The Role of the Pharmaceutical Industry

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The Role of the Pharmaceutical Industry
Health Disparities Forging Stronger
Community-Based Partnerships
April 26, 2005

• Dennis R. Cryer, MD, FAHA
• Vice President, External Medical Affairs
• US Pharmaceutical Group
• Bristol-Myers Squibb Company

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The Translational Highway
K. Schwartz JT Vilquin. Nature Med. 9493 (2003)
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Clinical Research to Clinical Practice Lost in
Translation?

• Claude Lenfant, MD
• 113th Shattuck Lecture
• Massachusetts Medical Society

NEJM 349 868 (2003)
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The Translational Highway
C. Lenfant. NEJM 349(9) 868 (2003) K. Schwartz
JT Vilquin. Nature Med. 9493 (2003)
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The Translational Highway
C. Lenfant. NEJM 349(9) 868 (2003) K. Schwartz
JT Vilquin. Nature Med. 9493 (2003)
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Health Disparities Barriers to Equal Care

• Health Systems Level Factors
• Financing
• Structure of Care/Access
• Cultural and Linguistic Barriers
• Patient Level Factors
• Patient Preferences/Beliefs
• Refusal of Treatment
• Poor Adherence
• Biological Differences
• Disparities Arising from the Clinical Encounter

Adapted from James M. Gavin, III 2004.
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Health Disparities Role of Industry

• Access to Medications
• Awareness of the problems Patients, Physicians,
  Policy makers
• Support generation and Analysis of Disparity
  Databases
• CRUSADE
• NMHMF
• Clinical Research Inclusion of Minorities and
  Women
• Support Disparity Initiatives of Professional and
  Patient Organizations
• ABC, ACC, AHA, ISHIB, NMA, Sister to Sister,
  WomenHeart
• Partnerships to Test Care Management Programs in
  Underserved Populations Culturally Sensitive

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Health Disparities Access

• Partnership for Prescription Assistance
• Purpose Help Patients Who Lack Prescription
  Drug Coverage
• Partnership Healthcare Providers, Patient
  Advocacy Groups, Pharmaceutical Companies,
  Community Organizations
• Point of Access For gt275 Public and Private
  Patient Assistance Programs, gt150 Pharmaceutical
  Company Programs
• Information www.pparx.org
• 1-888-4PPA-NOW

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Health Disparities Partnerships in Care
Management
Culturally Sensitive Programs
Providing Education Access to Care
Empowering Patients Communities
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Texas Diabetes Education Care Management Project
Health Disparities A Partnership Example

• Funded by
• Bristol-Myers Squibb Foundation
• Bureau of Primary Health, HRSA
• CDC Diabetes Prevention
• (in-kind support)

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Steering Committee
TDECMP

• Bristol-Myers Squibb Foundation
• HRSA/Bureau of Primary Health
• CDC/Division of Diabetes Translation
• UIC Midwest Latino Health Research, Training and
  Policy Center
• Texas Department of Health Diabetes Council
• Migrant Health Promotion
• Texas Association of Community Health Centers

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Overview
TDECMP

• Background on the Need for a Program
• Project Goals Objectives
• Diabetes Education Empowerment Program (DEEP)
  Training Sessions
• Initial Train-the-Trainer Training
• Follow-up Trainings
• Preliminary Patient Outcome Evaluation Results

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TDECMP Background
Top Five Community Health Center Medical
Diagnoses
(43.3)
(26.9)
(20.7)
(6.1)
(2.8)
N6304 Gateway Community Health Center
Source 2002 UDS
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Typical Payment Source Category
TDECMP Background
N14144
Source 2002 UDS
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TDECMP Background
Typical Profile of a Patient with Diabetes

• 43 year old Obese Hispanic Female
• 4 to 5 Children Multiple Family Dwelling
• Low Socioeconomic Status Uninsured
• Sixth Grade Education
• Hemoglobin A1c gt 9
• Has Difficulty Managing Her Diabetes

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Goals
TDECMP

• One 3 day intensive train-the-trainer course
• Five regional follow-up training courses in Lower
  Rio Grande Valley, Laredo, El Paso, San Antonio,
  and Houston.
• Train 160 community health workers (including
  promotoras) in self care management using the
  DEEP curriculum
• Impact 16,000 diabetic patients or people at risk
  of diabetes by providing diabetes education using
  DEEP curriculum.

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Framework for ImplementingDiabetes Self Care
Management Program
TDECMP
Three Phases

• Program Approach
• Train team of Promotoras
• and Clinical staff on DEEP
• Recruit patients for
• classes

• Patient Benefits
• Improved standards
• of care for patient
• Reduced HbA1c
• Off set complications
• Overall better health
• Reduced Health Care
• costs including ER

• Patient Empowerment
• Provide DEEP classes
• on weekly basis
• Provide coordinated
• services to patients

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Training Process and Content
TDECMP

• Didactic Training
• Medication use and side effects
• Comorbid conditions
• Experiential Training
• Food Labels
• Food Models
• Geared to Non-Professionals
• Promotoras Lay Health Workers
• Trained to Train Patients

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TDECMP
DEEP Curriculum in Action Diabetes Self Care
Management Program
Delivery Process
Patient Recruitment
PromotoraLed Classes
Medical Providers Involvement
Clinical Support Staff
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Process Evaluation Results
TDECMP

• Number of DEEP Staff Trainees
• Training sessions completed
• Regions Covered in Training
• Trainees per Session
• Trainee Satisfaction

Goal 160 Actual 177
Goal 6 Actual 7
Goal 5 Actual 8
Target 16-20 Actual 25
4.8 (maximum 5.0)
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Preliminary Patient Outcomes
TDECMP

• Base Line
• HbA1c before DEEP self-management class 9.1
• After Intervention (6-9 months)
• HbA1c after self-management course 7.4
• 87 Class attendance rate

Gateway Health Center Data from random chart
audit (N99 patients)
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Reaction to the Program
TDECMP

• DEEP Curriculum Well Received By
• Patients
• Community Health Centers
• Texas Department of Health
• Additional Training Requests
• Across Texas
• From Other States

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Expected Economic Impact
TDECMP

• In collaboration with a third party evaluator, a
  budget impact model using data from the enrolled
  diabetic patients will demonstrate the near-term
  fiscal value attached to the reductions in HbA1c.
  Example of cost differentials for 1 changes
  in HbA1c over a 3-year period
• Patient profile Change in HbA1c level ()
• 10 to
  9 9 to 8 8 to 7
• Diabetes only 1,205
  869 601
• Diabetes with HTN
  1,703 1,260 897
• Diabetes with CVD
  2,796 2,088 1,503
• Diabetes with HTN and CVD
  4,116 3,090 2,237
• Given the number and likely comorbidities of the
  patient population in the program it is predicted
  that the savings generated for a state may be
  significant.

Diabetes Care 20 (12)1847 (1997) Numbers
are summative when one combines a ? HbA1c
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Conclusions
TDECMP

• Providing Education in Self Care Management for
  Diabetic Patients can
• Significantly Improve Surrogate Markers of
  Diabetes
• Appears to Improve Clinical Outcomes

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Health Disparities Partnerships in Care
Management
Culturally Sensitive Programs
Providing Education Access to Care
Empowering Patients Communities
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Health Disparities Partnerships in Care
Management
Culturally Appropriate Programs
Empowering Patients Communities
Improved Community Practice
Clinical Research
Bench Research
The Translational Highway
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The Role of the Pharmaceutical Industry
Health Disparities Forging Stronger
Community-Based Partnerships
April 26, 2005

• Dennis R. Cryer, MD, FAHA
• Vice President, External Medical Affairs
• US Pharmaceutical Group
• Bristol-Myers Squibb Company