SOS Rx Oral Anticoagulants Advisory Group
September 21, 2005 Meeting Report
This was a meeting of the SOS Rx oral anticoagulant advisory group to develop a strategic framework for the SOS Rx safe oral anticoagulant medication use campaign. The objective of the day was to develop the campaign framework, to specify and prioritize key targets, opportunities, potential media, and scope. This project is one of the four SOS Rx action agenda projects.
II. Research Review
The meeting began with a review of the research conducted to date on the use of oral anticoagulants. Highlights of the focus group findings were first reviewed with the group. Then Harris Interactive staff presented results from the three Harris surveys (patients, caregivers and physicians). Harris summarized the findings across the surveys into three themes: 1) oral anticoagulant use presents a challenge to patients, caregivers and physicians; 2) there are gaps in education around oral anticoagulant use, both for patients and caregivers; 3) there are gaps in the health care management of oral anticoagulant patients. The group discussed the findings and raised various questions regarding the surveys, as well as content and presentation of results.
The strategy for the education campaign will be based on the findings from the various research activities conducted to date. Summaries of the research, including the focus group findings and the Harris surveys, are available on the SOS Rx website at www.sosrx.org. The final Harris report will be emailed to the group and available on the SOS Rx website in advance of the meeting on November 9th.
III. Discussion of Campaign Strategy
A. Who is the primary target?
There was discussion about identifying primary targets of this education campaign the patient, caregiver, physician or pharmacist, or some combination of these groups.
The discussion included the following points:
- Patient should be the agent of change in promoting safe use of oral anticoagulants
- Physicians will not respond to a campaign unless what is asked of them is easily implemented
- Whatever is developed should not be a burden to physicians
- We should assess the feasibility of getting physicians to actually use or distribute patient educational materials
- Both patients and physicians could be targeted - patient could be educated about the few, key questions they need to ask doctors, and the doctors would have patient education information at their disposal in order to answer those questions. Theoretically, the same messages repeated to both physician and patient would have more impact than just one or the other.
B. 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 physicians, the message would be that patients need to know the three key areas listed above. Physicians 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 physicians be simple, basic and refer patients and physicians, to additional resources.
C. Openings/Media -
Discussion of two parallel approaches to this education campaign:
- Active campaign targets specifically those who take (patients) and prescribe oral anticoagulants (physicians)
- Passive campaign targets caregivers and relevant patient and provider organizations, pharmacists
1) Active 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 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. Physicians 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 - Express Scripts, CareMark, Medco or health plans Group Health, Blue Cross Blue Shield, Preferred Health Systems, etc.
There was also discussion of involving those who print the patient medication information that comes with prescription medications.
2) Passive Campaign
In the near term, educational materials could be distributed to patients, caregivers, physicians and pharmacists, through a more passive campaign. 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 messages described above under B.
SOS Rx organizations targeted would include: AARP, CMS, FDA, National
Alliance for Caregiving, National Family Caregivers
Where possible, pharmacists could distribute educational materials at the point of sale, and in the hospital setting at the point of care with patients.
3) CMS Outreach ideas
- Medication Therapy Management SOS Rx could advocate that oral anticoagulant education should be integrated into the medication therapy management plans.
- Plans participating in Part D the Medicare Drug Benefit might be interested in the pilot project for this campaign.
IV. Next Steps
- NCL will write up report of this meeting and circulate report to advisory committee for review and comment
- NCL and meeting participants will report on progress at Nov. 9th SOS Rx meeting
- NCL will craft initial basic messages and send out to SOS Rx advisory committee for feedback.
- Once advisory group approves the messages, inform entire coalition if objections notify us.
- Pursue options for pilot project, while also refining messages for active campaign.