Chronic Disease and Self-Injection: Ethnographic Investigations into the Patient Experience During Treatment

Abstract

Introduction Drug administration by self-injection provides an option to treat chronic inflammatory diseases such as rheumatoid arthritis (RA) and Crohn’s disease (CD). However, a negative self-injection experience for patients may reduce patient adherence to the recommended treatment regimen. In this study, a holistic approach was used to identify common themes along the treatment pathway and at self-injection that, if changed, could improve patient experience and treatment outcomes. Methods Two ethnographic studies were conducted: Field Insights CODE (FI[CODE]) examined the treatment pathway within the context of the experience of living with RA or CD, and Injection Mission 2020 (IM2020) focused on the moment of self-injection. FI(CODE) used an open ethnographic approach to interview 62 patients and 10 healthcare professionals (HCPs) from the US and UK. IM2020 included a review of over 50 injection device design information sources from the sponsor, and interviews with 9 patients, 8 HCPs, and 5 medical device designers from the US, UK, Canada, and Japan. Results FI(CODE) identified suboptimal treatment practices along the treatment pathway in four key areas: treatment team communication, treatment choice, patient empowerment, and treatment delivery. Patients with more treatment options and greater disease understanding were less likely to struggle with the treatment process. IM2020 demonstrated that five related components influenced the self-injection experience: delivery process, emotional state, social perception, educational level, and ritualization of the self-injection process. Conclusion These analyses highlight several potential areas for improvement, including aligning the device more to patients’ needs to improve treatment adherence, better accessibility to educational resources to increase patient disease understanding, and guidance to empower patients to develop an optimal personalized self-injection ritual. Funding UCB Pharma. Electronic supplementary material The online version of this article (doi:10.1007/s40744-017-0080-4) contains supplementary material, which is available to authorized users.

Patient Satisfaction with CIMZIA® (Certolizumab Pegol) AutoClicks® in the UK

“…The results of this study revealed that, after routine training, patients generally found the CZP PFP easy to use, and patient confidence and satisfaction relating to self-injection were high. As expected, increasing self-injection experience, together with routine training and continued support from the service provider nurses, was associated with a numerical trend towards improvement in all three aspects of PEx [5,14], most notably in both confidence and satisfaction. Nevertheless, after self-injection at visit 1, levels of confidence around safe patient self-injection were higher among nurses than among the patients themselves; this suggests that some patients may initially be competent (based on nurse opinion) but lack confidence.…”

“…The CZP PFP, along with the PFS and reusable electronic injection device, allows patients to choose their preferred device. Provision of a choice of treatment devices could allow patients to align their treatment with their specific preferences and needs [14], which may improve confidence around self-injection. Previous studies have shown that innovative design of self-injection devices such as the CZP PFP can also improve patient confidence and satisfaction with self-injection [12], while the device used can influence the level of pain, ease of use, and convenience reported by patients [15].…”

Evaluation of Nurse Preferences Between the Lanreotide Autogel New Syringe and the Octreotide Long-Acting Release Syringe: An International Simulated-Use Study (PRESTO)

“…The second most important attribute identified in the present study was confidence that there would be no loss of product during preparation or delivery, with no difference observed between the percentage of nurses who ranked this attribute as the most important between the FPAS and SPAS (22.2% [95% CI 11.2, 37.1] and 20.0% [95% CI 9.6, 34.6]). Nurses have previously identified 'confidence that a full dose has been delivered' as the most important attribute for SSA syringes [7], and it is a concern among patients with chronic diseases who administer self-injections that product can be lost if injections are too shallow [20]. However, in the present study, 81% of nurses gave the highest rating for the statement regarding confidence of no product was lost with the LAN new syringe compared with 10% for the octreotide LAR syringe.…”

Biosimilar Pegfilgrastim: Improving Access and Optimising Practice to Supportive Care that Enables Cure

“…Assuming price parity, the choice of biosimilar may come down to a choice of device, as this can have a potentially strong influence on adherence. It is well known across all areas of medicine that patient anxiety and fear of needles can lead to poor adherence [52][53][54]. The biosimilar pegfilgrastim considered to have the most easy-touse device, for example, with a shorter and smaller diameter or hidden needles, would likely lead to improved adherence [54].…”