Charting patient pathways with precision for better healthcare

You need patience, persistence and a sharp eye for detail to place and synchronise all the moving parts in a Swiss watch. Making a healthcare system tick requires those qualities and more as many of the parts don’t mesh together, are fitted at different times and operate across a crowded spectrum.

Somewhere in that frenetic, whirring mechanism is the patient, often caught in the teeth of poor design and delivery, and forced to mark time before getting the right treatment.

Recalibrating healthcare is an engineering Everest but the process of mapping patient pathways is creating new opportunities for HCPs and industry to reframe how care is conceived and received with the patient as the pivotal component.

By using every last detail from patient experiences at every touchpoint on their journey, pathways can be shaped with clear, consecutive steps of action that will have a greater chance of delivering better outcomes.

The hope is that the approach will tap into a goldmine of insights that will prevent different elements of care grinding against each other like tectonic plates. The result should be more effective care for all patients that can be flexed to overcome local and cultural barriers as well as system bottlenecks.

“I think there is genuine excitement about what can be achieved,” said Stephen Jowett, Director, Healthcare Consulting UK & Ireland Healthcare at IQVIA, a leading data, technology and advanced analytics company. “People realise that care pathways are made up of lots of component parts and there is a real desire to handle them in a more integrated fashion and consolidate them around how care might be able to be managed more efficiently.

“Patient feedback is an imperative for this to work. If we can solicit feedback from the relevant part of the patient pathway, pull that together and analyse it in a holistic way, then we can start to build pathways that are more patient-centric.

“But that feedback data has to be collected in a way that [enables] you to do something with it and that people are comfortable with. We also have to develop a clear understanding of the best way of using that information to deliver care that will really benefit patients. And that is where technology comes in.”

Investing upstream

Advances in digital technologies have created new tools and processes to connect HCPs and patients, monitor conditions and generate insightful data. The government recently pledged £2.1bn for NHS digital transformation that should see greater connectivity and tools that can monitor health conditions with greater clarity.

But harnessing the technology and driving change across large healthcare systems is a difficult task.

“I don’t think we’ve cracked this yet and we need to do more to bring together digital therapeutics and interventions like social prescribing to really make a difference to people’s lives and to population health management,” added Jowett.

“Patient pathways don’t start when you enter a hospital or clinic or end when you are discharged, so it is about understanding the entire journey and what got them there in the first place, as well as how they move through the system. Can we look to the third sector, social care and other adjacent industries and organisations, to be a part of this, because what is often overlooked is that this is a health and social care system.”

He sees the advent of integrated care systems in the NHS adding extra potency to mapping patient pathways and wants it underpinned by investment focused more on preventative measures to move the needle on outcomes.

“We are making some inroads and I think investing upstream before people become patients, or patients with greater morbidity, will really unlock a lot of the innovation that can deliver more equitable care pathways, something our teams are working on extensively” he said. “Ultimately, we need a more collaborative culture that uses the information and evidence at hand to enable local healthcare systems to learn and take action.

“It’s a hard challenge but there are a lot of ways to improve population health and patient outcomes when you add up all the opportunities across all touchpoints of a person’s care journey.”

Patients shaping the future

David Williams, VISFO’s Chief Medical Officer whose 30 years of industry experience includes strategic roles in major pharma companies, commented: “An aspect of mapping patient pathways that really interests us is how we can empower those with conditions to have more choice in how their care is handled and how they can have better interactions, in person or virtually.

“It will help them take more ownership of the parameters of their care. If we empower someone with the right level of information, can they have fuller discussions that lead to better decisions?

One of the biggest challenges in healthcare is compliance, which is poor across a lot of conditions. In asthma it is down at around 50% and even in oncology the compliance figures are shocking.

“But if people are better equipped to understand and are more involved, they will be more able and willing to adhere, which will, of course, reduce waste in the system.”

VISFO specialises in generating insights from granular patient data and experiences to transform care and Williams believes examining every aspect of patient experience can release a wealth of transformative data.

“I don’t like the term patient, I prefer people with conditions because they live with it all the time, while the healthcare system sees them during an episode of care or once every few months,” he added. “We have to find and use what they experience every day to shape future care. If you only look at the system, you will only ask questions that relate to experiences inside the system rather than the questions about how they want to manage their health.

“The more people are engaged in their health, the better they will look after themselves, in theory.”

The hope is that mapping patient pathways will lead to more efficient use of clinical time and resources, as well as nudging people towards greater responsibility for their health.

“If you’re truly going to impact the patient’s outcome, you need to have these layers of thinking in place otherwise it creates a dependency on the hospital telling the patient what to do,” said Williams.

A need to look deeper

Scarce resources may be the biggest barrier to implementing effective and efficient pathways, he feels, but mobile technology should reduce some of the cost burden while bringing clinicians and patients closer during diagnosis, prescribing and monitoring.

“Giving people the opportunity to have a greater say in healthcare will help commissioners plan and adjust provision at a local level and across different age and societal groups – patient pathways will look different for different individuals and groups.

“There are models or pathways of care out there that show how this can work. Take diabetics using a constant glucose monitor, for instance. They and their clinicians can keep track of the metrics, see each other less frequently and, generally speaking, they can improve their health because they are more involved in it.”

Last month’s Patients as Partners Europe Conference examined the potency of patient experiences and Su Smith, Director of Origins Insights, recalls: “There was a really interesting quote from the conference reminding people that medicines are there to improve someone’s life not just to prove a clinical endpoint.

“More and more companies are looking at the emotional side of patients’ needs and what they’re experiencing but we shouldn’t fall into the trap of assuming that everyone has the same experience. We also need to look at subgroups of the population to understand how their emotions and needs throughout that journey might differ.

“When I entered the industry 15 years ago, people started patient journey maps by asking a clinician what the patient journey was. Now, people have a better understanding that, if you want to understand the patient experience, you should probably talk to a patient rather than solely a clinician.”

Leap of faith

Smith, who is passionate about the transformative potential of patients’ real-world experiences, believes mapping patient pathways can lead to significant advances in diversity and equitable access.

“It can also bring extra value whether you are a patient, healthcare professional or a pharma company,” she said. “It does take a leap of faith for a company to change its approach and concentrate on more holistic and diverse methods but when people see the value, others will follow. The conference demonstrated that the needle has started to move on this.

“We will see faster progress in areas such as CAR-T and gene therapies because these are personalised medicines and the patient is going to have as much of a decision-making stake in their own health as the physician. It is also key to think about caregivers separately from patients and physicians as, in some conditions, they are as impacted as the person with the condition themselves and their insights can be valuable.”

Technology will be the fuel of change but Smith cautions that many people do not have access to laptops, smartphones and tablets and that some groups do not respond to mainstream communication channels.

“It’s about finding the right tools for different populations of patients as the same tool won’t necessarily resonate with all,” said Smith. “Advocating for patients is what drives us as a company and it’s good to see that industry is waking up to the fact that getting the fundamentals right can have a positive impact on everything else.

“The message for industry is clear: if you don’t look at having more patient inputs and delivering based on that then someone else will step in and do it. You may not feel the impact right now but over time it will be to your detriment.”

Provide patient choices

Alison Dunlop, Senior Director, Patient Advocacy at ENGINE MHP, says patient experiences are at the heart of initiatives to improve the quality of care.

“The challenge when you’re mapping or implementing any services to support patients is that decisions tend to be made based on the broader population. The under-represented and diverse groups, and the way they engage with information, is often not considered. We must make sure the patients, and those who cannot engage with digital services, are not left behind.

“Whether it’s a pathway, a particular approach, a tool or service, to be truly patient-centric you have to provide the patient with choices. What may be the right approach for one patient may not work for another but if you don’t engage with the whole patient population, you won’t achieve optimum care. It is about choice at every stage.”

ENGINE MHP recently launched a Patient Voice Panel in collaboration with the Patients’ Association and feedback highlighted disparity in the quality and breadth of services offered on treatment pathways.

Patients and physicians are stronger together and Dunlop, who has more than 20 years’ experience leading patient advocacy programmes and engagement strategies for clients such as AstraZeneca, GSK, Novartis and Pfizer, added: “HCPs or patient groups cannot do it on their own and that is where industry can play a vital role, providing resources and its own insights.

“Patients are at the heart of transforming pharma brands and they need to understand that these insights will enable companies to design and deliver drugs, approaches, support services and treatments that are effective in engaging the patient and creating the best outcomes for them.”

Engage early and often

She identifies the company’s collaboration with AstraZeneca’s Patient Affairs oncology team to encourage people to return to cancer services following the worst waves of the pandemic as an example of patient voices helping to generate improved outcomes.

“People were naturally reluctant to go to hospitals during COVID-19 and many oncology treatments and services were paused, so we worked with patient groups to identify key concerns and how to address them,” added Dunlop. “We developed a creative campaign based on what they told us, then supported the patient groups with rolling out materials in their local markets.

“The campaign was effective because it was driven by patient insight and it has been used in 68 territories to encourage people to get diagnosed and return to oncology services and care.

“Engaging people with their health as early as possible is a significant factor in preventative care and in helping to address the huge financial impact on the NHS of an ageing population living with chronic conditions.

“By deploying patient insights, we can support healthcare professionals in mapping pathways that work for all patients, delivering the best possible outcomes and sustainable healthcare systems for the future.”