Human-Centric Design in Healthcare/Pharma

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Human-Centric Design- Pharma


Three examples of patient-centric design in Pharma are the Smart Pill Bottle by Adhere, the Reconstituted Drugs Dispensing Cap by Origin and the Companion Line of Syringes by Credence Medsystems.

Pharma Industry and Patient-Centric Design

  • Extensive research has resulted in an understanding that the companies that develop the new drugs, i.e. the "Pharmaceutical companies" as traditionally understood, are not the innovators in the field of patient-centric design. Instead, they work with companies that do the human-centric design and sell their designs to numerous pharmaceutical companies. This report will, therefore, provide information on patient-centric designs by companies in the pharmaceutical design field, not the drug development field.

Adhere Tech — Smart Pill Bottle

THE COMPANY

THE SYSTEM
  • Adhere has designed a system which notifies patients when they do not take their medications on schedule.
  • The medication comes in a Smart Pill bottle, which looks like a regular pill bottle and requires no changes to the patient's routine.
  • If the bottle is not opened on the physician recommended schedule, a signal is sent to Adhere where the information is analyzed, along with other data.
  • The system sends personalized information to the patient's phone. The system works with landlines, cell phones, or smartphones.
  • "This may be a simple reminder, a customized message, or a care-based question."
  • Patient responses are also analyzed.
  • Because the system is integrated directly with the pharmacist in real-time, they can follow up directly with the patient.

THE RESULTS
  • Patients rate the service at 4.7 out of five.
  • During clinical trials, Avella Specialty Pharmacy from UnitedHealth Group Clinical results showed a "Median adherence rate of [AdhereTech] patients was 100% adherence compared to 90.75% in the [non-AdhereTech] control group."
  • The clinical trial also showed that "Patients in the [AdhereTech] arm took 83% of doses within the recommended window, compared with 22% in the control arm."
  • When the Smart Pill bottle went into general use, the same group reports that "AdhereTech has improved duration on therapy by 26%, fill rates by 9%, and dose-level adherence by 15%."
  • Diplomat Pharmacy, the largest independent pharmacy in the US, reports that "The average patient using AdhereTech bottles experienced more than one additional medication fill annually."

Origin — Reconstituted Drugs Dispensing Cap

THE COMPANY

THE SYSTEM
  • There are forms of medications that need to be stored in a dry state to maintain their healing properties until just before the patient ingests it. This process requires mixing the correct dose of powder with the correct amount of solution, called a diluent, just before administration.
  • This requirement has been known to cause significant challenges for patients.
  • Origin has designed a device marketed as the Recon Cap.
  • The cap stores the correct dose of the dry preparation, as recommended by the pharmaceutical company, in the top of the container.
  • When a tear band is removed, the powder drops into the diluent below.
  • The container remains sealed, allowing the user to mix the solution through agitation without worrying about leaks. The top unscrews, and the liquid medication can be consumed.

THE RESULT
  • Using this type of packaging make it easier for patients to get the right ratio of powder to medication.
  • This design makes it possible for patients to travel with their medicine without having to visit their pharmacy every 7-10 days
  • It also now makes this type of dispensing available in parts of the world where there is no guarantee of access to purified water.

Credence Med — Improving Injectables

THE COMPANY
  • Credence MedSystems has designed an award-winning Companion Safety Syringe System which provides three different options for injectables that improve patient safety.
  • They have done this without the change that drug research companies usually have to incorporate in combination product development.

THE SYSTEMS
Staked System
  • If a pre-attached needle is the optimum delivery method, the "Credence Companion® Staked Needle Syringe allows the use of existing drug container components and provides integrated automatic needle retraction and reuse prevention. The platform scales to allow 1ml Long, 2.25ml and other barrel sizes."
Luer Syringe
  • If a medication delivery requires needle-choice flexibility, Credence Meds "Guide-On Needle Cover" ensures the proper needle attachment.
  • "The user is notified that the injection is complete, and then the needle retracts automatically and permanently into the barrel of the syringe."
Dual Chamber Reconstitution Syringe
  • When an injection requires a mixture of two components immediately before delivery, this design allows both solutions to be stored in a single syringe, which mixes them just before injection.

THE RESULT
  • All three systems improve patient safety using retractable needles, which prevent both accidental sticks by needles and patients reusing needles.
  • The reconstitution syringe not only allows drug companies more options in creating formulations but allows patients who previously were hospitalized to ensure correct administration of drugs, the ability to go home and treat themselves.
Part
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Part
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Importance of Human-Centric Design- Healthcare/Pharma

The patient-centered approach is a well-connected web, where one dot connects to the other. Shifts in the current mindset, transparency, patient’s education, narratives and the aid of technology are drawing the scenario for the future of health.

Pharmaceutical Companies

A SHIFT IN THE CULTURAL MINDSET — UNDERSTANDING PATIENTS' NEEDS
  • Patient-centricity demands a shift in the cultural mindset within the pharmaceutical industry, that involves listening to and partnering with patients, understanding their perspectives instead of inserting their views into the already established model.
  • A shift from disease-centered to patient-centered would require a change in the organizational model, encompassing all levels, from R&D to marketing, to capture patients’ insights and perspectives and respond to their needs.
  • This, in turn, would improve the information available to patients and physicians about risks and benefits as well as the relevance of new products, when it comes to matching the self-identified needs of patients.
  • However, the replacement of “brand strategy” with “patient strategy” is not enough. The process must start with the patient and not the commercial product in mind. The strategy should be based on understanding the patient journey and breakpoints such as diagnosis, new symptoms, relapse, the start of new medication, and adverse events.
  • A better understanding of the patient experiences at critical points or breakpoints will help determine what points would benefit most from pharmaceutical input. Discussions involving patient-value tables can be used to validate solutions and understand what patients are seeking or need.
  • UCB addressed that with medication for Parkinson's disease by noticing that patients with the disease need to take their medication daily at the same time, given how sensitive their motor function is to changes. When these patients are hospitalized for a different reason, hospitals rarely have the medication for control of motor symptoms readily available, this leads to their motor function deteriorating due to the delay and it takes longer for them to be discharged.
  • Understanding the patient’s scenario helped UCB to implement solutions with treating hospitals, ensuring the medications would be available, which in turn led to a decrease in hospitalization duration for these patients, demonstrating that understanding the patient’s journey can help to provide better outcomes.
PHARMA’S REPUTATION — BUILDING TRUST
  • The pharma industry has started to address some questions about past behavior and public perception in order to rebuild the perception surrounding it and form a new partnership based on trust.
  • The patient-centered approach may leverage that need for trust, through clear communication about medicines’ risk and benefits profiles and the drug development process. The relationship process between patients, the industry and practitioners are essential to building credibility and making patients trust the data received.
  • To build trust with patients and physicians, transparency is key, since an engagement with patients is only possible if there is credibility. In order to achieve that, GSK (GlaxoSmithKline) eliminated prescription sale targets in the US and introduced a new incentive model based on value and feedback. Since 2013, the company committed to promoting transparency of clinical research and it was the first to grant access to anonymized patient data (the "all trials" campaign).
COLLABORATIONS — DEALING WITH CHALLENGES
  • To truly create patient-centric culture requires a deep understanding of the implications for information flow, institutional habits and decision-making processes. “A unified industry approach to collaboration with the appropriate parties is the key to the adoption of patient-centricity across the industry, and to improving credibility.”
  • One way this can be achieved is through collaboration, like the collaboration between federal and/or regulatory agencies (FDA, EMA, and NIH), and pharmaceutical representatives in 10 diseased-focused working groups aiming to standardize PRO endpoint measures in order to facilitate comparisons and efficiencies in regulatory and payer decision-making.
  • Pharmaceutical companies could also gain insights from several organizations dedicated to the topic, such as the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) that has a patient-centered special interest working group, the European Patients’ Academy on Therapeutic Innovation (EUPATI) is a collaboration between 33 different patient organizations, universities, and pharmaceutical companies across Europe, the ongoing collaboration between FDA and EMA on patient involvement, among others.
  • Furthermore, the MDIC has also established a framework for introducing patient preference information into regulatory risk-benefit assessments, specifically on medical devices. “It is taking in the lessons learned by these collaborations and consortia that will help pharmaceutical companies reduce barriers to patient engagement.”
  • The collaborative efforts could help pharmaceutical companies solve several challenges regarding patient-centric approaches such as lack of standardization, lack of sufficient shared practices and lessons learned, lack of understanding of qualitative research methods and compliance frameworks, among others.
  • AstraZeneca is one company that used collaboration to facilitate a patient-centered approach by teaming up with PatientsLikeMe, to engage with patients through several research and therapeutic areas; now more than 30,000 patients are connected with AstraZeneca research projects to achieve an open and sustained engagement.
  • By doing this, AstraZeneca can capture information about the patient journey and gain an understanding of their needs to develop a patient-led strategy and design solutions to treat not only the disease but the patient.


The Healthcare System

REDUCED READMISSIONS AND THE HOLISTIC APPROACH
  • Readmission is one of the biggest costs for the healthcare system and the lack of care coordination between discharge and home care is one element that causes the most impact in this scenario. For instance, in 2017, the Advisory Board reported that some patients don’t receive any discharge information and are, therefore, 24% more likely to experience readmissions.
  • According to the Medicare Payment Advisory Commission, 76% of hospital readmissions are preventable. Some hospitals are trying to reduce the gap and extending care coordination in order to reduce readmissions. One example of that is the Presbyterian Healthcare, that partnered with Intel in 2011 to enforce a holistic, patient-centered approach to their hospitals.
  • Presbyterian and Intel took several steps to integrate the different parts of the system, with special focus on hospital discharge planning and post-discharge follow-up with patients, home health teams, rehab, and primary care providers. This initiative led to greater reach, more evidence-based care, and improved the ability to meet special needs.
TECHNOLOGY AND PATIENTS’ EDUCATION
  • One of the main aspects of a patient-centric approach to healthcare is the educational approach (meaning that a patient should be thoroughly informed about their own health, well-being, and choices). This approach can result in better care in general, plus reduced readmissions and costs.
  • Telehealth may also play a big part in preventing readmissions by providing ongoing patient education and remote monitoring of patients' conditions. A study conducted with five New York care-transition agencies discovered that by using telehealth, they saved $1.2 million in averted readmissions.
  • Another study demonstrated that by tracking readmission rates in heart failure patients saved more than 19% in hospital readmissions. "With more than five million Americans suffering from this disease, the cost-savings potential in this area could be very beneficial."
  • Tracking patients’ outcomes could also help develop evidence-based care models that can improve outcomes by providing organizations with a more personalized and individualized treatment plan and to allow doctors to prescribe treatment plans that patients will follow based on information available about the patient.
PATIENT'S NARRATIVE AND ENGAGEMENT
  • By using the patient’s own narrative and self-tracking, care providers can use the patients’ assessments to improve healthcare, particularly with the patients’ views of non-clinical aspects of care, care environment and experiences with the care process.
  • The process is still in its infancy and most of the time, an outsider’s perspective prevails over the patient’s. There needs to be a shift from the current condescending approach to a dialogic and collaborative relationship that recognizes patients as resourceful and capable.
  • This can be achieved by healthcare leaders examining more deeply the general assumptions about patient experiences which can be done with first-person data from patient surveys and interviews.
  • Another point to be addressed is clinicians using patient-friendly language to explain complex medical terms and concepts to ensure effective communication.
  • The ultimate goal is to turn a clinical consultation into a partnership in which “health professionals and patients work in active collaboration to improve health and health care. Patient engagement must include an invitation for patients to articulate their needs, together with a pledge for addressing and meeting these as essential goals in the care encounter.”
  • Initiatives like Open Notes, where patients have online access to physicians’ notes resulted in a positive attitude toward self-care and patient engagement which, in turn, correlated positively with preventive or disease self-management behaviors.
  • Highly engaged patients often are more motivated, involved and active in their care. For instance, patients using Open Notes described transparency as a tool for helping them understand the importance of their roles in their care.

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