A Rare Specialty Pharmacy’s Quick Response to Customized Patient Education Using QR Codes

In the outpatient setting, pharmacists are often the last point of contact before patients receive treatment. This interaction is a critical point in which pharmacists can intervene to provide comprehensive counseling to promote positive outcomes for those prescribed complex therapies.

It is important for the information given, whether written or verbal, to not only be comprehensive and understandable, but also be available for patients to reference when needed. Overloading patients and caregivers with this education upfront can be overwhelming and studies show that patients remember less than one-fifth of the information they were counseled on.¹

As a mail order pharmacy specializing in rare diseases, conveying such detailed directions via telephone, texted links, or on printed documents helps address some of these educational barriers, but there is room for improvement. The inability to provide in-person counseling remains an ever-present obstacle for specialty and rare disease pharmacies.

Although PANTHERx Rare Pharmacy leverages virtual counseling to meet the needs of those we serve, the counseling is not always readily available when the patient needs it most. As a result, PANTHERx has taken the opportunity to re-think how information can be available in a timely and meaningful way to patients. We aim to close this gap by delivering vital clinical information in a meaningful way that is not only easier to digest but available to patients when they want to receive it.

PANTHERx Rare Pharmacy has launched a new initiative using existing technology to supply customized educational materials that are available digitally to patients and caregivers. The initiative stemmed from the need to provide timely education surrounding the unique administration of a pediatric neurology medication.

Traditionally, these patients begin therapy with a complex titration with these instructions conveyed over the phone by a licensed pharmacist. For this specific pediatric population, a link to an instructional video outlining the medication admixture process was previously distributed to their caregivers via a singular handout and a text message at the beginning of therapy.

The shortcomings for these delivery methods revelaed that many caregivers were unaware of the video’s availability for a variety of reasons, such as patients may not have been enrolled in texting to receive the link, the initial handout containing the link was misplaced and not provided in subsequent shipments, or patients overlooked the information upon receiving it. Although these methods are considered adequate, they have significant limitations with information recall or consumers misplacing the mailed or electronic document containing this information.

Emerging from the pandemic, companies are continuing to use contactless methods as a means of conducting business. The impacts of COVID-19 can be felt across all industries, but technology has assisted us through the pandemic and helped the world reimagine effective means of communication. Originally developed in 1994 for keeping track of inventory for car manufacturing, Quick Response (QR) codes have reemerged during the pandemic and have proven their worth.²

A QR code is a 2-D barcode that can perform a multitude of tasks—from housing restaurant menus and boarding passes to sharing electronic business cards or streamlining payments.³

With the use of a QR decoder, the code can be translated into almost any piece of information. Fortunately, QR decoders are not hard to obtain and use, as most people have one in the palm of their hand: a smartphone.

As of 2021, 85% of American adults use smart phones, accounting for more than 294 million smart phone users in the United States.⁴ With the evolution of handheld technology, the need to use a computer to access the internet is decreasing.

Approximately 47% of all web traffic in the United States currently originates from smart phones or mobile devices, with an increase over time, which highlights the growing preference for convenience and accessibility.⁴

Scanning a QR code takes a matter of seconds and can provide the end user with a plethora of information. The simplicity and adaptability make QR codes an invaluable tool, and the data support that with a 110% increase in daily use in 2020 compared to 2019.⁵

The utilization of QR codes spans a wide variety of industries, including health care. QR codes are currently used in various health care settings, such as in hospitals for patient verification, but more recently for health care-related education.

“Just-in-time" learning is a concept that revolves around quickly providing information to the user at a time when it is specifically needed. In hospitals, QR codes are being used to house guidelines or video instructions for how to properly operate a certain piece of equipment.

This process not only cuts down on the time required to track down a particular resource or waiting for a facilitator to demonstrate, but the QR codes can be continually updated with the most current information in a matter of minutes. The response from health care providers on the QR code application was overwhelmingly positive.⁶

With the success and ease of implementing this process, the use of QR codes in health care should be integrated outside of the hospital setting and should not be limited to health care providers. QR codes have yet to be routinely utilized in conveying the frequently overwhelming amounts of patient or caregiver education materials that accompany prescription medications. The ability to provide extensive patient or caregiver education via a QR code on a label transforms how we deliver patient education materials in the future and eliminate barriers to understanding and readily accessing health care information.

Patient recollection of pharmacologic and lifestyle treatment information is an important factor in patient encounters and more specifically chronic disease management. In a study examining patient recall among those with chronic diseases, it was found that less than half of the patients were able to correctly recall the name of the medication discussed.

On average, patients recalled less than one topic per visit, which in addition to medication name, included instructions, adverse effects (AEs), main effects, adherence, and attitude toward medications.⁷

The rare disease population faces many of the same barriers to quality care just like the chronic disease population. Having drug information and education materials as readily available in a dynamic format could improve patient understanding and result in improved health outcomes.

Based on all the information discussed above, PANTHERx initiated a program to attach a customized QR code to patients’ prescription labels for every fill of the medication. Although third party organizations may be available to do this for your pharmacy, this service may also be done internally to meet the specific needs of the patients you serve.

The following presents a case study with a specific rare disease population. Pharmacy personnel processing the new or refilled prescription alerts the caregiver to the QR code and educates them on its purpose and instructions for use. After receipt of the medication shipment, patients or caregivers use their smartphone to scan the QR code and view enhanced information through a PANTHERx resource.

The video created encompasses the mixing and administration of the oral solution with step-by-step instructions, available in both English and Spanish. The content of the QR code can address multiple areas of medication management.

These can include administration videos, AE management recommendations, and proper medication disposal. Through this new delivery method, we are promoting continuity of care by allowing patients or caregivers to access educational information when they need it most.

The goal of this initiative is to improve patient outcomes by providing patients with the tools they need on their own terms. The evolution of this program will rely on the data being captured as well as the advancements in technology. This initiative will continue to be launched for other programs at PANTHERx Rare Pharmacy.

The ultimate goal is to provide patients with QR codes that are tailored to meet their unique treatment journey needs allowing for the application of different QR codes—even if it is for the same medication. The ability to use patient specific data to customize individualized education serves as a platform to improve patient outcomes and enhance quality of life for those living with rare diseases.

References:

1. Richard C, Glaser E, Lussier MT. Communication and patient participation influencing patient recall of treatment discussions. Health Expect 2017;20(4):760-70.
2. QR Code development story, Technologies, DENSO WAVE. 2022. QR Code development story｜Technologies｜DENSO WAVE. [online] Available at: <https://www.denso-wave.com/en/technology/vol1.html> [Accessed 4 August 2022].
3. Nyu.edu. 2022. [online] Available at: <https://www.nyu.edu/content/dam/nyu/studentAffairs/images/Explained/qr_code.pdf> [Accessed 4 August 2022].
4. U.S. Smartphone Industry Statistics [2022]: Facts, Growth, Trends, And Forecasts – Zippia. Zippia.com. https://www.zippia.com/advice/us-smartphone-industry-statistics/. Accessed August 4, 2022.
5. Timmons J. The Massive List of Use Cases for QR Codes in Healthcare — Etactics. Etactics | Revenue Cycle Software. https://etactics.com/blog/qr-codes-in-healthcare. Accessed August 4, 2022.
6. Karia CT, Hughes A, Carr S. Uses of quick response codes in healthcare education: a scoping review. BMC Med Educ 2019;19(1):456.
7. Yeung, Denise L et al. Low-health literacy flashcards & mobile video reinforcement to improve medication adherence in patients on oral diabetes, heart failure, and hypertension medications: JAPhA 2017;57(1):30-3.