Two recent surveys covered by FierceDrugDelivery have shown that the vast majority of patients don't use their drug delivery devices properly.
The most recent found that only 16% of patients used an autoinjection device properly. Mistakes included not holding the device in place for 10 seconds after releasing the drug, not placing the needle on the thigh or not depressing the device hard enough to trigger release of the drug. What should be done to fix the problem?
The rise of biologics makes finding a solution imperative. "Any sort of self administration is really being fueled by biologics and that's changing this space," Paul Sullivan, business development manager at drug delivery device training specialist Noble, said in an interview. He explained that unlike traditional drugs, biologics cannot be taken orally because they deteriorate in the stomach. Instead they must be injected--typically at the home--though the needle used is much shorter than that used for traditional injections given by the physician.
Noble believes improved patient education is the key. To that end, it offers customized solutions for its 10 to 15 pharma clients in an effort to help patients use their inhalers and injectable devices correctly. It assists in the design of mock devices for training purposes, which use multiple modalities such as speech-guided training and error correction, or "platform technology that can be built into training devices, packaging or ancillary support tools to monitor patient behavior and notify them if an error is made," according to a Noble spokesman.
A Noble-sponsored study of 55 patients determined that patients find error-correcting training devices to be the most effective method of learning to use injectable devices in real life. During simulated injections consisting of 15 steps, patients who received error-correction training and the device's instruction manual made an average of 0.8 errors per injection, compared to four errors in those patients who received the instructions as their only form of training.
Patients who received the instructions and a mechanical training device committed 2.7 errors per injection, while those who received a "talking" trainer that gives auditory instructions committed 1.9 errors per injection, the study found.
The results show that errors decreased as patients received training through more interactive and engaging means. Patients also overwhelmingly preferred the most effective method, with 84% of those who received training with and without error correction saying they preferred the simulation with the error-correcting trainer.
Interestingly, regardless of which of the four training methods that the patient received, a questionnaire found that anxiety decreased 15% following training and confidence increased 86%. The fact that confidence increased equally, even in the group that continued to commit an average of four errors per injection, shows that patients often don't know when they are making mistakes and may unknowingly use a device incorrectly over and over again.
Joe Jensen, Noble's director of communications, told FierceDrugDelivery that he has seen patients commit a variety of errors, including injecting themselves in the shin and ankle, and at the wrong angle or incorrect needle depth.
Sullivan said during the interview that standard 15-minute training sessions in the physician's office are performed inconsistently. He thinks patients should be given mock devices and other tools so that they can practice after the doctor's visit, and before using the drug delivery device for to administer therapy for the first time. Unfortunately, the Noble officials said that very few patients currently receive additional forms of training.
The study has not been published. The Noble officials said they would like to conduct a similar study focused on devices for inhaled drug delivery.
- here's more information about the study