Personalised patient care can empower patients to take a more active role in their treatment, and increase treatment compliance, according to a study published in Patient Preference and Adherence.
The study compared persistence between 3,573 patients prescribed intravitreal aflibercept for neovascular age-related macular degeneration (nAMD) in Australia who were enrolled in Bayer’s SmartSight support program, with 3,177 patients (a 10% sample) from the Australian Pharmaceutical Benefits Scheme dataset.
It found that after two years, people who took part in SmartSight were more likely to continue aflibercept treatment than those who did not take part (88% vs 64% p<0.05). Additionally patients participating in SmartSight felt more positive about their condition and treatment.
Understanding the barriers to treatment is critical to achieving positive patient outcomes. In Australia, persistence to anti-VEGF treatment for nAMD, a chronic condition requiring long-term treatment, declines over time, to approximately 70% after two years, 50% after five years and 40% after six years.
It is believed that improved education for doctors, clinic staff, patients and their caregivers, so that patients can be better supported in their treatment, may increase patient persistence. Further, understanding a patient’s beliefs and treatment awareness, their opinion on the necessity of treatment and their concerns, will enhance patientpractitioner communication.
Susanne Caney-Brown joined the SmartSight program in March 2020, and expressed her appreciation for the support and information it has provided.
Ms Caney-Brown was diagnosed with nAMD in 2005 at the age of 75, a year before her husband died.
“The thought of the injection is worse than the actual thing. I was very worried when I had my first one – I had a nervous reaction afterwards and was jittery, but it got better every time, and after about five injections in each eye, my eyesight was so much better.
“When they told me I would be treated with injections, I didn’t believe my vision would become so good. My hope was better than my belief – I thought if I could just find my way around, I would be happy.”
Now 91, Ms Caney-Brown has an injection in her right eye every eight weeks, and one in her left eye every nine weeks. With spectacles alone, she is able to pursue her love of reading and playing bridge, and she is back on the road driving herself to the Sydney Adventist Hospital every Monday where she volunteers to support chemotherapy patients.
Ms Caney-Brown receives regular booklets from SmartSight and a telephone call from one of the program’s nurses every month, both of which she said have been invaluable.
“I have a wonderful doctor and he is very approachable, but I never really understood why I had lost my sight. The information that SmartSight sent me explained everything so clearly, and reading about other people’s experiences was reassuring.
“Once a month, a nursing sister phones and asks me how I’m getting along and if I need anything… it is very nice to know people care about me in this situation.”
Having spoken to her ophthalmologist at length and read the experiences shared by SmartSight, Ms Caney-Brown is convinced she will need injections for the rest of her life. However, this is no longer something that concerns her.
“I was sitting in the waiting room one day and a woman said to me, ‘Oh you poor thing, you’re having injections’. And I said to her, ‘I’m not a poor thing, we should look upon those injections as a blessing and consider how lucky we are – we need to change the way we think’…. I see that woman now and she smiles at me, and I hope she has changed her way of thinking.”
Like Ms Caney-Brown, patients who participated in the study reported a high level of satisfaction with the SmartSight program, particularly valuing inbound telephone calls.
The study authors reported significant improvements in patient beliefs, declining concerns and better treatment persistence.
They recommended exploring ways to offer additional support to high risk patients (identified based on screening questions, age and distance to healthcare clinic) in an effort to increase their level of persistence. Citing studies that report 17% of patients with nAMD are not aware that their condition may result in vision loss or blindness, and that the majority hope intravitreal therapy is only required temporarily, they wrote, “Patients require appropriate counseling at the start of a course of treatment to align expectations with perceived treatment outcomes in order to improve persistence to treatment”.
Chang A, Stokes J, Priestman L, Holmes C, Said P. Impact of a Patient Support Program on Patient Beliefs About Neovascular Age-Related Macular Degeneration and Persistence to Anti-Vascular Endothelial Growth Factor Therapy. Patient Prefer Adherence. 2021;15:511-521. https://doi.org/10.2147/PPA.S293941