Abbott Laboratories · NYSE:ABT
Abbott Laboratories — A:CARE Congress (October 2021)
39 slides from Abbott Laboratories's conference presentation, October 2021
Slide 1: Educational purposes disclaimer
This presentation is offered for educational purposes only, intended to serve as continuing medical education for health care professionals. The content of the presentation represents the views and opinions of the original creators of such content and does not necessarily represent the views or opin
Slide 2: The paradox of non-adherence in symptomatic disease
A:CARE CONGRESS The paradox of non-adherence in symptomatic disease Prof. Matthias Löhr Dr. Sheri Pruitt Professor of Gastroenterology & Hepatology Clinical Psychologist and at the Karolinska Institute & leads the Behavioral Science Consultant, Pancreatic Team at Karolinska University California, US
Slide 3: Pancreatic Exocrine Insufficiency
THE PARADOX OF NON -ADHERENCE IN SYMPTOMATIC DISEASE Pancreatic Exocrine Insufficiency Prof. Matthias Löhr Karolinska Institute Karolinska University Hospital Sweden GLO2208857 | Nov-21 | 3
Slide 4: Disclosures
Disclosures HONORARIA FROM ABBOTT, MYLAN/VIATRIS GLO2208857 | Nov-21 | 4
Slide 5: Pancreatic exocrine insufficiency Symptoms
Pancreatic exocrine insufficiency Symptoms SYMPTOMS CAN BE Diarrhoea • EPI can cause problems with undigested food moving too quickly through the digestive tract Irritating Gas and Bloating • Smelling • People with EPI cannot properly digest the food they eat, which can result in • Farting uncomfort
Slide 6: Proper use of enzymes low in the US
Propper use of enzymes low in the US It’s slowly getting better PERT use Proper use of PERT 0,4 Proportion 0,3 0,2 0,1 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Forsmark CE, Tang G, Xu H, Tuft M, Hughes SJ, Yadav D. The use of pancreatic enzyme replacement therapy in patient
Slide 7: The dilemma
The dilemma WHY WOULD A PATIENT WITH Abdominal pain Foul smelling, Weight loss / greasy stools jaundice NOT follow physicians recommendations?! GLO2208857 | Nov-21 | 7
Slide 8: This is NOT a novel problem
This is NOT a novel problem CHILDREN’s HEALTH CARE, 27(4), 259-264 Copyright © 1998, Lawrence Erlbaum Associates, Inc. Unsuspected non-adherence with recommended pancreatic enzyme administration in patient with cystic fibrosis Lee S. Rusakow, Tami Miller, Catherine A McCarthy, William M. Gershan, an
Slide 9: Factors influencing Non-adherence
Factors influencing Non-adherence The patient The doctor The “system” GLO2208857 | Nov-21 | 9
Slide 10: Factors influencing Non-adherence
Factors influencing Non-adherence The patient The doctor The “system” Proprietary and confidential — do not distribute GLO2208857 | Nov-21 | 10
Slide 11: Factors influencing Non-adherence
Factors influencing Non-adherence The patient The doctor The “system” Proprietary and confidential — do not distribute GLO2208857 | Nov-21 | 11
Slide 12: Bad adherence to guidelines (1/2)
Bad adherence to guidelines (1/2) AN OVERVIEW OF ALL THE QIS OF THE FOUR DOMAINS CONCERNING THE NON- INVASIVE MANAGEMENT OF CP AND ADHERENCE TO THE HAPANEU GUIDELINES Adherence varies across different area • Best in diagnosis • Worst in genetics and nutrition Academic hospital better than teaching h
Slide 13: Bad adherence to guidelines (2/2)
Bad adherence to guidelines (2/2) p = 0.02 • Sex, age, etiology have no influence • Adherence best for PERT (85%) • Positive effect on – Iron – Vit D • Overall adherences increases (slowly) with/after HaPanEU Khan M, Rutkowski W, Vujasinovic M, Löhr JM. Adherence to European Guidelines for Treatment
Slide 14: Primary prescribers are surgeons
Primary prescribers are surgeons • Diagnosis is established mostly by surgeons • PERT prescription is mostly initiated by surgeons, but follow- up prescription is done mostly by general practitioners or gastroenterologists • Percentage patients receiving PERT is not increasing overall Khan M, Rutkow
Slide 15: Prescription dates vary
Prescription dates vary • Higher percentage PERT prescription by gastroenterologists (upper) • Most patients receive prescription around the time of first diagnosis, but some receive it > 18 months before or after diagnosis of chronic pancreatitis Khan M, Rutkowski W, Vujasinovic M, Löhr JM. Adheren
Slide 16: Specialist best in adherence to lifestyle recommendations
Specialist best in adherence to lifestyle recommendations LIFESTYLE MODIFICATION RECOMMENDATION AND ADHERENCE ACCORDING TO PROVIDER TYPE P=0.51 P=0.30 P=0.55 P=0.03 100,0% P=0.03 96,0% 100,0% 100,0% 100,0% 88,9% 92,5% P=0.34 P=0.38 P=0.01 P=0.34 80,0% 54,1% 58,3% 60,0% 44,0% 47,3% 40,0% 31,3% 24,1%
Slide 17: Factors influencing Non-adherence
Factors influencing Non-adherence The patient The doctor The “system” Proprietary and confidential — do not distribute GLO2208857 | Nov-21 | 17
Slide 18: Patient factors
Patient factors Socioeconomic “Drug-seeking” behavior – Overall status and dependency on compliance environment • Alcohol • Smoking • Drugs Few published data on the noncompliance due to alcohol & smoking BUT well-founded eminence-based experience! Mössner J, Keim V, Niederau C, Büchler M, Singer MV
Slide 19: Malnutrition after PERT in chronic pancreatitis: Risk factors in real world practice
Malnutrition after PERT in chronic pancreatitis: Risk factors in real world practice RESULTS FACTORS ASSOCIATED TO POOR COMPLIANCE Inclusion Current smoking was associated with no treatment • 1006 CP patients from 8 centers were included for analysis despite EPI Treatment adherence • 64% were correc
Slide 20: High adherence in pancreatic cancer patients
High adherence in pancreatic cancer patients ORIGINAL ARTICLE Taking the full dose Take them at every with each meal: 38 meal: 43 (62%) OPEN (88%) Frequency of Appropriate Use Started the Pancreatic Medical Oncologist:90 (45%) of Pancreatic Enzyme Surgeon: 49 (25%) Enzymes Survey Gastroenterologist:
Slide 21: Factors influencing Non-adherence
Factors influencing Non-adherence The patient The doctor The “system” Proprietary and confidential — do not distribute GLO2208857 | Nov-21 | 21
Slide 22: The cost of medication influences adherence
The cost of medication influences adherence Pancreatology 21 (2021) 1009-1010 Contents lists available at ScienceDirect Pancreatology Journal homepage: www.elsevier.com/locate/pan Projected 30- day out-of-pocket costs and total spending on pancreatic enzyme replacement therapy under Medicare part D1
Slide 23: Summary / conclusions
Summary / conclusions All three factors (doctor, patient, system) The patient influence adherence to evidence-based, guideline-compatible enzyme medication It starts with the physician • Right prescription • Follow-up & advice/adherence to life style changes (alcohol, smoking) Patient factors partly
Slide 24: Communication Strategies to Increase Adherence to Medical Advice
THE PARADOX OF NON -ADHERENCE IN SYMPTOMATIC DISEASE Communication Strategies to Increase Adherence to Medical Advice Dr. Sheri Pruitt, PhD Clinical Psychologist and Behavioral Science Consultant California, US GLO2208857 | Nov-21 | 24
Slide 25: Please let me know what you think!
Please let me know what you think! IN WHICH DISEASE CATEGORY DO YOU THINK ADHERENCE TO MEDICATION IS LOWER? They are about Symptomatic Asymptomatic the same disease disease To participate in polling please exit full screen mode GLO2208857 | Nov-21 | 25
Slide 26: What we know
THE ADHERENCE PROBLEM What we know Proprietary and confidential — do not distribute GLO2208857 | Nov-21 | 26
Slide 27: Adherence often goes unrecognized
Adherence often goes unrecognized Most providers think patients follow our excellent healthcare advice, but they don’t! Why we think our patients adhere: • Optimistic bias1 • Patients tend to exaggerate and want to please us2 • We think we can predict who will adhere3 1. Du Pasquier-Fediaevsky, Laur
Slide 28: Adherence and PEI
Adherence and PEI Management of PEI has been reported as suboptimal; non-adherence is associated with higher costs and utilization1 • Wrong timing of ingestion • Inadequate dosage • Cost2 1.Barkin JA, Westermann A, Hoos W, et al. Frequency of Appropriate Use of Pancreatic Enzyme Replacement Therapy
Slide 29: Adherence must be addressed
Adherence must be addressed “Increasing the effectiveness of adherence interventions may have far greater impact on health than any improvements in specific medical treatments”1 How can we do better with the medications we have? Is medical care more than writing a prescription? 1. Adherence to long-
Slide 30: Providers can change their communication style
WHAT PROVIDERS CAN DO TO IMPROVE ADHERENCE Providers can change their communication style Proprietary and confidential — do not distribute GLO2208857 | Nov-21 | 30
Slide 31: Common communication strategies to influence others
Common communication strategies to influence others WHICH APPROACH DO YOU USE? Ordering, directing, demanding Warning or threatening Persuading with reason, logic, argument, or lecture Most used – Moralizing, preaching, telling what Least effective for you “should” do changing behavior! Disagreeing,
Slide 32: Uncommon communication strategies to influence others
Uncommon communication strategies to influence others Curious Nonjudgmental Least used – Other-focused most effective for changing behavior! Empathic Collaborative GLO2208857 | Nov-21 | 32
Slide 33: Three steps to integrate effective communication strategies
Three steps to integrate effective communication strategies 1 2 3 Strategic, open- Empathic response Promise of provider- ended questions to patient partnership “You must be feeling assess adherence _________” “We can work (curious, together on this” (empathy) nonjudgmental, (collaborative) patient-
Slide 34: Step 1: Assess adherence with open-ended questions
Step 1: Assess adherence with open-ended questions OPEN CLOSED “Some of my patients have “You are taking your medications, difficulties taking the medications right?” as they are supposed to be taken. Over the past 2 weeks, how many “Are you still taking the medicine I days do you think you missed a
Slide 35: Step 2: Provide empathic responses
Step 2: Provide empathic responses EXAMPLES OF WHAT TO SAY This must be distressing for you It must be very difficult for you right now Things like this can be very tough This seems to be worrying you This is probably disappointing for you This seems to be challenging for you Proprietary and confide
Slide 36: Step 3: Promise patient-provider partnership
Step 3: Promise patient- provider partnership EXAMPLES OF WHAT TO SAY We can work on this problem together My goal as your doctor is to help you with taking your enzymes Let’s work together so you can be as healthy as possible Proprietary and confidential — do not distribute GLO2208857 | Nov-21 | 36
Slide 37: Example of patient-provider interaction
Example of patient- provider interaction USING THE THREE STEPS 1 “Some of my patients have difficulties taking their medications as they are supposed to be taken. Over the past 2 weeks, how many times do you think you missed a dose?” Patient: “Well, I’ve missed quite a bit. I have to take so many of
Slide 38: Final thoughts
FINAL THOUGHTS Everyone in healthcare When do you think you If what we’re doing wants adherence to be could try this new way isn’t working, we need better, but few of us of communicating to change ourselves want to change what we about adherence? Proprietary and confidential — do not distribute GLO2
Slide 39: Which statements describe what you are willing to do to improve adherence?
Which of the following statements describes what you are willing to do to improve adherence? I’ll try one of the three steps with my next patient I’ll try two of the three steps with my next patient I’ll try all three steps with my next patient I don’t think I can change my communication! To partici