Racheli Magnezi

Online Activity and Participation in Treatment Affects the Perceived Efficacy of Social Health Networks Among Patients With Chronic Illness

Background The use of online health-related social networks for support, peer-to-peer connections, and obtaining health information has increased dramatically. Participation in an online health-related social network can enhance patients’ self-efficacy and empowerment, as they are given knowledge and tools to manage their chronic health condition more effectively. Thus, we can deduce that patient activation, the extent to which individuals are able to manage their own health care, also increases. However, little is known about the effects of participation in online health-related social networks and patient activation on the perceived usefulness of a website across disease groups. Objective The intent of the study was to evaluate the effects and benefits of participation in an online health-related social network and to determine which variables predict perceived site usefulness, while examining patient activation. Methods Data were collected from “Camoni”, the first health-related social network in the Hebrew language. It offers medical advice, including blogs, forums, support groups, internal mail, chats, and an opportunity to consult with experts. This study focused on the site’s five largest and most active communities: diabetes, heart disease, kidney disease, spinal injury, and depression/anxiety. Recruitment was conducted during a three-month period in which a link to the study questionnaire was displayed on the Camoni home page. Three questionnaires were used: a 13-item measure of perceived usefulness (Cronbach alpha=.93) to estimate the extent to which an individual found the website helpful and informative, a 9-item measure of active involvement in the website (Cronbach alpha=.84), and The Patient Activation Measure (PAM-13, Cronbach alpha=.86), which assesses a patient’s level of active participation in his or her health care. Results There were 296 participants. Men 30-39 years of age scored higher in active involvement than those 40-49 years (P=.03), 50-64 years (P=.004), or 65+ years (P=.01). Respondents 20-29 years of age scored higher in perceived usefulness than those 50-64 years (P=.04) and those 65+ years (P=.049). Those aged 20-29 years scored significantly lower on the PAM-13 scale than those aged 30-39 years (P=.01) and 50-64 years (P=.049). Men and women had similar PAM-13 scores (F 9,283=0.17, P=.76). Several variables were significant predictors of perceived usefulness. Age was a negative predictor; younger age was indicative of higher perceived usefulness. Active involvement was a positive predictor. There was a negative relationship found between PAM-13 scores and perceived usefulness, as taking a less active role in one’s own medical care predicted higher perceived website usefulness. A trend toward higher frequency of website activity was associated with increased perception of usefulness. Conclusions Online health-related social networks can be particularly helpful to individuals with lower patient activation. Our findings add information regarding the social and medical importance of such websites, which are gradually becoming an inseparable part of day-to-day chronic disease management in the community.

Characteristics of patients seeking health information online via social health networks versus general Internet sites: a comparative study.

Background: Camoni.co.il, a Hebrew-language social health network offers advice, consultation, and connection to others with chronic illness. This study compared characteristics and objectives of Camoni.co.il users and individuals seeking medical information through general Internet sites. Methods: Similar questionnaires were sent to 1009 Internet and 900 Camoni users. Cluster analysis defined four modes of online social health network use: “acquiring information and support”, “communicating”, “networking” and “browsing”. Results: Six hundred and five Internet and 125 Camoni users responded. Diabetes, hypertension, obesity and lung diseases were found more often among general Internet users than Camoni users. Among Camoni users, “acquiring information and support” was the main motivation for individuals over age 55 years, women, those with lower income, chronic pain, obesity and depression. “Communicating” was the main incentive of men, those 20–34 years old, those with less education, or an eating disorder. “Networking” was the most significant motivation for those with multiple sclerosis or depression. Browsing was most frequent among individuals with multiple sclerosis. Conclusions: Identifying needs of social health network surfers will allow planning unique contents and enhancing social health sites. Physicians might advise patients to use them to obtain support and information regarding their conditions, possibly leading to improved compliance and self-management.

Cigarette and nargila (water pipe) use among Israeli Arab high school students: prevalence and determinants of tobacco smoking.

Cigarette smoking is a popular habit among Arab Israelis. Over the past decade, smoking tobacco using nargila, a water pipe, has become a popular and accepted behavior among teenagers in Israel. Although the use of a water pipe (nargila) is an old habit among Middle Eastern adult males, its emergence among youth is a new finding. A representative sample of high school students in Tayibe, Israel is the subject of this survey. The sample represents data from 326 adolescents (boys 52.5% and girls 47.5%), ages 15–18, studying in one of the largest high schools in the Arab region of Israel. Our results show that a third of the sample smoked either cigarettes (36.2%) or nargila (37.1%). The gender difference among youths smoking cigarettes was 24.8% (48.0% for boys and 23.3% for girls), in contrast to 37.6% (55.0% for boys and 17.4% for girls) for nargila. There was a statistically significant correlation between cigarette and nargila smoking in populations where there is low religious inclination, increased parental smoking, and low student academic achievement. Students’ perceptions of low academic achievement (OR 4.51, p < 0.001), students’ mothers who smoke (OR 3.57, p < 0.001), and students fathers who smoke (OR 2.75, p < 0.01) increase the youths’ chances of using nargila. Our conclusions are that smoking cigarettes and nargila are equally popular, and patterns of smoking cigarettes and nargila parallel each other. Causes that influence cigarette smoking also influence nargila smoking. Educational efforts are needed as a public health intervention.

Psychometric properties of the hebrew translation of the patient activation measure (PAM-13).

Objective “Patient activation” reflects involvement in managing ones health. This cross-sectional study assessed the psychometric properties of the Hebrew translation (PAM-H) of the PAM-13. Methods A nationally representative sample of 203 Hebrew-speaking Israeli adults answered the PAM-H, PHQ-9 depression scale, SF-12, and Self-efficacy Scale via telephone. Results Mean PAM-H scores were 70.7±15.4. Rasch analysis indicated that the PAM-H is a good measure of activation. There were no differences in PAM-H scores based on gender, age or education. Subjects with chronic disease scored lower than those without. Scores correlated with the Self-efficacy Scale (0.47), Total SF-12 (0.39) and PHQ-9 (−0.35, P<0.0001), indicating concurrent validity. Discriminant validity was reflected by a significant difference in the mean PAM-H score of those who scored below 10 (72.1±14.8) on the PHQ-9 (not depressed) compared to those scoring ≥10 (i.e. probable depression) (59.2±15.8; t 3.75; P = 0.001). Conclusion The PAM-H psychometric properties indicate its usefulness with the Hebrew-speaking Israeli population. Practice Implications PAM-H can be useful for assessing programs aimed at effecting changes in patient compliance, health behaviors, etc. Researchers in Israel should use a single translation of the PAM-13 so that findings can be compared, increasing understanding of patient activation.

Off-Label Use of Sodium Valproate for Schizophrenia

Background Off-label use of a drug not according to its regulatory labeling has become common in medicine, especially in the field of psychiatry. Mood stabilizers are intended to be used to attenuate mood fluctuations in bipolar disorder, but their use has spread to patients with schizophrenia, as it provides greater control of impulsivity and aggressiveness. Sodium valproate is one of the most frequently used mood stabilizers in psychiatry. This study determined the prevalence of off-label use of sodium valproate for schizophrenia and schizoaffective disorder in Abarbanel Psychiatric Hospital and the demographic and clinical characteristics associated with its use. Methods Retrospective study of patients hospitalized in 2011–2012 with a diagnosis of schizophrenia or schizoaffective disorder in one of three general psychiatric wards. Results Valproate use was significantly lower in the geriatric group (11.6% vs. 20.1%, chi square  = 4.7, p = .03), in patients with schizophrenia (14.1% vs. schizoaffective disorder (35.2%), chi square  = 29, p<.001) and in patients receiving both atypical and typical antipsychotics (23.3% vs. 16.4%, p = .04). In multivariate logistic regression analysis, diagnosis and the combination of atypical and typical antipsychotics predicted the use of sodium valproate. The number of other medications prescribed did not predict sodium valproate use. Conclusions Off-label use of sodium valproate in psychiatric patients with schizophrenia or schizoaffective disorder is extensive, especially in younger patients and those with schizoaffective disorder. More research is needed to determine whether it is being prescribed appropriately.

Frequent Surfing on Social Health Networks is Associated With Increased Knowledge and Patient Health Activation

Background The advent of the Internet has driven a technological revolution that has changed our lives. As part of this phenomenon, social networks have attained a prominent role in health care. A variety of medical services is provided over the Internet, including home monitoring, interactive communications between the patient and service providers, and social support, among others. This study emphasizes some of the practical implications of Web-based health social networks for patients and for health care systems. Objective The objective of this study was to assess how participation in a social network among individuals with a chronic condition contributed to patient activation, based on the Patient Activation Measure (PAM). Methods A prospective, cross-sectional survey with a retrospective component was conducted. Data were collected from Camoni, a Hebrew-language Web-based social health network, participants in the diabetes mellitus, pain, hypertension, and depression/anxiety forums, during November 2012 to 2013. Experienced users (enrolled at least 6 months) and newly enrolled received similar versions of the same questionnaire including sociodemographics and PAM. Results Among 686 participants, 154 of 337 experienced and 123 of 349 newly enrolled completed the questionnaire. Positive correlations (P<.05) were found between frequency and duration of site visits and patient activation, social relationships, and chronic disease knowledge. Men surfed longer than women (χ²3=10.104, P<.05). Experienced users with diabetes surfed more than those with other illnesses and had significantly higher PAM scores (mean, M=69.3, standard deviation, SD=19.1, PAM level 4; Z=−4.197, P<.001) than new users (M=62.8, SD=18.7, PAM level 3). Disease knowledge directly predicted PAM for all users (β=.26 and .21, respectively). Frequency and duration of social health network use were correlated with increased knowledge about a chronic disease. Experienced surfers had higher PAM than newly enrolled, suggesting that continued site use may contribute to increased activation. Conclusions Web-based social health networks offer an opportunity to expand patient knowledge and increase involvement in personal health, thereby increasing patient activation. Further studies are needed to examine these changes on other aspects of chronic illnesses such as quality of life and costs.

Association of Immunotherapy With Durable Survival as Defined by Value Frameworks for Cancer Care

Importance Modern immuno-oncology agents have generated great excitement because of their potential to provide durable survival for some patients. However, there is concern regarding the cost of cancer care, and multiple frameworks have been developed to assess value. The American Society of Clinical Oncology (ASCO) framework awards bonus points if substantial durable survival is demonstrated. Objective To assess whether modern immuno-oncology agents reach defined efficacy thresholds in value frameworks. Design, Setting, and Participants In this analysis, all US Food and Drug Administration (FDA) approvals for immuno-oncology agents between March 2011 and August 2017 were reviewed. Data required for the ASCO framework were collected, specifically improvement in proportion of patients alive with the test regimen and survival rate with standard treatment. Main Outcomes and Measures Awarding of bonus points for durable survival based on the ASCO criteria. Results Twenty-three metastatic indications for 6 immuno-oncology agents (ipilimumab, pembrolizumab, nivolumab, atezolizumab, avelumab, and durvalumab) were approved by the FDA from March 2011 to August 2017. Ten (43%) of the approvals were based on survival end points, while 13 (57%) were based on response rates. Only 3 drug indications fulfilled the threshold defined for the survival rate of patients receiving standard care (minimum 20%). Nine indications achieved the required level of improvement in proportion to patients alive in the test regimen compared with the standard (above 50%). There was overlap between these 2 criteria for 3 drug indications, allowing them to gain the durable survival bonus points awarded by the ASCO framework. Conclusions and Relevance Durable survival and response rates of modern immuno-oncology agents are rarely recognized as significant by current oncology value frameworks. This may be due to insufficient demonstration of efficacy of such agents or inappropriately calibrated value frameworks.

Would Your Patient Prefer to Be Considered Your Friend? Patient Preferences in Physician Relationships

Objectives. To understand how patient preferences and perceptions of their relationship with their doctor (as patient, friend, partner, client, consumer, or insured) affects confidence in care provided and participation in health care. Methods. Telephone questionnaire to 2,135 households, representative of the population in Israel. Results. A total of 508 completed the questionnaire. Most described perceived and desired relationships with their doctor as patient or friend. Individuals were least satisfied with business-type relationships implied by client, consumer, or insured. Preference in relationship type was not associated with participation in health care. Those with a patient, friend, or partner relationship were twice as confident in their care as those with a business-type relationship. Conclusions. Preferences for the terms patient and friend over business terms highlight the importance of the human connection in the patient–physician relationship. Although one might consider patient a paternalistic term, those with a patient, partner, or friend-type versus a business-type relationship had much greater confidence in their care and were no less likely to be active participants in their own health care.

Does the implementation of quality standards freeze action modes

Leaping between possible action modes is a vital rescue move for patient care, R&D projects, etc. We define ‘frozen action mode’ as, when in the face of an obvious gap between the expected and the actual results, leaping from current action mode to a more appropriate one is not considered or done on time. Freezing within an action mode may kill either the patient or the project. Quality standards are considered beneficial. However, when a need for leaping to an alternative action mode occurs, acting stringently according to quality standards may cause harm.‏ The importance of this unique study is that it defines and explains the idea of frozen action mode, and examines the possible correlation between working according to quality standards and the tendency to freeze within an action mode in R&D projects. We analysed 144 leaping events in 52 R&D projects.‏ All leaping events resulted from significant changes in the level of risk associated with the current mode. Project teams who obtained high quality assurance scores had low likelihood of leaping on time, whereas those who scored low had the highest likelihood to leap on time. The conclusion is that implementation of quality standards may intensify the frozen action mode problem in R&D projects.

Does drug price-regulation affect healthcare expenditures?

BackgroundIncreasing health costs in developed countries are a major concern for decision makers. A variety of cost containment tools are used to control this trend, including maximum price regulation and reimbursement methods for health technologies. Information regarding expenditure-related outcomes of these tools is not available.ObjectiveTo evaluate the association between different cost-regulating mechanisms and national health expenditures in selected countries.MethodsPrice-regulating and reimbursement mechanisms for prescription drugs among OECD countries were reviewed. National health expenditure indices for 2008–2012 were extracted from OECD statistical sources. Possible associations between characteristics of different systems for regulation of drug prices and reimbursement and health expenditures were examined.ResultsIn most countries, reimbursement mechanisms are part of publicly financed plans. Maximum price regulation is composed of reference-pricing, either of the same drug in other countries, or of therapeutic alternatives within the country, as well as value-based pricing (VBP). No association was found between price regulation or reimbursement mechanisms and healthcare costs. However, VBP may present a more effective mechanism, leading to reduced costs in the long term.ConclusionsMaximum price and reimbursement mechanism regulations were not found to be associated with cost containment of national health expenditures. VBP may have the potential to do so over the long term.