Hi Typhaine! You are one of the Ramsay Santé caregivers nominating a project to the Innovation Award 2022. Where do you work?
I am an intern in hospital pharmacy and parts of my internship take place at the Hôpital Privé Les Bonnettes in Arras, where I set up this project. I did it together with my mentor pharmacist Agnès Berneron, two other pharmacists, and four gastroenterologists who contributed with their opinion on the information materials and the conduct of the interviews. It’s been teamwork!
What is the idea of your project? How did you come to think of it?
Chronic Inflammatory Bowel Diseases (CIBD) are chronic diseases and their management must tend towards supporting the patient in being the actor of her/his disease. To support them the best we can, we use a multidisciplinary approach. The hospital pharmacists are a part of this team, and one tool we can bring to the table is the pharmaceutical interview. It provides personalized information to optimize the patient's therapeutic management and makes them autonomous with their treatment. The main objective is to ensure the link between the hospital and the city and to guarantee the follow-up of our chronic patients.
The standard biotherapy for CIBD has until recently been by intravenous infusion. This means giving the medication directly into the veins and thus it needs to take place in the hospital. However, subcutaneous infliximab (Remsima® SC) is a new treatment, available in pen form, just like insulin. Remsima is administered into the subcutaneous fat tissue once every two weeks and can be given at home by the patient or a nurse. Following the marketing authorization of Remsima, we all had the idea of working together in making the switch decision well-founded for all the patients.
Those whose disease was considered active and unstable, or were considered to have predictive criteria for non-compliance, were excluded. All other patients were offered the switch. After the consent of a pharmaceutical interview was obtained, a questionnaire was completed by the patient before the individual interview to assess his or her motivation or reluctance to switch and to transmit various information on the treatment. The interview was performed by a pharmacy intern and covered the following topics:
· efficacy and tolerance
· storage and administration procedures
· what to do in the event of forgetfulness or adverse effects
An information booklet was given to the patient. If the switch was made and the patient consented, the patient's pharmacist was also informed, by the information booklet. A second interview was offered to undecided patients.
We accompany the patients both in their decision (agreement or refusal) and in the implementation of the switch to the subcutaneous route. If a switch is made, the patients pick up their treatment from a town pharmacy, and then they give the injection themselves or ask a nurse to give it. Some patients have had subcutaneous medications in other situations and already know the drill, some want to learn from a nurse a few times and then do it themselves. Some want the nurse to keep doing it.
What have you learned?
We got these results from the interviews that were performed between June and September 2021: 36 patients were included. Their mean age was 42 years and they had been on intravenous treatment on average for about seven years. Prior to the interview, 26/36 had accepted the switch after a consultation with their doctor. Their reasons for doing so were primarily time-saving or freedom to choose the day or time of day to perform the injection. After the interview, all of them remained in favor of the switch. After interviews, three more patients accepted the switch which means approximately 30% of the hesitant patients.
We are also carrying out a satisfaction survey with 12 pharmacies to find out whether the information provided was useful and whether they would like this type of exchange to continue.
So we have learned a lot of things, from a rather quick intervention. The average duration of an interview was 23 minutes…
What did the patients say?
Some patients refused the interview because they did not want this treatment. It could be fear of "shots" or simply wanting to have their treatment in the hospital. But the majority of them were satisfied and appreciated the interviews - even those who did not accept the subcutaneous form appreciated the interview! They were happy about the support. The interview is an opportunity to ask questions specific to the treatment where we take the time to explain the treatment methods to them and to discuss their possible reservations and questions. We also show them how to carry out self-administration.
I think that the interviews will be done in the same way in the future. The patient questionnaires and the information will be standardized, but the aim of the individual interviews is to adapt to each patient, to what is important to him or her. For example, for some patients, the main issue was the management of the treatment when traveling (maintaining the cold chain, supplying the treatment...). For others it was the fear of forgetting an injection, so we are trying to find tools and advice to overcome this and not impact their daily life too much with this new treatment.
There are plenty of patients treated with medications with different routes of administration, and sometimes we propose a switch to a biosimilar treatment with better acceptability. We consider applying the same principle of interview for patients treated with other biotherapies when we propose a switch to a subcutaneous form or to a biosimilar treatment, for better acceptability.
What is your greatest pride in this?
The multidisciplinary support and the personalized information! Giving them the choice of treatment according to what suits each patient best (lifestyle, etc.). This makes it possible to optimize patient care and that makes me really proud.