Fix “weak link” in disease management with education
This article was originally published in Scrip
Regardless of the device or therapy being used, compliance regimes that rely on patient self-administration are staring at failure if the vital link – the patient – is not educated appropriately in use of the delivery device.
This key variable is probably the only element that the product developer can neither predict fully nor be in total control of.
The issue is becoming all the more important as telehealth solutions, requiring a high element of patient self-management, come ever closer to the market.
But it is in a more established field – that of device inhalers – where it has been shown most clearly that patient education – and preferences – can play a major role in the success or failure of remote healthcare/patient self-management solutions.
Failure to recognise this is a key factor in unsatisfactory symptom control, despite the availability of effective drugs and numerous inhaler types. Success of a therapy depends on several factors, not just the availability of drugs.
Take the case of pharmacologic control of chronic obstructive pulmonary disease (COPD), for instance, where inhalation is the chosen delivery method. Along with safety, efficacy, availability and affordability of the drug, the key success factors also include the ostensibly mundane consideration of whether patients can handle and use the device correctly.
A study by University of Brussels respiratory specialist Walter Vincken, published in the March 2010 Primary Care Respiratory Journal, notes that, while the choice of COPD drug for an individual may be relatively straightforward, selecting the appropriate device (among the three types available: electrically-powered wet nebulisers; pMDIs – pressure metered dose inhalers; and DPIs – dry powder inhalers) is much more complicated. In addition, certain drugs, especially proprietary compounds, may not be available in all device types.
Use of multiple inhaler types, for different drugs, can confuse the patient and increase the risk of handling errors, says Dr Vincken. And the risk increases with age, with inhaler handling errors doubling in the over-60s and quadrupling in the over-80s, compared to younger patients.
Lower levels of education and less instruction by healthcare providers have been shown to be key factors in device misuse. Proper training by healthcare providers can halve inhaler error rates. This is all the more pertinent, given that COPD patients often have problems with effective co-ordination.
Non-regular or incorrect use of the device lowers the benefit of the inhalers, and techniques can deteriorate without regular training updates.
Crucially, patients will not use a device properly if they do not feel comfortable with it, know how to use it or trust it, according to Dr Vincken, who adds: “Providing patients with a device which they find easy to use properly is as important as the drug itself.” For this reason, he recommends that the patient is involved in the choice of device.
That is as true for inhalers as for all devices used in the outpatient setting or at home, where compliance is the main element of a successful therapy episode.
Theoretically, education should improve compliance with treatment regimens and help patients self-manage their conditions.
Companies and providers will tend to ask themselves if patient education initiatives have a positive financial return, because such training can be costly. But clearly, developing the patient’s knowledge of how to use the device effectively is the only route to successful therapy. This can improve patients' compliance with their medication regimen and medical follow-up care.
And when patients learn how to have a meaningful discussion with their doctor, they are more likely to provide better information about their symptoms or adverse reactions, which, in turn, minimises the risk that they will discontinue their therapy.
In addition, healthcare costs are reduced by education interventions that decrease the patient’s demands on the healthcare system, and an effective education programme can prevent a minor illness or injury from progressing to the point where the patient needs professional intervention.
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