25 Sep

Improved Measures of Adherence: How HealthBeacon’s ICMS™ Enhances Confidence in Medication Adherence Rates

Medication Event Monitoring Systems Provide Improved Measures of Adherence: How HealthBeacon’s Injection Care Management System™ can Enhance Confidence in Adherence Rates. September 2020.
By Dr.Sharifah Sarhan, MB, BCh, BAO, Medical Science Liaison Officer & Sean Glynn, MSc, Director of HEOR

The ability to provide patients and their healthcare practitioners with individualised and real-time medication adherence data is a powerful tool in the management of chronic disease, and a key offering in our Injection Care Management System™ (ICMS). In this piece, HealthBeacon explores the different methods traditionally used to calculate medication adherence and how we offer an innovative approach for a more reliable measure.

Accurately and reliably measuring medication adherence can be challenging. There are both direct and indirect measures which can offer us insight into patient adherence rates. Direct measures, including measuring serum drug levels can be invasive and time-consuming. Therefore, it is largely indirect measures which are employed, the most common of which are Medication Possession Ratios (MPRs) and Proportion of Days Covered (PDC). These indirect measures can be calculated easily from pharmacy-based data; however, this convenience comes at the cost of reliability.

What are MPR and PDC?

Medication Possession Ratio (MPR) has been used for several decades as an indirect measure of medication adherence. MPR is a calculation of the number of days of supplied medication divided by the number of days between the first and last prescription refill. A fundamental flaw with MPR is that it can overestimate adherence; if a patient gets their prescription filled early, the number of days of supplied medication can be greater than the number of days in the time period, and hence can result in a score of greater than 100%.
The MPR’s successor is Proportion of Days Covered (PDC). PDC addresses the MPR calculation shortfall by considering the number of days supplied divided by the number of days in the refill period. In this way, the ratio can never be greater than 1, making PDC more accurate. Both MPR and PDC can be relatively easily calculated from inexpensive data acquired from pharmacy refill records, however they are not without their shortcomings.

 

 

 

How accurate are MPR and PDC as measures of adherence?

When it comes to mail-order and specialty pharmacy data, MPR and PDC are more reflections of an organization’s quality of shipping and logistics, than true measures of patient medication adherence. They inform us that medications have been shipped and are in the patient’s possession, but not whether they have been taken by patients or not. As such, they become financial measures passed back to manufacturers and lose their clinical focus. Further, they over-estimate adherence as they do not account for doses not taken and/or doses not taken on time. A leading Paediatric Endocrinologist told us of a patient under his care who was coming off injectable medication after almost twelve years of treatment. The patient’s mother was delighted her son was due to finish his treatment and enquired as to what she should do with the unused injections she had at home. These however were doses that the child had been scheduled to take during his treatment period. Indeed, although MPR and PDC can give us an indication of a patient’s access to and possession of medication, they do not provide us with insight into the medication taking behaviours of patients.

 

HealthBeacon’s Measure of Adherence


At HealthBeacon, our measure of adherence is based off real-time data, customized to both individual patients and the pharmacokinetics of each product. The HealthBeacon Smart Sharps Bin records (to the minute) each time a patient drops a used syringe/needle/auto-injector into the unit. Each drop is then reconciled with the patient’s customized dosing schedule. To calculate a Personal Adherence Score, the number of drops made into the Smart Sharps Bin within the product-specific window of time is divided by the number of scheduled drops. Using this method, HealthBeacon can provide a more clinically meaningful adherence score for any injectable medication, ranging from daily growth hormone to a bi-weekly anti-TNF inhibitor.

As part of HealthBeacon’s ICMS™, patients can self-report doses taken at times when they may not have access to their Smart Sharps Bin, such as when on vacation. Patients can self-report by calling or emailing our Customer Care Team or through the HealthBeacon Companion App. This allows us to minimize any under-estimation that may occur if patients were otherwise unable to log their medication as taken.

 

 

Summary

Clinicians and researches are recognizing devices that are classified as Medication Event Monitoring Systems (MEMS) as the new “gold standard” for tracking medication adherence, due to greater reliability and validity of the data they produce. MEMS have the capability to capture dose-to-dose medication taking behaviour and to get that data out of the patient’s home. The HealthBeacon Smart Sharps Bin does this by simply recording the disposal of the waste, requiring no additional work by the patient. Therefore, this real-time data capture, with analysis tied to product specifics and injection frequencies, provides far more accurate and insightful adherence data than traditional pharmacy refill records.

 

Sean Glynn, Director of HEOR, joined the HealthBeacon team three years ago with the critical role of launching HealthBeacon’s operations in the US. Sean’s background in behavioral sciences and his deep understanding of the medication adherence issue will be instrumental in furthering HealthBeacon’s mission to improve patient outcomes. Sean is based out of HealthBeacon’s Boston office.

 

 

 

 

 

 

Dr.Sharifah Sarhan joined the HealthBeacon team as a Medical Science Liaison, to facilitate clinical research and assist with Regulatory Affairs. Sharifah is a medical doctor, graduating from University College Dublin and experience across a number of medical specialities as a junior doctor. Sharifah is based out of HealthBeacon’s office in Dublin, Ireland.

 

 

 

 

 

 

About HealthBeacon

HealthBeacon is a medication adherence technology company which develops smart tools for managing medication at home. HealthBeacon’s FDA cleared smart sharps bin tracks patient injection history, provides personalized interactive reminders and safely stores used injectables. With the intervention of HealthBeacon’s Smart Sharps Technology, patients’ persistence and adherence increased by 25-30% within twelve months of initiating therapy. The HealthBeacon integrated model connects a patient’s routine and the prescribing clinician’s workflow. This technology has been adopted across thirteen countries with >300,000 injections tracked since launch in 2014, with a patient acceptance rate of 80-90%.

10 Sep

Virtual Injection Training: A Novel Addition to HealthBeacon’s Injection Care Management System

Virtual Injection Training study represents new approach to successful patient onboarding. September 2020.

Here at HealthBeacon we are continuously looking for novel approaches to successful onboarding of patients into our Injection Care Management System (ICMS™). Research into video assisted injection training for patients by Sean Glynn, Director of Health Economics and Outcomes Research, explores this idea further. Reviewed by Dr.Sharifah Sarhan, Medical Science Liaison and our experienced nurse trainer, Lorraine Smith, this innovative idea has potential to become a key aspect of our ICMS™ offering.

Encouraging patient autonomy and supporting them to self-manage medication regimes at home is central to the ethos of HealthBeacon and our ICMS™. As healthcare and the management of medical conditions becomes increasingly digital, the need for remote patient care is coming to the fore. This is especially so in the current era of COVID-19. To explore how we can further support such remote care, HealthBeacon conducted a study to assess the efficacy of remote injection training as an exciting alternative to in-person training for patients. Our experienced nurse trainer, Lorraine Smith also offers her opinion on this innovative offering and what it could mean for both patients and practitioners alike – Dr.Sharifah Sarhan, MSL, HealthBeacon

Virtual Injection Training Study

by Sean Glynn, Director of HEOR, HealthBeacon

 

In-home injection training is the current standard of care for patients newly prescribed a self-injectable medication. This service may be provided through a pharmaceutical company’s patient support program as an aid to successful initiation to therapy. Patients may also get this training in clinic depending on the requirements of the product. However, both training modes create financial and resource burdens on healthcare systems and/or directly on the patient. (Homer, 2009)

Previous research has shown that video-based self-injection training may be a more desirable option for patients than in-person training, and that it can result in high levels of confidence amongst patients to perform the self-injection correctly (Homer, 2019). Video training, was found to reduce nurse resource utilization, while demonstrating equal efficacy when compared to in-person training (Katz, 2015).

As a digital health company, HealthBeacon has developed an Injection Care Management System™ to support patients on self-injectable medications. As such, through leveraging e-learning and tele-health concepts, a training auto-injector to simulate the injecting experience, and a novel approach, HealthBeacon sought to improve the patient training system and demonstrate that Virtual Injection Training is as viable and as effective an approach as in-person training.

Prior to deployment of this new platform, HealthBeacon wanted to ensure that trainees would receive the same high-quality training as they would from a nurse practitioner, whilst ensuring patients’ safety and confidence in performing the self-injection. Our paper summarizes HealthBeacon’s first round assessment of the program.

 

To receive a full copy of our Virtual Injection Training White Paper and to learn more about our study, please email: Sharifah.sarhan@healthbeacon.com or sean@healthbeacon.com

 

Results

Our research provided exciting results: virtual injection training can be deployed with as high and equal quality as in-person training. Overall knowledge regarding self-injection was higher in the virtual-injection group, with participants in both groups having equal and high scores regarding their confidence to self-inject remotely.

Resource utilization and associated costs were also considered as part of this study. Analysis of cost for both training modes show that the VIT can be performed for 50%-60% of the IPT cost, resulting in considerable cost savings.

These results represent an exciting idea that remote patient interactions and training is not only possible, but equitable to in-person interactions. As the future of medicine becomes increasingly digital, the need for such service offerings in remote patient management systems will only increase.

We reviewed these findings with our nurse Lorraine Smith, (R.G.N. BSc with over 20 years nursing experience, 10 of those specifically in-home injection education and training) who said, “These results give me confidence as a trainer that conducting the training remotely can be done effectively. This training is a critical first step for patients, to give them the experience needed to build their confidence.”

 

Q&A with Nurse Lorraine

In discussion with our experienced nurse trainer, Lorraine Smith, Dr. Sharifah Sarhan asked for her opinions and thoughts on virtual injection training as a novel alternative to in-person training. Lorraine has over 20 years’ experience as a nurse and a decade of experience training patients on self-injecting at home and offers some invaluable insights.

From your experience training patients how to self-inject, what are some of the things you must consider prior to training?


For me, when training patients how to self-inject, the key thing to think about is the pre-training interaction. Both the patient and their healthcare practitioners (HCPs) need to know they are in good hands. Reassurance is key. With virtual injection training, we also want to reassure them both that we have put time and effort into getting demo devices to patients to practice with and provide them with the equipment they need to practice successfully before attempting to self-inject.

What do you think are some of the benefits of virtual injection training for patients?

Of course, HCPs are indispensable, but virtual injection training can give patients great insight and further understanding into how to use their injection device, providing them with greater autonomy over their medication management, and increasing their compliance and overall wellbeing. Although virtual, patients are still linked-in with their HCPs and can rest-assured that they are supported by them.

Virtual training will also free up time for busy HCP’s in the hospital / clinic environment. It allows faster scheduling of patient training than in person training provides (nurses can be booked up, patients can live far away in hard to access areas leading to scheduling delays, etc). Also, should training not happen for any reason, be delayed or was not satisfactory, HealthBeacon are open and honest in their ICMS™ service, giving feedback as required and are someone prescribers can trust. Experienced RGN’s are interacting with patients and will relay any issues they identify.

In the unlikely event we are concerned that a patient may need a supervised visit, we let them know this and do not assume the patient will eventually ‘get around to it’ or get over any fears they may have regarding self-injecting, for example. We follow up with our referred patients to ensure patients have the level of support they need.

How do you feel virtual injection training could change your practice going forward?

From my more recent experience of visiting patients at home, I have noticed a recurring worry. Patients are very concerned that HCP’s coming into their home could potentially expose them to COVID -19. Given the challenges facing us all currently, the need for an alternative to in-patient interactions is significant. The option of a virtual interaction as part of the ICMS™, with an experienced nurse in a remote, and safe manner, who can guide patients on their self-injection journey, can only benefit everyone.

 

 

Sean Glynn, Director of HEOR, joined the HealthBeacon team three years ago with the critical role of launching HealthBeacon’s operations in the US. Sean’s background in behavioral sciences and his deep understanding of the medication adherence issue will be instrumental in furthering HealthBeacon’s mission to improve patient outcomes. Sean is based out of HealthBeacon’s Boston office.

 

 

 

 

Dr.Sharifah Sarhan joined the HealthBeacon team as a Medical Science Liaison, to facilitate clinical research and assist with Regulatory Affairs. Sharifah is a medical doctor, graduating from University College Dublin and experience across a number of medical specialities as a junior doctor. Sharifah is based out of HealthBeacon’s office in Dublin, Ireland.

 

 

 

 

 

Lorraine Smith, R.G.N. BSc, has over 20 years’ experience working as nurse in a variety of hospitals in Ireland. Lorraine also has 10 years’ experience working specifically in the area of patient education and self-injection training in the home setting.

 

 

 

 

 

About HealthBeacon

HealthBeacon is a medication adherence technology company which develops smart tools for managing medication at home. HealthBeacon’s FDA cleared smart sharps bin tracks patient injection history, provides personalized interactive reminders and safely stores used injectables. With the intervention of HealthBeacon’s Smart Sharps Technology, patients’ persistence and adherence increased by 25-30% within twelve months of initiating therapy. The HealthBeacon integrated model connects a patient’s routine and the prescribing clinician’s workflow. This technology has been adopted across thirteen countries with >300,000 injections tracked since launch in 2014, with a patient acceptance rate of 80-90%.

 

References

• Homer D. (2019). Using video-based training for button-free auto-injection of subcutaneous methotrexate: A pilot study. Musculoskeletal Care, 17(3), 247–279. https://doi.org/10.1002/msc.1420
• Homer D, Nightingale P, &Jobanputra, P. (2009). Providing patients with information about disease‐modifying anti‐rheumatic drugs: Individually or in groups? A pilot randomized controlled trial comparing adherence and satisfaction. Musculoskeletal Care, 7(2), 78–92. https://doi.org/10.1002/msc.141
• Katz SJ, Leung S. (2015). Teaching methotrexate self-injection with a web-based video maintains patient care while reducing healthcare resources: a pilot study. Rheumatology International, 35(1):93-96. https://doi.org/10.1007/s00296-014-3076-1