CASE STUDY:

Self-injectable Therapy

CHALLENGE

Our client wanted to provide better patient support to increase initiation and adherence to their self-injectable therapy; on average patients stayed on treatment 3.5 months out of the prescribed 6-month course. Patients faced multiple challenges: learning to self-inject, an expensive medication with payment options that were difficult to manage, and potential side effects that could be severe. Patients diagnosed with a rare disease also had a difficult time finding social support.

HCS SOLUTION

HCS designed and delivers an omnichannel support program to address patient and clinician barriers to initiation and adherence. In addition to phone support and educational materials, the program includes home visits for injection training and a patient website that allows patients to engage in cognitive behavioral exercises to address their barriers.

IMPACT

Our program increased script to fill from 68% to 86%. A 25:1 ROI.

A Patient's Experience

MEET MARIA

Maria*, a 37-year-old restaurant manager with hypertension, presented with swelling in her hands and feet. After multiple tests, her primary care physician referred her to a nephrologist, who finally diagnosed her with a rare kidney disease and prescribed a self-injectable therapy.

STRUGGLING WITH TREATMENT

Maria had mixed feelings; she was frustrated because the diagnosis took so long, but she was hopeful that the new therapy would help. She was also afraid of needles. She worried that she wouldn’t be able to self-inject correctly and was concerned she wouldn’t be able to find a quiet time and place to inject due to her busy schedule.

ENROLLED IN THE PROGRAM

Dr. Brown* could sense Maria’s frustration with a delayed diagnosis and could tell that she was nervous about self-injecting. Knowing that additional support could help Maria stay on her treatment plan, Dr. Brown enrolled her in the Patient Support Program. He used the treatment education page of the Patient Starter Kit to guide their discussion about self-injection therapy and how to identify and manage potential side effects.

WELCOME PHONE CALL

Maria’s Nurse Case Manager called to welcome her to the program and completed a barrier assessment, which was entered in the SmartCARE Platform and reported to Maria’s clinician through the Clinician Feedback Loop.

Maria’s Barriers

  • Fear of injection
  • Emotional concerns
  • Medication routine and logistics
  • Managing side effects

SUPPORT OFFERED

The Nurse Case Manager acknowledged Maria’s concerns and talked her through how to prepare and administer self-injections. She reassured Maria that it was natural to be nervous but that with practice and a positive outlook, she would become more comfortable with self-injection. She also reviewed the potential side effects of the medication and the importance of reporting any side effects to her clinician.

First Call: Barriers Addressed

  • Fear of injection
  • Emotional concerns
  • Managing side effects

Communication preferences

  • Patient interested in continuing phone conversations and receiving more information by email
  • Patient scheduled home injection training

Content Delivery: Email

  • Day 1: “Set Yourself Up for Success” provided tips on having a positive mindset about self-injection
  • Day 3: “Mastering Self-injection” offered tips on self-injection, such as how to inject, rotating the injection site, and the importance of staying positive
  • Day 5: “Managing Side Effects” gave an overview of possible side effects and tips on how to manage them

IN-HOME SELF-INJECTION TRAINING

Before Maria’s first injection, a Nurse met with her at home for a self-injection training session. She reviewed the injection materials and supplies with Maria, showed her how to prepare the medication, and demonstrated how and where to inject. They also talked about how to store the medication and how to safely dispose of used needles. After the visit, Maria felt much more confident in her ability to self-inject.

BARRIERS REASSESSED

During their next call, the Nurse Case Manager helped Maria think of a quiet time and place to self-inject and reviewed the logistics of scheduling refill deliveries. Although Maria was more comfortable with self-injection, she was feeling depressed about having to be on self-injection therapy. The Nurse Case Manager empathized with Maria, connected her with a support group for people with her condition, and suggested that she talk about her feelings with her clinician or a friend/family member.

Second Call: Barriers addressed

  • Emotional concerns
  • Medication routine and logistics

Content Delivery: Email

  • Day 15: “Coping With Emotions” gave advice on how to handle anxiety and stress
  • Day 20: “My Supply Management Plan” included tips on safely storing and disposing of needles and a worksheet Maria used to record her upcoming medication deliveries
  • Day 25: “Building a Routine” gave Maria more information, motivational tips, and activities to help her stay on track

LEARNING ON HER OWN

Maria used the Interactive Website to learn more about her condition and to watch videos on self-injection. She also used the online tools to develop an action plan to stay on her medication and to record her dosage and keep track of refills.

INJECTION LOGISTICS WHILE TRAVELING

Maria had been looking forward to an out-of-state family reunion, but she was worried about self-injecting during the trip. The Nurse Case Manager reviewed some tips on traveling, such as bringing extra medication and supplies, a sharps disposal container, and a doctor’s note explaining the need for the medication.

Content Delivery: Email

  • Day 73: “Traveling With Your Medication” included checklists of injection supplies and gave tips on planning ahead to avoid interrupted treatment, such as how to store and dispose of the medication safely

ONGOING SUPPORT

During subsequent scheduled calls, the Nurse Case Manager continued to monitor Maria’s progress, reassess her barriers, and update her record for the SmartCARE Platform and Clinician Feedback Loop.

 
A Clinician’s Experience

LACK OF CONFIDENCE IN PATIENT'S ABILITY TO SELF-INJECT

Dr. Brown was concerned that Maria wouldn’t be able to self-administer her medication or that she would stop therapy because of treatment fatigue.

LIMITED TIME AND RESOURCES TO ADDRESS PATIENT'S PSYCHOSOCIAL NEEDS

Dr. Brown and his staff didn’t have the time or resources to support Maria when she was struggling with her fear of needles or her anxiety about the stigma of self-injection therapy.

SOLUTIONS

The Patient Support Program provided additional personalized support that complemented Dr. Brown’s care of his patients. The program also offered tools that helped Dr. Brown improve his communication with patients and monitor their progress between appointments, including the:

  • Patient Starter Kit, which included patient-friendly language and offered tips on how to set expectations for self-injection
  • Clinician Skills and Training Tools, visual/print resources that provided information on identifying non-adherence, responding to patients’ psychosocial needs, and giving effective direction
  • Clinician Feedback Loop, which shared information collected by the Nurse Case Manager between appointments, including reported side effects, missed doses and refills, and barriers addressed

MORE SUPPORT, BETTER OUTCOMES

As a result of being enrolled in the Patient Support Program, patients like Maria were more likely to adhere to their self-injectable therapy and therefore have better outcomes. Clinicians were able to provide better care for patients because the program strengthened patient–clinician communication, helped clinicians set expectations for self-injection therapy and identify and manage side effects, and provided data between follow-up appointments.

*Illustrative, not an actual patient/clinician

Channels of Support

NURSE CASE MANAGER

Nurses identify and address each patient’s treatment barriers during scheduled outbound calls and are available via a 24/7 hotline to answer questions and offer support

PATIENT STARTER KIT

Provides treatment overview information and tools designed to improve patient adherence

INTERACTIVE WEBSITE

Provides a private space for patients to learn about their condition and self-injections

SUPPORT MAILERS / EMAILS

Information, tips, activities, and motivational messages are sent to patients throughout treatment based on patient barrier assessments and Nurse Case Manager conversations

CLINICIAN FEEDBACK LOOP

Reports real-time data on patient status and engagement with the program via a portal, push email, or fax

CLINICIAN SKILLS AND TRAINING TOOLS

Virtual/print training provides information on identifying non-adherence, responding to patient’s psychosocial needs, and giving effective direction

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