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The Intervention Program
THE MISSING LINK IN BIOPHARMACEUTICAL SCIENCESTM
A basic principle
“Help your doctor help you”
medAmigo intervention program
medAmigo
med=medicine, Amigo=Friend
medAmigo patient management model
Patient Starts
Screening vs.
Algorithms &
Interventions Plans
Intervention Plan
SelectedPhysician &
Patient Feedback
Monitoring & Data
Collection
Intervention
Physician & Patient
Feedback
Measurement-Guided Medication Management (MGMM) based intervention
Successful techniques for improving compliance require two key elements:
• Realistic measurement– the objective, continuous electronic recording of day by day
dosing times, which can be easily interpreted by most patients
• Scheduled appointments with feedback – continuing periodic review with the patient, by the prescribing
physician, pharmacist, or nurse of the patient’s ongoing dosing history.
Illustrative results of a medAmigo intervention
Beforeintervention
Dos
ing
Tim
e
Dosing Date
Do
sin
g T
ime
0 100 200 300
00:00
06:00
12:00
18:00
24:00
1926 / 42 RE+
Strata : USA
1
2
23
6
0
4
5 5
6
21 1
1
1 0
1234
4
2
45
6 0
3
123456 0123456 0
345
6 012345
6 0123456 0
12
3456 0123456 01
1
3456 0123
456 01
23
3
456 0123456 0123456 0123456 0123456 01
23456 01
23456 0123456 0123456 0123456 0123456 0123456 0123456 012456 012345
5
6 0123456 0123445
6
0123456 0123456 0123456 012
3456 01234556 0123456 0123445
6
0123456 0123455
6 0123456 01234
5
6 012345
5
6 01234566123456 01
2
2
25
VVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV VV V V
2 3 4 5 6 7
Days on treatment
After intervention
Treatment of osteoporosis
V= a missed dose, 0= Sunday; 1= Monday; 2= Tuesday; 3= Wednesday;…
MGMM tested successfully in Hypertension
McKenney et al., 1992 J Clin Pharmacol
No Intervention (N = 34) Mean compliance = 78%
Intervention (N = 36) Mean compliance = 95%Difference = 17%
12 weeks data
MGMM tested successfully in Hypertension
McKenney et al., 1992 J Clin Pharmacol
MGMM tested successfully in Serious Mental Illness
Month 1 Month 6
Intervention 81 ± 22%
N=31
76 ± 22%
N=25
No Intervention 68 ± 27%
N=29
57 ± 30%
N=20
Difference 13% 19%
P-value 0.023 0.008
Cramer and Rosenheck, 1999 J of Nervous & Mental Diseases
Burnier et al., 2001 J of Hypertension
MGMM tested successfully in Resistant Hypertension
MGMM tested successfully in Smoking Cessation
* p<0.05 ** p<0.001
Week
**** * *
Dose compliance
Schmitz et al., 2005, Journal of Behavioral Medicine
No InterventionN = 46
InterventionN = 51
Difference of
± 30%
MGMM tested successfully in HIV
• N=26 experienced patients (>6 months on treatment)
De Bruin et al., 2005 Aids Patient Care
2 months 3 months
Intervention
82% 93%
Difference = 11%, p<0.05
Larger confirmatory trial is ongoing
MGMM tested successfully in Lipid Lowering
~86%
~71%
Vrijens, et al., Pharmacoepidemiology and Drug Safety, 2006
P<0.01
Daily Percentage of adherers
Days since inclusion
%
0 50 100 150 200 250 300
60
70
80
90
10
0
InterventionNo Intervention
Difference of 15%
Poor adherence/short persistence
Decreased drug efficacy
Increased care costs
Early dropouts; lost sales
Patients LOSE
Payors LOSE
Industry LOSES
Breaking the downward spiral
Decreased care costs
Payors WIN
IndustryWINS
Late dropouts; retained salesTimely detection, focused
Intervention
Robust adherence/long persistence
Increased drug efficacy
Patients WIN