|
E-mail this page to a friend!
Senior Citizen Health & Medicine
New Mayo Clinic Tool Helps Get Diabetic Seniors to
Take Life-Saving Drugs
Tool is clearly effective and preferred by 84% of
patients
May 29, 2007 Diabetes is a common chronic disease
among senior citizens and thousands may die from failing to take their
prescribed medications. A Mayo Clinic research team has
designed a simple tool to improve compliance with life-saving diabetes
medications. The tool is clearly effective and preferred by 84 percent
of patients, according to a study published in the May 28 issue of the
Archives of Internal Medicine.
| |
Related Stories |
|
| |
Sen. Grassley Says FDA Knew Dangers of Avandia,
Wants Faster Action
Ranking Senate Finance Committee members says there
should already be black box warning on diabetes drug
May 25, 2007
Better Diabetes Care
May Lead to Reduced Blindness, Kidney
and Heart Disease
One of the first studies of quality improvement in
diabetes care
May 18, 2007
Diabetes Drug Spending May Surge 70% by 2010, Cancer
Now Drives Specialty Drugs
Medco finds generics, Medicare Part D
keeping increases down
May 17, 2007
Women with Heart Disease and Diabetes Get Less Care
Than Men
Women on Medicare fare better than those on private
insurance
May 14, 2007
Senior Citizens Who Experience Depression More
Likely to Get Diabetes
2 million older adults experience depression, 15.3%
of over 65 have diabetes
April 24, 2007
Increasing Rate of Diabetes Linked to Increased
Cardiovascular Disease
Call for aggressive efforts to prevent
diabetes, control CVD risks
March 28, 2007
Diabetes, High Blood Pressure Trump Race in Causing
Heart Failure Among Older Americans
African-Americans have more heart failure because
they have more diabetes, hypertension
March 27, 2007
Read the latest news on Senior
Health & Medicine |
|
Victor Montori, M.D., an endocrinologist at Mayo
Clinic and lead investigator of the study, recommends using this tool as
a decision aid to spark conversation between doctors and patients about
medication.
It consists of an easy-to-follow guide with answers
to four questions tailored to individual patients:
(1) What is your risk of having a heart attack in 10 years?
(2) What are the benefits of taking statins as compared to
not taking statins?
(3) What side effects can you expect from statins?
(4) What do you want to do now?
"Conversations with patients about prescription
medications tend to be brief and incomplete, but we found that when a
decision aid was introduced, it was the start of a conversation in which
the patient -- now better equipped with information -- felt empowered to
participate in deciding whether a statin would be appropriate for them,"
Dr. Montori says.
How They Did It
The study was done in concert with Mayo's SPARC
Innovation Program. SPARC (See, Plan, Act, Refine and Communicate) is a
laboratory that identifies innovative and effective ways to improve
health care. Dr. Montori is director of research and education at SPARC.
This preliminary study focused on compliance with
statins among diabetes patients. (Statins are used to lower cholesterol
and thus, lower the risk of developing heart disease, which is often a
complicating factor with diabetes.)
Dr. Montori videotaped 98 sessions between doctors
and patients. Only half the patients expressed satisfaction with the way
they get information now, compared to 84 percent of patients who were
satisfied with the decision aid.
Patient-doctor visits took on an entirely new
dimension after the decision aid was introduced: body postures changed
as patient and physician leaned in to focus on the material and both
listened intently during the ensuing conversation.
"The first thing that is apparent in the videotape:
the nature of the conversation changes when the decision aid is
introduced. Without the decision aid, their body language was not in
synch; but with this tool, their postures changed while they both
focused on the decision aid. The quality of the communication, both
verbal and nonverbal, improved as did the relationship," Dr. Montori
says.
The decision aid plainly and simply displays for a
patient his or her risk of heart attack in the next 10 years with and
without a statin. Is the risk worth it?
"That much people understand," he says. "If my risk
of having a heart attack is very small, a pill that reduces that risk
may not be worth it for me, but if my risk is really high, a pill that
reduces that risk sounds compelling."
Once a patient has a sense of the potential
benefits, they can look at the potential downsides (side effects and
costs) and make an informed choice with their clinician.
Among the decision-aid users, the number of
patients still taking a statin after three months increased threefold.
The decision aid had a greater impact on patients with a high risk of
heart attack as compared to low risk patients. The high-risk group was
more likely to start using statins than low-risk patients
Conversation is Critical
So why don't these conversations take place in the
absence of a decision aid?
"That's a good question as we put forward that
having an open and candid conversation with your physician is a primary
reason for the visit. But clinicians are not necessarily trained to help
patients make decisions using quantitative information. Secondly, we
don't have tools available to routinely do this in a meticulous way.
Thirdly, there is no perceived need for this despite scores of patients
who start medication but don't follow through or even fill the
prescription," Dr. Montori says.
"Time is the universal barrier in any effort to
improve the health care experience. Society needs to have this
discussion: How should we dedicate the time in the visit" If we have
programs to improve the quality of care, should those programs include
tools like this to ensure that patients make better decisions with their
clinician and take their medications as prescribed or would that visit
be better spent in other ways?" Dr. Montori asks.
Dr. Montori and his research team continue to study
the effectiveness of this and other decision aids for diabetes patients.
In addition, they are currently developing decision aids for patients
with other chronic conditions.
Editors Notes:
For more information and to view a decision aid,
visit the Montori lab online at:
http://mayoresearch.mayo.edu/mayo/research/ker_unit/decision-aids.cfm
The study was funded by Mayo Clinic and the
American Diabetes Association. Study co-authors include: Audrey
Weymiller; Lesley Jones; Sandra C. Bryant; Teresa Christianson; Rebecca
Mullan; Steven A. Smith, M.D., all of Mayo Clinic's Knowledge and
Encounter Research Unit; and Amiram Gafni, Ph.D.; and Gordon H. Guyatt,
M.D.; both of McMaster University in Hamilton, Ontario.
Click to More Senior News on the
Front Page
Copyright: SeniorJournal.com |
