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Problem:Problem:Therapy MalTherapy Mal--Compliance or Compliance or
NonNon--Adherence ...Adherence ...(Therapie(Therapie--ontrouw ...) ontrouw ...)
If a patient does not comply to the doctor’s or pharmacist’s instructions
concerning continuation, dosage andinterval of the medication, we speak of
“Mal- or Non-Adherence”
Non-Adherence, (Therapie-ontrouw),
is an Issue as old as Medicine …
Non-Adherence, (Therapie-ontrouw),
is an Issue as old as Medicine …
Non-Adherence is a problem that predates Hippocrates, who advised his fellow physicians to "keep watch for that fault in patients which
makes them lie about the taking of things prescribed."
Non-Adherence is a problem that predates Hippocrates, who advised his fellow physicians to "keep watch for that fault in patients which
makes them lie about the taking of things prescribed."
HippocratesHippocrates (460(460--377)377)Early Warning of the NonEarly Warning of the Non--AdherenceAdherence--IssueIssue
HippocratesHippocrates (460(460--377)377)Early Warning of the NonEarly Warning of the Non--AdherenceAdherence--IssueIssue
Penicillin:
The Gift from the Gods …
Penicillin:
The Gift from the Gods …
The Gift from the Gods …The Gift from the Gods …
However:
“If there were a cure for non-adherence -a pill that would make you take your other
pills - it would be a greater boon to health than any medication since penicillin” …
“Medicine’s stealthiest problem” 1999
However:
“If there were a cure for non-adherence -a pill that would make you take your other
pills - it would be a greater boon to health than any medication since penicillin” …
“Medicine’s stealthiest problem” 1999
5NonNon--Adherence to Therapy: The Doomsday Machine Similarity …?Adherence to Therapy: The Doomsday Machine Similarity …?
Concurrent Therapy: The Doomsday Machine …?
Improving Patient’s Therapy AdherenceImproving Patient’s Therapy Adherencevisvis--aa--visvis
Preventing Colossal Costs & Wastage Preventing Colossal Costs & Wastage through simple innovations …through simple innovations …
June 10, 2014Willem Kort, Confrérie Clinique
Zorg 2025, Rabobank, Amsterdam Economic Board
8From Dr. Strangelove …From Dr. Strangelove …
9
Homo Sapiens ...?Homo Sapiens ...?
10
Homo Sapiens ...?Homo Non-Adherent!
Homo Sapiens ...?Homo Non-Adherent!
“If there were a cure for non-compliance - a pill that would make you take your other pills - it would be a greater boon to
health than any medication since penicillin …”Dr.Craig Saxton, fmr Head Pfizer HQ R&D, New York, USA.
Dr. Koop
“Medicines don’t work in patients who don’t take them …”Dr.C. Everett Koop, frmr Surgeon General, USA.
Dr. Koop
Negative Effects of Mal-Compliance for Specific Drugs
Antidepressiva Serious Rebound Phenomena
Beta Blockers Rebound Hypertension, TachycardiaCa-Antagonists Reflex tachycardia at „restart“Antibiotics New „resistant“ infectionsAntiarrhythmica Life threatening arrhythmias
Anti Hypertensives Stroke and myocardial infarctionImmunosuppressants in organ transplantation
Organ rejection
Anti Diabetica Blood circulation problems
None, or less, therapeutical efficacy of the medication!
Researched by Dr.Dr.med. Joerg Dellbruegge
M.Mitzel:”Defining the Problem of Malcompliance”
“In Flagrante Delicti …”
Counseling, education and behaviour modification techniqueshave achieved only limited success
in boosting compliance ...
40% Of patients will experience treatment failure or a new
medical problem as a result of improper use of medication …
Of all medication prescribed, Of all medication prescribed, only 60% are actually consumed ...only 60% are actually consumed ...
analysis | status otcm | technology | roll out
Giga Costs ...Giga Costs ...
17Play ZDF “Heute Magzine” life-action storyboard?
Non-Adherence … The Very Costly Facts of Trash Medication.
Non-Adherence … The Very Costly Facts of Trash Medication.
Yes No
18NonNon--compliance: many patients take drugs incorrectly, infrequently, compliance: many patients take drugs incorrectly, infrequently,
or not at all. Rates & reasons vary between therapeutic areas. or not at all. Rates & reasons vary between therapeutic areas.
Source: The Hidden Epidemic by Boston Consulting Group, 2003
19NonNon--compliancecompliance::
a major a major problemproblem in in minorminor & & seriousserious illnessesillnesses, i.e. , i.e. ……
Source: PWC, Pharma 2020, 2007
20From Dr. Strangelove …From Dr. Strangelove …
RFID
Radio Frequency IDentification
NFC
Near Field Communications
24Anatomy of the (actual) Technology Principle …Anatomy of the (actual) Technology Principle …
Printed circuitry Printed circuitry ––“conductive lines”“conductive lines”
Printed Printed AntennaAntenna
Mini cellMini cellBatteryBattery
Microchip:Microchip:•• MemoryMemory•• RFID interface (NFC)RFID interface (NFC)•• Clock calendar (counter)Clock calendar (counter)•• Sensor inputsSensor inputs
Smartblister Label attachedincludes the electronic therapy adherence measurementcircuitry
Label can be attached to theexisting blister and returnedinto the original box (secondaryPackaging)
Wireless communication at the Pharmacy’s reader/programmerand with the patient’s Smartphone
SmartblistersSmartblisters in Original (secondary) Packaging …in Original (secondary) Packaging …
26Scenes we’d like to see (3): transfer of data by standard NFC cell …Scenes we’d like to see (3): transfer of data by standard NFC cell …
27Example: NonExample: Non--Compliance of Medication Taking in Compliance of Medication Taking in DiabetesDiabetes--IIII
Compliance events recording
Outcome measurements (i.e. blood glucose levels)
Confidential
Live at Work Now ...Live at Work Now ...
29From Dr. Strangelove …From Dr. Strangelove …
Live (clinical) trials: 2005Live (clinical) trials: 2005--2006, the onset ...2006, the onset ...Evidence of Functionality ...Evidence of Functionality ...
Live (clinical) trials: 2007Live (clinical) trials: 2007--2010, 2 theses (Jekle, Zeiter)2010, 2 theses (Jekle, Zeiter)Evidence of Functionality ...Evidence of Functionality ...
Prof. Dr. Irene Krämer, Prof. Dr. Irene Krämer, University of MainzUniversity of MainzPharmacy Department Pharmacy Department Johannes GutenbergJohannes Gutenberg--University University HospitalHospitalMainz, GermanyMainz, Germany
Conclusion:Effective therapy adherenceleads to regular, tied INRvalues in chronic patients.MEDICCINE enhances thestatus required.
Pharmaceutical CareResearch Group
Live (clinical) trials: 2007Live (clinical) trials: 2007-- ongoing (2 theses, Walter, Boeni)ongoing (2 theses, Walter, Boeni)Evidence of Functionality ...Evidence of Functionality ...
Polymedication Electronic Monitoring System (POEMS): Introducing a new technology as gold standard for therapy
adherence measurement.
Prof. Dr. Kurt E. Hersberger, Prof. Dr. Kurt E. Hersberger, Dr. Isabelle Arnet,Dr. Isabelle Arnet,University of BaselUniversity of BaselDepartment of Pharmaceutical Department of Pharmaceutical Sciences, Pharmaceutical Sciences, Pharmaceutical Care, Basel, SwitzerlandCare, Basel, Switzerland
Prof. Dr. med Rudolf BruppacherDr. Markus Lampert
Markus Messerlieidg. dipl. pharm
Fabienne Boenieidg. dipl. pharm
Philipp Waltereidg. dipl. pharm
Pilot “Efficiency & Wastage of Returned Medication”,Pilot “Efficiency & Wastage of Returned Medication”,Evidence of Evidence of Functionality re: Functionality re: T⁰T⁰--Monitoring ...Monitoring ...
Prof. Dr. Prof. Dr. ToineToine EgbertsEgberts, , Prof.DrProf.Dr. Marcel . Marcel BouvyBouvy, , University University of Utrecht,of Utrecht,Department of Pharmaceutical Department of Pharmaceutical Sciences, Pharmacotherapy, Sciences, Pharmacotherapy, Utrecht UMCU, NetherlandsUtrecht UMCU, Netherlands
Dr. Bart van den Dr. Bart van den BemtBemt, Principal Investigator, Principal Investigator
Live (clinical) trials:Live (clinical) trials:Evidence of Functionality ...Evidence of Functionality ...
• First trial in NL, University of Maastricht, Netherlands• Benefit Project, Vienna, Austria, BMGFJ & BMVIT• Clinical Studies Johannes Gutenberg University, Mainz, Germany• Clinical Studies Basel University, Basel, Switzerland• Projects at Sanofi Aventis, Montpellier, France• Projects at Janssen Johnson&Johnson CTI, Beerse, Belgium• Clinical Studies at Cologne University, Cologne, Germany• Clinical Studies at University of Western Australia, Crawley, Australia• Projects at BMS Bristol Myers Squibb, Utrecht, The Netherlands• Projects at Abbvie, Hoofddorp, The Netherlands• Projects at Radboud University, Nijmegen, The Netherlands• Projects at Leiden University, Leiden, The Netherlands• Projects at Utrecht University, Utrecht, The Netherlands• Projects at MediZorg HomeCare, Houten, The Netherlands
Cooperation & Associates …
• Co-operation with NXP, (Sony), regarding dedicated NFC/RFID chip and active RFID/NFC labels (Schreiner Medipharm), and Alu foils
(AMCOR)
• Novartis, Basel – East-Hanover, Barcelona, Australia
• Sanofi Aventis – Montpellier, Paris, France
• TEVA – Opava, Czech Republic - Israel
• BMS Bristol - Myers Squibb, Utrecht, Netherlands
• Janssen Pharmaceutica Johnson &Johnson – Beerse, Raritan, San Diego, Vienna
• Basel University – Basel, Geneva, Zürich, Lausanne, Bern, St. Gallen
• MSD Merck & Co., Haarlem, New Brunswick
Cooperation & Associates …
• Johannes Gutenberg Universität - Co-operation on Clinical R&D –Clinical Phamacological Vigilance, Mainz, Germany
• Sandoz – Basel, Almere, USA
• Abbvie – Amsterdam, Abbott Park, Chicago, USA
• Boehringer Ingelheim – Ingelheim am Rhein, Weesp
• Mediq - Utrecht, Netherlands
• SMK, Sint MaartensKliniek, Ubbergen, Netherlands,Radboud Universiteit, Nijmegen, Netherlands
• Transposafe, BradyCorp – Sassenheim, Milwaukee, WI
•MediZorg – Houten, The Netherlands, Benelux
•Market potential Medication Blisters –Worldwide estimation 2012: 35 Billion medication blister packages per year …
•Market potential Medication Bottles –Kaiser Family Foundation’s Report Prescription Drug Trends: 3.4 Billion prescription (medication) bottles per year …
•Market potential Licenses Pharma & Packagers -More than 400 therapeutical chemicals (groups), per therapeutical group 1 exclusive license …
•Financial Worth Healthcare Packaging by 2018 –Report Pharmaceutical Packaging Market(MarketsandMarkets) $ 80 Billion p.a.
Global Market …Global Market …
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•
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They ‘They ‘veve put their money where their mouth is …put their money where their mouth is …
••
••••
••
•“Geen Terugbetaling, Geen Markt” …Ron de Graaff
•“Willen, Kunnen, Mogen” … Bob van der Kamp
En En dandan nu: nu: WieWie gaatgaat datdat regelenregelen & & betalenbetalen? …? …
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