been aided, of course, by social media.  Also, as part of an interactive panel at Medicine 2.0 a couple years ago we posed this question (attendees’ responses here).

This discussion has recently been formalized as a Commentary published along with Matthew Seamon PharmD, JD and Brent Fox, PharmD, PhD (@Brent_Fox) in the American Journal of Health System Pharmacy.  An accompanying podcast has also been produced for it by AJHP.  Ideally the article and podcast help promote dialogue and encourage the profession to think proactively on the subject.

@kevinclauson