Notes & Links: September 17, 2013

Hospital Cost Cutting and Productivity
Austin Frakt writing on The Incidental Economist shares his recent publication in Health Services Research on hospital cost shifting and productivity which comments on a yet to be published paper by Vivan Wu and Chapin White. 

The central question that Frakt asks is this 

A key question is what these cost cuts do to patients’ outcomes. That is, will hospitals become more productive, converting fewer resources into the same or better health? Or will they cut costs in ways that harm patient care?

Previously Wu and Shen found 

…hospital cuts required by the 1997 Balanced Budget Act, heart attack mortality increased. Each 1% cut in payment resulted in a 0.4% increase in heart attack mortality rates. Lindroth et al. found that lower hospital service line Medicare profitability was associated with an increase in mortality

Frakt excerpted from his full commentary which is behind a pay wall a terrific chart and some cogent thoughts. In his estimation we may not be able to lower cost and improve outcomes but as an economist he sees this in terms of what is acceptable and not. If you get the PDF of his commentary let me know what you think?

What Brings Patients to Pharma Websites
Dominic Tyer writing on Digital Intelligence Blog share a new survey on how people access online health information. The survey found that physician recommendations were top influencers for traffic to pharma websites. The third survey found the average US patient visits their physician three times a year and searches the web 52 hours.

A survey of 1,000 Americans found that 42% said their physicians recommendations were key in visiting a pharma website, next at 33% were news articles, and at 30% were family, friends, or colleagues. TV was at 25%. Match that to the fact only 9% of survey respondents saying they would directly visit pharma websites for information. 

Gil Bashe, practice director at Makovsky Health, said: “The survey results demonstrate that even as consumers research health-related information online, they seek trusted resources for that information – their physician, or a fellow patient.

“Healthcare providers and patient advocates serve an increasingly key role in guiding consumers to credible information and community support that can benefit their care.”

I read this data and was reminded of a study done by Annisa Lai Lee which was published in Journal of Health Communication “Who Are the Opinion Leaders? The Physicians, Pharmacist, Patients and Direct-to-Consumer Prescription Drug Advertising” Annisa’s study basically supports the value of the HCP when it comes to drug recommendations. When a patient goes to their physician and says I saw a drug on TV they will likely not get the Rx. But if the patient says my pharmacist recommending the same drug they will get the script. Speaks to the data you have the HCP remains the single most important link to patient engagement. 

… the influence of drug prescription behaviors certainly has come from interpersonal influence of health care providers other than from the mass or hybrid media only. The influence is so strong that patients would switch their own physicians who go against the advice given by pharmacists. The two-step flow model is therefore still upheld in one major aspect that physicians (opinion leaders) seldom are influenced by their media-educated patients (followers) only and they are instead influenced by opinions of their colleagues or other health care opinion leaders, meaning that the power of interpersonal communication still is stronger than mass media in
the case of DTCPDA.

This also strikes me that the influence pharma remains focused on the physician. Even in the day of the Sunshine Act and physicians feeling pressure to move away from direct monetary compensation from pharma there is the fact that a physician recommendation to read this or that on this or that sites is a powerful and present influence on patients. 

An Exploration of Social Circles and Prescription Drug Abuse Through Twitter
Hanson, Cannon, and Giruad-Carrier out of BYU published this study in JMIR. There is no surprise regarding their conclusions. people who discuss drug abuse online surround themselves with others who do the same. I guess I wouldn’t expect Lindsey Lohan to hang out with Mother Teresa. 

Beside seeing clearly that there is significant activity beyond just talking about prescription drugs on Twitter. There is the fact this type of data may point to access and new ways to reaching those abusing drugs. This is another study similar to the one on tobacco use (here) that besides showing the problem may in fact identify solutions. 

Whereas Twitter is a social media platform used to discuss and reinforce prescription drug abuse, prevention specialists should be mindful of this communication channel as another setting for understanding and monitoring prescription drug abuse and potentially intervening online.

Riding the Rails: News from the Caboose
My neighbor Bob and his lovely wife Mac are blogging about what sounds like an amazing trip. They are heading to San Francisco to board a New York Central Train originally build for Harold Sterling Vanderbilt over 85 years ago. They will head to Seattle and make a return trip south  through Naps Valley, Stampede Pass, head to Hanford Nuclear site just for this train, to Deschutes River Canyon Gorge, Crater Lake National Park. Klamath Falls, Modoc national Forest Lassen Volcanic National Park, Feather River Canyon. 

Bob is a great story teller and his blog should be replete with some great photographs albeit touristy in style and composition. I am looking forward to following this just see this train which makes various trips throughout the nation. And I want to hear if the food and wine works as well. You can follow Bob at News from the Caboose.