Help for Medicare Patients to Avoid ‘Donut Hole’
Posted in News on 7.5.2018
Dr. Jing Luo, in-house Physician Advisor at Alosa Health and faculty member in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital, recently spoke at the American Diabetes Association’s 78th Annual Scientific Sessions on the comparative effectiveness and cost-benefit impact of using analogue versus human insulin for managing type 2 diabetes. Significantly, the cost of insulin drives many Medicare patients into the Part D coverage gap, which refers to the period of time after Medicare beneficiaries have outspent their initial coverage but before catastrophe coverage kicks in.
Luo and his colleagues analyzed prescription and claims data from thousands of Medicare participants and found that Medicate beneficiaries with type 2 diabetes switched from analogue to human insulin were less likely to reach the spending limit for their Part D drug plan. As Luo explains, “The unit price of insulin has risen dramatically across a variety of settings, and… newer analogue insulins are more expensive than comparable human insulin products.” This cost-savings was achieved at no expense to clinical outcomes. “They [analogue insulins] may not result in substantially improved clinical outcomes for most patients with type 2 diabetes.”
Want to learn more? Read the full article.
Pitfalls of FDA’s Breakthrough Drug Program
Posted in News on 4.17.2018
While the FDA’s expedited review programs are often touted as a way of speedily getting life-saving or life-altering drugs into the hands of patients in need, some experts, among them Alosa Health founder Jerry Avorn, are skeptical about the FDA’s breakthrough drug therapy (BTD) program.
Firstly, Avorn and colleagues note that the BTD program results in huge gains for the pharmaceutical industry by eliminating years’ worth of research and development costs. This means that there is a clear profit motive associated with submitting a request for the BTD designation.
Secondly, drugs undergoing expedited review are able to win approval based on less supporting data than would be required through the standard review process, leaving their value and value relative to other therapies “untested and uncertain”. The process is faster, but at the expense of rigorous evaluation of evidence.
Add in the media’s tendency to refer universally to drugs undergoing expedited review as “innovative” and “game changers” (labels that are often applied prematurely, well before there is sufficient supporting evidence), and it is easy to see how the BTD program leaves the door open to misunderstanding and misinterpretation concerning drugs’ perceived safety and value.
Interested in learning more? Read the full article from Endpoints News here.
PACE Introduces Acute Pain Module
Posted in Updates on 4.9.2018
On the heels of Chronic Pain, Alosa Health has recently released an Acute Pain module through Pennsylvania’s PACE program.
Acute pain is a frequent problem for older individuals and its prevalence has been shown to increase with age. Effective treatment of acute pain is important and reduces suffering, improves return to function, and importantly, may help prevent progression to chronic pain. This module focuses on finding the right balance between under-treating acute pain and over-medicating for a self-limited condition.
Our team of academic detailers is already out in the field delivering this module to providers across the state of Pennsylvania.
Congenital Syphilis Program in Maryland Underway
Posted in Updates on 3.23.2018
After winning a bid to provide educational outreach services in the city of Baltimore, Alosa Health has partnered with Maryland Department of Health to develop educational training materials on the topic of congenital syphilis prevention and to deploy a field-based educational program. Rates of congenital syphilis has been on the rise in the state of Maryland in recent years. Key messages on congenital syphilis prevention include screening all pregnant women at first prenatal care visit, 28 weeks, and delivery.
We are proud to welcome Shelley Bacchus to the team as our primary clinical educator for this program.
JAMA Study Challenges Efficacy of Opioids vs Non-addictive Alternatives
Posted in News on 3.21.2018
For some time now the medical community has sought guidance on responsible prescribing related to opioids. A large, randomized trial, recently published in JAMA, demonstrated that for patients with moderate-to-severe chronic back pain or hip or knee osteoarthritis pain, a non-opioid medication regimen produced as much pain relief and recovery of function as an opioid regimen, but with fewer medication-related side effects.
To learn more about the implications of this study, read Alosa Health’s Prompt Evidence Assessment and Review of the Literature (PEARL).
Psychology of Clinical Decision Making
Posted in News on 2.26.2018
In a Perspective piece published earlier this week in the New England Journal, Alosa Health Founder and Clinical Advisor Dr. Jerry Avorn discusses the science of decision-making. While the science of decision-making is a well-developed field, its application to the field of medicine has been slow.
Dr. Avorn ascribes this slow uptake to medicine’s “ongoing assumption” that clinicians and patients are rationale decision makers, when in fact reality paints a different picture. We know, for instance, that humans are influenced disproportionally by information that is most easily accessible or prominently featured. We also know that humans are influenced by recent experiences, even if those experiences are not a representative sample, and that humans are poor estimators when it comes to the probability of adverse events.
One method to overcome these natural inclinations toward non-rational decision-making, and to introduce concepts from behavioral economics into the world of medicine, is academic detailing. The goal of academic detailing is to move clinicians toward more evidence-based choices around prescribing, and the approach involves educational outreach in which specially trained educators meet with clinicians in their own offices to discuss a particular clinical topic or medication-use situation.
Learn why Dr. Avorn believes that academic detailing is the best way to incorporate psychology of decision-making into the medical realm by reading the full piece here.
Contract Expansion Targets Opioid Epidemic in Pennsylvania
Posted in Updates on 1.11.2018
Alosa Health’s contract with Pennsylvania's Pharmaceutical Assistance Contract for the Elderly (PACE) expands thanks to a $26.5 million federal grant awarded to the State of Pennsylvania to combat the opioid epidemic. The funding will allow Alosa to visit more PA physicians to provide educational outreach (academic detailing) to help them treat pain more effectively while avoiding opioid overuse. It will also offer prescribers the most current information on treating patients with opioid use disorder.
Academic detailing, which interactively 'markets' the best evidence to doctors in their offices, has been shown to improve medication use more than mailed guidelines, reminders, or warnings sent to physicians. For more information visit: http://alosahealth.org/our-solutions/clinical-modules/opioids
PACE Introduces Chronic Pain Module
Posted in Updates on 12.14.2017
Alosa Health has just released an updated Chronic Pain module through Pennsylvania’s PACE program. This educational program presents the most recent evidence for effectively treating pain in the elderly. The emphasis is on non-pharmacologic and non-opioid pharmacologic options, with the goal of minimizing or avoiding the use of opioid analgesics in this population.
Academic detailers in Pennsylvania are just beginning to bring this module into the field, where we expect it will be well received, as we know that this is a challenging topic for providers.
Talking to Patients About Health Policy
Posted in News on 12.14.2017
Alosa Health founder and clinical consultant Dr. Jerry Avorn offered an opinion in the Journal of the Medical American Association’s (JAMA’s) essay feature on the topic of engaging patients in health policy talk.
The question of whether clinicians should interact with their patients about health policy debates remains contentious; some argue that doing so is either ideologically inappropriate or pragmatically impossible given the time constraints of an average patient encounter, but Dr. Avorn makes the case that talking about policy debates which will directly impact patient care is actually a core responsibility of clinicians.
Dr. Avorn also acknowledges that, given the myriad of social issues that impact health (i.e.: sanitation, nutrition, poverty) and the varying degrees to which they may be perceived as falling within a clinician’s purview. Therefore, he suggests, might be reasonable to begin somewhat more narrowly with “a concrete issue like health care coverage”.
Curious about the single action that Dr. Avorn recommends all clinicians take to engage with patients in this way? Read about it here.
Academic Detailing to Combat Opioids in Northern California
Posted in News on 11.17.2017
Kasier Health News recently reported that money from Obama-era grants is being used to fund academic detailing programs in California for the purpose of educating providers on the risks of prescribing opioids. To date, academic detailing programs has been used to address overprescribing of opioids and provide alternatives to managing patient pain in at least seven other states, as well as Washignton, DC.
Alosa Health Dr. Jerry Avorn spoke with Kaiser Health News to elaborate on the utility of using academic detailing programs to combat overprescribing of opioids, and he also commented on the “poetic justice” of “using the same kind of marketing approach to disseminate helpful evidence-based information as some [drug] companies were using [to aggressively push opioids]”
As for the educators, or detailers, they are California doctors and pharmacists who want to bring evidence-based information to their peers. “I view it as peer education,” said one detailer, a physician who no longer sees patients. The academic detailing interaction is not a scolding or a lecture, but rather an opportunity to provide support for a challenging topic.
Original title: Tearing a Page Out of Pharma’s Playbook to Fight the Opioid Crisis, KQED News, 11/8/2017
Academic Detailing Conference Inspires
Posted in Updates on 11.9.2017
Earlier this week members of the Alosa Health team attended the 5th International Conference on Academic Detailing, hosted by our friends and colleagues at NaRCAD. The conference is always an amazing opportunity to connect with others doing academic detailing work and to share insights and best practices.
One of the salient topics this year was PrEP – our own Dr. Jing Luo sat on a panel to discuss Alosa Health’s PrEP detailing program in Shelby County, TN along with co-panelists who spoke about their PrEP detailing programs in other regions. Additionally, our Director of Clinical Materials Development Ellen Dancel led an interactive breakout session on how to create engaging materials. Needless to say, the team returned energized and eager to act on learnings from the conference.
To learn more about what happened at this years conference and to watch sessions you might have missed, check out The Conference Hub over on NaRCADs website.
Executive Director Testifies at Senate Committee Hearing
Posted in Updates on 10.25.2017
This week Alosa Health Executive Director Paul Fanikos testified at the Special Senate Committee Hearing on Health Care Cost Containment and Reform in support of investing in an evidence-based educational outreach program. During the testimony, Fanikos explained how a program focused on therapeutic and cost-effective utilization of prescription drugs would be a significant step in improving patient outcomes and reducing unnecessary costs to the healthcare system.
Alosa Founder Speaks at Innovation Meeting
Posted in Updates on 10.19.2017
Alosa Health founder, Dr. Jerry Avorn, was invited to speak at the Adriadne Labs health systems innovation meeting on October 12th. The focus of the dialog was on "Improving Physician Decision-Making at Scale: Alosa Health and the Academic Detailing Model". There was a lengthy question and answer period hosted by moderator Atul Gawande, MD, MPH, Adriadne Labs Executive Director. Dr. Avorn and Alosa Health Executive Director Paul Fanikos engaged the audience on successful projects, aligning business needs for program implementation as well as the integration of technology platforms to scale future projects.
Web-Based PrEP Resource Center Debuts in TN
Posted in Updates on 9.29.2017
Alosa Health partners at the Shelby County Department of Public Health unveiled a web-based resource for Tennessee residents who want to learn about PrEP, the FDA-approved HIV prevention medication. Visitors to the website, http://GetPRePTN.com/, can find a PrEP navigator, connect with a PrEP prescriber, or access educational materials from Alosa Health and the CDC.
Get PrEP TN is also accessible via the following social media links:
Pharmaco-Epi Community Responds to New Study
Posted in News on 9.15.2017
Pin pointing the dollar amount that it actually costs to bring a drug to market is a tricky business. Until recently, the most widely accepted estimate has come from Tufts Center for the Study of Drug Development, at $2.7 billion per drug.
Yet a new study published in JAMA places that number much lower, a median cost of $757million per drug. The JAMA study evaluated 10 cancer drugs, which are among the most expensive drugs, making their findings even more surprising.
The paper was received with both praise and criticism. Dr. Aaron Kesselheim, a faculty member of Brigham and Women’s Hospital’s Division of Pharmacoepidemiology and Pharmacoeconomics (DoPE) described the study as “thoughtful and rigorous”.
Representatives of the biotech industry, however, took issue with the way calculations were made—specifically, that they did not take into account the cost of many drugs that never make it to market.
Dr. Jerry Avorn, Alosa Health founder and Director at DoPE, commented that study is sure feed the ongoing debate over cancer drug prices, elaborating, “We are getting into areas that are almost unimaginable economically.” Read the full article here.
Dr. Choudry to Deliver Keynote at HIMSS Forum
Posted in Updates on 9.14.2017
Dr. Niteesh Choudry, Alosa Health physician advisor and professor at Harvard Medical School, as well as Executive Director at the Center for Healthcare Delivery Sciences, will deliver the keynote address at the upcoming Big Data and Healthcare Analytics Forum along with colleague Dr. John Quakenbush, of the Dana-Farber Cancer Institute and Harvard School of Public Health.
The forum is hosted by HIMSS, a nonprofit organization focused on better health through information technology. Each year, professionals from hospitals and health systems, private and public payers, government, and academia meet to discuss insights and best practices on healthcare data.
Dr. Choudry’s keynote address titled “Less Intervention or More? Let the Data Decide” will discuss the use of data to address non-adherence to evidence-based medication regimens.
TOPCARE Intervention Shows Promise For Opioid Prescription Monitoring
Posted in Publications on 7.28.2017
A multicomponent intervention including academic detailing improved prescription opioid monitoring compared with electronic decision tools alone in a randomized trial of 4 urban safety-net primary care practices.
JAMA Intern Med. Published online July 17, 2017. doi:10.1001/jamainternmed.2017.2468
Prescription opioid misuse is a leading public health problem and likely contributes to overdoses. The evidence base supporting interventions to change clinical practice at the level of primary care physicians with respect to opioid prescribing is limited. For example, the effect of non-controlled interventions may be difficult to interpret in the setting of local, state and national level initiatives to reduce inappropriate opioid prescribing.
Lead investigator Jane Liebschutz and others from the Section of General Internal Medicine at Boston Medical Center conducted a cluster-randomized trial of 53 primary care providers and 985 of their patients categorized as long-term opioid users within 4 safety net clinics. Patients had a mean age of 55 and 62% had a history of a mental health diagnosis. 45% were insured by Medicaid. Over sixty percent of patients were using between 0 to 50mg of morphine equivalent doses prior to the start of the intervention. This dose is generally considered to be associated with a lower risk of drug overdose.
Opioid Intervention Methods
The trial was designed to test the efficacy of a multicomponent intervention called TOPCARE that included 1-on-1 academic detailing, nurse care management, an electronic registry and electronic decision tools. Control PCPs received the electronic decision tool only. The detailing component was a single session between one of the study coauthors (considered opioid prescribing experts) and the PCP. Topics discussed included: principles of safe opioid prescribing, monitoring, registry reports, details on patient monitoring and risk and challenging patient cases. The nurse care manager was a credentialed nurse who performed risk assessments, prepared prescriptions for PCPs, collected urine drug tests, pill counts, and checked the prescription drug monitoring program on behalf of PCPs. The web-based registry allowed data to be imported from the electronic health record and produced reports used to direct work flow. Furthermore, the registry provided feedback to the program, for example, by allowing study staff to see a PCP’s percentage of patients with an opioid use agreement. Finally, the decision tool included tools for assessment of opioid risk and interactive tools to assist with interpretation of urine drug testing results (a challenging clinical topic).
Study investigators found that the intervention improved the rate of adherence to recent opioid treatment guidelines. Specifically, at 12 months, patients randomized to the intervention were more likely to have a opioid-use agreement (OR 11.9) and have undergone at least 1 urine drug screen (OR 3.0). Unfortunately, the intervention did not reduce the probability of a proxy for opioid misuse: early refills, defined as a prescription refill for an opioid given more than 3 days before the next expected refill date. In exploratory analysis, they found that intervention patients had lower total morphine equivalent doses (6.8mg lower than controls, p<.001).
In conclusion, this study found that a multicomponent intervention including academic detailing improved prescription opioid monitoring compared with electronic decision tools alone in a randomized trial of 4 urban safety-net primary care practices.
With Drug Resistance, Prevention and Early Detection is Key
Posted in News on 7.13.2017
A news release from the World Health Organization (WHO) stated that gonorrhea bacteria are evolving in a way that makes the infection much harder to treat. Gonorrhea is a sexually transmitted infection (STI) that is generally curable with antibiotics. However, new data from various countries around the globe suggest that existing antibiotics are no longer sufficient in some cases as bacteria evolve to resist the known treatments.
While researchers are hard at work developing new drugs, prevention will be an essential component of public health strategy aimed at gonnorrhea in the meantime. As with any STI, education and communication around safer sex practices as well as the ability to recognize symtpoms and seek care can reduce the likelihood of spreading among sexual partners.
Among the innovative strategies adopted by local and regional health departments to address the spread of STIs is expedited partner therapy (EPT). Contact Alosa Health or check out our modules pages to learn more.
Post Editorial Reflects on Progress in HIV/AIDs Treatment and Prevention
Posted in News on 7.12.2017
The Washington DC Department of Health HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA) recently published its Annual Epidemiology & Surveillance Report with good news, as noted by the editorial staff of the Washington Post. The report shows substantial progress being made in the D.C. area with respect to the number of newly diagnosed HIV cases as well as the number of people living with HIV.
For instance, the number of new cases of HIV diagnosed each year has gone down steadily since 2012, marking a 46.9% decline over the 5-year period of 2012-2016. The number of people living with HIV has held steady, but viewed as a proportion of total population and given the improved prognosis for individuals with HIV this data is encouraging.
D.C. is notable for the wide range of activities undertaken to address the issue. These include “increased testing and awareness campaigns, condom distributions, increased use of preventive medication … and a needle exchange program”.
Though not called out by name, we at Alosa Health know that academic detailing is included in at least two of the categories mentioned above— awareness campaigns (i.e., EPT) and increased use of preventive medication (i.e., PrEP).
Clinical Advisor Wins AGS Award
Posted in Updates on 7.11.2017
Alosa Health Clinical Advisor Dr. Dae Kim was recently presented with the prestigious Junior Investigator of the Year Award by the American Geriatric Society (AGS). This award is given annually to an outstanding junior investigator who is committed to a career in aging research. Dr. Kim’s research focuses on studying outcomes of drug therapy and cardiac surgical procedures in older adults. He also contributed his expertise in aging to Alosa Health’s Elder Abuse and Dementia module.
We at Alosa wish Dr. Kim a sincere congratulations on this achievement!
Alosa Exec Interviewed on Nightly News
Posted in Updates on 7.1.2017
Alosa Health Executive Director Paul Fanikos was recently featured on a news segment airing on NECN regional news network. Paul spoke with Brian Shactman about the opioid crisis in the state of Massachusetts, and in particular what can be done to mitigate harm related to opioid prescribing. He explained why academic detailing is an effective means of reducing opioid prescribing while giving providers other tools to manage pain in patients. We are so proud to raise public awareness of academic detailing and grateful to Paul for representing us on the show!
Want to hear more? Watch the segment here.
Baystate Health Opioid Overdose Program Initiated
Posted in Updates on 6.22.2017
A team of researchers at Baystate Health led by principle investigators Dr. Peter Friedmann and Dr. Josiah D. Rich have contracted with Alosa Health to implement a study testing academic detailing as a means to increase naloxone and buprenorphine prescribing in HIV treatment settings. Impetus for this study comes from previous research demonstrating high rates of opioid overdose among people living with HIV. Baystate researchers hypothesize that HIV physicians, given proper training, might be willing to integrate naloxone prescribing into their practice to prevent overdose death among patients.
Alosa Health is thrilled to work in tandem with this group to help execute the academic detailing component of the study.
PACE Introduces Elder Abuse Module
Posted in Updates on 6.22.2017
Alosa Health recently introduced an Elder Abuse/ Dementia module through Pennsylvania’s PACE program. This module focuses on caring for vulnerable elders by addressing elder abuse, managing dementia, and supporting caregivers. In keeping with our commitment to disseminating evidence-based information, this module contains guidelines on screening for both abuse and/or cognitive impairment as well as information on when it may or may not be appropriate to use cholinesterase inhibitors and other drugs in the treatment of dementia.
Academic detailers in Pennsylvania have already completed 250 visits to date, with feedback from providers describing the information they received as “relevant” and “very useful”.
Alosa Program Makes National News
Posted in Updates on 6.15.2017
Alosa Health’s successful work promoting safe opioid prescibing practices in Pennsylvania has captured the attention of several national news outlets researching stories on the opioid crisis. One of these, the Associated Press, recently contacted Alosa Health to see if they could send a reporter all the way to Monroeville, PA to shadow clinical educator Melissa Jones during her meetings with physicians in the field. Naturally we jumped at the chance to spread the word about academic detailing. After all, we love an opportunity to teach others about how academic detailing works and why.
Curious about how the visit went? Read the full story here.
Alosa Partner Recognized for Exceptional Work
Posted in Updates on 5.23.2017
Congratulations to our longstanding partner the Pennsylvania Department of Aging and to Director Denise Getgen on being recognized for demonstrating exemplary leadership and strong commitment to protecting the health and wellbeing of elderly citizens... a well-deserved honor. Denise is one of a small group of state employees to receive the Governor’s Award of Excellence. We are grateful for the opportunity work alongside you, and look forward to continuing our work together.
What Assault on FDA Authority Means for Public Health
Posted in News on 5.11.2017
In a piece recently published in The American Prospect, Alosa Health founder Dr. Jerry Avorn discusses regulatory trends around drug manufacturing and marketing as well as their consequences, making the case that diminishing FDA authority could have harmful effects on patients.
Specifically, he cites the 21st Century Cure Act, which nudges the FDA away from controlled clinical trials and toward measures of evaluation that are narrower in scope, such as whether a drug has an impact on a particular biomarker. Without information gleaned from controlled clinical trials, drugs may come to market absent proof of a net benefit to patients.
In addition to its primary responsibility of evaluating drug efficacy, the FDA also has a responsibility to evaluate marketing claims made by drug manufacturers. Now it appears that authority is also weakening, with the effect that pharmaceutical companies have more leeway in the statements that they can make to consumers. During a 2011 case, for instance, a pharmaceutical sales rep successfully invoked the First Amendment to defend statements that he made promoting a drug for use in clinical situations for which it was not approved.
As Dr. Avorn cautions, the two developments above combined with a president and FDA Commissioner intent on de-regulation as a matter of policy hearken back to a much earlier era in history when medical treatments were not regulated and public health suffered, prompting the government to step in. Read the full article here.
Alosa CEO Tapped for Church Crusade Against Opioids
Posted in Updates on 5.10.2017
Alosa Health CEO Cheryl Bartlett was asked to speak to students at Holy Cross Greek Orthodox School of Theology in Worchester, MA as part of an ongoing effort to dispel myths around opioid addiction and reduce stigma. The Saint Spyridon Greek Orthodox Church has made caring for community members with opioid addiction a top priority by embracing a doctrine of caring without judgement. Members of the clergy see themselves as frontline responders to the opioid crisis; as such, they believe that understanding families struggling with addiction is an essential part of their training.
The church's approach is so innovative that the story (and Cheryl’s appearance!) was picked up by Channel 5 news. Take a look at the clip here.
FDA Review Process Speedier than European Counterpart
Posted in News on 4.6.2017
The FDA has been getting flack from the U.S. President as well as the president’s nominee to lead the agency, Dr. Scott Gottlieb, on account of their approvals process, which has been characterized as “slow and burdensome”.
Yet, a recent study published in the New England Journal of Medicine (NEJM) revealed that the FDA approved drugs, more quickly than its European counterpart, the European Medicines Agency (EMA), during the 4-year study period. The median review time of the FDA was 306 days, while the median review time for the EMA was 383 days.
It appears that the relative speed of the FDA compared with the EMA may be attributed to certain sub-groups of drugs. While the FDA was speedier at approving drugs for cancer and blood diseases, as well as “orphan drugs” for rare conditions, there was no difference in speed between the two agencies for other drug approvals.
The information from this study is particularly relevant as lawmakers wrestle with the question of whether to maintain or discard certain FDA regulatory processes. Read the full article here.
Proposed NIH Cuts Would Inhibit Medical Research
Posted in News on 3.30.2017
The current iteration of the federal budget proposed by the U.S. President would cut $1.2 billion to the National Institutes of Heath (NIH), though the budget needs to be approved in both houses of Congress before it can go into effect and thus modifications are possible.
The cuts target research grant funding, which would substantially reduce the capacity of NIH to fulfill its primary objective of conducting biomedical research. In the past, NIH research has led to breakthroughs in our understanding of diseases such as cancer, diabetes, and Alzheimer’s as well as new technologies that map the human brain, sequence genes, and show us images of the human heart.
Advocates of science and research have criticized the proposed budget cuts to the NIH, stating that it would be “throwing progress out the window” and endanger the health of Americans. Read the full article here.
New Faces: Linda Cordell and Dr. XinQi Dong
Posted in Updates on 3.28.2017
We are excited to announce that Linda Cordell has joined Alosa Health as an academic detailer in Shelby County, TN. She will be detailing on the use of PrEP, or pre-exposure prophylaxis, as an HIV prevention strategy for high-risk individuals. Linda brings 15 years of experience in clinical nursing to this role as well as extensive knowledge of the region’s healthcare landscape. She has cultivated relationships with local providers based on mutual respect and earned trust over years of working as a clinical consultant in the pharmaceutical industry. Welcome to the team, Linda!
We were also delighted to have XinQi Dong, MD, MPH, serve as subject matter expert during the development process of our upcoming Elder Abuse and Dementia module. Dr. Dong not only provided invaluable content input, but also hosted a webinar for academic detailers who plan to go into the field with this topic. Dr. Dong has published extensively on aging, culture, and mental health throughout his career, and has received both national and international awards for his research and policy work on elder abuse. He serves as a primary investigator for two large cohorts, the Chicago Health and Aging Project and the Chinese Health, Aging and Policy Program, examining the relationships between elder abuse, culture, and psychosocial factors and is the editor of the first major book on elder abuse, Elder Abuse - Research, Practice and Policy.
Educational Outreach to Opioid Prescribers: The Case for Academic Detailing
Posted in Publications on 3.15.2017
Pain Physician 2017; 20:S147-S151 • ISSN 1533-3159
In recent years, deaths from accidental overdose due to prescription opioids exceeded deaths from motor vehicle accidents in the United States. Inappropriate prescribing of opioids by physicians may have contributed to this growing epidemic. A variety of approaches have been proposed to address this public health problem, from state legislation on prescription drug monitoring to limits on the quantity of opioids dispensed as an initial prescription. Academic detailing, or one-on-one educational outreach to physicians, has been shown in several randomized trials to be effective in reducing inappropriate prescribing. In a recent review, Drs. Davis, Bateman and Avorn describe how physician training through academic detailing may help reduce the problem of inappropriate opioid prescribing.
Read the full article here.
DC Program Closes Knowledge Gap on EPT
Posted in Updates on 3.6.2017
Alosa Health’s program in Washington, DC is having a measurable impact on healthcare providers’ knowledge of expedited partner therapy (EPT) to manage patients with STIs and their current partners. Among healthcare providers who received academic detailing through our program, none were previously aware that EPT was permitted in Washington, DC. Yet, after participating in academic detailing, all stated they would be willing to prescribe EPT in the appropriate circumstances. We are so proud to see that our work is driving behavior change, and grateful for the continued support of our DC DOH partners at HAHSTA!
The Case for Academic Detailing with Nurse Practitioners
Posted in Publications on 3.1.2017
Journal of the American Association of Nurse Practitioners 2016; 28, 574-575
Academic detailing (sometimes called educational outreach) programs have historically been directed at physicians. However, nurse practitioners (NPs), like other clinical providers, must also stay current with the latest evidence in order to provide the highest quality care to their patients in today’s rapidly evolving healthcare environment. In their editorial, Drs. Doyle-Tadduni and Jackowski describe the benefits to NPs of face-to-face academic, rather than commercial, encounters.
Read the full article here.
Academic Detailing: “Marketing” the Best Evidence to Clinicians
Posted in Publications on 3.1.2017
JAMA 2017; 317(4)
In 1983, Drs. Avorn and Soumerai published the seminal randomized trial that evaluated the effect of academic detailing on clinical practice. In a recent JAMA Viewpoint, Dr. Avorn describes the rationale that led to that trial’s publication as well as a few of the follow-up studies that have been conducted in a variety of settings around the world. Historically, the strongest academic detailing programs have originated in integrated healthcare systems such as Kaiser, the VA, or the nation of Australia. As healthcare in the US moves increasingly from a fragmented, fee-for-service basis to an accountable system of global payment, academic detailing will assume a much more important role in helping to provide clinicians with the best evidence to care for patients.
Read the full article here.
Alosa CEO Wins Committee Appointment
Posted in Updates on 2.21.2017
Massachusetts Governor Charlie Baker recently appointed Alosa Health CEO Cheryl Bartlett to the newly minted Special Commission on Behavioral Health Promotion and Substance Use Prevention. The Commission’s purpose will be to investigate evidence-based practices, programs and systems to prevent behavioral health disorders and promote behavioral health across the Commonwealth. Bartlett is one of 24 commission members in total, and she will serve as the designated expert in community-based public health.
Ulterior Motive in Question with Drug Companies’ Charity
Posted in News on 2.16.2017
The Massachusetts U.S. Attorney’s Office is currently leading a nationwide investigation into drug companies’ charitable contributions toward organizations that provide financial assistance to patients whose health conditions require expensive drugs. These organizations typically cover copayments, alleviating the financial responsibility of patients, while Medicare covers the rest of the cost.
Drug companies may appear to be acting altruistically when they donate large sums of money, but there is concern that ongoing support for financial assistance organizations actually allows them to keep prices high. Specifically, without the existence of these organizations, drug companies would likely be forced to lower their prices in order to remain competitive. However, under the current system, drug companies can make a small contribution to a financial assistance organization and still pick up a profit from Medicare.
At least six companies have been subpoenaed by the Massachusetts U.S. Attorney’s Office. Read the full article here.
MA Program Reduces APMs
Posted in Updates on 1.2.2017
The second wave of Alosa Health’s Massachusetts program to reduce misuse of antipsychotic medications (APMs) in nursing homes came to a close with the 2016 calendar year. While it is too early to evaluate our impact on this group of nursing homes, we are pleased to announce that nursing homes participating in the first wave of our program experienced an overall reduction in APMs prescribing rates. In fact, the decrease in prescribing rates at our participating nursing homes actually outpaced the national and state average. Thank you to our detailers and Massachusetts DPH partners who worked hard to make this a success!
Approving a Problematic Muscular Dystrophy Drug: Implications for FDA Policy
Posted in Publications on 12.20.2016
In September 2016, the head of the FDA’s Center for Drug Evaluation and Research approved a new drug (etiplersen) for the treatment of Duchenne muscular dystrophy, despite an advisory committee who voted 7 to 3 finding no evidence that the drug had clinical efficacy. Drs. Kesselheim and Avorn recently published a Viewpoint in JAMA where they describe the problematic case of etiplersen. They highlight the troubling fact that the pivotal trials which supported the drug’s approval were based on an outcome that was not likely to translate into meaningful clinical benefit: a change in protein dystrophin levels based upon muscle biopsy specimens. The authors also point out that approving drugs on the basis of such surrogate outcomes may translate into worse outcomes for patients, by exposing them to the risk of adverse events and high drug costs.
Read the full article here.
Alosa Joins MA Public Health Association
Posted in Updates on 12.12.2016
Alosa Health is now a member of the Massachusetts Public Health Association (MPHA), an organization devoted to preventing illness, disease, and injury in the state of Massachusetts and particularly among those most vulnerable to health disparities. MPHA is also an affiliate of the American Public Health Association (APHA). We are so proud to be aligned with the Association and its other members! Thanks for the welcome message and feature on the MPHA blog.
Congress Says ‘Yes’ to Fast Track FDA Approvals
Posted in News on 12.9.2016
Last week Congress passed legislation addressing questions of healthcare regulation and public health funding. The 21st Century Cures Bill was able to gain easy approval in both the House and Senate because it contains provisions that appeal to both sides of the aisle and to various industry and public interest groups.
One of the most salient features of the bill is its loosening up of current FDA standards for approving drugs and medical devices, naturally drawing ire from critics who are concerned that relying on less rigorous standards of evaluation (using types of studies other than the gold standard of clinical trials and using fewer studies to make a determination) will result in ineffective or unsafe products on the market. Advocates of the bill, including representatives from industry, say the new standards will streamline what is currently a bureaucracy-laden approval process and bring beneficial or potentially life-saving treatments to patients more quickly.
Despite lack of consensus around parts of the bill pertaining to FDA deregulation, other features written into the bill, including increased funding for the National Institutes of Health (NIH) and $1 billion earmarked for prevention and treatment of opioid addiction, helped it to gain widespread support. Read the full article here to see what Alosa Health founder Dr. Jerry Avorn has to say.
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Bill to Ease FDA Approval Draws Praise and Rebuke
Posted in News on 12.1.2016
Alosa Health founder Dr. Jerry Avorn was quoted in the Wall Street Journal regarding a healthcare bill scheduled for a vote in the House next week. The bill in question covers a breadth of topics from funding for biomedical research to opioid addiction to the FDA’s regulatory processes. The proposal to ease FDA standards for approving drugs and medical devices has elicited support from those in industry who say the current approval process is long and arduous, to the detriment of patients waiting on new treatments. It has also drawn sharp criticism from those in the medical and academic communities who say that relying on fewer studies and studies that adhere to less-strict scientific standards to inform decision-making will result in ineffective or unsafe treatments on the market.
This bill throws into the spotlight a broader question about linking up priorities from opposing groups in order to build a broad base of support for legislation. For instance, the same medical and academic institutions that would likely oppose deregulating FDA processes might be swayed by the promise of funding for research and public health initiatives. What some view as bipartisan compromise, others view as a kind of extortion in which accepting money for medical research cedes control of drug and device approvals to industry. See our founder Dr. Jerry Avorn’s take by reading the full article here.
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Healthcare Bill to Fund Research, Overhaul FDA Regs
Posted in News on 11.30.2016
The $6.3 billion bill that has been called “parting gift” to Vice President Joe Biden contains a smorgasbord of healthcare related provisions, including a commitment to additional funding for cancer research through the National Institutes of Health (NIH). Notably, Biden’s son died of brain cancer last year.
Other topics that the bill touches on include mental health, opioid use, Alzheimer’s disease, and regulatory changes pertaining to the FDA and standards used to evaluate drug safety and efficacy. While there is widespread support for the bill among members of both houses of Congress, some are skeptical. The most contentious feature of the bill would relax the FDA’s current standards and introduce a streamlined approval process. Alosa Health founder Dr. Jerry Avorn voiced the concern shared by many in the medical community that a “lower bar” for drug approval will ultimately jeopardize patient safety. Find Dr. Avorn’s full quote in the article here.
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PACE Launches Hypertension Training
Posted in Updates on 11.15.2016
Alosa Health’s newly updated hypertension training module launched recently through the PACE program in Pennsylvania, providing guidance on the latest evidence on hypertension treatment goals and recommendations for therapy. In keeping with our mission to deliver the most up-to-date evidence available, our module encompasses recommendations from landmark trials such as ACCORD and SPRINT, neither of which were included in the most recent consensus guidelines last updated in 2004. Primary care practitioners have responded to the hypertension guidelines with positive feedback, commenting that the information is “solid”, “well-organized”, and “helpful.”
Alosa Wins PrEP Bid in Shelby County, TN
Posted in Updates on 11.1.2016
This year Alosa Health will kick-off a new program based in Shelby County, TN to support the county health department’s HIV prevention initiatives. The program will focus on educating primary care providers in high-risk areas about the use of PrEP, or pre-exposure prophylaxis, as an HIV prevention strategy. This initiative is supported by funding through the CDC’s Project Pride. We are looking forward to partnering with Shelby County on an issue that is near to our public health roots here at Alosa Health!
The High Cost of Prescription Drugs in the United States: Origins and Prospects for Reform
Posted in Publications on 9.6.2016
High prescription drug prices are increasingly straining the budgets of patients, payors and healthcare systems in the United States. In this JAMA clinical review, Drs. Avorn, Kesselheim and Sarpartwari describe the origins for high drug prices and recommend policy options to help contain these rising costs. They find that per capita prescription drug spending in the United States is more than twice the average of other industrialized countries, and now comprise about 17% of total healthcare expenditures. High prices arise primarily because of government-protected monopolies. Other contributors include the fact that some physicians prescribe high cost drugs when comparable and less costly alternatives are available. Enhancing generic competition, increasing opportunities for meaningful price negotiation by governmental payers, and academic detailing were cited as realistic strategies to help contain prescription drug prices.
Read the full article here.
Forbidden and Permitted Statements about Medications – Loosening the Rules
Posted in Publications on 9.10.2015
The promotion of drugs by manufacturers for uses not previously approved by the FDA (aka off-label use) is controversial because it may lead to more patients being exposed to medicines with an uncertain risk-benefit profile. In an article published in the New England Journal of Medicine, Drs. Avorn, Kesselheim and Sarpartwari describe a 2015 federal judge ruling on a suit between Amarin pharmaceuticals and the FDA regarding the deliberate off-label promotion of a prescription fish oil product. Rather than addressing the practice of off-label prescribing itself, an issue not addressed in the suit, the case pertains to whether or not the FDA can restrict a manufacturer from marketing a drug to a prescriber for an unapproved use. Historically, the right of the FDA to regulate promotional materials has been based upon the government’s substantial interest in ensuring the safety and efficacy of prescription drugs available to the public. However, in recent years, both the courts and the agency itself have relaxed the FDA’s ability to restrict off label promotion, in part so that the government does not restrict “commercial free speech.” The authors discuss the potential negative impact of relaxing the FDA’s ability to police the marketing of drugs for unapproved uses, namely that larger numbers of patients will be exposed to increase risk without a rigorous evaluation of evidence supporting clinical benefit.
Read the full article here.