EBM II sec 2

what is participatory medicine

patient and HCP working together in making the best possible healthcare decision for the patient

how do patients feel about participatory medicine

90% of patients believe working with their healthcare provider as a partner will help enhance their overall health situation

what do the majority of patients use as their first source of health information

the internet

what is the goal of patient education

improve patient behavior, adherence, and ultimately health

what is patient education

interaction with patients that is individualized to their specific information

what are examples of patient education

brown bags, face-to-face consultations, health screenings and POC testing, MTM counseling

what is consumer health information

information actively sought by the patient in response to their need for more information about their health. not individualized

what are examples of consumer health information

word of mouth, internet, social media, TV shows

what is the success of delivering meaningful CHI dependent on

patients must have the ability to identify, interpret, and apply relevant information

how should information on the internet be used

as a supplement to information given to them by their health providers

how does EBM relate to social media in terms of information

EBM minimizes the importance of anecdotal reports

social media affirms anecdotal reports

what is the wisdom of crowds

patients are less likely to depend on a single expert opinion than the opinion of many participants

therefore, people tend to believe collective wisdom over the opinion of a physician

what is the difference between patient education and CHI

it is easier to control the quality during patient education

quality can very with CHI

what are the 4 types of quality of CHI

1. excellent quality and beneficial to patient

2. high quality but irrelevant to the patient's situation

3. incomplete

4. simply wrong

what are examples of digital health

telehealth, voice assistants, robotics/automation, mobile health apps, sensors/wearables, AI

what is likely most important to focus on when evaluating mobile health apps

apps that present a greater risk if they don't function as intended

what is BlueStar

analyzes data entered by the patient including blood glucose and medications that compares information to deliver personalized in-the-moment guidance

FDA approved and statistically significant reduction in A1C seen

what are examples of direct to consumer care products

lab tests, genetic tests, telemedicine and prescriptions (ro)

what are the 4 endpoints of digital health products

1. trial validates product's functionality (compares measurements taken by product to those taken by validated means)

2. trial validates product's clinical usability (assess the safety, tolerability, engagement, and adherence to a product)

3. trial uses data captured by the product to inform another intervention

4. trial uses the digital product as the primary intervention

what are the 4 key issues with digital health

1. data ownership and privacy

2. patient trust and access (privacy concerns and low digital literacy)

3. standards and interoperability (compliance to regulatory bodies)

4. challenges with reimbursement

what is real world data

data relating to patient health status and/or the delivery of healthcare routinely collected from a variety of sources

what can real world data lead to

real world evidence

what is real world evidence

clinical evidence regarding the use and potential benefits or risks of a medical product derived from analysis of real world data

*designed for the purpose of informing decisions about comparative balance of benefits and risks at an individual or population level

what is narrow AI

AI designed to perform a specific task or narrow range of tasks

what are examples of narrow AI

machine learning (chatGPT), robotics, medical diagnostics, recommender systems

what is AI proven best at in healthcare

managing administrative functions

what are limitations of chatGPT

trained from data obtained from open sources on the internet

can create false responses

cannot use privately restricted data

what are the legal considerations of using AI

avoiding AI may risk malpractice d/t missed benefits

there is limited precedent for AI-related errors: liability is unclear

what is a concern of increasing technology related to social determinants of health

increased reliance on technology may increase the gap those with educational or language barriers experience

what is a MAJOR concern in using AI

bias

AI models are known to underdiagnose underserved groups and worsen healthcare disparities

how can you prevent this bias

use diverse training data to improve accuracy for underserved patients

how do pharmacists bridge the gap in terms of DHI

accept that many patients obtain healthcare info from many sources and embrace the opportunity to work with patients as they look for devices to improve their health

what are 3 steps pharmacists can take when talking to patients about DHI

1. talk to patients about where they get their information and counsel them that online info doesn't replace a conversation with a HCP

2. develop a list of recommended online resources for patients

3. be familiar with common CHI resources and be comfortable evaluating any website

what questions should be asked when evaluating CHI websites

1. is the material written in an understandable manner

2. who is responsible for the website

3. does the info have supporting evidence

4. is the info unbiased and objective

5. can visitors contact website owners with questions/feedback

6. is health info regularly updated

7. is the only purpose to provide information

8. does the website provide a source

what is health literacy

ability to obtain, process, and understand basic health information and services to make appropriate health decisions

what things can improve accessibility for patients with poor digital literacy

simple home page, easy to navigate, audio option, designed for old software, printer friendly

what are the questions you should ask when evaluate digital health products

1. what is the purpose of the device

2. who created it

3. what is the evidence of effectiveness

4. is it easy to use

5. is there broad system compatibility

6. who intiated care with the device

7. is the data produced accurate, clinically useful, and UTD

8. what is the data privacy

what questions should you ask when evaluating AI programs

1. how was the model trained

2. what kind of data sets were used

3. how representative is the training dataset

4. what are the limitations of its use

5. what is the process to verify performance

6. how is the product continuously monitored for safety

7. what implicit biases are there

8. what is the intended use of the product

what is a formulary

a continually updated list of preferred medications evaluated by an expert panel and determined to be uniquely valuable to the patient population managed

what is the objective of a formulary

support safe, appropriate, and cost-effective medication selection

what is the challenge of a formulary

promiting clinical and cost-effectivness while not overly restricting medication use and limiting patient access

what are the different types of formularies and what are they

open: no limit on what can be prescribed, a portion of all drugs are covered regardless of status

closed: limitations on what can be prescribed, non-formulary drugs are not reimbursed unless override approval is granted

what are the types of closed formularies

positive: add meds as you go

negative: start with current stock and eliminate non-essential medications

what is a P&T committee

interdisciplinary team that provides guidance for medication selection

responsible for developing, managing, and upt=dating the formulary

who is on a P&T committee

physicians, nurses, pharmacists, administrators

what does a P&T committee do

approve or deny formulary updates based on drug monograph, class reviews, MUEs

handle drug shortages, med safety alerts, and ADRs

provide emdication use management like therapeutic interchange and guided-ues policies

what are drug monographs

written document that is an evaluation of medications for addition to a formulary

when are drug monographs written

in response to a formulary request or after medication/new indication approval

who creates drug monographs

different between institutions, usually:

purchasing/formulary pharmacist

clinical pharmacist

any pharmacist

outsourced to DIC

what are therapeutic class reviews

regular review of drug classes to assure that optima drug options are available

what types of drugs undergo drug use evaluations

high-cost, high-risk, high-use

what are the 3 types of DUEs

diagnosis related, prescriber related, drug specific

what is the process of drug use evaluations

a request is made, data is collected, findings are summarized, a recommendation is made

what is the role of a P&T committee in medication safety alerts

committee reviews med safety alerts, campus ADR data, and medication errors to alter formulary or recommendations

what is the role of a P&T committee in addressing drug shortages

designing appropriate therapeutic alternatives identifying strategies for mitigating use of available drug product and establishing use restrictions

what is a therapeutic interchange

authorized exchange of therapeutic alternatives

often drugs with different chemical structures that are expected to have similar therapeutic effects

what are examples of guided-use policies

established use criteria

restricting drug use by specialty

designating medications for use in specific areas

approval of medical director before use

who often manages a payer's formulary

PBMs

what is a PBM

a company that manages prescription drug benefits for health insurance plan

what are the types of payer formularies and what are they

open: coverage provided for most or all formulary and nonformulary medications, potentially higher costs to payer and member due to increased choice

closed: only formulary drugs are covered, formulary exception policies allow providers to request coverage when medically necessary

what are the tiers of formulary

tier 1: generics

tier 2: preferred brand

tier 3: non-preferred brand

tier 4: specialty medications

what is a value assessment

identifies and quantifies the value of a health information

what are the components of value

efficacy and effectiveness

safety

cost

what is efficacy

performance under ideal conditions, such as a controlled clinical trial

what is effectiveness

performance of an intervention in the real world, considering aspects of patient behavior, compliance, and discontinuation

what are direct costs

costs incurred for the healthcare service

what are indirect costs

costs incurred by the patient or society that are not related to healthcare but with the disease or intervention

what is QALY

quality-adjusted life-year: comprehensive measure that accounts for quality of life and life expectancy in one outcome

what is the institute for clinical and economic review good for

they publish reports on new and upcoming technologies that can be used by payers for value assessment

what are clinical guidelines

disease-specific document published by clinician groups that are widely used for making clinical decisions

how do payers manage the formulary

quantity limits, DURs, PAs, site/prescriber restrictions

what are quantity limits

the highest amount of a prescription drug that an insurance plan will cover over a specific period of time

what are DURs

authorized, structured, ongoing reviews of the prescribing, dispensing, and use of medications

what are the types of DURs

prospective: evaluation of a patient's drug therapy before medication is dispensed

concurrent: ongoing monitoring of drug therapy during the course of treatment

retrospective: review of drug therapy after patient has received the medication

what is the goal of prior authorizations

encourage appropriate use of medications both to reduce the incidence of preventable drug-related morbidity and certain costs

what is the goal of step therapy

reduce cost of treatment by ensuring that a proven and cost-effective therapy is tried before progressing to more costly remedies

what are lock-in programs

restrict patients to a designated pharmacy and prescriber when filling prescriptions for a controlled substance