Patient Centricity: What Can Pharma Companies Do? Advice by Amitabha Gangopadhyay

I vividly remember a time when I had to accompany my mom to the doctor due to her fever, cough, and breathing problems. At that young age, I was unaware that her steroid medication for systemic sclerosis, a chronic illness, made her susceptible to infection. My mom and I were quite afraid of our anticipatory plight, yet we were hopeful! 

Despite providing a recommendation in the form of a prescription, we were oblivious to the severity of the situation at hand. We had no idea how to control the recurrence of her disease. We were in the same quandary as when we arrived!

- Mr. Amitabha Gangopadhyay

Consider the purpose of a medical visit.

Is it all about the diagnosis and drug recommendations? 

Undoubtedly, these are the primary objectives, but they aren’t the only ones.

The term Health ‘Care’ Provider (HCP) originates from the purpose of essential care, which includes treatment and psychological comfort through dialogue, counselling, and addressing the patient's questions and concerns.

This consideration explains the context of 'patient centricity in pharma'; and the concept extends beyond the practice model of clinicians, as it encompasses a broader perspective that determines the extent to which the entire health care system is geared up or capable of providing comprehensive support for patient welfare. It should span the value chain, from basic access to health care, infrastructure and facilities, diagnostics, and treatment to the post-procedure rehab stage.

Concepts of care, empowerment, and overall person-centred care (PCC) gained prominence in psychiatry during the 1950s and 60s. Psychoanalyst Michael Balint first coined the term "patient-centred” medicine.

Balint was the key person in spreading education to GPs on the psychodynamic factors of patients and actually challenged the so-called traditional illness-orientated model. This led to a significant shift in the role of physicians, including not only physical but also psychosocial aspects. Balint explained, “Here, in addition to trying to discover a localised illness or illnesses, the doctor also has to examine the whole person in order to form what we call an ‘overall diagnosis.’ In fact, we must understand the patient as a unique human being”.

Observing the recent trend, we know that the pharmaceutical and healthcare industries are moving towards an outcome-based approach, rather than the current product / service based approach. Our "out-of-pocket" population expects to pay for the overall 'performance'. Therefore, it is prudent to quote Yeoman & Furlong, who defined patient centricity as "putting the patient first in an open and sustained engagement of the patient to respectfully and compassionately achieve the best experience and outcome for that person and their family."

As a result, a patient-centric approach is critical in Pharma industry because...

• Patients who manage their own disease conditions, instead of blindly relying on fate, experience maximum clinical improvement. Patient centricity aids in collectively building such ownership.
• Even among sufferers of the same disease, condition, and the patients’ living environment can vary widely. An individualised approach is thus critical.
• Awareness, education, and knowledge about a condition and the purpose of its treatment create more cooperation and better compliance, leading to a better outcome.
• When patients feel listened to and truly valued, they actively participate in the treatment plan and procedural decision-making.
• Finally, patients are the only ones to receive impact of all actions in the health care chain.

Over the last decade or so, the pharma industry has contributed to this journey towards patient centricity in certain ways. However, these contributions were made indirectly through their promotional plans, collaborative ventures in terms of content, medico marketing and various digital / physical patient education programs. 

However, we understand that there is still significant work to be done!

To bring such a transformation essentially requires a paradigm shift in the philosophy underlying the business purpose.

Here’s an idea that pharmaceutical companies should consider and implement to accelerate the shift towards patient-centric benefits, especially when planning commercial investments and designing products or services. 

This transformation involves changing the focus from selling products to offering holistic outcomes, which is a combination of products and customised services tailored to a specific type of patient. This will significantly aid and empower the clinician community to advance towards implementing true patient-centric care and higher patient satisfaction. 

Otherwise, as it happened in the past, general physicians, who carry the humongous burden of poor 'ratio of doctor to patient’ in India (as of now, the ratio is 1:834, as stated by Union Health Minister Mansukh Mandaviya on February 9, 2024: ET), will be severely constrained to provide any additional effort to any patient more than just writing a prescription. This is evident when we compare it to that of any specialists, who have a much lower patient load and spend considerably more time in conversation and counselling, addressing most of the patients' agonies.

What can pharmaceutical companies provide to propel today's treatment industry toward a more patient-centric operating model?

Here, we can scrutinize the pharma value chain to pinpoint potential avenues for enhancing this crucial aspect, surpassing current practices:

Diagnostic Algorithms and Priority: 

Proposing diagnostics that are willingly agreed upon by patients or the caregiving family is a lifelong clinical challenge. This happens due to two critical factors:

1. Poor health-related knowledge of patients or family members. 

2. The want of valid and lucid explanations of the importance of the suggested diagnostics. 

Med-science recommends two theories for determining diagnosis (the threshold approach and the hypothetico-deductive model) that are complex and not feasible in general practice. [6] Ultimately, it all boils down to providing a clear explanation and engaging in a thorough dialogue with patients or their families. 

Pharma companies can help to overcome such a time challenge for the HCPs by developing AI-driven customised demonstrative experience tools for patients so that they understand and realise the purpose and the need for any specific diagnostic, yet spare the HCPs’ time.

Formulation: 

So far, pharma companies have introduced various kinds of formulations, e.g., time-release, mouth-dissolving, melts, gummy, and many others. Most of them, however, serve more as patient-preference enhancers than addressing any special population or specific need group. 

Patients, R&D experts, clinicians, health authorities, and industry experts need to collaborate to design patient-centric formulations. They prioritise patient needs, evaluate the criticality of medication, the significance of the proposed NDDS, and regulatory procedures. Furthermore, the assessment of patients' phenotype and genotype variants is emerging as a well-known personalisation approach. 

Pharma should consider developing prudent formulations that meet the needs of "old, frail, multimorbid, the long-term cancer survivor, and the cognitively impaired (dementia)." Similar to the paediatric population, these special elderly patient populations will differ from the traditional adult population, e.g., with respect to their clinical presentation and physical, physiological, or psychological patterns." 

For India, given the size of the population, it's not unusual to believe that the number of elderly patients will be sufficient as to undermine the business viability of such special formulations.

Packaging:

 “The world’s population is living longer and growing older... While India has the highest number of young people, ageing is rapidly progressing. By 2050, we expect the current elderly population of 153 million (aged 60 and above) to reach a staggering 347 million. This demographic shift is not merely a statistic; it's a societal transformation of unparalleled magnitude with far-reaching implications.” 

 For such an ageing population, the biggest challenge is compliance with therapy, and that leads to a poorer therapeutic outcome. Quite often it’s a practical issue of self-administration due to lack support and complex drug packaging. 

Similar to the use of special formulations, implementing patient-centric solutions through technological innovation in packaging can significantly improve outcomes. Consider "ergonomic packaging, smart packaging systems, and human-factor engineering." It also highlights the potential benefits for other patient populations.” 

Building Awareness and Understanding in Patients, Carers, and Cohabitees; Patient Counselling for Treatment Initiation and Compliance:

Numerous studies in the past concluded that the critical prerequisite of any treatment success is awareness, understanding, and acceptance of the treatment regimen, along with actually practicing compliance.

The carer and co-habitee provide an ecosystem for the patient to sustain and recuperate. Knowledge, cooperative understanding, hygiene practices, and mutual belief build such a favourable ecosystem.

A structured education system fosters a positive mindset and trust in therapy. Patient education and awareness (therapeutic) requires an individual-centred learning process, especially for chronic conditions. The goal is to instil essential knowledge and understanding that empowers patients to manage the condition independently, following prescribed medications, lifestyle modification, and practices. 

Trained health professionals impart this knowledge, and it persists throughout the patient's lifetime. It is crucial for health policymakers and professionals to incorporate prudent content and technique into the education of disease-management protocols. Such protocols state what way, how much, and when to impart effective therapeutic patient education.

Pharma companies should invest significantly to enable HCPs to communicate and educate better at an individualized level, following their own style by providing:

1. Rich, AI-driven, technically sound, customisable content that imparts knowledge about diseases, therapeutic purposes, and lifestyle modification.

2. Digital tools that assess the exact requirements of understanding and behavioural modification in various therapy areas (education strategy and selection of the appropriate module)

3. Offering low-cost, patient-friendly knowledge tools that don't rely on the internet.

4. Offering subsidised authentic teaching demo sessions.

5. Broadcasting podcasts or webinars that facilitate patient-to-patient conversations.

6. Providing display tools for therapy camps that include printed materials, catering to a deeper market with limited access.

Finally, the industry should consider developing skill-up sessions for HCPs with experts, psychologists, and counselling authorities, as well as introducing certifications on patient management acumen. This will enhance HCPs’ skills to manage various psychological types of patients, including their resistance to therapy, inhibitions, queries, and worries.

Treatment Approach 

Finally, all the factors discussed so far regarding a holistic patient-centric approach is supposed to culminate into one prescription strategy with multiple considerations through the lens of a particular patient as an individual. It entails...

1. An empathetic, but thorough physical examination

2. While prescribing, choosing medications, diagnostics, or procedures that are appropriate for the patient's condition, taking into account their ethnicity, physical characteristics, and mental state, as well as their preferred formulation, availability, and affordability.

3. A friendly information exchange, whether through a traditional print or an advanced digital tool/app, should be just adequate, non-frightening, and reassuring.

Conclusion

Thus, to create an in-depth understanding of the disease, emphasize a therapy plan with easy-to-understand data on the "chance of success," and finally, schedule medication, diet, lifestyle modification, and other instructions.

Pharmaceutical companies can now play a pivotal role in accelerating the patient-centric approach by the medical fraternity. Pharmaceutical companies must foster advanced collaboration to create highly relevant tech-driven content for education resources aimed at medics and paramedics. They should facilitate the development of newer treatment with ‘procedural algorithms’ to align outcome goals with patients' needs. Moreover, pharma companies can empower HCPs through key project initiatives to support patient-centric innovative practices and deliver more personalised, effective, and compassionate care, ultimately enhancing patient outcome and wellbeing.

References

[1] PLosS1. 2020;15(3):e0229923. NIH National Library of Medicine

[2] PLosS1. 2020;15(3):e0229923. NIH National Library of Medicine

[3] Balint M. The possibilities of patient-centred medicine. The Brit Journ of Gen Pract. 1968; 17(82): 269–276.

[4] G. Yeoman, P. Furlong, M. Seres, H. Binder, H. Chung, V. Garzya, R.R. Jones, Defining patient centricity with patients for patients and caregivers: a collaborative endeavour, BMJ Innov. 3 (2017) 76–83. https://doi.org/10.1136/bmjinnov-2016-000157.

[5] Doctor-population ratio in country stands at 1:834, Mansukh Mandaviya tells Lok Sabha , ET 09.02.2024

[6] Solving the Diagnostic Challenge: A Patient-Centered Approach; ANNALS OF FAMILY MEDICINE ✦ WWW.ANNFAMMED.ORG ✦ VOL. 16, NO. 4 ✦ JULY/AUGUST 2018

[7]Defining Patient Centric Pharmaceutical Drug Product Design; https://d-nb.info/1104044897/34#:~:text=Patient%20centric%20pharmaceutical%20drug%20product%20design%20•%20The%20process%20of,that%20target%20patient%20population%20over 

[8] UNFPA Report: https://india.unfpa.org/en/news/indias-ageing-population-why-it-matters-more-ever#:~:text=The%20current%20elderly%20population%20of,a%20complex%20and%20intricate%20issue. 

[9] Roechling Whitepaper: https://www.roechling.com/fileadmin/downloads/Roechling_Medical/Brochures/EN/Roechling-Medical-Patient-Centric-Design-Whitepaper.pdf