Thursday 28 August 2014

NHS complaints rise to 480 every day

Nurse with patients

Healthwatch England’s survey suggests people are unsure who to complain to

The number of complaints made about NHS care in England increased to an average of 480 every day, official data shows.


The Health and Social Care Information Centre (HSCIC) figures on written complaints showed an 8% rise in 2013-14, compared with the previous year.


The complaints cover all aspects of the NHS from hospitals and GPs to dental practices and ambulances.


However, a patients’ watchdog said the official figures were just the tip of the iceberg.


In the year 2013-14 a total of 174,900 complaints were made about the NHS. It compared to 162,019 the previous year and 131,022 in the 2007-08 financial year.


The most complaints – 34,400 – were focused on inpatient hospital care.


The largest percentage increase in complaints was for ambulance crews – up 28.5% to 5,700.


‘Pay close attention’


Kingsley Manning, the chairman of the HSCIC, said: “Our latest figures show that the NHS is receiving a large number of written complaints each day.


“Today’s report also shows a rise over the last year in the number of written complaints made against NHS hospitals and community services.


“I’m sure staff who manage NHS complaints will want to pay close attention to these statistics.”


The patients’ watchdog Healthwatch England said most people do not report poor care.


A survey by the body suggests there were 500,000 unreported cases of unsatisfactory patient care across the NHS in the past two years.


Anna Bradley, the chairman of Healthwatch England, said: “The report out today really is just the tip of the iceberg when it comes to complaints about health and social care services in this country.


“The need to improve the way the complaints system operates is well documented and we have been working with the government to simplify the often baffling process for patients and their families.


“But for things to work properly, health professionals clearly need to do more to make people feel less intimidated about making their voices heard.”


A Department of Health Spokesperson said: “We welcome the fact that more people have felt able to raise their concerns with hospital trusts, as listening to patients is one of the best ways to improve standards and this has been a priority in the wake of the appalling events at Mid Staffs.”


They called for a “culture of openness” in hospitals where it was clear how patients could complain.


Source BBC News/Health http://www.bbc.co.uk/news/health-28965026



NHS complaints rise to 480 every day

Wednesday 27 August 2014

Diagnostics are rising up the pharma value chain

Rising up the value chain


Pharma interview: Anssi Pulkkinen from Roche Diagnostics, Finland on the increasing prominence of diagnostics


As many voices have said in these pages before, the age of the blockbuster drug is something that is increasingly a past era for the pharma industry.


Where opportunities expire, however, new ones emerge, and greater technology, superior scientific understanding and improved research methods are paving the way for targeted drugs for specific variants of diseases.


Scientists have long known about different types of cancer, for example, but it’s only recently that research has allowed them to understand the genetic mutations associated with an increased risk of disease.


According to the US National Cancer Institute, about 12 per cent of women in the general population will develop breast cancer sometime during their lives. However, if a woman has the BRCA1 mutation, there is a 55 to 65 per cent chance she will develop breast cancer by the age of 70, while women with the BRCA2 mutation have about a 45 per cent chance.


Despite the crucial role of labs, they have been in the periphery of the healthcare value chain, down in the basements


These genetic mutations – which also include Epidermal Growth Factor Receptor (EGFR) and Anaplastic Lymphoma Kinase (ALK) in lung cancer – have become targets in medicines research, allowing companies new avenues to develop personalised drugs that are superior to more general treatments in certain patients.


This area of interest, which is by no means limited to cancer, would mean nothing if we didn’t understand what patients were suitable for specific drugs and who would likely benefit. This is where new diagnostics can play a hugely important role. As an industry, diagnostics are not new and have, in fact helped guide treatment decisions for decades. But their importance to pharma has grown in recent years in line with a greater ability to understand the personalised nuances of different diseases.


One man who is able to see this change of attitude in action is Anssi Pulkkinen, head of strategic marketing at Roche Diagnostics Finland – the Finnish diagnostics business of the Roche Group. “One of our senior managers said that everything starts from the right diagnosis,” says Pulkkinen. “If you do it wrong then you take your first treatment steps wrong and then you might end in trouble.”


Despite this significance, Pulkkinen suggests that diagnostics have remained an unknown aspect of the health industry, accounting for only 2 per cent of expenditure on healthcare. “I think laboratories and their suppliers are really challenged by this,” he says.


This historical lack of interest has meant diagnostics has not been at the centre of healthcare businesses, says Pulkkinen: “To paint the picture, despite the crucial role of labs, they have been in the periphery of healthcare value chain, down in the basements.”


Things are changing, however, and diagnostics are getting some of the floorspace currently favoured by other fields. “The labs are moving to epicentre of campuses because clinically-relevant data is being produced and the pathologies are being researched in big numbers.”


Patients as consumers

The prominence of diagnostics is also being driven by wider changes in healthcare attitudes, with Pulkkinen repeating the now widely-held view that patients need to be treated as consumers with their own mind rather than just as an endpoint of a doctor’s decision.


“We are moving towards a more consumerised healthcare,” says Pulkkinen, noting the influence of such tools as TripAdvisor, which give the public the freedom to look for a hotel and make an informed choice based on other customers’ recommendations.


“The old heroic roles of healthcare professionals are changing. They are going to be the consultant advising the customer,” Pulkkinen notes, adding that, for diagnostics, an illustration of this can be seen in the choices of a certain Hollywood superstar.


“Take Angelina Jolie for example. She had a family history of cancer [her mother died of ovarian cancer in 2007] and so she initiated the testing process to see if she was at risk.” Unfortunately for Jolie, the test results showed she had mutation in the BRCA1 gene, meaning she was more likely to get breast or ovarian cancer. With this knowledge, Jolie opted for a double mastectomy to offset the risk of breast cancer. “She gave a face for the current times of the medicines,” says Pulkkinen. “She initiated the investigation by herself, of course with support of medical experts. The doctor was helping with the samples, but it was a consumer who started it.”


Diagnostic drivers

It’s not just this idea of changing public attitudes that is creating renewed interest in the diagnostics sector; the sector is also influenced by the wider forces affecting every aspect of healthcare.


“The ageing population needs more testing,” explains Pulkkinen. “That is self-evident. As the proportion of people is more elderly than young, you see testing needs and volumes get higher.”


Diagnostics also has a part to play in that pressing issue of reducing healthcare costs, according to Pulkkinen. “What we see more is how we add value to our customers. And as I said the clinical labs are getting a more central role in that healthcare process. We used to be supporters of healthcare, but now labs are taking a more active role.”


Relationships with pharma

This changing role can be seen with the increase in the number of companion diagnostics approved alongside important new drugs, including Roche’s FDA approval for Tarceva in lung cancer, which was backed together with Roche Diagnostics’ cobas EGFR Mutation Test. GlaxoSmithKline and Boehringer Ingelheim have had similar approvals for new cancer drugs if used with a companion diagnostic.


Diagnostics companies have to get used to having a greater impact on healthcare decisions though, says Pulkkinen. “As always when there is a culture change, it takes a lot of effort and energy to change thinking to take a more central role.”


The relationship between diagnostics and pharma will continue to grow in any case, and for Roche Diagnostics, it’s not just a case of supporting Roche’s pharmaceutical division. “As commonly known, we work with lots of different pharma companies,” says Pulkkinen. As evidence of this, Roche Diagnostics’ collaborative work includes a deal to provide diagnostics for Boehringer’s cancer portfolio. As for what closer collaboration means for drug development, it is likely that links with diagnostics will come in earlier phases.


“As medicines become molecular, why not start as early as possible. With translational science, everything starts from knowing how the disease is affecting the body,” says Pulkkinen. “It will be interesting to see how many companies are actually doing it from the very first steps.”


Bioinformatics

One area to keep track of is the amount of data associated with diagnostics, and the need to interpret it in a meaningful way as more people have access to information. “The challenge is that people get more and more data and start to interpret and value their own data, with consultants or doctors. It’s a challenge for society – how it can cope,” says Pulkkinen.


He adds: “What do we do when a person says they have a mutation of this type of cancer and there seems to be a drug. The human would say ‘of course go for that drug’, but the system is not yet designed to cope with that. To develop new contemporary and comprehensive systems to cope with the emerging needs will be a great challenge but also an opportunity,”


More thought is certainly being spent on incorporating diagnostics into regulatory systems, but still more does need to be done if the area is to truly advance. As with any step going forward, a key point for every healthcare stakeholder is understanding the role diagnostics play in a holistic approach to healthcare.


Pulkkinen concludes: “The thing I hope is that my colleagues in pharma would find time to go and see what the labs are like and how they work, what they produce, and what’s their value. It is an interesting world to discover. Go and see!”


Source PMLive http://www.pmlive.com/pharma_thought_leadership/diagnostics_are_rising_up_the_pharma_value_chain_594399




Diagnostics are rising up the pharma value chain

Tuesday 26 August 2014

AZ launches DoctorsNotes online medical literature tool

New browser extension aims to make HCP’s reading ‘shareable and social’


AstraZeneca AZ DoctorsNotes DigitasLBiAstraZeneca has launched a new web tool to help healthcare professionals (HCPs) ‘consume, discover and share’ medical literature as part of its ‘beyond-the-pill’ strategy.


Currently only available in a US-beta launch, DoctorsNotes is a free extension for Google’s Chrome internet browser that allows HCPs to annotate and organise their online reading.


It will also offer HCPs the option to discuss and compare notes with their peers, a function AZ says could be used to establish communities around specific areas of interest or study – something the company hopes will be of interest to those researching or working in hospitals and institutions.


Bob Allen, a senior director within AZ’s Digital Innovation Group (DIG), said: “From our work within Digital Innovation Group (DIG), we’ve discovered that medical professionals now have less time than ever to keep up-to-date with the most relevant literature in their given field, even though they are required to do so.


“Finding new ways to easily and effectively share information with one another also forms a key part of AstraZeneca’s commitment to achieving scientific leadership.


“We hope that the tool will prove useful and enhance scientific exchange in the USA and beyond.”


DoctorsNotes is the first product to be launched by DIG, a collaboration between AstraZeneca and global marketing and technology agency DigitasLBi that forms a key part of AZ’s ‘beyond-the-pill’ strategy.


The Group holds a themed day every seven weeks to focus on a particular healthcare challenge, a process that has so far encompassed ongoing medical training, disease management and healthcare problems in China.


DIG is then divided into small, multi-disciplined teams and each one is given three weeks to further explore the challenge and propose a solution – if this is seen to have value they then get another six weeks to develop it more fully.


In addition to DoctorsNotes a number of other projects have won further funding from AZ through this process. They include a service to connect Chinese doctors and patients and an iPad application called Tempus that aims to help HCPs get more value from medical conference content.


AZ is also working on a service for chronic obstructive pulmonary disease (COPD) called Breathe.Able that will combine wearable technology with a messaging function to help patients understand and manage their condition.


In the meantime DoctorsNotes is expected to be launched in a number of markets outside the US later this year.


Source PMLive http://www.pmlive.com/blogs/digital_intelligence/archive/2014/august/az_launches_doctorsnotes_online_medical_literature_tool




AZ launches DoctorsNotes online medical literature tool

Friday 22 August 2014

Doctors who harm patients face 'tougher sanctions'

Doctor with stethoscope

Doctors can be suspended or struck off medical registers if they cause serious harm

Doctors who make mistakes in the care of their patients could face tougher sanctions, under plans being considered by the General Medical Council.


Under the proposals the regulator could force doctors to apologise if they have previously refused to do so.


The GMC also wants to be able to restrict practice of those who have made mistakes and since retrained, even if their work has improved.


Views of the public and specialist groups are now being sought.


Suspensions and restrictions



These measures are a step in the right direction but they are not yet wide enough and comprehensive enough”


Peter Walsh Action Against Medical Accidents


The GMC, which regulates all doctors in the UK, said the intention was to protect patients in the small number of cases where the public expects stronger action.


It has powers to restrict practice, suspend or permanently remove doctors from a register that allows them to work.


Extensive guidelines are already in place but the regulator said certain situations merited much stricter measures.


For example, according to new proposals doctors who fail to raise concerns about a colleague’s ability to practise safely could face harsher penalties than currently.




Niall Dickson, GMC: “The public expects accountability”




GMC chief executive Niall Dickson said: “Doctors are among the most trusted professionals, and rightly so.


“In the vast majority of cases one-off clinical errors do not merit action by the GMC.


“But if we are to maintain that trust, in the small number of serious cases where doctors fail to listen to concerns they should be held to account for their actions.”


Mr Dickson said he believed doctors and patients wanted to see “stronger action” in serious cases.


‘Fair sanction’


Clare Gerada, medical director of the NHS practitioner health programme, which supports doctors with mental health problems, told BBC Radio 4′s Today programme she accepted the GMC had a “difficult job”.


But she said she was “concerned” tougher sanctions in some cases could “traumatise and put in additional fear for the vast majority of doctors who go in every day to do a good job”.




Dr Clare Gerada: “Thousands of doctors are being referred to the GMC… they sometimes lose their livelihood… in some cases, they take their life”




Dr Gerada also told the BBC: “Of course it’s important that we take into account the patient and we look at the damage that’s been done to the patient, but it’s also important that whatever sanction is a proportionate sanction, is a fair sanction.”


BBC health correspondent Branwen Jeffreys said many doctors would feel tougher sanctions simply added another layer of regulation.


“Doctors are feeling really quite beleaguered at the moment,” she added.


Peter Walsh, from the charity Action Against Medical Accidents, told the BBC: “These measures are a step in the right direction but they are not yet wide enough or comprehensive enough to make it a genuinely patient-centred process.”


Health Secretary Jeremy Hunt said: “After the tragic failings at Mid Staffs [hospital], we are taking steps to improve patient safety and ensure doctors are held to account for poor care.”


The consultation closes on 14 November and the the outcome will be published next year.


Source BBC News/Health http://www.bbc.co.uk/news/health-28881560



Doctors who harm patients face 'tougher sanctions'

Thursday 21 August 2014

MHRA launches online oral anticoagulation module

Aims to help healthcare professionals understand new blood clot treatments

mhra logoThe Medicines and Healthcare products Regulatory Agency (MHRA) has launched a new online learning module to educate healthcare professionals about new oral anticoagulant drugs.

The MHRA hopes the module will help professionals manage the risks and ensure patients get the best possible benefit from the medicines, which include Boehringer Ingelheim’s Pradaxa (dabigatran etexilate), Bayer and Johnson & Johnson’s Xarelto (rivaroxaban) and Bristol-Myers Squibb and Pfizer’s Eliquis (apixaban).


Designed for doctors, nurses and pharmacists, the interactive programme takes the learner through key points about these medicines, how to manage the risks and how to make sure patients get the most benefit from these medicines.


This is the latest of a series of free-to-use learning modules developed by the MHRA.


The organisation has tackled classes of drugs that are frequently prescribed and associated with important risks, the organisation said. Topics already covered are opioids, SSRIs, antipsychotics and benzodiazepines.


What sets this module apart, the MHRA told PMLiVE, is its presentation.


Unlike previous modules, this one is mounted on a learning management system.  This allows learners to keep a record of their learning.  The system also makes it easier for learners to pause their learning and return to the place where they paused.


On successful completion of the module, learners will be able to download a certificate to show they have completed the course. The module has been approved for continuing professional development (CPD) by the Faculty of Pharmaceutical Medicine of the Royal Colleges of Physicians of the United Kingdom.


“The MHRA has succeeded in delivering excellent material in a user-friendly and very engaging manner. This makes learning about anticoagulants enjoyable. The quiz at the end is a useful test of the learning,” said Dr Angela Thomas, director of the Haemophilia Centre at Edinburgh Hospital.


Source PMLive http://www.pmlive.com/pharma_news/mhra_launches_online_oral_anticoagulation_module_593860




MHRA launches online oral anticoagulation module

Wednesday 20 August 2014

Private hospitals 'must provide more safety data'

Blood pressure measurement


Private hospitals should release the same levels of data about patient safety incidents as NHS providers, a report says.


The organisation behind the report says it is difficult for the public to judge the safety of private hospitals.


Private hospitals now receive 28% of their income from treating NHS patients.


Independent hospitals say they are working hard to provide better data.


Private hospitals are required to report all serious incidents to regulators at the CQC and Monitor, and additionally to commissioners if NHS-funded patients are involved.


But it is not possible to compare data side-by-side from NHS and private hospitals for death rates or complications such as infections.


A think tank scrutinising the role of markets and competition in the NHS, the Centre for Health and the Public Interest (CHPI), says figures obtained from the Care Quality Commission (CQC) show just over 800 patients died unexpectedly in private hospitals in England between October 2010 and April 2014 – and there were more than 900 serious injuries.


The report says: “It is not possible to state whether these rates of death and serious injury are significant, as we do not know in which hospitals they occurred, the health status of the patients concerned, nor the types of treatments that were being provided.


“It is also not possible to state whether the rates are unusually high or to be expected.”


Private hospitals’ representatives say those figures need to be examined against comparable NHS data.


The report also says there were 2,622 emergency admissions to the NHS from the private sector in 2012-13.


CHPI is calling on the government to review the nature and costs of these admissions.


Transparency ‘crucial’


Report co-author, Prof Colin Leys, said: “The public and regulators have access to more information than ever before about how NHS services are performing but the same cannot be said for private hospitals.


“The government has recognised the crucial role of transparency in making hospitals safer, but reporting requirements should apply wherever patients are treated. This is too important to be left to the industry to address.


“This is a question of accountability. It’s a basic necessity for all hospitals to report the same data.”


The report recommends that private hospitals report on their performance in the same way as NHS providers – with data such as infection rates made available on the NHS Choices website, and monitored by the Health and Social Care Information Centre.


Peter Walsh, chief executive of Action Against Medical Accidents, said: “This report confirms it is time for the same level of scrutiny, regulation and protection of patients’ safety and rights to be afforded to private patients as is now being done for NHS patients.


“A comparable complaints procedure and access to independent advice on complaints would be a good starting point.”


‘Overwhelmingly safe’


Fiona Booth, chief executive of the Association of Independent Healthcare Organisations (AIHO), said: “From the data already publicly available from the CQC, it is clear that the care provided by independent hospitals is overwhelmingly safe.


“The independent sector has been working with the NHS for a number of years on a project to share and report quality data.


“A lot of work has been undertaken to make reporting systems compatible. That work is ongoing, and will enable the independent sector and the NHS to report incidents in a directly comparable way.”


The Private Healthcare Information Network (Phin), which collates data, said: “Our network was set up precisely to improve the availability of information for patients, and has strong support from private hospitals, insurers, and doctors to do so.


“Most of the specific issues raised in the report are already being addressed, and indeed all private hospitals and consultants in private practice will soon be legally required to work with us to publish far more comprehensive information in the near future.”


By Jane Dreaper Health correspondent, BBC News


Source BBCNews/Health http://www.bbc.co.uk/news/health-28837402



Private hospitals 'must provide more safety data'

Tuesday 19 August 2014

Issue 3 of Primary Care Nursing Review PCNR is now online!

Content in this edition includes articles on wound care, continence and allergies. There is a wide selection of comment and opinion and even a look at innovative board games that help you learn.


PCNR will be attending Wounds UK in Harrogate in November for the first time as an exhibitor (although definitely not for the first time as delegates!) and all the while continuing to bring you the best from the nursing world through Twitter and on our Facebook page too.


We will have more about our autumn plans for you soon but for now we invite you to log in and take a look at the latest edition of PCNR


The PCNR Team.



Issue 3 of Primary Care Nursing Review PCNR is now online!

Report finds new medicine service improves treatment adherence and saves NHS money



Pharmacist in consultation with patient


Source: Photofusion / Rex Features


A consultation service provided by community pharmacists offering advice on new medicines has led to an increase in patient adherence



A service delivered by community pharmacists that helps patients take new medicines effectively has been found to increase the number of patients who are adherent to their treatment by about 10%.


The authors of a long-awaited report, ‘Understanding and appraising the new medicines service in the NHS in England’[1], recommend that the new medicine service (NMS) should continue to be funded by the NHS.


The NMS is performed by community pharmacists when a patient is prescribed a new medicine for one of four therapy areas – hypertension, type II diabetes, anticoagulation/antiplatelet therapy and asthma/chronic obstructive pulmonary disease. Around 7 to 14 days after the patient presents at the pharmacy with the prescription, the pharmacist offers a consultation to find out if the patient is having any problems taking their medicine and provides support to remove any barriers to adherence.


The Department of Health (DH) initiated the NMS in 2011 to address the problem of poor adherence to medicines, which is considered a major public health concern. The report’s authors highlight that 25% of medicines for long-term conditions are not taken as directed. For conditions like diabetes, poor adherence can be up to 78%, they say.


The DH commissioned an evaluation of the service in 2012 to help determine if it should continue to be funded by the NHS. A research team led by the University of Nottingham, in collaboration with University College London, were awarded a grant to carry out the evaluation, which included conducting a randomised controlled trial of the service.


The results show that since the implementation of the service there has been wide adoption by community pharmacy, with 91.2% of community pharmacies conducting at least one NMS.


Pharmacists are paid £24.60 each time they conduct the NMS. In the financial year 2013–2014 there were 76,3401 NMS interventions performed according to the NHS Business Services Authority, costing NHS England £19m.


“The NHS is constantly challenged to provide evidence of the effectiveness of interventions,” says David Branford, chairman of the Royal Pharmaceutical Society’s (RPS) English Pharmacy Board. “Here we have a rigorous and thorough piece of work that leaves me in no doubt that this service is benefitting patients through improved use of medicines as well as saving money through fewer hospital admissions.”


Branford wants to see the service expanded. “People with depression and dementia would be a wise place to start a wider roll out of the NMS to patients.”


This sentiment is mirrored by Gary Warner, chairman of the service development subcommittee of the Pharmaceutical Services Negotiating Committee (PSNC), which negotiates with NHS England on behalf of pharmacy contractors.


“It has been a massive success, now let’s see it expanded out to other disease areas and patient groups; this is what I’ll be saying to NHS England,” he says.


“We will be using the outcomes to inform our ongoing negotiations with NHS Employers (who are acting on behalf of NHS England),” explains Sue Sharpe, chief executive of the PSNC. “Given the results, we are of course optimistic about the future development of the service. We expect an announcement to be made when the whole package has been agreed.”


Since the decision to commission the evaluation, responsibility for funding the service has shifted from the DH to NHS England. But because funding negotiations over the pharmacy contract are still ongoing, NHS England says it cannot comment on the report.


But Keith Ridge, chief pharmaceutical officer at NHS England, was positive.


“We now need to explore with clinical commissioning groups how this service can be linked into pathways of care, including whether there are other options to enhance the service further,” he says. “For example, how clinical pharmacists in GP practices can contribute to improved patient care, linking with their community pharmacy and hospital colleagues.”


NMS intervention flowchartNew medicines service intervention

Flowchart shows standard care pathway of patients receiving the new medicine service from a community pharmacist. Source: Understanding and evaluating the new medicines service in England, Elliott R.A. et al / Nottingham University School of Pharmacy



Randomised control trial shows NMS improves adherence


Patients in the randomised control trial received either “current practice” care from the pharmacy or the NMS. Adherence to medication was assessed after ten weeks. Adherence to treatment was 64.9% in the current practice group and 74.7% in the NMS group (95% confidence interval 1.09–2.58; P=0.018), including patients who switched or stopped medicines after advice from their healthcare professional. When the analysis was restricted just to patients who continued with the same medication, 60.5% were adhering to their medicine in the current practice group, compared with 70.7% in the NMS group (95% CI 1.06–2.62; P=0.027).


The researchers used data on the effects of adherence to treatment to model the long-term effects of the difference between the patient groups.


“For example, not taking your antihypertensives can lead to higher blood pressure, which can lead to stroke and lower quality of life,” says Rachel Elliot, Lord Trent professor of medicines and health at University of Nottingham, who led the study. “We modelled the long-term effects based on probabilities of outcomes that were based on levels of adherence in both arms.”


Among the patients classified as adherent, the researchers are assuming an 80% adherence level and in the non-adherent group, a 50-60% adherence level. “So actually the differences in adherence levels are quite small, but on a population level, this can make a big difference,” says Elliot.


Using this information, the researchers calculated that for each patient taking part in the NMS, the NHS saves £190 and the person gains 0.06 Quality Adjusted Life Years (QALYs) — QALYs are used as a measure of the state of health of a person by the National Institute for Health and Care Excellence (NICE) to assess health gains from a new technology. For comparison, a 65-year-old man with moderate hypertension and mild to moderate chronic kidney disease who is prescribed a statin will gain 0.10 QALYs. One QALY is equal to one year in perfect health. Looking at the NMS service, it was found that for each QALY gained on a population level, the NHS saves £3,005; the threshold for implementation of a technology is usually a cost per QALY of £20,000.


“In the long term, our economic evaluation suggests that it is likely that NMS will deliver better outcomes at overall reduced cost per QALY well below most accepted thresholds for technology implementation,” the researchers’ report says.


Health economist, Sam Keeping, researcher at London School of Economics Health and Social Care, says that the study seems robust and that the NMS appears to be a good example of how delivering care in novel ways and settings has the potential to deliver savings for the NHS.


Elliot explains that the cost to the NHS is less for NMS patients because their economic model predicts that these patients will have fewer adverse events and so make fewer contacts with the health service than patients who did not receive the service. Even during the ten weeks of the study it was found that patients visited their GP fewer times and so delivering the NMS was cheaper. However, the study was not designed to show differences in use of NHS services during the ten weeks that it was conducted, but rather to model outcomes in the future based on adherence — adverse effects from not taking medication sometimes do not happen for years, says Elliot.


None the less, the finding that the service improved adherence and reduced burden on the NHS was welcomed by the Royal College of General Practitioners (RCGP).


“Patients have a lot to gain from the NMS,” says RCGP chairman Maureen Baker. “The RCGP has recently warned that half of all adults in England find the health advice given to them by doctors and health professionals too complicated – including instructions on how to take medication appropriately. And so we are optimistic that this study shows the NMS to significantly increase patients’ adherence to their new medicine.”


She adds that the study makes it clear how important it is for GPs to work closely with pharmacists, one of the key recommendations from the study.


“A lot of pharmacists and patients liked the service, but it needs to be much better integrated into primary care in general — virtually none of the patients were referred by their GP and GPs weren’t very aware of the service,” says Elliot.


Warner argues that the service needs to be both integrated into primary care and more longitudinal. “This means that the pharmacist is providing a continuing package of care over a period of time, rather than discreet services such as the NMS, medicines use reviews or dispensing,” he says. “It’s about ongoing patient management that doesn’t cease after the service is completed.”


Elliot believes the service could be extended to other diseases. “It is interesting that the effectiveness of the intervention was the same across the different diseases, which is an encouraging finding,” she says. “It shows that the NMS is applicable to other diseases. Plus, we had much higher withdrawal from the study in the current practice arm; it shows patients seem to like the NMS.”


Mental health is one of the areas that the report recommends could benefit from the NMS. Warner agrees. “Antidepressants are a good example; they take three weeks to work and often by week two the patient may be experiencing side effects without any benefit and become disengaged from their treatment,” he says. “This is when the pharmacist can step in.”


But Warner goes further, arguing that there should now be a move towards all patients with long-term conditions being offered the NMS.


Unexpected outcome


One of the unexpected outcomes from the evaluation was that patients who received the NMS through a small multiple were twice as likely to be adherent to their medication as patients who were given the NMS through an independent pharmacy.


“We weren’t expecting to find that small multiples were better,” says Elliot. She explains that one of the small multiple pharmacies involved in the study recruited 99 patients out of a total of just over 500, which may have skewed the findings. In addition, the study was not powered to identify differences between types of pharmacies.


As part of the evaluation, the researchers observed how the NMS was conducted in 23 pharmacies, as well as interviewing patients and pharmacists.


“The most successful pharmacies were very good at team working which allowed them to accommodate services — they were flexible with good communications skills,” says Elliott. “This is not necessarily specific to a type of pharmacy.”


In addition, she adds that patients seemed to volunteer more information to the pharmacist when the consultation had a less rigid format. “Listening to patients is something healthcare professionals can struggle with, but it is really important,” she says.


The report also recommends that access to patients’ records could help facilitate the advice given to patients.



Panel 1 How the trial was conducted


Community pharmacies in the East Midlands, South Yorkshire and London were recruited to take part in the study. A total of 61 pharmacies participated, although four withdrew after study initiation.


Pharmacists recruited patients when they presented at the pharmacy with a prescription for a new medicine. After accepting the invitation to take part, the patients were randomised to receive either current practice (n=253) or the new medicines service (n=251).


Current practice was the normal supply and advice associated with presentation of a prescription for a new medicine for a long-term condition and did not exclude patients from contacting the pharmacist or another healthcare professional if they wished.


The primary outcome of the study was patients’ adherence to their medicine. Adherence was measured at week 6 and week 10 using the Morisky’s medication adherence scale 8-item version and the Visual Analogues Scale, both assessed by self-completed postal questionnaire and by telephone interview.


During the telephone interview patients were asked: “People often miss taking doses of their medicines, for a wide range of reasons. Have you missed any doses of your medicine, or changed when you take it?”


Secondary outcomes were patients’ understanding of their medicines, health status and healthcare costs.


Qualitative research was conducted to assess if the service was well received by patients and healthcare professionals. Interviews were carried out with 47 pharmacists, 19 patients and 11 GPs, while 23 pharmacies were profiled.






References:



 [1]Elliott R, Boyd M, Waring J et al. Understanding and appraising the new medicines service in the NHS in England. Available from: http://www.nottingham.ac.uk/~pazmjb/nms/downloads/report/files/assets/basic-html/index.html#1 (accessed 14 August 2014)






Citation: The Pharmaceutical Journal, 23/30 August 2014, Vol 293, No 7824/5, online | URI: 20066177


Source PJOnline http://www.pharmaceutical-journal.com/news-and-analysis/news/report-finds-new-medicine-service-improves-treatment-adherence-and-saves-nhs-money/20066177.article




Report finds new medicine service improves treatment adherence and saves NHS money

Monday 18 August 2014

Depression 'more common' in early Parkinson's

Woman with hand over her face

Depression and anxiety are twice as common in people newly-diagnosed with Parkinson’s disease compared with the general population, research suggests.


Writing in the journal Neurology, US researchers say depression increases in frequency in Parkinson’s patients and is often left untreated.


Previous research suggests that the disease’s impact on the brain can be a trigger for depression.


Parkinson’s UK said depression could be due to a number of causes.


Researchers from the University of Pennsylvania School of Medicine examined 423 newly-diagnosed Parkinson’s patients and tracked their mental health over two years.



There are psychological reasons why people with Parkinson’s can become depressed, but their brain pathways are also affected by the disease”


Prof Daniel Weintraub University of Pennsylvania



At the outset, 14% of patients with Parkinson’s disease were found to have depression, compared with 6.6% of a group of healthy volunteers.


During the follow-up, there was a small rise in the frequency and severity of depression in the group with Parkinson’s, while in the control group a decrease was noted.


At the start of the study, 16% of patients with Parkinson’s were taking an anti-depressant, and this increased significantly to 25% two years later.


But 65-72% of patients who screened positive for depression were still not being treated with medication, the study said.


Brain pathways and mood


Dr Daniel Weintraub, associate professor of psychiatry and neurology at the Perelman School of Medicine at the University of Pennsylvania, said depression in Parkinson’s disease was under-recognised.


“There are psychological reasons why people who have been diagnosed with a neuro-degenerative disease like Parkinson’s can become depressed, but their brain pathways are also affected by the disease and these are closely associated with mood.”


Prof David Burn, from the University of Newcastle, who is funded by Parkinson’s UK, said depression can be a sign of Parkinson’s.


“It is well-recognised that people do get depression and anxiety up to 10 years before they develop Parkinson’s disease.


“People recognise the tremor and movement problems of Parkinson’s, but the disease actually starts in the brain, affecting certain chemicals.


“This can cause sleep problems initially and can also lead to minor forms of depression.”


Depression can also be a side effect of Parkinson’s drugs.


Because of the range of possible causes, Parkinson’s UK says it is important that patients speak to their healthcare professional if they are worried about their symptoms.


After Robin Williams died in an apparent suicide last week, it emerged the actor – who had depression – was in the early stages of Parkinson’s disease.


Source BBC News/Health http://www.bbc.co.uk/news/health-28801953



Depression 'more common' in early Parkinson's

Friday 15 August 2014

Cancer Research UK calls for accuracy on Wikipedia

Appeals to healthcare community to keep online information up to date


Wikipedia logoThe charity Cancer Research UK has called for the healthcare sector to keep online cancer information current and accurate.


Cancer Research UK has appealed to scientists, doctors and nurses to get more involved in free online encyclopaedia Wikipedia to help ensure it has the most up to date and correct information on cancer.


Speaking at the Wikimania 2014 conference in London on August 8, Cancer Research UK discussed Wikipedia’s role as a resource for people searching online for cancer-related information, and how this fits in with their use of other online medical content.


The charity also outlined its plans – as part of the same project – to evaluate how people use the site to find information, and how to make its pages easier to understand.


“Wikipedia is probably the most frequently used online source of medical information. Keeping it up to date, accurate and relevant is a huge challenge – one that requires a lot of input, effort and time,” said Henry Scowcroft, Cancer Research UK’s news and multimedia manager.


“We feel it’s our responsibility to make sure that cancer information online is as good as it can be, to remove uncertainty, reduce fear and worry, and to help people take their next steps after they, their family or friends hear the phrase ‘it’s cancer’.”


Jon Davies, chief executive of Wikimedia UK, said: “As someone who has personal experience of cancer, I know the information on Wikipedia has to be as good as possible. The work that Cancer Research UK is doing to support the improvement of medical content is excellent. ”


Earlier this year Cancer Research UK appointed an in-house ‘Wikipedian in Residence’ to help keep online information accurate. The role, funded by the Wellcome Trust and supported by Wikimedia UK, is the first of its kind created by a medical research organisation.


Source PMLive http://www.pmlive.com/pharma_news/cancer_research_uk_calls_for_accuracy_on_wikipedia_592505




Cancer Research UK calls for accuracy on Wikipedia

Thursday 14 August 2014

Failing GP practices face closure

Doctor with stethoscope

Failing GP practices will face closure under plans being unveiled in England.

The Care Quality Commission confirmed the sanction as they announced the special measure regime being used for hospitals will be extended to GPs.


It is effectively the first time there will have been a national failure regime for the profession.


Practices given the bottom rating – inadequate – will get six months or a year to resolve problems before facing being shut down.



Prof Steve Fields: “The vast majority of GPs do a great job in England”



Prof Steve Field, the CQC’s chief inspector of GPs, said: “Most GP practices provide good care.


“But we can’t allow those that provide poor care to continue to let their patients have an inadequate service.”


The failure regime is being accompanied by a new system of inspections – something that has already been announced.


‘Poor care’


This is getting under way in October and will involve nearly 8,000 practices being inspected by March 2016.


Each surgery will be given a rating of either outstanding, good, requires improvement or inadequate.


To date, they have just had to report whether they are compliant with a set of core standards.


line

How the failure regime will work


GP practices given an inadequate rating by the CQC will be given six months to improve.


If after that they have not managed to move out of the bottom rating they will be placed in special measures and given another six months. Where there are extremely serious issues raised a practice can be placed straight into special measures.


During the time spent in special measures, practices will be given some support – yet to be defined – to turn themselves around. For hospitals that has involved being buddied with good trusts and having senior managers parachuted in.


GP with patients

Failure to improve while in special measure will lead to either the CQC withdrawing its registration or NHS England terminating its contract. In both cases the practice will not be allowed to continue as it is.


If this happens, one of two things can then happen for patients registered at that practice – either new GPs can take over or alternative local surgeries are found.


line

GP organisations gave the announcement a cautious welcome.


Royal College of GPs chair Dr Maureen Baker said: “Patients should expect high quality and consistent care from every GP practice and the vast majority of practices do an excellent job.


“But there is occasionally a very real variation in the quality of care provided and this must be addressed.”


‘Long time to wait’


However, she said in many of those cases they were struggling because of “factors beyond their control” such as a lack of funding, rises in patient demand or problems recruiting patients.


And Dr Chaand Nagpaul, of the British Medical Association, added: “It is right GPs are held to account, but in many circumstances failures are more about the environment they work in than the individual practice.”


But Patients Association chief executive Katherine Murphy said: “It is about time we had something like this. But it does seem like a very long time for patients to be exposed to poor care while GP practices try to sort themselves out.”


There is no comparable failure system in the other UK nations.


By Nick Triggle Health correspondent, BBC News


Source BBC News/Health http://www.bbc.co.uk/news/health-28775987



Failing GP practices face closure

Wednesday 13 August 2014

UK pharmacies can play bigger public health role

Report says pharmacies should extend range of services for communities

pharmacy standardUK pharmacies have a bigger role to play in supporting the health of their communities, according to a new report.

Research by Durham University demonstrated that that 89 per cent of people in England live within a 20-minute walk of a pharmacy, while that proportion rises to nearly 100 per cent for people in deprived areas.


This reach means that community pharmacies are well placed to support public health, according to the study authors, with suggestions that they can provide services such as blood pressure checks and diabetes screenings.


The potential for pharmacies in deprived areas is especially important as this goes against the ‘inverse care law’ – a theory that suggests good medical care is most available to those who need it least.


“This is particularly important for the poorest areas where more people die from conditions such as smoking, alcohol misuse and obesity compared to people from more affluent areas,” said lead author Dr Adam Todd.


“With easy access without patients needing to make an appointment, the results suggest there is a potential for community pharmacies to deliver public health interventions to areas which need it most.”


The suggestion that pharmacies had a bigger role to play in public health was welcomed by Dr David Branford, chair of the Royal Pharmaceutical Society’s pharmacy board.


“The less formal approach and sheer convenience provided by a high street presence means they are a beacon of wellbeing and advice to many who would simply never engage with other healthcare settings,” said Dr Branford.


He added: “This study confirms their accessibility and the huge potential they have for delivery of quality healthcare to those who need it most.”


The report, which was published in the BMJ Open journal, says the results are timely following the recent launch of the NHS England initiative Call to Action, which is seeking to develop local strategy for community pharmacy initiatives and inform strategic policy making in terms of commissioning community pharmacy services


“Our work supports this initiative and shows that community pharmacies are uniquely placed in the community to deliver healthcare interventions,” said the study authors.


Source PMLive http://www.pmlive.com/pharma_news/uk_pharmacies_can_play_bigger_public_health_role_592254




UK pharmacies can play bigger public health role

Tuesday 12 August 2014

Cancer drugs row: A sign of things to come?


Breast cancer cell

Breast cancer cells dividing

There is a real sense of sadness – and anger for that matter – that the new breast cancer drug Kadcyla looks unlikely to be made routinely available on the NHS, something that is obvious from the bitter language being used by both sides.


The decision by England’s official NHS advisory body, the National Institute for Health and Care Excellence (NICE), to reject Kadcyla prompted manufacturers Roche to claim the system was “broken”.


NICE – not known for its strong use of language – responded by saying it was “really disappointed” in the approach taken by the drugs firm.


At the heart of this dispute is price. While the drugs are not a cure, they are effective at giving women with an aggressive form of the disease an average of six months of extra life expectancy.


But the drugs do not come cheap. A course of treatment costs £90,000 – more than five times what NICE would normally sanction.


When the row erupted in April after the watchdog first took a look at the drug, the two sides agreed to keep talking.


Cost-effectiveness


Kadcyla

The drug Kadcyla costs around £90,000 for an average course of treatment

Several discussions were held during which NICE took the fairly unusual step for a breast cancer treatment of agreeing to consider Kadcyla as an end-of-life therapy.


This meant NICE could sanction spending twice what it was originally proposing to do. But this still wasn’t enough.


Officials at Roche told me that they were willing to come down on price “significantly”, but that there was a limit to this considering other European countries, including Sweden, Switzerland, Denmark and Austria had agreed to pay the full price.


Comparisons between health systems are hard as the NHS is pretty unique in terms of how it is funded – and in terms of cost-effectiveness it is often lauded as among the best in the world.


But the case of Kadcyla does raise some interesting questions for cancer treatment.


In recent years NICE has become less likely to approve cancer drugs. Since 2012, there have been 14 treatments given the green light and 22 blocked – a rejection rate of 61%.


That compares to 48 rejections out of 148 appraisals since NICE started doing looking at drugs for the NHS in 2000 – a rejection rate of 32%.


There are two schools of thought about why this is.


One is that as medicine has developed – particularly for this disease which has attracted a lot of funding over the years – it has become more and more difficult to produce new drugs that represent a significant improvement on what is already available.


The other – and as you would expect it is one being put strongly by the drugs industry – is that the way NICE assesses drugs is out-of-kilter with modern medicine.


It is a debate that looks set to run and run.







Source BBC News/Health http://www.bbc.co.uk/news/health-28688316



Cancer drugs row: A sign of things to come?

Monday 11 August 2014

Actelion partners with PatientsLikeMe on blood cancer research

Will create patient-reported outcomes tool for rare form of non-Hodgkin’s lymphoma

PatientsLikeMe Open Research Exchange OREActelion has formed a research partnership with an online patient community to create a new research tool for a rare form of non-Hodgkin’s lymphoma.

The Swiss pharma company and PatientsLikeMe will work with patients to develop new health measures that better reflect patients’ experiences living with and managing MF-CTCL., a disfiguring cancer, primarily of the skin.


The most prevalent form of cutaneous T-cell lymphomas (CTCL), mycosis fungoides CTCL accounts for about two per cent of all lymphomas.


Mitchell Nagao, Actelion’s senior director – medical head of Valchlor and Zavesca, said: “As changes in technology, culture, and treatment affect how patients live with disease, we want measurement to evolve accordingly.


“Our work with PatientsLikeMe will help ensure we’re applying the best principles for patient-centered research and giving tools back to the community so they can evolve them even more.”


Actelion joins the likes of Sanofi, Merck & Co and Boehringer Ingelheim in working with PatientsLikeMe, but will be the first pharma company to use its online Open Research Exchange (ORE) hub.


PatientsLikeMe vice president of innovation Paul Wicks: “We created ORE to help patients and researchers work together to transform care and discovery that truly serve the patient. Now we’re past the initial pilot stage, and it’s exciting to see members of industry engaging with patients to develop more tools that really measure what matters to patients.”


Source PMLive http://www.pmlive.com/blogs/digital_intelligence/archive/2014/august/actelion_partners_with_patientslikeme_on_blood_cancer_research_tool




Actelion partners with PatientsLikeMe on blood cancer research

Friday 8 August 2014

NHS waits: Getting the excuses in early?

Inside an operating theatre

The devil – as always – is in the detail.


The pledge by Health Secretary Jeremy Hunt to end year-long waits for routine treatment seems to make perfect sense.


After all, the NHS has already made great strides on this issue.


Three years ago the numbers of patients waiting over 52 weeks were hovering around the 20,000 mark. Now there are fewer than 600.


So what could be wrong with the health secretary giving the NHS a last little shove over the line?


Nothing, of course. But it is important to see this in context of the wider pressures on the system.


While the number of patients facing long waits has dropped significantly since 2011 – when ministers first ordered action – there are signs the tide has begun to turn.


The numbers facing long waits have actually started to creep up in the past year or so.


In May last year 434 people had been waiting for 52 weeks, compared to 574 in May this year.


There is a similar story for those waiting over half a year. A year ago it stood at 51,562, but now it is 65,394.


In fact, whichever way you slice the waiting time figures there are warning signs.


The numbers on the waiting list overall (once you add those waiting over 18 weeks to those who are still within deadline) have been going up.


This year they have topped 3m for the first time in six years.


Patients in a hospital waiting room

More are waiting longer than four hours in A&E

The average wait for treatment has also been high in recent months – and in February hit its highest level since the 18-week target was introduced.


While this has been going on, the NHS has still managed to keep to its official target.


That is measured not by the numbers on the waiting list or the average wait, but by the proportion of patients seen within 18 weeks.


For patients who need to be admitted – those undergoing hip and knee replacements, for example – the NHS has to see 90% in 18 weeks.


Apart for February and March when it was missed ever so slightly, the 90% target has been met this year – as it has for most of the time since it came into place under Labour.


But within the health service it has been widely acknowledged that this achievement – met despite the squeeze on spending and rising demands – could only be maintained for so long.


That threat – I am told – has been causing a lot of angst at the Department of Health.


So the acknowledgement that the 18-week target will be missed in the coming months in a “managed breach” is a critical detail.


This is unheard of. The 18-week target is enshrined in the NHS Constitution and was personally committed to by the prime minister in June 2011 when the controversy over the government’s NHS reforms were at their peak.


What is more, the big improvements made from late 2011 through to early 2013 when the number of year-long waits fell 40-fold did not lead to a breach in the 18-week target.


Instead, by making it clear the target is going to be missed at this stage and pinning it to the desire to tackle long waits the government – it could be said – has got its excuses in early.


Source http://www.bbc.co.uk/news/health-28638505



NHS waits: Getting the excuses in early?

Thursday 7 August 2014

London GPs take Save Our Surgeries campaign to Downing Street

SOS campaign

The Save Our Surgeries campaign is calling on NHS England to reverse funding cuts

Campaigners fighting new funding arrangements for GPs’ surgeries are delivering a 21,000-signature petition to Downing Street.


The group, Save Our Surgeries, says 22 practices in Newham, Tower Hamlets and Hackney could be forced to close, if proposed changes go ahead.


They are calling on NHS England to reverse funding cuts.


NHS England said it recognised “the unique financial challenges some GP practices were facing”.


The government has decided to phase out the Minimum Practice Income Guarantee (MPIG) nationally, over a seven-year period and changes started taking place in April.


The MPIG was introduced in 2004, to support some GP surgeries and was used to top-up the core funding of practices.


Campaigners say practices in inner-city deprived areas will be worst hit.


March to save local GP surgeries

More than 400 people in east London marched against changes being made by NHS England in July

Dr Naomi Beer, GP at Jubilee Street Practice in Tower Hamlets, east London, one of the affected surgeries, said: “Our patients often tell us how much they appreciate the high quality, accessible service that Jubilee Street provides.


“We’ve already taken pay cuts to try to keep going, but we can’t absorb such a huge loss.”


An NHS England spokesman said: “The decision to phase out Minimum Practice Income Guarantee (MPIG) is national policy which is being implemented all across the country, in order to make GP funding more equitable.


“The majority of practices in London will gain as a result, however we recognise the unique financial challenges that some GP practices are facing as a result of these changes.


“That is why we are working with the affected practices, the Office of London CCGs and Local Medical Committees from across the capital, to consider how these changes can take effect, and what arrangements might be put in place to support those affected.”


Source BBC News/Health  http://www.bbc.co.uk/news/uk-england-london-28673981



London GPs take Save Our Surgeries campaign to Downing Street

Wednesday 6 August 2014

Blood diagnosis app 'can detect diseases'

Athelas

The app was one of the winners of a recent hackathon held in California that allows blood-cell analysis via a smartphone

The app, called Athelas, won a prize at a coding event held by the prestigious start-up hub Y Combinator.


The team says it can detect diseases such as malaria and cancers in seconds, through so-called predictive cell counting.


But experts warned of the difficulty of reproducing the quality of medical labs results using just a smartphone.


Users take a picture of their blood using the lens attachment, which is then sent to the app’s servers, and the results are then sent back to them.


Team leader Tanay Tandon said in his submission: “For more than two centuries, cell morphology – or the practice of viewing/analysing a person’s blood in order to diagnose conditions – has been the primary way to approach medicine.


“Yet, despite the critical nature of blood analysis to the medical industry – the process has hardly changed from its long, expensive form for 150 years.”


Mr Tandon added that in “rural areas, the tech will really shine, providing previously unavailable diagnostic skills through the power of artificial intelligence and computer vision”.


‘Create more confusion’


But experts in the field are not so convinced by the reality of using a smartphone to detect and diagnose.


“This app will create more confusion then alleviate anxiety,” Dr Amar Safdar, the director of transplant medical diseases at New York University’s Langone Medical Center, told the BBC.


“The major limitation for this approach is that most viruses require electron microscopic exams to see them.”


Using the example of the current outbreak of Ebola – which has killed more than 800 people in western Africa and is spreading partly through air travel – Dr Safdar said that patients in the early stages of illness might not have large enough quantities of the Ebola virus in their peripheral blood to be diagnosed.


Blood

Lab tests have a lot of regulation to ensure the correct results are delivered

The threat of false positives, or incorrect results, was another concern.


“I’ve no problem with it in principle – but in reality, these need to be carefully calibrated around the right type of diseases,” Dr Mike Chapman, of the University of Cambridge’s Department of Haematology, told the BBC, adding that some diseases were easier to detect than others.


“In a laboratory diagnosis, there is a lot of regulation that goes on behind the scenes to make sure that your results are meaningful.”


Dr Chapman added that he was aware of instances where people took a smartphone picture of a microscopic image of their blood and sent it to an expert.


The Athelas app won a prize as Y Combinator held its first “hackathon” last weekend, where teams come together and are invited to create software together in a limited amount of time.


Mr Tandon won an interview with YC to be in its next batch of start-ups. The California-based accelerator counts billion-dollar start-ups such as Airbnb, Reddit, and Dropbox among its alumni.


Source BBC News/Health http://www.bbc.co.uk/news/technology-28658155



Blood diagnosis app 'can detect diseases'

Tuesday 5 August 2014

Wearing it well: the healthcare potential of wearable technology

For pharma the possibilities presented by wearable technology could be enormous

Innovation updateThere is a feeling that 2014 could signal the start of the widespread adoption of wearable technology that will – according to some – make us all leaner, fitter and hopefully less likely to develop chronic diseases.

Of course, many people are already using their smartphones as a loose form of wearable technology to carry out health enhancing activities such as monitoring their calorie intake and boosting their fitness levels.


There is a plethora of personal trainer apps available, and many runners use the GPS functionality built into many smartphones to monitor their routes and running speeds with apps like RunKeeper. Some apps – notably the popular Zombies, Run with more than 800,000 users – have also introduced a gaming element to encourage people to stick with their training schedules.


Meanwhile, additional functionality is constantly being introduced such as the M7 co-processor in the recently-launched iPhone 5S that functions as a built-in pedometer.


Increasingly however developers are envisaging a series of interlinked devices – some wearable – that will allow users to keep track of their fitness and health goals via the cloud.


Despite the hype surrounding smartwatches such as Samsung’s Gear 2 and the Pebble – and some very optimistic market forecasts – sales have been somewhat lacklustre to date, and a recent survey by NPD found only one in five consumers in the US were interested in buying one. The subcategory of smartphone-linked fitness bands seems to be performing rather better, however, with sales developing fairly well for the likes of Nike’s FuelBand, Jawbone’s Up and Fitbit, although Nike has said it intends to exit the hardware market and concentrate on fitness apps.

Fitbit meanwhile hit a setback earlier this year when a skin rash issue forced a recall, but retail outlets such as RadioShack in the US have reported encouraging uptake for the device along with the fitness band category in general.


“Digital fitness is still a relatively small category, but one that is certainly expanding along with the growth in all forms of wearable technology products,” said the company’s chief executive Joe Magnucca. That ties in with market research from Canalys, which predicts that there will be 8 million fitness bands sold in 2014, rising to 23 million next year and 45 million-plus by 2017, representing a global market of around $25bn.


Smartphone giants get in on the act

Samsung laid down something of a marker in the health and fitness segment with the launch earlier this year of its Gear Fit device, which added a lot more smartphone-like functionality to the platform compared to the first-generation devices.


It has however (like some of its peers) been somewhat let down by a lack of GPS and automation in its fitness apps. That means users have to tell the device when they start walking or running, if they want to check their heart rate or let it know they are falling asleep. As a result, it kind of breaks the cardinal rule of successful technology, which is to fit as seamlessly as possible into users’ daily routines.


The sector is moving along at great speed, however, and with Google’s health data service Google Fit recently launched and Apple promising its own variant HealthKit will be available for iOS 8 in the autumn there are no signs of a slowdown.


Both systems promise to act as fitness and health tracking systems, collecting data from fitness tracker devices and health-related apps but details are few and far between at the moment.


Google and Apple are already announcing partnerships with app developers such as RunKeeper, as well as wearable companies like Fitbit and crowd-funded start-up Misfit, whose Shine movement tracker has been featured on Apple’s recent TV advertising campaign.


The big problem for companies targeting the consumer end of the market is how to stop these devices gathering dust in a drawer after the initial techno thrill wears off, perhaps lying alongside other health-targeted platforms like the Wii Fit.


They key to solving that problem will be to improve the accuracy of sensors, as well as their integration into a network of devices so that the data can be collected and interpreted automatically, with a minimum of effort on behalf of the user.


From fitness to health

The market for fitness technology is clearly moving, but what about health? Here too, there are some interesting portents to repot. Amazon recently launched a dedicated wearable technology store with a Fitness & Wellness category but also a section called Healthcare Devices which features blood pressure monitors, pulse oximeters, sleep and mood trackers and posture sensors.


Ultimately, wearable devices could include sensors and software to measure a broad range of physiological parameters, including heart rate, blood pressure and oxygen levels, body mass index, and potentially even complex measures such as stress or blood sugar levels.


Apple, Google and Samsung are all rumoured to be researching ways to give wearable devices such as smart watches the ability to check blood sugar and help diabetics manage their condition. For example, Google has just signed a deal with Novartis for its contact lenses that measure glucose levels in tears.


Achieving that goal would give it a beachhead in a diagnostics market currently valued at more than $10bn a year and – potentially – have a massively disruptive effect on the businesses of current diagnostics players such as Johnson & Johnson and Medtronic.


Samsung’s Simband a game changer?

All this is still fairly speculative, but once again things are developing quickly. Samsung has just unveiled a prototype system called Simband – that combines what the company claims is the first open-platform sensor module with a smartwatch it describes as a “modular reference platform for wearable health sensors”. The device links with Sami, a cloud-based data repository and the company is planning to have a beta version of the system in place by the end of the year.


At the moment, the prototype collects heart rate, heart rate variability, and skin temperature data, and Samsung is working with technology partners to develop sensors for other variables such as oxygen and carbon dioxide levels.


It has deliberately chosen open-source software and hardware to make it as easy as possible for developers to work with the platform and offered the sweetener of a $50m fund – dubbed the Digital Health Challenge – to encourage them to get on board.


At the unveiling of the Simband and Sami health platform in May, Samsung chief strategy officer Young Sohn said that understanding our physical well-being better through technology is the “single greatest opportunity of our generation”.


It is not yet clear how any of the new integrated fitness and health platforms will handle privacy issues, particularly as newer and more sophisticated sensor technology is developed.


From consumer to patient

For the pharmaceutical industry, the possibilities presented by wearable technology are clearly enormous. Imagine being able to record such a wealth of data in real-time from patients in clinical or post-marketing trials for example, although it seems likely that privacy issues will have to be addressed. Meanwhile, for healthcare systems the promise of keeping patients out of hospital via remote monitoring and providing timely health and lifestyle advice and feedback is a major draw.


One example of the latter approach is Playtabase’s home automation system Reemo, which allows the user to control just about any networked device using simple gestures. While targeted at the consumer market in the first instance, the potential applications in allowing elderly, infirm and disabled people to maintain their independence are interesting.


Moreover, regulators are certainly waking up to the idea. The US FDA approved two motion-tracking wristwatch-like devices earlier this year – CamNtech’s MotionWatch and Pro-Diary – for use in clinical trials. Meanwhile, it is likely only a matter of time before a wearable could follow the footsteps of mobile apps such as WellDoc’s BlueStar diabetes management programme and become a reimbursable item.


Of course, the sector will only really gain momentum when the technology appeals to patients on a consumer level, so it is driven from the user up, rather than from the healthcare system down.


Some observers have sounded a note of caution however, suggesting that access to wearable technology could eventually evolve healthcare towards a two-tier healthcare system. The digitally-literate could use the technology to demonstrate a commitment to health – securing preferential access to new medicines and enjoying favourable insurance rates – while others miss out.


It remains to be seen whether wearable technology goes mainstream, let alone has a fundamental impact on society in the way that the internet and mobile devices have, although the early signs are good.


Pharma has been talking for years about moving away from a product-oriented business model to one more closely focused on serving the needs of patients – perhaps wearables could become a pillar of that new approach.


Source PMLive http://www.pmlive.com/pharma_news/wearing_it_well_the_potential_of_wearable_technology_in_healthcare_589546




Wearing it well: the healthcare potential of wearable technology

Monday 4 August 2014

UK invests in genetic research for cancer and rare diseases

Government outlines £300m boost for 100,000 Genomes Project


Genomics England 100,000 Genomes Project


The UK has outlined new investments in its plans to harness genetic research to transform how cancer and rare diseases are diagnosed and treated.


The Government, which wants to map 100,000 human genomes by 2017, has agreed genomic sequencing deals with Illumina, the Wellcome Trust and the Medical Research Council.


The partners will provide vital infrastructure and expertise as the NHS prepares to invite tens of thousands of patients to give DNA samples under government plans to make it the first mainstream health service to offer genomic medicine as part of routine care.


Prime Minister David Cameron said: “I am determined to do all I can to support the health and scientific sector to unlock the power of DNA, turning an important scientific breakthrough into something that will help deliver better tests, better drugs and above all better care for patients.”


The on-going 100,000 Genomes Project will be boosted by an investment package of more than £300m, the largest share of which involves Illumina.


The San Diego-based biotech will receive £78m for the use of its genomic sequencing services and will, in turn, invest around £162m into the work in England over four years, creating genome sequencing knowledge and jobs in a partnership with Genomics England.


Jay Flatley, CEO of Illumina, said the project to create the first comprehensive national programme for genomic healthcare would “push the boundaries of medical science”.


“This project confirms the UK as a leader in the global race to implement genomic technology and create a lasting legacy for patients, the NHS and the UK economy.”


Meanwhile, the Wellcome Trust has agreed to spend £27m on a sequencing hub at its Genome Campus near Cambridge to house Genomics England’s operations alongside those of the Sanger Institute. The Medical Research Council has also earmarked £24m to help provide the computing power required by the enterprise.


The final part of the new investment package involves NHS England’s promise to underwrite an NHS contribution of up to £20m over the life of the project. NHS England has started tendering for the first five NHS Genomics Medicine Centres, which are expected to be up and running by January 2015.


Simon Stevens, NHS England’s Chief Executive, said: “The NHS is now set to become one of the world’s ‘go-to’ health services for the development of innovative genomic tests and patient treatments.”


Source PMLive http://www.pmlive.com/pharma_news/uk_invests_in_genetic_research_for_cancer_and_rare_diseases_590422




UK invests in genetic research for cancer and rare diseases

Friday 1 August 2014

Germany to set up eHealth council to promote healthcare technology

Plans new eHealth legislation in the Autumn


GermanyThe German government plans to set up a new eHealth council in order to help the country make more effective use of healthcare technology.


The health service uses around 200 separate IT systems and their ‘interoperability’ – how well they connect to each other – has been highlighted as an barrier to further progress.


The eHealth Council will form part of the ‘gematik’, the government department responsible for Germany’s electronic health card (eGK) and its infrastructure.


Federal Health Minister Herman Gröhe said: “Our common goal is to continue to improve healthcare, with the help of modern information and communication technologies – modern technologies can benefit patients enormously.”


Gröhe picked out telemonitoring, which allows the elderly to remain at home longer, while doctors monitor their health on an ongoing, remote basis, as an example of where better use of technology could help.


But he said that eHealth activities like this are dependent on separate communications systems being able to share information. On a European level eHealth progress was earlier this year found to still be patchy and a survey of doctors across 31 countries saw them pick out interoperability as one of the three biggest barriers to making greater use of eHealth services.


The decision by the Federal Ministry of Health (BMG) to set up the eHealth council follows an interoperability study launched as part of Germany’s mid-2010 eHealth Initiative. The findings of the study will form the basis of a new eHealth law, which is expected to be in place by October.


The study found that IT and communications systems in Germany have traditionally been used to support individual institutions and that this is restricting progress across the healthcare sector as a whole.


“The market development for medical software solutions has led to a variety of system within doctor’s offices, hospitals and pharmacies, as well as parallel developments and electronic solutions, so that their cooperation potential is as a whole today not nearly exhausted,” it found.


The proposed eHealth council will operate as an independent scientific committee and be tasked with promoting the exchange of digital information in the German healthcare sector.


Source PMLive http://www.pmlive.com/pharma_news/germany_to_set_up_ehealth_council_to_promote_healthcare_technology_589888




Germany to set up eHealth council to promote healthcare technology