Oral Anticoagulant Education Campaign Update
1) Overview - This education campaign targets patients taking oral anticoagulants in the outpatient setting, as well as those who prescribe and dispense these medications. The campaign will produce tools and messages designed to encourage safe use of these medications. Campaign messages will, at a minimum, inform patients that other medications and substances they may be taking (prescription, OTCs, vitamins, and herbals as well as food) could interact with oral anticoagulants, and stress the importance of monitoring.
2) Research conducted – Two phases of research:
a) Qualitative research - Focus groups – Bearing point conducted four focus groups last February - Two patient groups, one physician, one pharmacist group. Findings presented last coalition meeting, and the report is on the SOS Rx website.
b) Quantitative research - Harris Interactive surveys of patients, caregivers and providers.
i) Patients (over 400) - Internet surveys using the Harris Interactive Chronic Illness Panel. Results from this survey were presented at last coalition meeting in May.
ii) Caregiver survey – 100 people who are caregivers for a person taking oral anticoagulants.
iii) Provider survey – 100 using the online physician panel.
iv) Key findings from the Harris surveys are on the SOS Rx website.
c) Advisory group assisted with both phases of research – developing the focus group discussion guide and the surveys, and reviewing the results.
Development - Since the last full coalition meeting, we have been working
with the advisory group to develop the messages for this campaign, based on the
research findings. On September 21, 2005 the advisory group met in
a) Research Review – Since the strategy for the education campaign will be based on the findings from the various research activities conducted to date, the meeting began with a review of the research. Harris Interactive staff presented results from the three surveys (patients, caregivers and physicians).
b) Campaign Framework
i) Primary target – discussion about identify the primary target of the education campaign – patient, caregiver, clinician or pharmacist, or some combination of these groups. In the end consensus by the group that patients are primary target, but physician and other providers also need to be targeted - patient could be educated about the few, key questions they need to ask doctors, and the health care professionals would have patient education information at their disposal in order to answer those questions. Theoretically, the same messages repeated to both clinician and patient would have more impact than just one or the other.
ii) What is the message? There was agreement that, based on the research, there are three key education areas for patients:
(1) Blood testing - importance of blood tests, knowledge of INR number (and desired range), and implementation of a regular feedback loop for communicating goals/achievement to patients.
(2) Drug interactions - OTC drugs, other prescription drugs, and dietary supplements may cause harmful interactions with the oral anticoagulant
(3) Diet - education on appropriate diet and following a consistent diet. Also emphasize stability, cultural diversity regarding diet.
For clinicians, the message is that patients need to know the three key areas listed above. Clinicians would be provided with the patient education materials to disseminate, and would also be prompted to proactively address these questions with patients.
It was suggested that the messages and supporting information for both patients and clinicians be simple, basic and refer patients and physicians, to additional resources.
iii) Openings- Discussion of two parallel approaches to this education campaign:
(1) Direct Patient education campaign – targets specifically those who take (patients) and prescribe oral anticoagulants (clinicians)
(2) Indirect patient education campaign through partners – target caregivers and relevant patient and provider organizations, pharmacists
1) Direct Patient Campaign –
Patients on oral anticoagulants could be sent a postcard to remind them of their next blood test, reiterate the importance of blood testing, and re-state their target INR range. They would also be reminded of the need to ask about interactions and diet, and any other concerns about the medication – at their next physician visit.
At the same time, physicians or other providers of oral anticoagulant patients would be informed of the postcards, and provided with educational information to give to patients when they are confronted with questions about diet, interactions, and blood test results.
This could be set up as a pilot project – in which oral anticoagulant patients would be identified and sent postcard reminders of blood tests, thereby triggering patients to get their blood tested, and to ask questions about drug interactions and diet. Providers would also give patients educational materials at these visits. A health plan could track participating patients (and compare them to controls) to see whether any difference in outcomes (fewer adverse events, trips to ER, lab tests) is achieved. Given the nature of the effort, this pilot project is viewed as a long-term campaign approach – requiring 1 – 2 years to fund, coordinate and implement.
Resources – Work through SOS Rx participants – Pharmacy benefit managers or health plans
2) Indirect patient education campaign – through partners
In the near term, educational materials could be distributed to patients, caregivers, physicians, pharmacists, and other health care professionals through SOS Rx partners, and others. This would involve having SOS Rx partners commit to distributing educational materials to their members through a variety of media. The educational materials would include the same messages described above.
SOS Rx partner organizations - caregivers, health care professionals, pharmacists, patient groups, employers, and other. .
1) We will incorporate comments received at November 9, 2005 meeting.
2) Work with advisory group to continue to draft messages for clinicians and patients – January/February.
3) Draft messages circulated to entire coalition and if objection must notify – February
4) Finalize messages – March
5) Media launch – May (National Stroke Month), will include press release campaign messages, website development
6) Work with partners to disseminate the messages.
7) Pursue options for pilot project, while also refining messages for active campaign.