The ninth full coalition meeting of SOS Rx was held on
November 9, 2005, and included more than 40 participants. The meeting was held in the George Meany
Conference Room at the
Presentation
Dr. Carolyn Clancy, Director, Agency for Healthcare Research and Quality (AHRQ) talked to the group about recent AHRQ activities, including the new AHRQ Effective Health Care program. A question-and-answer session followed Dr. Clancy’s comments. Highlights from her presentation and the discussion are listed below.
· To help patients and clinicians determine which treatments and drugs work best for them, AHRQ is launching an Effective Health Care Program, which will, among other things, conduct studies comparing the relative effectiveness of different treatments. As these comparative effectiveness reports are issued, AHRQ welcomes comments.
·
Also part of this AHRQ program is the new
· AHRQ has been holding a series of consumer outreach and education meetings across the country to discuss how consumers can play an informed role in their health care. As part of this outreach, AHRQ has been promoting the “Check Your Meds Bag” program to encourage consumers to take all their medications to their health care professional so they can be checked for proper use and to avoid interactions.
· With the increasing use of prescription drugs, electronic prescribing will be key in ensuring effective and safe drug use. The fast rate of change in health information technology is a challenge to both providers and consumers.
· SOS Rx Clearinghouse project may be something AHRQ can collaborate on as a way to positively impact seniors and medication use.
· AHRQ recognizes that warfarin is a dangerous drug and supports the SOS Rx oral anticoagulation education campaign.
Discussion of
Action Agenda
Each workgroup representing the four action agenda projects gave a progress report. After each presentation there were questions and discussion. Set forth below is a summary of each action agenda project and the discussions.
1. Oral Anticoagulant Education Campaign - Targeting high-risk situations - Jill Pierce, American Medical Women’s Association Foundation
Project Summary:
This education
campaign target patients taking oral anticoagulants in the outpatient setting,
as well as those who prescribe and dispense these medications. The campaign
will produce tools and messages designed to encourage safe use of these
medications. Campaign messages will, at
a minimum, inform patients that other medications and substances they may be
taking (prescription medications, OTCs, dietary supplements, herbals), as well
as some foods, could interact with the prescribed medication. The campaign will also target providers and
dispensers to 1) reaffirm the importance of interaction messages to patients
and 2) provide them with techniques that can be used to enhance awareness and
message compliance among their patients.
The progress report included a review of the research conducted to date, an outline of the strategic framework for the campaign, introduction of a draft message, and a presentation by CMS about collaboration opportunities.
The qualitative and quantitative research that has been conducted provided a basis for the campaign’s advisory group to develop a strategic framework for the campaign. The advisory group developed the following framework at their September meeting:
o Primary target – There was a consensus that patients are the primary target, but clinicians will also be targeted. Patients will be educated about the few, key questions they need to ask clinicians, and clinicians will have patient education information at their disposal to answer the questions.
o Key messages –Based on the research, there are three key education areas for patients: 1) Blood testing, including the importance of blood tests, patients’ knowledge of their INR number, and implementation of a regular feedback loop for communicating to patients; 2) Drug interactions – Patients need reminding that OTC drugs, other prescription drugs, and dietary supplements may cause harmful interaction with their oral anticoagulant; 3) Diet – Patients need education on appropriate diet and the importance of following a consistent diet; such education should emphasize dietary stability and be sensitive to patients’ cultural diversity regarding diet. For clinicians the message will be that patients need to know the three key areas listed above.
o Campaign approaches - two parallel approaches to the education campaign:
§ Direct Patient Education campaign targets specifically those who take and those who prescribe oral anticoagulants. Patients could be sent a postcard to remind them of their next blood test, reiterate the importance of blood testing, and re-state their target INR range. They would also be reminded of the need to ask at their next medical appointment about drug interactions, diet, and any other concerns about the medication. At the same time, SOS Rx would inform oral anticoagulant patients’ physicians or other providers about the postcards, and provide them with educational information to give to patients when they ask about diet, interactions, and blood test results. This could be set up as a pilot project. Given the nature of the effort, this pilot project is viewed as a long-term campaign approach, requiring one to two years to fund, coordinate and implement.
§ Partner Education Campaign – In the near term, educational materials could be distributed to patients, caregivers, physicians, pharmacists, and other health care professionals through SOS Rx partners and others. SOS Rx partners will commit to distributing educational materials to their members through a variety of media. The educational materials would include the same messages described above.
The coalition also reviewed a draft message for clinicians, and then the meeting was opened up to questions and discussion. The following issues were discussed: offering health care professionals CME credit for an online course on oral anticoagulants; identifying which physicians are prescribing this medication; involvement and role of oral anticoagulation clinics; use of a term other than “physician” or “doctor” for health care provider messages (“clinician” or “provider” were recommended instead); use of “teach back” method for to improve patients’ understanding of provider instructions; FDA involvement in the education campaign; and involvement in hospital stroke programs as a way to reach stroke patients.
Dr. Eugene Freund, CMS, presented information on the Quality Improvement Organizations and how SOS Rx might collaborate with CMS for the oral anticoagulation education campaign. Discussion followed about possible next steps SOS Rx can take to explore collaboration with CMS. Now that CMS knows who will be offering the prescription drug plans, they should soon be able to focus on SOS Rx ideas and what the coalition has to offer. SOS Rx will try to meet with CMS again in early 2006.
Next steps-
1) We will incorporate comments received at the November 9, 2005, meeting regarding the draft message and campaign framework.
2) We will work with advisory group to continue to draft messages for both clinicians and patients
3) Draft messages November – December, circulate to entire coalition and, if an objection arises, NCL will inform the coalition
4) January-February - finalize messages
5) Work with partners to disseminate the messages.
6) Pursue options for pilot project, while also refining messages for active campaign
7) Pursue meeting with CMS
2. Personal Medication Record – Andy Barbash
Project Summary:
With a personal medication record a patient is able to keep track of all medications (Rx, OTCs) as well as vitamins and herbal supplements he or she may be taking, regardless of the prescriber of the medications. While there are various initiatives ongoing, standards and uniformity are needed to ensure that such records are consumer-friendly, useful and easily incorporated into the health care experience. After reviewing an inventory of some of the current initiatives on personal medication records, an expert panel met in June 2004 to determine what information is critical to include in a PMR. A model PMR has been developed based on the panel’s findings. The coalition will promote the use and adoption of the model PMR by all stakeholders, including consumers. A public education campaign will encourage consumers to use personal medication records.
The progress report noted that since the last coalition meeting there has been ongoing interest in the PMR. We recently submitted a proposal to the Rite Aid Foundation for a grant to test the PMR templates with consumers and pharmacists. The proposal also requested support for a small-scale pilot test of the PMR. In addition, the AARP Wise Use website is up and running and includes the PMR chart developed by SOS Rx. AARP gave an update on the website, described how AARP state chapters are choosing 2006 projects, and suggested that some chapters will choose to focus on medication use.
Next step is appropriate testing of the PMR. We would like to explore holding focus groups or some type of evaluation with consumers for both the broad campaign messages and proposed templates. These research efforts are dependent on funding. Ultimately, we would like to see an outreach campaign to encourage patients to keep track of all medications and dietary supplements and vitamins by using some type of PMR.
Coalition member discussed various ways the PMR could be used and expressed support for the PMR project. The discussion included the following points:
· PhRMA is interested in the PMR and will follow up after the meeting. They could send the PMR to those consumers who recently signed up for prescription assistance.
· AHRQ is interested in using some type of tool similar to the PMR.
· Consider why people do not use or update their PMR. By using certain data could prepare an initial PMR for consumers.
· The Joint Commission is working on a medication reconciliation project that could be an opportunity for SOS Rx collaboration, possibly a demonstration project.
· Core elements of medication management are set forth in the MTM document by NACDS.
· Massachusetts Coalition for the Prevention of Medical Errors is pilot testing a medication form and will have data in early 2006.
Next Steps:
1) Continue exploring pilot-test possibilities, as well as opportunities to integrate PMR with other efforts
2) Obtain funding for further consumer testing (particularly focus groups) of templates
3) Obtain funding to develop and test campaign messages
4) Launch public education campaign on medication management
3. Clearinghouse of Safe Practices on High-Risk Situations – Lou Diamond, Medstat
Project Summary:
Develop a clearinghouse of safe practices for high-risk
situations in the outpatient medication arena. The clearinghouse will be a
comprehensive dynamic resource to which healthcare professionals can turn for
guidance on safe practices to be followed when prescribing certain
medications. The clearinghouse will also
contain consumer-friendly versions of the safe practices.. SOS Rx is currently seeking a partner
organization with the capacity to help develop and house the clearinghouse.
While various organizations have been contacted about partnering with SOS Rx to develop the clearinghouse, there has not been any progress on actually establishing the clearinghouse. The critical issue is to secure some interest from a group to fund a pilot of the clearinghouse. There are only a few viable groups that would have the capacity to do this. We need to be clear that, although SOS Rx is not responding to an RFP, we would like to see potential funders issue an RFP on this.
Next Steps:
1) Clarify in our information materials that we are requesting an RFP to be issued for the establishment of a clearinghouse
2) Follow up with CMS on their interest
3) Continue to discuss the project with other interested organizations
4. Promoting Electronic Prescribing - Will Lang, American Association of
Colleges of Pharmacy
Project Summary:
To accelerate the use of E-prescribing the project will 1) adopt guiding
principles that define and encourage a patient role, 2) promote various ongoing
initiatives supportive of those principles, 3) launch a public awareness
campaign to educate patients about the potential benefits of E-prescribing. The full coalition will then approve and
coordinate a media campaign to educate patients about the benefits of
E-prescribing and their role as health care consumers in advancing its use.
Will Lang updated the coalition on the purpose of this project and recent activities. It is a dynamic time for electronic prescribing as there is much current activity. At our last meeting we approved a fundraising letter for E-Health Initiative to circulate. There will be follow up with E-Health on the status of this letter.
Regarding national initiatives, Alison Rein gave an overview
of the ONCHIT, the Office of National Coordinator of Health Information
Technology. Electronic prescribing is
part of a larger national trend and providers are feeling the pressure to adopt. NCL is
an organization member of the Health Information Technology Standards Panel
(HITSP), which is one of the four ONCHIT contract project awards, and Alison
Rein is the consumer representative to the Board. Alison also serves as a consumer
representative to the Markle Foundation’s Connecting for Health Steering Committee and Markle's Personal Health Technology Council (PHTC). Through her involvement in these groups,
Alison continues to give the consumer perspective on electronic prescribing in
meetings and hearings.
Discussion by the coalition focused on how this effort fits into the broader Health IT initiatives. Participants discussed the importance of explaining why it is important for consumers to become involved in this issue. It was mentioned that about a year ago AHRQ held a meeting to explore creating a public education campaign to stimulate consumer demand for health information technology. The AHRQ meeting concluded that the timing and environment was not currently conducive to this type of campaign. It might be more fruitful to stay involved in this issue at another level than a campaign. While many groups are involved in electronic health issues, SOS Rx has unique features and should stay involved.
Next Steps:
1) Follow up with E-Health Initiative on fund raising letter
2) Continue involvement in ongoing health IT meetings and initiatives
3) Continue to consider a public education campaign on E-prescribing
Other:
· Watch your e-mail for additional SOS Rx materials in the coming months regarding the SOS Rx oral anticoagulation education campaign.
· Members may access the members-only section of the SOS Rx Website (www.sosrx.org) by using the following. User name: coalition Password: seniorsafety04
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The tentative date for the next full meeting of
the coalition is Wednesday, April 5, 2006, from 10 am–2 pm (EST) at the