By Aiden Kenny
The Patient Adherence Challenge
Drug adherence is one of the biggest challenges facing the healthcare system today. Within six months of starting treatment less than 50% of patients are adherent to their therapy resulting in reduced efficacy, spiralling costs, and in severe cases increased patient mortality. (Related Article). Non-adherence is a complex problem with multiple root causes ranging from sociological, psychological, and cognitive issues. To effectively tackle any specific non-adherence issue, we must first understand the underlying triggers.
Amgen is a global pharmaceutical company, and we have worked together on a range of user experience projects for both the Swiss and European markets. Our work has focussed on patient training, information delivery, and behaviour change, with the ultimate aim of improving patient adherence and outcomes. Central to our approach is a user-centred philosophy. Through understanding the experience of patients and their healthcare providers we can reframe the problem from a human perspective. Defining the problem accurately is the core of our design process.
Over the years these solutions have often been a blend of digital technology combined with improved service design protocols. However, sometimes the answer is simpler than you might expect and in the healthcare context simplicity is valued above all.
Patient Training Materials
Repatha® is an Amgen drug used to reduce the risk of heart attack or stroke in adults with heart disease or as a treatment to lower High LDL Cholesterol. Patients self-administer the medicine using an injectable pen. As with all home therapeutics, effective training is critical. This must be easy for the patient to follow and efficient for the professional to deliver. We worked with Amgen to explore new ways of supporting both healthcare professionals and patients on Repatha within the Swiss healthcare system.
Our design brief was informed by input from stakeholder groups, including sales reps and nurses, along with some observational research on how training was being delivered in the clinical environment. Video diaries recorded how patients used the injector pen at home, highlighting how the procedure was being followed in practice. Unfortunately, human memories have a limited capacity for retaining new information and research showed that patients forgot much of what they were told. They forgot to wash their hands, they forgot to disinfect, they even forgot why they should take their medicine. All factors which can contribute to patient non-adherence and treatment drop-off over time.
Our solutions explored all aspects of the Patient Training Experience. Firstly we designed a more durable and compact way to store all of the training materials. Sales Reps requested a modular kit with components they could choose from, based upon their knowledge of each HCP.
The previous patient materials had combined both medical information about the drug and instructions for use in one document. Research suggested that this information should be delivered separately. The core document that we created is a comprehensive Step-by-Step Instruction Guide for patients. This now takes the form of a fold-out leaflet which uses clear illustrations to explain all of the steps in using the injector pen. We revised the layout to focus on a single action per page, which reduces the cognitive load on the patients. We also created a new suite of icons to improve clarity for patients.
For the companion leaflet, we concentrated upon improving the layout and typography of the medical information to maximise patient understanding. We restructured and reordered the content, simplifying the layout, and prioritising the key information. Our refined typographic treatment has significantly improved the legibility of the text.
A larger double-sided summary version of the step-by-step instructions was provided for the health care professional to use as a one-on-one training aid. Lastly, we redesigned and refined the Monthly Planner which patients use to record their adherence over the first ten months of their treatment.
Patient Disinfection Kit
At present, when most patients wish to inject, they need to gather all of the necessary items to accompany their injector pen from different places around their house. We explored solutions which could provide patients with a re-useable kit containing the relevant materials to both increase convenience and more importantly to reinforce the correct procedure to follow. Following the training session, patients would receive a Disinfection Kit containing enough supplies (pre-injection wipes, hand sanitiser, and post-operative dressings) for the first few months of their treatment. This helps build the correct disinfection habit in the early stages of the patient’s treatment resulting in a better medication experience and ideally improving adherence over the longer-term.
Working with the Frontend.com has helped us to improve how training is delivered and created a more engaging patient experience. Nurses found real value in the new Patient Guide, it was such a success that we had to order a reprint straight away.
Amgen Customer Experience Lead, Business Analysis, and Insights
This is a pathway document for patients who have had a cardiovascular event such as a heart attack or a stroke. The overall project goal is preventing secondary cardiovascular events. The HertzPass (Heart Pass) achieves this by improving coordination between the primary care provider and the various specialist clinicians needed to treat such patients.
The primary issue to resolve was that patients often present to the cardiologist with incomplete values for key measurements such as cholesterol from their previous appointment, which may have been with a different specialist or GP. This makes appointments less efficient and can lead to the incomplete recording of values over time. The HertzPass booklet is designed to link all of the specialist visits together becoming a log of the patient’s progress through their treatment journey.
Initial research with cardiologists highlighted a preference for a paper-based solution rather than in an electronic format. A paper-based approach is less disruptive, and avoids any potential technical issues. Designing this as a fold-out journal made the recording of their progress more tangible to patients as it becomes a literal timeline of their clinical interactions.
The fundamental benefit for patients is that taking ownership of this HertzPass and using it while engaging with the clinicians empowers them. The patient becomes more of a partner in their treatment and gains an element of control over their therapy, which in turn has a positive effect on adherence.
The HertzPass is also a tool for the Cardiologists. It reminds them of conversation topics to have with their patients about exercise, stress, smoking, diet and so on. It helps them explain all of these lifestyle risk factors. It also helps them to inform patients about preventative next steps such as walking more. The design is carefully considered to facilitate ease of use for the physician relying on ticking boxes or circling icons rather than cursive input where possible.
The HertzPass is a proven success and we have now produced additional French and English language editions. We have also now developed a similar AngioPass product with the team at Frontend.com. Both are now being deployed in multiple of countries across the EU.
Senior Marketing Manager — Beyond the Molecule Lead at Amgen
While the potential for digital tools in the healthcare context continues to grow, in some cases using a simple paper-based approach still makes sense. Our guiding principle is that an excellent user experience is platform-agnostic and that thinking deeply about the user context and user needs must always inform and guide the design solution. These principles reflect our team’s experience in medical devices, industrial design, usability, psychology, and business process improvement.
Our multidisciplinary healthcare design team is based in our studio in Dublin, Ireland. Contact us to collaborate on your upcoming healthcare project.