Achieving at-home administration by investing in patient education and connectivity

What is your vision for self-administration of medicine at home becoming the next big shift in healthcare?

Kate said: The aim of shifting more healthcare to the home is to improve both financial and human aspects of the healthcare system. Patients will benefit by having increased flexibility of care and the ability to comfortably administer at home. Healthcare systems will benefit by gaining cost and time advantages. Our research shows that hospital to home solutions, which involve treating and monitoring patients at home, are expanding rapidly as technology and science accelerate what is possible, and as patients and health systems see the benefits.

What obstacles or challenges must we overcome in order to achieve that vision?

Kate said: Educating patients and getting them on board to take medication in their own environment, rather than going to a doctor, like they’re used to, is a big first step. We also need to ensure that the healthcare professionals are comfortable and don’t feel like they are losing their patients or losing track of their patients when they self-administer outside the clinic.

To overcome those obstacles, we need to keep the delivery and monitoring devices as simple as possible to use and administer. We need to make sure the patient can use the device correctly repeatedly without feeling pressured or stressed. Equally, we have to ensure that there are appropriate and robust models in place to ensure the financial aspects add up.

Are there specific areas where we are seeing this education and engagement?

Kate said: If you look at hemophilia, for example, patients have been used to injecting themselves for a long time. In general, there are a number of therapeutics shifting from patients doing IV in the hospital to administering the IV at home. And people have been self-administering with subcutaneous injections for a long time in the home environment as well.

There has also been a shift to long-acting injectables that provide patients more time between injections. Longer time between injections is suggested to improve patient compliance but adds the challenge of keeping track of patients between their injections, particularly if these are to be administered in the home by the patient themselves. Without that normal touchpoint between the patient and doctor, it can be more challenging to make sure the patient is okay. Digital and connected technologies can be a good approach. But whilst these may suit many people, some patients may want to just call their physician rather than interact through an app. Therefore different ways of communicating and staying in contact do need to be in place.

How do we effectively integrate that connectivity?

Kate said: You need to ask whether and how connectivity should be built into the system. That may mean an app for a smartphone but that could also mean building phone calls into the treatment follow up for patients who don’t have smartphones. You also need to think about how you get patients to stay connected over time. Enforcing connectivity to ensure patient compliance may not be acceptable, as people don’t usually respond well to being “pushed” into doing things. In addition, healthcare professionals need to feel comfortable with patients administering at home. There may be some patients whom physicians think are not as capable and some may need more help and interaction.

The solution will need to be more aligned to certain communication preferences, whether that be through apps, over the phone or through visits by an at-home nurse. You cannot let the patient be out there on their own without support. It’s also important to ensure cost and the ability to use is considered when building in connectivity. Autoinjectors are a good example of this. Connecting autoinjectors often requires adding on extra devices to enable the autoinjector to be connected. These are hardware solutions and have to be specific to each autoinjector. They take time, money and robust business cases to be accepted and integrated. With the aim of liberating this market we at

PA Consulting are developing a software-only solution, called the ARInject™, for connecting autoinjectors with the aim of tackling the cost, time to market, flexibility and also environmental aspects hardware solutions face. We are reimagining connectivity for the autoinjector with this approach, aiming to make connectivity and the use of autoinjectors easier and more acceptable for the patient and pharma companies alike.

Patient segmentation is also a large part of this. You cannot introduce one solution and assume that it will fit everybody. Otherwise, we’d all be driving the same car and buying the same fridge. We need to consider the total consumer experience. There is a real need to conduct thorough segmentation analysis of patients to ensure the use cases are understood and aspects of human behavioral science are utilized to create more specific user-driven experiences to help better categorize patients and how they operate in their home environment.

Is there a business model to support the increased investment in monitoring and segmenting solutions?

Kate said: The important thing is to focus on those conditions or indications that really need it, and also the patients that really need that kind of help. The more work we do understanding those patients, the better we will be able to use connected solutions. Similarly, we need to better understand different business models to support this. There aren’t many connected systems like this out there, so it is important to start with simple plans and get feedback to determine where the highest need is and how to create the best business models.

Are there any products already on the market that we can get guidance from?

Kate said: There are some self-injection devices with connectivity but there is limited data available publicly about how these are performing. There are also patients who have treated themselves in the home for a long time whom we can learn from, for example, diabetes patients, rheumatoid arthritis patients, multiple sclerosis patients and patients with other chronic diseases. We should be engaging these patient groups to understand how we can improve the experience in total, not just from a specific device and connected system perspective.

What potential risks and liabilities for at-home administration should we be aware of and prepare for?

Kate said: One of the risks is unintentional misuse of a product. This can be because a patient isn’t trained well, or they misinterpret the user interface or forget things over time. You need to make sure that products are intuitive and as straight forward to use as possible. This is where human factors and user studies comes in. We need to do user testing and engineering beyond what is required from a regulatory perspective to the level of making the patient experience intuitive. It cannot be good enough, it must be exemplary.

How should we prioritize what to invest in, between usability, connectivity, etc?

Kate said: You need to design a product with a simple process of use so that people can self-administer. This is much easier said than done because it is all too easy for people to be distracted by all the things going on in their lives. We can learn from phones. People don’t just think of phones as a way to call. They’ve become multipurpose tools. While we may think of our tools as drug delivery devices, the patient might see them more as a tool to get better. We should wrap that experience into the experience of using the device and being connected. If you have interactions with the patient, build in positive elements about getting better and checking in on their health. While there always needs to be a factual education for patients to properly use devices, we need to think about how we can make that education more engaging and positive.

What does the self-administration space look like in 2025 and how do we get there?

Kate said: I would really like to see, in the next few years, a coming together of industry and healthcare providers to collaborate and create a system of connectivity with patients. This will allow us to monitor that patients are taking their medications correctly and provide us with structures to receive feedback and continue to design products that are easier for patients to use.