In the early days of auto-injectors, people learned how to use their devices by practicing with the skin of an orange, according to Noble‘s research manager, Joe Reynolds.
“The rationale was ‘Well, let’s teach patients how to penetrate a skin-like membrane into a soft tissue to replicate what the human body would be like,'” he told Drug Delivery Business News.
Luckily, technology has evolved in the last four decades.
“Today the standard of care is healthcare provider in-office training with training devices – the type of solutions that we make. Then patients can use those same products at home to practice and learn that before using their actual drug delivery systems,” Reynolds said.
At Noble, Reynolds and his team consider a patient’s first 30 – 60 days of treatment as a key predictor of long-term behaviors. During this period of time, many users adopt habits that ultimately prevent them from using their medical devices correctly, he said.
“We’ve seen a few studies over the years that have found that 84% of patients with auto-injectors make mistakes and that 93% of patients with inhalers make mistakes,” Reynolds added.
Noble’s training devices are designed to help patients avoid the mistakes that can impact a therapy’s efficacy. Reynolds’ team begins by identifying user needs and factors that could influence patient onboarding. From there, they define product requirements and prioritize them to create initial designs.
“We’ll bring patients in and we’ll introduce them to our designs and concepts. Then we’ll get their feedback,” Reynolds explained. “Patient feedback is really central to our process. We like to look at patient feedback in all of our design reviews just to make sure that we’re satisfying those needs and that our products have the objectives that we’re trying to satisfy in the market.”
After hearing from their future users, Reynolds’ team gears up for mass production with the final design.
To develop an auto-injector training device, Reynolds and his group will begin by analyzing a commercial device. They examine the product down to the tiniest detail – like the Newtonian force required to remove the product’s protective cap.
One factor that is unique to an auto-injector is the time a user needs to wait before they can inject their therapy.
“That’s a key thing that we like to incorporate into our devices. Being able to mimic that and make that experience as realistic as possible is really important for patient onboarding,” Reynolds said.
Another important component of Noble’s training device is auditory or visual feedback linked to the start and the end of the injection or medication delivery process. This detail can help users feel confident that they’ve received their full dose of medicine.
Getting feedback from the training device to the user is essential, Reynolds noted, because often patients don’t know that they’re making mistakes.
“We’ve seen patients in user studies that have been on treatments for months or even years and they can’t figure out why the medication isn’t working. We’ve seen them come into focus groups and interviews and give themselves an injection or use an inhaler and the reason the medication isn’t working is that they’re making mistakes,” he said.
Beyond ensuring that a patient is using a product correctly, training devices can also help to alleviate the anxiety that patients may feel when beginning a new regimen.
“Onboarding and being prescribed a new treatment is really emotional for a lot of patients,” Reynolds said. “And those emotions can range from anxiety and fear to regrets – it’s really a broad spectrum. When those emotions are not properly supported, they can manifest into anxiety or other avoidance behaviors.”
“Some patients, we’ve found, like to practice multiple times for the first few weeks of treatments. And that’s great. It’s those first few weeks of repetition that let them build the muscle memory and the behaviors they need downstream. But we also find some patients like to practice before every injection just to refresh themselves, reduce anxiety, and make sure that they’re confident in using their device before their actual injections,” he added.
As companies are considering innovative ways to boost medication adherence and improve patient outcomes, Noble sees its technology as a major value-add.
“We like to think of our trainers as a way to really create more value for a lot of different stakeholders in the industry but for us, it all starts with the patient,” Reynolds said.