Strategies to Improve Injectable Biologic Hesitancy

Starting a new injectable biologic medication can be a challenging, life-changing decision for patients. Biologic prescribing and initiation are a complex process that involves a multidisciplinary approach. As patients navigate this process, an injectable biologic may be prescribed as part of their treatment plan (depending on their diagnosis and available treatment modality).

Several factors may need to be taken into consideration when starting a patient on an injectable medication. Variables such as the ability to learn how to use an injection drug-delivery device, manage injection-related adverse effects (AEs), and adhere to proper storage and disposal of injectable biologics may cause hesitancy.¹ Additional patient-dependent factors, such as a fear of needles and injection-related AEs, can make initiating and continuing on injectable treatments much less straightforward when compared to oral therapies.¹

Several factors may need to be taken into consideration when starting a patient on an injectable medication. Image Credit: © Natalia - stock.adobe.com

Community accessibility and specialized training in effective medication counseling make pharmacists a valuable resource in helping address injectable biologic hesitancy. The acronym “TEACH” summarizes strategies pharmacists can implement to manage biologic hesitancy²:

1. T – Talk about your role as a pharmacist in the biologic initiation process during your introductory meeting with the patient. Explaining your position as a specialty pharmacist and delineating your expertise in clinical management of the patient’s condition creates a good rapport and reassures the patient that you can be relied upon for ongoing support during treatment initiation and maintenance.
2. E – Enquire about the patient’s current knowledge and concerns regarding injectable medications. Through motivational interviewing, explore the patient's understanding of their expectations and fears of self-administering injections. Identify any support systems available to the patient, such as caregivers or family members, who have experience in injection administration as they may be useful in aiding the patient.
3. A – Acknowledge and affirm any patient concerns identified as part of the rapport building process. Effective listening skills allow the pharmacist to create a tailored counseling plan to address these concerns or fears.
4. C – Counsel the patient on their new treatment regimen, offer various injection training methods, and allow the patient to choose the option that best suits their learning style. Examples of injection support resources include: manufacturer offered nurse injection support programs (virtual, phone, or in-person), clinic-offered injection training, online instructional videos, virtual and phone training by injection support professionals.
5. H – Help patients overcome their fears or concerns by offering on-going support during their treatment journey. A good predictor of whether patients will stay on their biologic treatment is the depth of support offered. Periodic patient monitoring through scheduled check-in calls ensures that patients remain engaged, supported, and capable of self-administration.

Conclusion

As more injectable biologics become available for treating a variety of chronic conditions, pharmacists are poised to play an integral role in safe medication utilization. Patients are more likely to start and stay on an injectable biologic if they feel supported by their multidisciplinary care team, underscoring the importance of pharmacists partnering with patients to make injectable biologic initiation successful.

REFERENCES

1. Saraux A, Hudry C, Zinovieva E, et al. Use of auto-injector for methotrexate subcutaneous self-injections: High satisfaction level and good compliance in self-I study, a randomized, open-label, Parallel Group Study. Rheumatology and Therapy. 2018;6(1):47-60. doi:10.1007/s40744-018-0134-2

2. van den Bemt BJ, Zwikker HE, van den Ende CH. Medication adherence in patients with rheumatoid arthritis: A critical appraisal of the existing literature. Expert Review of Clinical Immunology. 2012;8(4):337-351. doi:10.1586/eci.12.23