Alzheimer's Diagnosis: Real-World Physician Behavior Across Countries.

INTRODUCTION: Appropriate management of patients with Alzheimer's disease (AD) helps preserve their independence and time at home. We explored physician behavior in the management of AD, focusing on diagnosis. METHODS: Online questionnaires and patient record forms (PRFs) were created by an independent market research agency and completed by participating physicians. Physicians were recruited from France, Germany, Japan, the UK, and the USA. A sample of 1086 physicians was recruited, including general practitioners, geriatricians, neurologists, and psychiatrists. Physicians completed an online interview and 2-3 PRFs based on randomly selected records of their patients with AD. Data on triggers and timing of diagnosis were captured. Data were assessed for all countries combined (global) and within each country and physician specialty. RESULTS: A total of 3346 PRFs were submitted. Approximately half of patients received diagnosis within 6 months. There were large country differences. In France, only 35% of patients were diagnosed within 6 months compared to 65% in Japan. Physicians in France also reported diagnoses taking > 9 months for a substantial number of patients (39%) compared with other countries (16-29%). Caregivers were the main driver toward diagnosis. Physician suspicion of AD was a trigger for diagnosis in only 20% of cases, globally. Overall, referral rates were low (14-23%). CONCLUSION: This study suggests that detection and timely diagnosis of AD remains suboptimal. This highlights the importance of fostering awareness of early symptoms and education on the benefits of timely diagnosis, a critical step in initiating treatment as early as possible.

Identification of Patient Needs and Preferences in Pigmented Villonodular Synovitis (PVNS) Using a Qualitative Online Bulletin Board Study.

INTRODUCTION: Pigmented villonodular synovitis (PVNS), also known as giant-cell tumour of the tendon sheath (GCTT), is a rare, benign proliferative tumour affecting the inner lining of synovial joints and tendon sheets. Information on treatment needs of PVNS patients to inform drug development is currently scarce. We conducted an exploratory qualitative study with PVNS patients to generate insights into the objective and emotional aspects related to their medical journey and experiences of living with this disease. METHODS: A 4-day study using an online bulletin board (OBB), an asynchronous, online qualitative research platform, was conducted with patients recruited via physician referral who underwent screening questions to ensure eligibility for the study and willingness to participate. The discussion was moderated, was structured and allowed open answers in response to other participants' posts. RESULTS: Eleven patients (4 from the USA, 4 from the UK and 3 from Canada; 45% female), aged 28-57 years, suffering from PVNS for 2-27 years participated in the study. Key patient insights from the study were: (1) pain was the topmost, spontaneous thought that the participants associated with PVNS, constituting a significant emotional and psychological burden; (2) surgery (arthroscopy) did not completely ameliorate symptoms associated with PVNS, as the relapse rate was high in these patients; (3) PVNS has a substantial negative financial impact on patients, their families and the healthcare system; (4) orthopaedic specialists/surgeons predominantly managed PVNS, as surgery is currently the only therapeutic option. CONCLUSION: PVNS patients expressed an urgent need for a medical drug treatment, which can reduce pain, avoid relapses and provide an alternative to surgery, the current standard of care.

Patient Needs, Perceptions, and Attitudinal Drivers Associated with Obesity: A Qualitative Online Bulletin Board Study.

INTRODUCTION: To gain insights into the needs, attitudes, perceptions, and preferences of people living with obesity using an online bulletin board (OBB) study. METHODS: The OBB is a moderated asynchronous online qualitative market research method that allows interactive discussion among participants. Participants were recruited via physician referral followed by screening questions to ensure eligibility and willingness to participate. The discussions in the OBB were moderated and allowed anonymized open answers and responses. Analysis was performed using various qualitative analytical tools. RESULTS: This OBB study included 23 participants (n = 11, UK; n = 12, USA). Participants expressed negative emotions associated with obesity. Obesity impacted various aspects of their life, and the feeling of loneliness caused food indulgence, especially during the evenings. Their appearance was their primary cause of anxiety, whilst health considerations were secondary. The participants felt trapped in a cycle where food was (ab)used to overcome problems associated with being obese. Participants were pessimistic about weight management measures as a result of unsuccessful past attempts, with little/no support from healthcare providers, friends, and family for weight management. They preferred medications that would allow them to maintain their current lifestyle yet cause visible weight reduction. Along with medications, they expressed a strong preference for an online support group with similar peers for motivation, support, and sustained outcomes. CONCLUSIONS: As losing excess weight is a challenge for most overweight individuals, the qualitative insights from this OBB can inform the planning and successful execution of various weight management and drug development programs. FUNDING: Novartis Pharma AG, Basel Switzerland.

Patient preference for a maintenance inhaler in chronic obstructive pulmonary disease: a comparison of Breezhaler and Respimat.

BACKGROUND: Good compliance in chronic obstructive pulmonary disease (COPD) is of 'paramount importance' in reducing the occurrence of acute exacerbations, hospitalisation and mortality and in improving quality of life. However, a number of studies have confirmed that long-term compliance is low and often associated with difficulties in handling maintenance inhalers. Therefore, the easier an inhaler is to use, the more likely the patient will comply with handling instructions and so, optimise control of the condition. A research study was undertaken comparing the maintenance inhalers BreezhalerTM (BH-available in combination with Ultibro, Seebri and Onbrez from Novartis) and RespimatTM (RM-available in combination with Spiriva, Spiolto and Striverdi from Boehringer Ingelheim). METHODS: The research was conducted among 240 maintenance inhaler-naive participants who before handling the inhalers were asked to indicate how important they felt it was that an inhaler offered each of a list of 22 handling-related attributes. They then handled each inhaler on three separate occasions familiarising themselves with the correct handling procedure by consulting respective 'Instructions for use' and short training videos. Following the handling process, participants rated the individual inhaler against each of the 22 attributes and finally expressed their preference between the two on a number of key handling-related attributes and indicated which they preferred overall. RESULTS: A significant majority of participants preferred BH to RM overall. BH was rated statistically superior on 20 of the 22 handling-related attributes particularly those participants rated most highly including dosing confidence, 'easy to use' and 'easy to learn'. CONCLUSIONS: Significantly more participants were confident that BH would deliver a full dose of medication and was easier to learn and use. These attributes are crucial for achieving improved patient compliance. As a result, BH offers an opportunity for improved symptom control in the maintenance treatment of COPD.

Factors associated with appropriate inhaler use in patients with COPD - lessons from the REAL survey.

Background: Nonadherence to medication and incorrect use of inhalers represent significant barriers to optimal disease management of patients with chronic obstructive pulmonary disease (COPD). Thus, health care professionals (HCPs) play a critical role in educating their patients on appropriate inhaler use and in ensuring medication adherence. However, many patients do not receive appropriate inhaler training or have not had their inhaler technique checked. Methods: The Real-life Experience and Accuracy of inhaLer use (REAL) survey was a computer-assisted, telephonic survey consisting of 23 questions gathering real-world information on correct inhaler use, inhalation technique, device attributes, adherence, dosing accuracy, training, correct device use, ease of use, and factors that influence patient adherence in commercially available inhalers delivering COPD maintenance therapy. All results are based on patient-reported data. Results: The survey was conducted between January 4, 2016 and February 2, 2016. A total of 764 patients using various inhalers (Breezhaler® =186; Ellipta® =191; Genuair® =194; Respimat® =201) with mild to very severe COPD, with a mean ± SD age 56±9.8 years, completed the survey. Patient self-reported adherence was significantly lower in younger patients compared to older patients (p=0.020). Eighty-three percent of patients indicated that a demonstration (in-person) was "very helpful" versus 58% for video. Patient preferences for training methods were as follows: demonstration of inhaler use (83%), video (58%), instructions for use (51%), and leaflet (34%). Twenty-nine percent of patients had not been checked to see if they were using their device correctly by a HCP within the last two years. Patients who were checked were significantly more adherent than unchecked patients (p=0.020). The majority of the patients using Breezhaler reported either being very confident or confident of having taken a full dose, which was higher than those using Genuair, Ellipta (α=0.05), and Respimat (α=0.05). Treatment adherence in the last 30 days was highest with Breezhaler followed by Respimat, Ellipta, and Genuair. Conclusion: The REAL survey identified attributes that influenced patient adherence and optimal inhaler use. Predictive attributes that influence patient adherence which HCPs should be aware of include age and disease severity. Modifiable attributes which the HCP can influence include correct inhaler use training, choice of training methods, checking patient inhaler technique at subsequent visits, and device selection. Inhalers are integral in the effective management of patients with COPD; it is therefore important that patients use the inhaler correctly and have full confidence in the dosage.