SUCCESS OF ALIGNED PHYSICIAN AND …...Medscape Education, New York, NY SUCCESS OF ALIGNED PHYSICIAN...
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Amy T. Larkin, PharmD; Colleen S. Healy, MA; Susan Grady, MSN, RN-BC; Anne Le, PharmD Medscape Education, New York, NY SUCCESS OF ALIGNED PHYSICIAN AND PATIENT/CAREGIVER ONLINE EDUCATION ON COMBINATION THERAPY FOR T2D MANAGEMENT Scan here to view this poster online. MON 278 INTRODUCTION ■ Although HbA 1c levels of <7% are associated with health benefits, nearly half of patients with type 2 diabetes (T2D) in the United States are not meeting recommended targets [Casagrande 2013] ■ To achieve optimal glycemic control, healthcare providers (HCPs) must individualize T2D management plans [Cefalu 2014; Garber 2013] ■ According to Healthy People 2020, only 57% of adults with diabetes report that they have received formal diabetes education [HHS 2013] ■ Strategies to improve the patient experience should focus not only on providers but also on improving patients’ ability to elicit what they need from their providers [Greene 2013] ■ Professional and patient education that supports shared decision making helps improve adherence, patient experience, and achievement of clinical outcomes [AHRQ] ■ We sought to determine if an online parallel physician-patient/caregiver education intervention could improve knowledge/competence of HCPs and knowledge of patients/caregivers related to T2D management with combination therapy Notes For more information contact Amy Larkin, PharmD, Director of Clinical Strategy, Medscape, LLC, at [email protected]. Source of Support This initiative was developed with an independent educational grant from AstraZeneca. Disclosures The authors have nothing to disclose. References Casagrande SS, Fradkin JE, Saydah SH, Rust KF, Cowie CC. The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988-2010. Diabetes Care. 2013;36:2271-2279. Cefalu WT, Buse JB, Del Prato S, et al. Beyond metformin: safety considerations in the decision-making process for selecting a second medication for type 2 diabetes management: reflections from a diabetes care editors’ expert forum. Diabetes Care. 2014;37:2647-2659. Garber AJ, Abrahamson MJ, Barzilay JI, et al. American Association of Clinical Endocrinologists’ comprehensive diabetes management algorithm 2013 consensus statement—executive summary. Endocr Pract. 2013;19:536-557. Greene J, Hibbard JH, Sacks R, Overton V. When seeing the same physician, highly activated patients have better care experiences than less activated patients. Health Aff (Millwood). 2013;32:1299-1305. Krass I, Schieback P, Dhippayom T. Adherence to diabetes medication: a systematic review. Diabet Med. 2014. doi: 10.1111/dme.12651. [Epub ahead of print] Agency for Healthcare Research and Quality. The SHARE approach—achieving patient-centered care with shared decision making: a brief for administrators and practice leaders. http://www.ahrq.gov/professionals/ education/curriculum-tools/shareddecisionmaking/tools/tool-9/index.html. Accessed October 19, 2016. US Department of Health and Human Services (HHS). Healthy People 2020. http://healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=8. Updated August 28, 2013. Accessed December 5, 2016. Educational need and clinical performance gaps related to combination therapy in T2D management informed content development PHYSICIAN CME ■ Two online CME activities were developed, each as a 30-minute roundtable discussion between 3 leading experts • CME activity 1 discussed overcoming patients’ psychosocial barriers to optimum T2D management • CME activity 2 covered the role of fixed-dose combination therapy in T2D management • Both activities included transcripts and downloadable slide decks to reinforce key concepts and recommendations ■ The target audience was primary care physicians (PCPs) and diabetologists/endocrinologists (diabs/endos) who treat patients with T2D ■ Educational impact was measured with 4 repeated pairs, pre/post assessment questions • A chi-squared test assessed if the mean post-assessment score differed from the mean pre-assessment score ■ Each CME activity included a link to 3 interactive patient/caregiver education modules, developed in parallel, to educate patients and their caregivers about diabetes progression and combination therapies for T2D management ■ CME activity 1 launched online October 30, 2015, and data were collected through January 20, 2016; CME activity 2 launched online November 23, 2015, and data were collected through February 1, 2016 PHYSICIAN CME ■ A total of 99 diabs/endos and 380 PCPs participated in the CME activity and answered all pre- and post-assessment questions ■ Significant improvements (all P <.05) post-assessment vs pre- assessment were observed, including: • Identifying appropriate role in therapy of fixed-dose combination therapy (27% increase diabs/endos; 26% increase PCPs) (Figure 1) • Identifying patient barriers to effective diabetes management (32% increase diabs/endos; 28% increase PCPs) (Figure 2) • Identifying fixed-dose combination therapy as a strategy to improve adherence (32% increase diabs/endos; 14% increase PCPs) (Figure 3) PATIENT/CAREGIVER EDUCATION ■ In total, 8913 learners participated in the education. Visitation data include: • 8427 learners accessed 1 activity • 378 learners accessed 2 activities • 108 learners accessed 3 activities ■ 5696 of the 8913 patient/caregiver learners completed the pre- and post-education questions ■ 79% of participants self-identified as having T2D ■ Significant improvements in knowledge resulted from participation in the educational activities: • 20% improved their knowledge related to benefits of controlling blood glucose ( P <.0001; Figure 4) • 14% improved their knowledge related to medications and their associated side effects ( P <.0001; Figure 5) • 5% improved their knowledge related to benefits of fixed-dose combination therapy ( P =.0012; Figure 6) combination therapy PATIENT/CAREGIVER ACTIVITY ■ Patient/caregiver learners had access to 3 targeted educational modules, both as directed by their physicians and, via Internet search, on WebMD.com ■ Patient/caregiver responses to a knowledge question post-education were compared with pre-education responses to measure improvement ■ The activities launched online in November 30, 2015, and data were collected through March 21, 2016. PATIENT/CAREGIVER EDUCATION FIGURE 4. I Have Diabetes. Will It Ever Get Better? WHAT STATEMENT ABOUT T2D IS TRUE? 0% 20% 40% 60% 80% 100% Controlling blood sugar levels can help prevent the long-term problems of T2D Diet, exercise, and medicine can reverse T2D Most people with T2D can control their blood sugar levels with diet and exercise alone There are medicines that can cure T2D when you take them together Pre (n=1088) Post (n=1088) 51% 71% 25% 15% 24% 13% 1% 1% P <.0001 FIGURE 5. Does More Medicine for Diabetes Mean I’m Getting Worse? WHICH OF THE FOLLOWING DIABETES MEDICINES DOES NOT CAUSE EITHER WEIGHT GAIN OR VERY LOW BLOOD SUGAR (HYPOGLYCEMIA)? 0% 20% 40% 60% 80% 100% Glyburide and sodium- glucose cotransporter-2 (SGLT2) inhibitors Metformin and glyburide Metformin, dipeptidyl peptidase-4 (DPP-4) inhibitors, and insulin Metformin, DPP-4 inhibitors, and SGLT2 inhibitors Pre (n=456) Post (n=456) 9% 10% 53% 39% 12% 11% 25% 39% P <.0001 FIGURE 6. New Combination Therapies for T2D: What’s Out There? WHAT MIGHT HAPPEN IF YOU TAKE 1 PILL THAT HAS BOTH A DPP-4 INHIBITOR AND AN SGLT2 INHIBITOR WITH YOUR METFORMIN? 0% 20% 40% 60% 80% 100% You may have lower blood sugar levels and may lose more weight You’ll have a greater risk of dangerously low blood sugar (hypoglycemia) You’ll have fewer side effects All of the above Pre (n=2852) Post (n=2852) 23% 28% 11% 6% 11% 15% 55% 51% P =.0012 METHODS RESULTS ■ This study demonstrates that well-designed aligned HCP and patient/caregiver education can be successful in improving knowledge/competence of key components of successful T2D management ■ Targeted and focused digital education has the potential to empower, engage, and equip patients and their care partners with information needed for self-care condition management CONCLUSIONS PHYSICIAN CME FIGURE 1. WHICH OF THE FOLLOWING IS THE MOST EFFECTIVE THERAPEUTIC STRATEGY TO ADD TO METFORMIN AT THIS TIME? 0% 20% 40% 60% 80% 100% Reinforce lifestyle changes and continue the metformin Combination therapy with addition of a DPP-4 inhibitor combined with an SGLT2 inhibitor Add a DPP-4 inhibitor Add an SGLT2 inhibitor Diab/Endo Pre (n=74) PCPs Pre (n=142) PCPs Post (n=142) Diab/Endo Post (n=74) 3% 4% 10% 5% 51% 78% 53% 79% 15% 1% 21% 10% 31% 16% 16% 6% P <.05 P <.05 FIGURE 2. WHICH OF THE FOLLOWING IS A PATIENT-RELATED BARRIER TO EFFECTIVE T2D MANAGEMENT? 0% 20% 40% 60% 80% 100% Speaking to their healthcare provider about their disease Feeling of hopelessness Only trusting their health- care provider (eg, not seeking out information from other sources) Not being motivated to be healthy Diab/Endo Pre (n=25) PCPs Pre (n=238) PCPs Post (n=238) Diab/Endo Post (n=25) 16% 0% 16% 9% 40% 72% 47% 75% 12% 8% 7% 5% 32% 20% 30% 11% P <.05 P <.05 FIGURE 3. WHICH OF THE FOLLOWING STRATEGIES HAS BEEN SHOWN TO HELP INCREASE THERAPY NONADHERENCE? 0% 20% 40% 60% 80% 100% Use of medications that are only available as generics Use of fixed-dosed combinations Use of medications that are injectable Use of older "traditional" antihyperglycemic agents Diab/Endo Pre (n=25) PCPs Pre (n=238) PCPs Post (n=238) Diab/Endo Post (n=25) 12% 0% 9% 6% 44% 76% 47% 61% 36% 20% 34% 23% 8% 4% 10% 11% P <.05 P <.05 46% 54% Female Male 2% 4% 11% 22% 62% Under 25 25-34 35-44 45-54 Over 54 DEMOGRAPHICS AGE ETHNICITY 1% 2% 5% 6% 9% 14% 63% Native Hawaiian/Pacific Islander American Indian/Alaskan Native Hispanic or Latino Black/African American White/non-Hispanic Prefer not to say Asian GENDER
Transcript of SUCCESS OF ALIGNED PHYSICIAN AND …...Medscape Education, New York, NY SUCCESS OF ALIGNED PHYSICIAN...
Amy T. Larkin, PharmD; Colleen S. Healy, MA; Susan Grady, MSN, RN-BC; Anne Le, PharmDMedscape Education, New York, NY
SUCCESS OF ALIGNED PHYSICIAN AND PATIENT/CAREGIVER ONLINE EDUCATION ON COMBINATION THERAPY FOR T2D MANAGEMENT
Scan here to view this poster online.
MON 278
INTRODUCTION
■ Although HbA1c levels of <7% are associated with health benefits, nearly half of patients with type 2 diabetes (T2D) in the United States are not meeting recommended targets [Casagrande 2013]
■ To achieve optimal glycemic control, healthcare providers (HCPs) must individualize T2D management plans [Cefalu 2014; Garber 2013]
■ According to Healthy People 2020, only 57% of adults with diabetes report that they have received formal diabetes education [HHS 2013]
■ Strategies to improve the patient experience should focus not only on providers but also on
improving patients’ ability to elicit what they need from their providers [Greene 2013]
■ Professional and patient education that supports shared decision making helps improve adherence, patient experience, and achievement of clinical outcomes [AHRQ]
■ We sought to determine if an online parallel physician-patient/caregiver education intervention could improve knowledge/competence of HCPs and knowledge of patients/caregivers related to T2D management with combination therapy
Notes
For more information contact Amy Larkin, PharmD, Director of Clinical Strategy, Medscape, LLC, at [email protected].
Source of Support
This initiative was developed with an independent educational grant from AstraZeneca.
Disclosures
The authors have nothing to disclose.
References
Casagrande SS, Fradkin JE, Saydah SH, Rust KF, Cowie CC. The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988-2010. Diabetes Care. 2013;36:2271-2279.
Cefalu WT, Buse JB, Del Prato S, et al. Beyond metformin: safety considerations in the decision-making process for selecting a second medication for type 2 diabetes management: reflections from a diabetes care editors’ expert forum. Diabetes Care. 2014;37:2647-2659.
Garber AJ, Abrahamson MJ, Barzilay JI, et al. American Association of Clinical Endocrinologists’ comprehensive diabetes management algorithm 2013 consensus statement—executive summary. Endocr Pract. 2013;19:536-557.
Greene J, Hibbard JH, Sacks R, Overton V. When seeing the same physician, highly activated patients have better care experiences than less activated patients. Health Aff (Millwood). 2013;32:1299-1305.
Krass I, Schieback P, Dhippayom T. Adherence to diabetes medication: a systematic review. Diabet Med. 2014. doi: 10.1111/dme.12651. [Epub ahead of print]
Agency for Healthcare Research and Quality. The SHARE approach—achieving patient-centered care with shared decision making: a brief for administrators and practice leaders. http://www.ahrq.gov/professionals/education/curriculum-tools/shareddecisionmaking/tools/tool-9/index.html. Accessed October 19, 2016.
US Department of Health and Human Services (HHS). Healthy People 2020. http://healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=8. Updated August 28, 2013. Accessed December 5, 2016.
Educational need and clinical performance gaps related to combination therapy in T2D management informed content development
PHYSICIAN CME
■ Two online CME activities were developed, each as a 30-minute roundtable discussion between 3 leading experts
• CME activity 1 discussed overcoming patients’ psychosocial barriers to optimum T2D management
• CME activity 2 covered the role of fixed-dose combination therapy in T2D management
• Both activities included transcripts and downloadable slide decks to reinforce key concepts and recommendations
■ The target audience was primary care physicians (PCPs) and diabetologists/endocrinologists (diabs/endos) who treat patients with T2D
■ Educational impact was measured with 4 repeated pairs, pre/post assessment questions
• A chi-squared test assessed if the mean post-assessment score differed from the mean pre-assessment score
■ Each CME activity included a link to 3 interactive patient/caregiver education modules, developed in parallel, to educate patients and their caregivers about diabetes progression and combination therapies for T2D management
■ CME activity 1 launched online October 30, 2015, and data were collected through January 20, 2016; CME activity 2 launched online November 23, 2015, and data were collected through February 1, 2016
PHYSICIAN CME
■ A total of 99 diabs/endos and 380 PCPs participated in the CME activity and answered all pre- and post-assessment questions
■ Significant improvements (all P <.05) post-assessment vs pre-assessment were observed, including:
• Identifying appropriate role in therapy of fixed-dose combination therapy (27% increase diabs/endos; 26% increase PCPs) (Figure 1)
• Identifying patient barriers to effective diabetes management (32% increase diabs/endos; 28% increase PCPs) (Figure 2)
• Identifying fixed-dose combination therapy as a strategy to improve adherence (32% increase diabs/endos; 14% increase PCPs) (Figure 3)
PATIENT/CAREGIVER EDUCATION
■ In total, 8913 learners participated in the education. Visitation data include:
• 8427 learners accessed 1 activity
• 378 learners accessed 2 activities
• 108 learners accessed 3 activities
■ 5696 of the 8913 patient/caregiver learners completed the pre- and post-education questions
■ 79% of participants self-identified as having T2D
■ Significant improvements in knowledge resulted from participation in the educational activities:
• 20% improved their knowledge related to benefits of controlling blood glucose (P <.0001; Figure 4)
• 14% improved their knowledge related to medications and their associated side effects (P <.0001; Figure 5)
• 5% improved their knowledge related to benefits of fixed-dose combination therapy (P =.0012; Figure 6) combination therapy
PATIENT/CAREGIVER ACTIVITY
■ Patient/caregiver learners had access to 3 targeted educational modules, both as directed by their physicians and, via Internet search, on WebMD.com
■ Patient/caregiver responses to a knowledge question post-education were compared with pre-education responses to measure improvement
■ The activities launched online in November 30, 2015, and data were collected through March 21, 2016.
PATIENT/CAREGIVER EDUCATION
50%
0%
20%
40%
60%
80%
100%
Question #1 Question #2 Question #3 Question #4
% Correct Pre % Correct Post Relative % Change
75% 45% 107%
Nephrologists (n = 113)
87%
61%
88%82%
53%
40%
0%
20%
40%
60%
80%
100%
Question #1 Question #2 Question #3 Question #4
% Correct Pre % Correct Post Relative % Change
169% 105% 24% 165%
100%
79%71%
26% 27%
65%
24%
64%
Primary Care Physicians (n = 214)
35%
50%
53%
FIGURE 4. I Have Diabetes. Will It Ever Get Better?WHAT STATEMENT ABOUT T2D IS TRUE?
0%
20%
40%
60%
80%
100%
Controlling blood sugar levels can help prevent the long-term problems
of T2D
Diet, exercise, and medicine can
reverse T2D
Most people with T2D can control their blood sugar levels with diet
and exercise alone
There are medicines that can cure T2D when you take them together
Pre (n=1088) Post (n=1088)
51%
71%
25%15%
24%13%
1% 1%
P <.0001
FIGURE 5. Does More Medicine for Diabetes Mean I’m Getting Worse?WHICH OF THE FOLLOWING DIABETES MEDICINES DOES NOT CAUSE EITHER WEIGHT GAIN OR VERY LOW BLOOD SUGAR (HYPOGLYCEMIA)?
0%
20%
40%
60%
80%
100%
Glyburide and sodium-glucose cotransporter-2
(SGLT2) inhibitors
Metformin and glyburide
Metformin, dipeptidyl peptidase-4 (DPP-4)
inhibitors, and insulin
Metformin, DPP-4 inhibitors, and SGLT2
inhibitors
Pre (n=456) Post (n=456)
9% 10%
53%
39%
12% 11%
25%
39%
P <.0001
FIGURE 6. New Combination Therapies for T2D: What’s Out There?WHAT MIGHT HAPPEN IF YOU TAKE 1 PILL THAT HAS BOTH A DPP-4 INHIBITOR AND AN SGLT2 INHIBITOR WITH YOUR METFORMIN?
0%
20%
40%
60%
80%
100%
You may have lower blood sugar levels and may lose more weight
You’ll have a greater risk of dangerously low blood
sugar (hypoglycemia)
You’ll have fewer side e�ects
All of the above
Pre (n=2852) Post (n=2852)
23%28%
11%6%
11% 15%
55% 51%
P =.0012
METHODS
RESULTS
■ This study demonstrates that well-designed aligned HCP and patient/caregiver education can be successful in improving knowledge/competence of key components of successful T2D management
■ Targeted and focused digital education has the potential to empower, engage, and equip patients and their care partners with information needed for self-care condition management
CONCLUSIONS
PHYSICIAN CME
50%
0%
20%
40%
60%
80%
100%
Question #1 Question #2 Question #3 Question #4
% Correct Pre % Correct Post Relative % Change
75% 45% 107%
Nephrologists (n = 113)
87%
61%
88%82%
53%
40%
0%
20%
40%
60%
80%
100%
Question #1 Question #2 Question #3 Question #4
% Correct Pre % Correct Post Relative % Change
169% 105% 24% 165%
100%
79%71%
26% 27%
65%
24%
64%
Primary Care Physicians (n = 214)
35%
50%
53%
FIGURE 1. WHICH OF THE FOLLOWING IS THE MOST EFFECTIVE THERAPEUTIC STRATEGY TO ADD TO METFORMIN AT THIS TIME?
0%
20%
40%
60%
80%
100%
Reinforce lifestyle changes and
continue the metformin
Combination therapy with addition of a DPP-4 inhibitor combined with
an SGLT2 inhibitor
Add a DPP-4 inhibitor
Add an SGLT2 inhibitor
Diab/Endo Pre (n=74) PCPs Pre (n=142) PCPs Post (n=142)Diab/Endo Post (n=74)
3% 4%10%
5%
51%
78%
53%
79%
15%
1%
21%
10%
31%
16% 16%
6%
P <.05 P <.05
FIGURE 2. WHICH OF THE FOLLOWING IS A PATIENT-RELATED BARRIER TO EFFECTIVE T2D MANAGEMENT?
0%
20%
40%
60%
80%
100%
Speaking to their healthcare provider about their disease
Feeling of hopelessness
Only trusting their health-care provider (eg, not
seeking out information from other sources)
Not being motivated to be healthy
Diab/Endo Pre (n=25) PCPs Pre (n=238) PCPs Post (n=238)Diab/Endo Post (n=25)
16%
0%
16%9%
40%
72%
47%
75%
12%8% 7% 5%
32%
20%
30%
11%P <.05 P <.05
FIGURE 3. WHICH OF THE FOLLOWING STRATEGIES HAS BEEN SHOWN TO HELP INCREASE THERAPY NONADHERENCE?
0%
20%
40%
60%
80%
100%
Use of medications that are only
available as generics
Use of fixed-dosed
combinations
Use of medications that
are injectable
Use of older "traditional" antihyperglycemic
agents
Diab/Endo Pre (n=25) PCPs Pre (n=238) PCPs Post (n=238)Diab/Endo Post (n=25)
12%
0%
9% 6%
44%
76%
47%
61%
36%
20%
34%
23%
8%4%
10% 11%P <.05 P <.05
46%
54%
Female
Male
2%
4%
11%
22%
62%
Under 25
25-34
35-44
45-54
Over 54
DEMOGRAPHICS
AGE
ETHNICITY
1%
2%
5%
6%
9%
14%
63%
Native Hawaiian/Pacific Islander
American Indian/Alaskan Native
Hispanic or Latino
Black/African American
White/non-Hispanic
Prefer not to say
Asian
GENDER
