Self-injectable Therapy

Anne*, a 67-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.

Anne 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.

Dr. Brown* could sense Anne’s frustration with a delayed diagnosis and could tell that she was nervous about self-injecting. Knowing that additional support could help Anne 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.

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

The Treatment Experience Nurse acknowledged Anne’s concerns and talked her through how to prepare and administer self-injections. She reassured Anne 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.

Before Anne’s first injection, a Nurse met with her at home for a self-injection training session. She reviewed the injection materials and supplies with Anne, 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, Anne felt much more confident in her ability to self-inject.

During their next call, the Treatment Experience Nurse helped Anne think of a quiet time and place to self-inject and reviewed the logistics of scheduling refill deliveries. Although Anne was more comfortable with self-injection, she was feeling depressed about having to be on self-injection therapy. The Treatment Experience Nurse empathized with Anne, 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.

• Emotional concerns
• Medication routine and logistics

Anne 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.

Anne had been looking forward to an out-of-state family reunion, but she was worried about self-injecting during the trip. The Treatment Experience Nurse 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.

• 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

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

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

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

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 Treatment Experience Nurse between appointments, including reported side effects, missed doses and refills, and barriers addressed

As a result of being enrolled in the Patient Support Program, patients like Anne 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