Health is an Investment

1
Health is an Investment

• The Asthma Society of Canada in the workplace

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Asthma Society of Canada

• Vision
• to empower every child and adult in Canada with
  asthma to live an active and symptom-free life.
• Mission
• We are the balanced voice for asthma in Canada,
  advancing optimal self-management, prevention,
  research and health care.
• We help patients to take control of their
  symptoms by providing credible and leading edge
  information, programs, services and the guidance
  and education they need to live their lives
  symptom free.
• We lead and advocate for the best interests of
  Canadians with asthma through effective
  collaboration with policy-makers, researchers and
  health care providers.

3
The Problem

• According to the Ontario Health Quality Council
• 1 in 3 Ontarians have gt 1 chronic diseases
  including diabetes, asthma, congestive heart
  failure depression .
• In Ontario, financial burden of chronic diseases
  consumes
• 33 of direct health care costs
• gt60 of total health care costs
• More effective management could lead to
• 29,000 ER visits avoided,
• 67,300 fewer hospitalizations,
• Estimated annual savings of 200 to 350 million.

4
Chronic Disease in the Workplace

• Respiratory diseases exert a significant economic
  impact on the Canadian health care system, and on
  worker productivity
• Employer borne costs include Absenteeism, Lost
  Productivity, and Health Benefits
• Traditionally, it was thought that good health
  arises from high standards of living from
  economic prosperity, however, it appears that
  this concept might be backwards perhaps economic
  prosperity arises from a healthy
  population(source Brandt-Rauf P, Burton WN,
  McCunney RJ. Health, productivity, and
  occupational medicine. J Occup Environ Med
  2001431).

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Chronic Disease in the Workplace

• We might conclude that a healthy population
  results in a healthy economy
• With the prevalence of asthma increasing for
  about the last three decades in western
  countries, it is plausible that some of the
  anaemic performance of the economy has been due
  to the prevalence in chronic disease in the
  workplace

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Allergic Rhinitis

• According to one study, allergic rhinitis was the
  most prevalent chronic condition at a workplace
  55 of employees reported experiencing allergic
  rhinitis symptoms for an average of 52.5 days,
  were absent 3.6 days per year due to the
  condition losing 2.3 hours of productivity each
  workday while symptomatic at work
• 70 of people with asthma suffer from allergic
  rhinitis.
• Prevalence of allergies has increased
  significantly in the last 20 years and is
  anticipated to reach up to 75 of the population
  worldwide by 2015

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Chronic Disease in the Workplace

• More hours are lost to persons who are present
  but unproductive than people who are absent.
• Research concludes that lost productivity from
  workers who are present but not at peak health
  (presenteeism) is 7.5 times more costly than
  absenteeism.
• (source Lowe G. Here in body, Absent in
  productivity. 2-12-2002. Canadian HR Reporter.
  25-9-2006).
• Lost productivity is greatest in those
  individuals who have chronic and generally benign
  conditions, such as asthma and allergies.

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ASC Asthma Control Programming

• Telephone and Email Based Asthma Counseling
• Asthma Control Booklet Series
• National Asthma Patient Alliance
• Advocacy Initiatives directed at driving patient
  and system behaviour change
• Asthma Care Gap Research
• Adult and Pediatric Guideline Dissemination
• Websites for teens and children with asthma
• Four Seasons of Asthma Trigger Management
  Website
• Asthma and Allergy Friendly Certification
  Program

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Asthma Society Workplace Programming

• The ASC has workplace programming directed at
• improving quality of life, disease management and
  control of asthma
• reducing overall medical benefit costs, lowering
  absenteeism rates and increasing productivity
• improving knowledge about asthma and associated
  allergies and self-management skills
• increasing awareness about asthma and its impact
  on daily/work-related activities among employees
• Objective measures include
• pulmonary function testing
• medication compliance rates
• absentee days (both long term and short term).

10
Return on Investment

• Disease management models, in contrast with
  traditional benefit programmes, can yield a
  return on investment of 2.85 for each 1.00
  invested
• (source Cousins MS, Liu Y. Cost savings for a
  preferred provider organization population with
  multi-condition disease management evaluating
  program impact using predictive modeling with a
  control group. Dis Manag 20036207-17).

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Asthma Society of Canada

• For further information about ASC workplace
  programming, contact
• Christine Hampson
• President CEO
• champson_at_asthma.ca
• direct 416-787-4050 x 109
• 4950 Yonge Street, Suite 2306
• Toronto ON M2N6K1
• Canada

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Chronic Disease Management (CDM) and Medication
Adherence

• Pilot Project developed by
• Asthma Society of Canada
• Oxford Outcomes Ltd

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Oxford Outcomes Ltd.

• Academic affiliated research consulting company
  (list academic affiliations)
• Expertise in
• Health program evaluation
• Economics evaluation (cost-effectiveness)
• Epidemiology
• Burden of illness
• Health outcomes evaluation
• Reimbursement and government relations
• 60 employees worldwide, located in Toronto,
  Vancouver, Bethesda, Oxford UK.
• Part of COPERA network of consultancies in six
  European countries
• Services offered (summary) strategic and
  regulatory consulting, design and analysis of
  observational studies and randomized trials,
  cost-effectiveness, patient reported outcomes,
  utility studies, linguistic translation and
  validation
• www.oxfordoutcomes.com

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The Problem

• In Ontario, chronic diseases account for 60 of
  total health care costs
• Employer borne costs include Absenteeism Lost
  Productivity, and Health Benefits (disability).
• 60 of prescribed medication is taken incorrectly
  or not at all leading to poor health outcomes
• Forgetfulness is a key reason for non-compliance,
  and number 1 reason for non-compliance among
  adolescents and seniors.

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One Potential Solution

• A medication reminder program designed to enhance
  the management of asthma.
• A system which enables automated, telephony-based
  (voice and text messaging) and email adherence
  reminders and associated tele-services.

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Joint Public-Private Pilot Project

• Ministry personnel overwhelmed by numerous and
  disparate pilot projects undertaken by private
  sector.
• ASC promoting a collaborative public-private
  approach to piloting this concept within primary
  health care and in an employer setting

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Adherence Activities forChronic Disease
Management (CDM)

• Typically involves counseling and/or distribution
  of pamphlets at time of prescription is written
  or dispensed.
• Currently, limited use of medication reminder
  services in primary care practices, patient
  groups (health charities), or large employers.

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Pilot Objectives

• To empower patient self management of chronic
  disease
• To improve adherence through automated reminders
• To implement and evaluate an automated medication
  reminder program

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Project Mandate

• MOHLTC directed the pilot as an implementation
  project
• Not research
• Use existing primary health care infrastructure
  (FHGs, FHNs, FHTs, LHINs etc.)
• At the end of the project
• transfer knowledge from pilot to provide
  evidence-based recommendations on how to
  integrate reminders systems within health care in
  a sustainable manner
• investigate linkages to ePrescribing

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Principal Investigators

• Adrian R. Levy, Ph.D.
• Department of Health Care and Epidemiology
• School of Population and Public Health, UBC
• Director Oxford Outcomes Ltd.
• D. Wayne Taylor, Ph.D.
• Director, Health Leadership Institute,
• DeGroote School of Business, McMaster U.
• Christine Hampson Ph.D.
• President CEO,
• Asthma Society of Canada

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Approach

• Develop pilot framework (methodology)
• Confirmation of all partners funding
• Technology development
• Implementation (pilot sites, patient recruitment
  etc.)
• Patient follow-up
• Evaluation and analysis
• Recommendations to the Ministry of Health

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Methodology Considerations

• Multiple Patient Recruitment Sites (3 at the
  least)
• Involvement of Local Health Integration Networks
  (LHINS)

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Program Evaluation

• MOHLTC supporting access administrative health
  databases (OHIP/CIHI) to determine
• emergency room visits
• hospitalizations
• primary care visits
• visits to respirologists
• prescription refills
• Patient reported Symptom Control Measure
  baseline and end of program
• For employer arm of study absenteeism and/or
  presenteeism, medication costs

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Anticipated Project Deliverables

• At the end of the project
• Evidence-based recommendations and roll-out plan
  to integrate reminders systems within health care
• Recommendations for linking to ePrescribing
• Scalable patient reminder system (technology)
• Reminder system impact analysis on health care
  resources and direct medical costs

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Employer Participation

• ASC is seeking to identify a partner to run this
  pilot within an employer setting.

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Oxford Outcomes

• For further information about this pilot project,
  contact
• Robert Bick
• Oxford Outcomes
• robert.bick_at_oxfordoutcomes.com
• direct 416-986-2426
• 235 Yorkland Blvd, Suite 402
• Toronto Ontario M2J 4Y8