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Swapnil N. Rajpathak Part 5, Future Real World Study Research For Merck

In part 5, the conclusion of this Exclusive Interview, Dr. Swapnil N. Rajpathak talks with Diabetes in Control Publisher Steve Freed during the ADA 2017 Scientific Sessions in San Diego, CA about upcoming research for Merck including studies on patient adherence.

Swapnil N. Rajpathak, MD, MPH, DrPH is Executive Director for the Center for Observational and Real World Evidence at Merck.


Transcript of this video segment:

Steve: Obviously, there are other things you are doing at Merck. This is not the only thing, you sit around at table and you come up with an idea. What do you see in the future?

Swapnil: So, terms of real-world evidence, I would say in addition to what I have mentioned before is to understand the comparative effectiveness of individual drugs and understand which drugs may have better outcomes. But, that is only one part of the real-world evidence. One thing I wanted to mention which you may have remembered from last time, we also try to understand issues like clinical inertia or lack of adherence to clinical guidelines and what can it impact, what can be done there and how does it impact the healthcare system? So, clinical inertia is a known phenomena where patients quite possibly don’t get intensified even they are indicated by a guideline. So, patients are not controlled should be adequately intensified with potential newer therapy, if that is indicated for that particular patient. However, that doesn’t happen. We have done research 30% – 40% patients do not get intensified on time. With that how that impacts their outcomes and goal attainment in short terms we have being doing. As I mentioned you, hypoglycemia is big area research. We have tried to focus on mild and moderate hypoglycemia as I mentioned to you before. Claims typically capture the severe hypoglycemia but mild and moderate may not be able to capture in the database. So, what are the methods we can use? And there were newer technologies that have recently coming included non-invasive technology like flash glucose monitoring. There was a booth here and you may have seen. But, its a device whether that can really help you to identify hypoglycemic events otherwise wouldn’t have been captured in real world database. That is one example for future. In addition, we are also trying to understand how to improve medication adherence. So, as you know patients who take chronic medication, including medication for type 2 diabetes, often don’t comply to treatment even discontinued the treatment. So, how do we manage to create awareness of the issue and also motivate these patients and what kind of interventions can we develop to help these patients adhere treatment by helping them understand the importance of the medication to ultimate improve the outcomes in the future? So, we have previously done research to understand the issues with adherence now we are going more in future and trying to understand how we can improve adherence and there have been several interventions I think it has to be tailored to the patients and that area of research is also something we are focused on and just to mention one more thing about clinical inertia we are also trying to understand how tools that can be created that might help the physicians when a patient is in their office and EMR base tool that helps them alert when patient are indicated by guidelines let’s say actually intensifying the therapy that is incorporated with EMR system. We have done similar things for hypoglycemia as well that we have also done an EMR tool that we want to now validate in other databases of how it will impact the concern of hypoglycemia and therefore more education for the patient from the physician to really understand the risk as well as to alert the patient of the symptoms and signs of hypoglycemia.

Steve: And where are you with all those?

Swapnil:  Some of the studies have already been initiated. We are hoping to come back to you again next year, Steve, to share some of those results next year. Some of the studies will be initiated in next few months so that we are ready for ADA next year.

Steve: It’s always interesting to see a drug company do something besides promoting their drug.

Swapnil:  I am really proud to be  at Merck. We do a lot of research, which actually is so meaningful and provides real-world data to really help peers, physicians, and providers, and other stakeholders to really make the decisions they need to make in their everyday life. And much of the research we do is published. Some of the abstracts you see in the publication give us more opportunity to more detail information when these publications are out in the journals.

Steve: OK, I want to thank you for your time and enjoy the rest of your stay here in sunny San Diego.

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