Schiff Michael, Saunderson Shane, Mountian Irina, Hartley Paul
University of Colorado School of Medicine, Denver, CO, USA.
Idea Couture, Toronto, Canada.
Rheumatol Ther. 2017 Dec;4(2):445-463. doi: 10.1007/s40744-017-0080-4. Epub 2017 Sep 27.
Drug administration by self-injection provides an option to treat chronic inflammatory diseases such as rheumatoid arthritis (RA) and Crohn's disease (CD). However, a negative self-injection experience for patients may reduce patient adherence to the recommended treatment regimen. In this study, a holistic approach was used to identify common themes along the treatment pathway and at self-injection that, if changed, could improve patient experience and treatment outcomes.
Two ethnographic studies were conducted: Field Insights CODE (FI[CODE]) examined the treatment pathway within the context of the experience of living with RA or CD, and Injection Mission 2020 (IM2020) focused on the moment of self-injection. FI(CODE) used an open ethnographic approach to interview 62 patients and 10 healthcare professionals (HCPs) from the US and UK. IM2020 included a review of over 50 injection device design information sources from the sponsor, and interviews with 9 patients, 8 HCPs, and 5 medical device designers from the US, UK, Canada, and Japan.
FI(CODE) identified suboptimal treatment practices along the treatment pathway in four key areas: treatment team communication, treatment choice, patient empowerment, and treatment delivery. Patients with more treatment options and greater disease understanding were less likely to struggle with the treatment process. IM2020 demonstrated that five related components influenced the self-injection experience: delivery process, emotional state, social perception, educational level, and ritualization of the self-injection process.
These analyses highlight several potential areas for improvement, including aligning the device more to patients' needs to improve treatment adherence, better accessibility to educational resources to increase patient disease understanding, and guidance to empower patients to develop an optimal personalized self-injection ritual.
UCB Pharma.
自我注射给药为治疗类风湿性关节炎（RA）和克罗恩病（CD）等慢性炎症性疾病提供了一种选择。然而，患者负面的自我注射体验可能会降低患者对推荐治疗方案的依从性。在本研究中，采用了一种整体方法来确定治疗过程中和自我注射时的共同主题，若对这些主题加以改变，可能会改善患者体验和治疗效果。
进行了两项人种学研究：“现场洞察编码”（FI[CODE]）研究在类风湿性关节炎或克罗恩病患者的生活体验背景下考察了治疗过程，“2020注射使命”（IM2020）则聚焦于自我注射时刻。FI(CODE)采用开放式人种学方法，对来自美国和英国的62名患者和10名医疗保健专业人员（HCP）进行了访谈。IM2020包括对来自申办方的50多个注射装置设计信息来源的审查，以及对来自美国、英国、加拿大和日本的9名患者、8名HCP和5名医疗设备设计师的访谈。
FI(CODE)在四个关键领域确定了治疗过程中次优的治疗做法：治疗团队沟通、治疗选择、患者赋权和治疗实施。治疗选择更多且对疾病了解更多的患者在治疗过程中遇到困难的可能性较小。IM2020表明，五个相关因素影响自我注射体验：给药过程、情绪状态、社会认知、教育水平和自我注射过程的仪式化。
这些分析突出了几个潜在的改进领域，包括使设备更符合患者需求以提高治疗依从性，更好地获取教育资源以增加患者对疾病的了解，以及提供指导以帮助患者制定最佳的个性化自我注射仪式。
优时比制药公司。
