Abstract
PurposeTo develop a model for systematic introduction and to test the feasibility in a chronic disease population. We also investigated how the approach was received by the patients.Methods and resultsThe systematic introduction approach is a seven-step procedure: step 1, define a few main criteria; step 2, primary scan patients with the one or two main criteria using computerized medical records/databases/clinical registries; step 3, identify patients applying the other predefined criteria; step 4, evaluate if any examinations/laboratory test updates are required; step 5, summon identified patients to the clinic with an information letter; step 6, discuss treatment with the patient and prescribe if appropriate; and step 7, follow up on initiated therapy and evaluate the applied process. The model was tested in a case study during introduction of the new drug sacubitril-valsartan in a heart failure population. In total, 76 out of 1924 patients were identified to be eligible for sacubitril-valsartan and summoned to the clinic to discuss treatment. Patient experiences with the approach were investigated in an interview study with general inductive approach using qualitative content analysis. This resulted in three final categories: a good approach, role of the information letter, and trust in care.ConclusionsThe systematic introduction approach ensures that strict criteria are used in the selection process and that a treatment can be implemented in eligible patients within a specified population with limited resources and time. The model was effective in our case study and maintained the patient’s confidence in healthcare.
Highlights
When novel treatments prove to be more effective than conventional therapies, there is a challenge on how the novel treatment should be introduced
The model of systematic introduction approach was able to identify patients eligible for sacubitril-valsartan in a heart failure population, and the patients were overall satisfied with the approach
Our case study with sacubitrilvalsartan shows that it is possible to introduce a novel therapy to a majority of eligible patients in a specified population with
Summary
When novel treatments prove to be more effective than conventional therapies, there is a challenge on how the novel treatment should be introduced. Effective implementation is especially important for patients with chronic diseases who may be treated both in primary care and/or specialist clinics. Patients with chronic diseases depend on their physician’s knowledge and interest in trying the new therapy, and there may be a long passive waiting period, which is referred to as clinical inertia [1]. Local databases and clinical registries to identify eligible patients would potentially maximize cost-effectiveness and assure that strict criteria are applied to identify eligible patients within a hospital district. Using strict objective criteria would help to reduce structural inconsistencies in treatment. Previous studies have shown that older patients and women often receive less evidence-based therapies and patients with moderate renal impairment are less likely to be prescribed guideline-recommended medications
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