Patients at risk due to overconfidence in their ability to use medical devices, extensive survey reveals

As cost pressures on healthcare fuel the desire for patients to self administer more medicines, this overconfidence could lead to serious problems as the incorrect use of medical devices can lead to either inaccurate dose delivery, or worse no delivery of the drug at all. Looking at a range of drug delivery options, in the majority of cases patients felt that they would need no training or support to use a device correctly, or would only need to be shown how to use a device once. For inhalers nearly 85% of patients felt this minimal training would be sufficient, for nebulisers nearly 70%, injector pens 63%, and needle and syringe just under 50%. The survey also sought the opinions of the specialist doctors who are treating these patients. They are far less confident in their patients’ ability to quickly understand new medical devices. Typically they feel that patients require between two and four ‘sessions’ to be competent with each device type. With a needle and syringe and wearable pumps some doctors would favour more than four familiarisation sessions – although this raises the issue of how can the ‘training burden’ on healthcare professionals be reduced?

“With predicted increases in the prevalence of chronic conditions, shrinking bandwidth and the growing cost pressures on healthcare professionals how can we ensure patients get the amount of training they need – not just what they think they need – and in the format that will help them the most?” – Paul Greenhalgh

Diane Aston-James, Managing Consultant at Team Consulting, said: “I find the patient confidence levels very interesting, and a little alarming. Correct procedure of use for a drug delivery device is rarely intuitive. For example, Pressurised Metered Dose Inhalers (pMDIs) involve a high degree of coordination in order to ensure a correct dose is delivered and they are frequently used incorrectly by patients. This is a challenge for the industry as many patients may not be aware of their poor proficiency and worse still, the drugs may not be delivered at all – with the potential for serious harm to be caused to patients.”

Charlotte Harris, Senior Consultant at Team adds: “The results of the survey certainly match our years’ of experience. We have seen some people doing some really odd things with their devices even though they say they’ve been shown how to do it – or they have made up their own rationale for what they are doing and believe that it’s right. As a result, it’s important not only that we get the training right in the first place, but that we also continue to monitor technique over time.” Charlotte continued: “In order to reduce the overall costs of healthcare, there are many in the industry who feel it is inevitable that patients will self-administer more medicines in the coming years. In theory, this relieves the burden on healthcare systems, professionals and infrastructure but it increases the emotional and physical burden on patients. Patients frequently disregard instructions for use as they often resemble risk management documentation, full of lists of Do’s and Don’ts in tiny print. We need to reduce this burden on the patients if they are going to be able to rise to the challenge of increasing self-administration.” It is also clear that patients prefer to be shown in person how to use a new device rather than use paper-based instructions, online tutorials or mobile apps. The survey found that patients overwhelmingly (86%) prefer to learn how to take their medicine from a doctor or nurse directly. Despite the availability of smartphones, patients would not choose to use a mobile app to learn how to use a new drug delivery device – with only 2% of those surveyed saying it would be their preferred training method.

Paul Greenhalgh, Director of Design at Team Consulting, added: “With predicted increases in the prevalence of chronic conditions, shrinking bandwidth and the growing cost pressures on healthcare professionals how can we ensure patients get the amount of training they need – not just what they think they need – and in the format that will help them the most? Our survey of doctors suggests that patients need multiple sessions and the patients want to do these with doctors or nurses. For a number of reasons this is near impossible to fulfil.” Greenhalgh continues: “We have to find alternative methods to complement professional-led training. For example, whilst a mobile app can never replace the experience of interacting with a real person, we shouldn’t overlook the opportunities that technology will give us in the future. I think that acceptance of alternative training methods will change as people inevitably become more ‘digitally literate’ and have real experience of using well-designed interactive training aids. After all, 15 years ago there were no smartphones and even two years ago many people wouldn’t imagine doing their banking or grocery shopping via an app.” The research is part of our study of patient and doctor perspectives, exploring influence, trust, confidence and concerns about healthcare both now and looking forward to 2030. We interviewed over 2,000 patients and over 200 doctors in the US and UK and a full report summarising the findings of this in-depth survey will be published on November 18th.