For patients living with Rheumatoid Arthritis, Crohn’s or other autoimmune diseases, one of the hardest parts of dealing with the condition may be the need to self-inject medication. While doctors and nurses try to put patients at ease by demonstrating self-injection techniques in the office, there are many factors that may affect patients’ comfortability injecting. These can include needle anxiety, diminished memory recall and retention and device familiarity, which pose the risk of patients self-injecting improperly or incompletely, or even avoiding their treatment altogether.
To address this widespread problem, training devices have been developed to emulate the look, feel and operation of autoinjectors (minus the needle) for the purpose of helping reinforce correct device administration techniques for patients prior to performing an actual self-injection. A recent longitudinal study conducted by Insight Product Development and Noble sought to determine if patients with access to training materials outside a healthcare provider’s office would perform better than those with traditional training and no training device for practice.
The study enrolled healthy adults with no professional medical training and split them into three cohorts. Each cohort first attended an in-office session demonstrating the proper use of a mechanical autoinjector training device—much like a patient would receive initially upon being prescribed a self-injectable.
The first cohort was sent home with only a medication Instructions for Use (IFU); the second cohort was sent home with a mechanical trainer and a training IFU; and the third cohort was sent home with a mechanical trainer, training IFU and an interactive training video.
Participants used the support materials to prepare for or practice self-injecting on their own for 14 days. Upon returning for a follow-up session, they were asked to conduct a simulated injection using a real autoinjector and injection pad.
What researchers found demonstrates the importance of training devices for patients. Participants having a training device on hand at home significantly increased how often they chose to prepare for self-injecting over the 14 days. The second and third cohorts—those with trainers—were able to prepare for and practice at home more than those who had just been sent home with the IFU leaflet alone. Findings from the study showed in both the second and third cohorts, 100 percent of participants practiced at least three times over the two weeks. In the second cohort, more than half practiced five to nine times, and approximately one-third practiced 10 or more times.
Findings were significant within the third cohort—those who took home IFUs, a training device and the video—as well. Eighty-three percent practiced five to nine times and again one-third practiced 10 or more times.
This uptick in practice sessions for cohorts two and three could be attributed to the fact that they were given tools to bolster their self-injecting experience and felt increasingly comfortable each time they practiced, leading them to practice even more to improve comfortability and confidence.
Researchers also found that using the training devices improved the study participants’ performance. Whereas 56 percent of the members in the first group made critical self-injection mistakes during the follow-up visit, 100 percent of the other two groups—those who had trainers to practice—successfully completed all critical steps. This is case in point for why trainers and other support materials are so vital to patients who self-inject.
Finally, 92 percent of participants reported that they would prefer to bring home a training device to practice with prior to conducting a self-injection.
The takeaways from this study are striking and send a clear message. First, the current standard method of imparting self-injection technique to patients—which is satisfactory as far as it goes—can be improved if patients are given realistic training devices to use in the privacy of their own homes prior to beginning actual treatment. Second, the sentiments of patients who self-inject suggest that they are apprehensive about their treatment when they are not provided an opportunity to practice repeatedly on their own. To truly learn the proper self-injection technique involves multiple practice sessions—as many times as it takes to get acquainted with the various steps involved. This, in turn, proposes a crucially important conclusion: When anxiety over self-injection is diminished and patients have mastered the self-injection technique, they may have a higher likelihood of adhering to their treatment and obtaining the maximum benefit from it.
As the study results suggest, autoinjector training devices may play a valuable role in helping patients who self-inject get the most from their course of therapy. Trainers also help reinforce injection memory, potentially mitigating the statistic that 90 percent of treatment information is lost within one week. Additionally, trainers could help increase adherence for the 50 percent of patients who are nonadherent due to gaps in their treatment experiences. It is also suggested that 45 percent of patients avoid injections entirely due to anxiety, which can be reversed through trainers and other support materials. This is a goal for which HCPs, pharmaceutical companies and patients themselves should be striving.
Raj Abraham, Product Analyst, is responsible for providing market intelligence on the biopharmaceutical and medical device industries at Noble. Raj holds a Bachelor of Science in Biology from Florida Gulf Coast University and a Master of Science in Biotechnology from the University of Central Florida.