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Considering Patient Medication Administration Preferences

October 2019 | Written by Gosia Sylwestrzak, MA

The last two cold and flu seasons, my son’s pediatrician approached me about two different treatment options – a flu shot or a flu vaccine through nasal spray. I was thankful that he initiated this conversation that allowed me to make the choice that I felt was best for my child. Unlike this scenario, a 2014 HealthCore study showed that conversations about different methods of administering medications are not always happening between patients and their doctors.

Our analysis, published in the Journal of Health and Drug Benefits, studied patients with rheumatoid arthritis and Crohn’s disease, two relatively common chronic inflammatory conditions treated with anti-tumor necrosis factor, or anti-TNF medications. These patients typically have multiple treatment options for choice of drug, route of administration, and location for receiving the medication.

Patients using anti-TNF medications can choose whether they prefer to receive their infused medications at a medical facility (a hospital outpatient or physician’s office) or at home through a home infusion company. Studies have shown that there aren’t clinical outcome advantages to infusing drugs at a medical facility compared to home-based infusion [1].

Patients can also potentially choose a medication that is injectable and can be self- administered at home. This option offers flexibility and convenience, because medication can be administered during the time selected by the patient with no need for medical appointments. Self-administration also eliminates the need to travel to the physician’s office or to other facilities, which usually needs to occur during business hours, making it an attractive option for individuals who are more active, or those in the workforce.

At the time of the study, it was unclear whether patients were aware of these different treatment options, or whether they discussed them with their primary care provider. Knowledge of these options could save patients a significant amount of time and out-of-pocket expenses.

HealthCore developed and administered a survey of these patients asking about their use of anti-TNF medications, locations of administration, preferences for the infusion or self-injected therapy, interest in anti-TNF home therapy options, and their physician’s role in their decision making process.

One concerning finding was that less than half of the respondents had discussed alternative treatment options with their medical care providers. Another surprising fact was that 46 percent of patients receiving infusion medications preferred the home administration option, but only 1.5 percent of the group were using it.

Alternatively, we were happy to find that patients reported high satisfaction with anti-TNFs’ effectiveness, convenience, and lack of side effects. We also found that physicians were by far the most common source of information about anti-TNF choices and options with approximately 90 percent of patients listing their physician as one of three sources of such information.

While it’s certainly positive news that a great majority of patients were satisfied with their medications, in the current healthcare climate of offering a wide variety of treatment options to improve convenience and adherence, we hope to see increased attention to the shared decision making between physicians and their patients, including route and place of medication administration. Patients and their doctors should have these important treatment conversations.

[1] Polinski JM, Kowal MK, Gagnon M, Brennan TA, Shrank WH. Home infusion: Safe, clinically effective, patient preferred, and cost saving. Healthc (Amst). 2017 Mar;5(1-2):68-80.
Gosia Sylwestrzak, MA
Director, Econometric Modeling, Translational Research
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