I.4B Human Factors Engineering to Address Adherence for Life Saving Medications
Many patients, including several children and adolescents, need to carry life-saving medications, like an Epi pen or an Albuterol inhaler, with them at all times. The applicators for these medications are awkward to carry and therefore are oftentimes forgotten at home. As an Emergency Medicine physician, I often see patients in the ER who are in extremis because they were unable to self-administer their prescribed life-saving medications early on in their symptom course, mainly because they did not have the medications on hand when they were actually needed. We need a way to increase medication adherence for life savings medications.
There are two thematic opportunities students may consider addressing in this project centered on adherence to two medications: albuterol and epinephrine. This project will allow the design team to select which opportunity to be pursued per the interests of the team.
Currently, Albuterol is often prescribed in a metered dose inhaler (MDI). These are handheld pressurized inhalation systems that deliver small, precisely measured therapeutic doses of medication directly to the airways of a patient. MDIs treat health conditions such as asthma and chronic obstructive pulmonary disease and are approved by the Food and Drug Administration (FDA). An estimated 144 million HFC MDIs (122 million HFC-134a MDIs and 22 million HFC-227ea MDIs) were sold in the United States in 2020, which accounts for both MDI products manufactured in the United States and MDIs imported from the EU and Asia.
Epinephrine is often prescribed in a pen. It is a life-saving medication used when someone is experiencing a severe allergic reaction, known as anaphylaxis. EpiPen is just one of the brand names of devices known generically as Epinephrine Auto-Injectors. This medication acts on the whole body to block the progression of the allergic response. It constricts the blood vessels, leading to increased blood pressure, and decreased swelling. This allows the muscles around the airways to relax, causing the lungs to open. Epinephrine also prevents the release of more allergic chemicals, which stops the progression of the allergic response. Epinephrine is the only medication that works on the entire body, multi-system, multi-organ, for anaphylaxis, which is why it is the only drug recommended. There are approximately 2 million prescriptions for Epinephrine each year, with more than 20 million patients experiencing an allergic reaction and hundreds of thousands of patients seeking emergency care.
The biggest limitation I see with these life-saving medications is not the effectiveness of the medication or delivery system itself, it’s that patients often do not have the device with them when an emergency occurs. Particular circumstances that are common include, children at school and the device is at home (or in their backpack in a classroom when they are at recess) or an adult who is traveling and they forget it at home (or just out for the day and they don’t put it in their pocket).
Patients with asthma account for 11 million visits to a doctor’s office, 1.3 million emergency room visits, and 439,000 hospitalizations annually. Asthma is the most common chronic illness in childhood, accounting for 13.8 million missed school days each year. It also accounts for 14.2 million lost work days for adults. The estimated economic cost of asthma is $56 billion annually. Early intervention of symptoms could prevent this cascade of events which would improve patient outcomes and overall burden on the healthcare system.
Thirty-two million Americans have food allergies (1/10 adults and 1/13 children). Every three minutes, a food allergy reaction sends someone to the emergency room (200,000 patients annually). Pediatric hospitalizations for food allergy tripled between the late 1990s and the mid-2000s, with an average of 9,500 children receiving in-patient hospital care for food allergies each year. More than 40 percent of children with food allergies have experienced a severe allergic reaction such as anaphylaxis. Early intervention of symptoms would ensure that the increasing number of patients (particularly children) with food allergies would not experience a poor outcome and would decrease the overall burden on the healthcare system.