Social Media “The use of web-based technology to facilitate interaction with others.”
ARS Question:With the exception of e-mail, how often do you interact with peers online through social networking sites like Facebook & Twitter? • Always • Very Often • Sometimes • Rarely • Never
ARS Question: How likely are you to use social media to help increase public awareness of chronic hepatitis C? • Very likely • Likely • Maybe • Probably not • Never
ARS Question: In patients who present with non liver related complaints, how often do you evaluate a patient’s risk factors for chronic hepatitis C infection? • Always • Very Often • Sometimes • Rarely • Never
ARS Question: Among all your genotype 1 patients who are eligible for current therapy, how often are you withholding therapy while waiting for novel drugs? • Always • Very Often • Sometimes • Rarely • Never
ARS Question: Among your genotype 1 patients, how frequently will you be incorporating novel agents once they are approved? • Always • Very Often • Sometimes • Rarely • Never
How Will Social Media Impact Your Practice? Bryan S. Vartabedian, MD, FAAPAssistant Professor of Pediatrics Section of Gastroenterology, Hepatology, & Nutrition Baylor College of Medicine Houston, Texas
How Health Information Was Shared MD Patient Graphic courtesy of Dr. Bryan Vartabedian.
Evolution of Social Health Graphic courtesy of Dr. Bryan Vartabedian.
4: Individuals – email lists 3: Closed networks – MySpace, Facebook 2: Open networks – blogs, feeds, YouTube 1: Mainstream media – press, influencers Armano D. Influence ripples. Available at: http://darmano.typepad.com. Accessed on: April 13, 2010.
“You don’t need to go any further doctor. Just spell ‘eosinophil’ if you would.”
CureTogether Available at: http://www.curetogether.com. Accessed on: April 13, 2010.
CureTogether • Patient to patient • Crowdsourced data • “Clinical trials” Available at: http://www.curetogether.com/Irritable-Bowel-Syndrome/treatments/. Accessed on: April 13, 2010.
Participatory Medicine • User-generated healthcare is shifting the balance of power from doctor to patient • The physician encounter is evolving as a narrow, more defined element in a patient’s quest to understand what’s wrong with them
What Is Social Media? • Content created by people using scalable online publishing technologies intended to facilitate communication and interaction • Most often refers to activities that integrate technology, telecommunications, and social interaction, with the construction of words, pictures, videos, and audio
With permission from Solis B, et al. The conversation prism. Available at: http://www.theconversationprism.com. Accessed on: April 13, 2010.
Percentage of Adults Who Look Online for Health Information 61% Fox S. The social life of health information. January 14, 2009. Pew Internet & American Life Project. Available at: http://pewinternet.org/~/media//Files/Reports/2009/PIP_Health_2009.pdf. Accessed on: April 13, 2010.
The Social Media RevolutionHow Is Its Use in Adults Growing? 2005 2009 Lenhart A. Adult and Social Network Websites. January 14, 2009. Pew Internet & American Life Project. Available at: http://pewinternet.org/Reports/2009/Adults-and-Social-Network-Websites.aspx. Accessed on:April 13, 2010.
US Hospitals on YouTube and Twitter With permission from Bennett E. Hospital social network data and charts. Available at: http://ebennett.org/hsnl/data/. Accessed on: April 13, 2010.
Where Are the Doctors?The Absence of MDs in Social Media Space • Late adopters • Time/impatience • Concerns over privacy, liability, and image
What Can You Do on Social Networks? • Educate patients • Influence behavior • Promote awareness of yourself or your hospital • Build relationships • Filter information
Armano D. Human feed. Available at: http://darmano.typepad.com. Accessed on: April 13, 2010.
Do Physicians Have an Obligation To Be in the Online Space? 60,000 Number of Pediatricians in the AAP KevinMD.com. Available at: http://www.kevinmd.com/blog/2009/08/delayed-vaccine-schedule-dangerous.html. Accessed on: April 13, 2010.
16,000 3000 Number of Members in the AGA Number of Membersin the AASLD 10,000 2500 Number of Members in the ASGE Number of Members in the SSAT DDW’s 4 Sponsoring Societies Abbreviations: AASLD, American Society for the Study of Liver Diseases; AGA, American Gastroenterological Association; ASGE, American Society for Gastrointestinal Endoscopy; DDW, Digestive Disease Week; SSAT, The Society for Surgery of the Alimentary Tract. DDW 2010. FAQs. Available at: http://www.ddw.org/wmspage.cfm?parm1=710. Accessed on: April 13, 2010.
How Should Physicians Handle Patient Encounters in the Social Media Space? They Shouldn’t
Staying Safe on Social Networks • Never discuss patients • Patients, boss, future employer will read everything you write • Be nice • Don’t be anonymous
Blog Put a stake in the ground Graphic courtesy of Dr. Bryan Vartabedian.
Blog Graphic courtesy of Dr. Bryan Vartabedian.
Visibility in Action Left graphic: Kaplan Publishing. Spring 2009 Catalog. Available at: http://www.kaptest.com/pdf_files/publishing/seasonal-catalogs/KPSpring09Catalog.pdf. Accessed on: April 13, 2010. Upper right graphic: Courtesy of Dr. Bryan Vartabedian. 33 Charts blog. Available at: http://www.33charts.com. Lower graphic: Courtesy of Dr. Bryan Vartabedian. Personal Correspondence. 2010.
Armano D. Conversion. Available at: http://darmano.typepad.com. Accessed on: April 13, 2010.
The Low Rates of Chronic HCV Diagnosis and Treatment: Why and What Can We Do? Hashem B. El-Serag, MD, MPH Professor of MedicineChief, Section of Gastroenterology and HepatologyBaylor College of Medicine Michael E. DeBakey VA Medical CenterHouston, Texas
Past and Future US Incidenceand Prevalence of HCV Infection Decline among IDUs Overall incidence Overall prevalence Infected 20+ years Armstrong GL, et al. Hepatology. 2000;31:777-782. Graphic courtesy of the CDC.
Histologic Fibrosis Stage by Year Number of Persons Year Davis GL, Alter MJ, El-Serag H, Poynard T, Jennings L . Gastroenterology 2010
Hepatitis C—Age-Adjusted Rates of Ambulatory Care Visits and Hospital Discharges with All-Listed Diagnoses in the United States, 1979–2004 Data from National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) (averages 1992-1993, 1994-1996, 1997-1999, 2000-2002, 2003-2005), and National Hospital Discharge Survey (NHDS). Everhart JE, ed. The burden of digestive diseases in the United States. 2008. NIDDK: US Government Printing Office, 2008; NIH Publication No. 09-6443.
Efficacy of Peginterferon + Ribavirin in Achieving Sustained Virologic Response (SVR) 1. Manns M, et al. Lancet. 2001;358:958-965. 2. Fried M, et al. N Engl J Med. 2002;347:975-982. 3. Kamal SM, et al. Hepatology. 2007;46:1732-1740. 4. Khuroo MS, et al. Aliment Pharmacol Ther. 2004;20:931-938. 5. Conjeevaram H, et al. Gastroenterology. 2006;131:470-477.
Virus Factors Treatment Factors Genotype 2/3 Low viral load Rapid virologic response Tolerability Adherence Provider experience Supportive medical team Host Factors IL28B gene polymorphism Not African American Immunocompetent Lean, non-diabetic, insulin sensitive Young, good renal function, minimal comorbid illness HCV Patients Most Likely to Achieve SVR
Treatment of HCV Effectiveness in community practice Efficacy x Access x Correct Diagnosis x Recommendation x Acceptance x Adherence Efficacy in clinical trials and research centers El-Serag HB. Gastroenterology. 2007;132:8-10.
Efficacy and EffectivenessA Demonstration of the Multiplicative Effect of Factors Example 1: Rx “X” Example 2: Rx “Y” Example 3: Rx “X” Modified El-Serag HB. Gastroenterology. 2007;132:8-10.
Awareness of HCV Infection Among HCV-Infected Persons Colvin HM, Mitchell AE, eds. Hepatitis and liver cancer: a national strategy for prevention and control of hepatitis B and C. Institute of Medicine. Washington, DC: The National Academies Press, 2009.
Provider specialty HCV experience Continuity Demographics Genotype, viral load Cirrhosis diagnosis ALT, Hct, Plt, WBC, Cr Comorbidity HIV diagnosis Insurance Predictors of Treatment Patient factors Provider factors Receipt of Treatment Facility factors Graphic courtesy of Dr. Hashem El-Serag.
Eligibility and Acceptability of HCV Treatment 4084 HCV+ patients in VA Multicenter Study 12/99–12/00 Eligibility – 32% by standard criteria, 41% by treating physician Predictors of noneligibility Ongoing substance abuse OR 17.68 Comorbid medical disease OR 9.62 Psychiatric disease OR 9.45 Advanced liver disease OR 8.43 Acceptability – 76% of eligible patients Reasons for nonacceptance Defer Rx until better therapies 50% Concerns regarding side effects 22% Treatment completion rates ~50% of those treated (~8% of all patients) Bini E, et al. Am J Gastroenterol. 2005;100:1772-1779.
Completed treatment Achieved SVR Treatment Outcomes Retrospective Observational Cohort N = 5944 48-week treatment for genotype 1, 24-week treatment for genotype 2/3. Backus LI, et al. Hepatology. 2007;46:37-47.
Actual Projected Antiviral Therapy for HCV per YearActual, 2002–2007Projected, Through 2014 Volk ML, et al. Hepatology. 2009;50:1750-1755.
Underutilization and Disparity Clinical appropriateness and patient preferences Healthcare system: access, legal, and regulatory issues Under- utilization and Disparity Percent Discrimination, bias, uncertainty Graphic courtesy of Dr. Hashem El-Serag.
Refused treatment Did not f/u with clinician Survey Responses Received treatment Clinician did not recommend treatment Unaware of diagnosis Reasons for Lack of Treatment Among Respondents to the NHANES Hepatitis C Follow-Up Questionnaire N = 133 Abbreviation: NHANES, National Health and Nutrition Evaluation Survey.Volk ML, et al. Hepatology. 2009;50:1750-1755.
Summary • HCV prevalence peaked in 2001 at 3.6 million persons • Number and proportion of HCV patients with cirrhosis, decompensation, and HCC will increase for at least another 10–15 years • Age of persons with complications will rise • Will antiviral therapy change the future? • Eradication of HCV stops progression, eliminates the risk of liver failure, and reduces HCC risk • Requires therapeutic intervention before onset of advanced fibrosis • Requires identification of infected cases
Summary • Clinical effectiveness is dependent on several factors in addition to clinical efficacy • HCV diagnosis • Referral to specialists • Treatment of comorbidities • Adherence to treatment
Institute of Medicine Report Underlying Factors • Lack of knowledge and awareness about chronic viral hepatitis among Healthcare and social service providers At-risk populations Policy makers and the public • Insufficient understanding about the extent and seriousness of this public health problem Colvin HM, Mitchell AE, eds. Hepatitis and liver cancer: a national strategy for prevention and control of hepatitis B and C. Institute of Medicine. Washington, DC: The National Academies Press, 2009.