Customer discovery reveals why patients do not carry their epinephrine autoinjectors
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Key takeaways:
- Users most often carried autoinjectors in diaper bags, backpacks and fanny packs.
- None of the customers said they would return home if they forgot their autoinjector when going out.
ANAHEIM, Calif. — Inconvenience and forgetfulness are among the reasons why people do not always carry their epinephrine autoinjectors, according to a poster at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.
“Only about 40% of the highest-risk patients will actually carry their epinephrine,” Sabine Eid, MD, a second-year fellow in the allergy and immunology section at Children’s Hospital Colorado, told Healio.
Previous studies also have indicated that patients with allergies fail to carry epinephrine autoinjectors due to perceived abilities to avoid allergens and complacency with their diagnoses, as well as cost, availability and expiration dates.
“Our objective was to employ a customer discovery methodology to identify barriers to epinephrine autoinjector carriage and then understand the needs related to that,” Eid said.
Eid participated in a 6-week National Science Foundation Innovation Corps program designed to use customer discovery to commercialize academic research.
Customer discovery begins with a business model canvas, which comprises a hypothesis, a value proposition and identification of customer segments. Next, investigators interview potential customers. Based on those interviews, the investigators revise their business model canvas.
When it comes to epinephrine autoinjectors, Eid said, customers include patients, parents and caregivers, teachers, primary care doctors, allergists, pharmacists and hospital staff.
“It’s everybody that comes into contact with the product,” Eid said.
Eid and her colleagues interviewed 30 customers categorized into four groups.
Group 1 (n = 17) included patients, parents, significant others, babysitters, teachers and coaches. Group 2 (n = 10) included allergists, pediatricians, registered nurses, pharmacists and school registered nurses.
Group 3 was a single customer who worked at an airport for the Transportation Security Administration. Group 4 included two customers who manufactured and sold products on Etsy designed to help people carry their autoinjectors.
The interviews offered multiple insights about who carries epinephrine, Eid said.
“Young children rely on their caregivers, obviously, and then caregivers modify how they’re carrying their epinephrine based on the developmental age of the child,” Eid said.
However, these caregivers have not really considered how they will carry the autoinjector once their child has gotten older.
“Once they’re no longer in diapers, and no longer have a diaper bag, those caregivers have not thought about what they’re going to do,” Eid said.
These caregivers also have not considered what they will do when they are no longer with their child all the time, Eid continued, such as when the child goes off to daycare or school.
Carriage methods included diaper bags (30%), lunch boxes (11%), fanny packs (20%) and backpacks (20%).
Customers who used lunch boxes were concerned about temperature control, such as when they were outdoors, Eid said, adding that fanny packs were popular with adolescents and backpacks were popular among college students.
Also, 100% of the customers said that they would not return home if they had forgotten their epinephrine.
“They have figured out their own strategies to avoid allergic reactions and then also justify why they don’t need it,” Eid said.
For example, Eid explained, customers would decide that they simply would not eat anything whenever they forgot their epinephrine, or they would intentionally leave the epinephrine at home if they have no plans to eat while they are out.
Complacency with their diagnosis plays a big role here too, Eid continued.
“How long ago was your last reaction? How long ago did you need to use your epinephrine?” she said. “Some of our interviewees shared with us that it had been so long, their priorities had changed.”
Some customers may be more focused on taking care of their young children than of themselves, Eid suggested.
“Out of sight, out of mind,” Eid said, “especially if they haven’t encountered an allergen in a long time.”
All the interviewees said that thinking about anaphylaxis was distressing as well, Eid said.
“It’s something that teenagers are bullied about. It somehow impacts their everyday life,” she said.
Adolescents and college students among the customers both said that even their friends tease them about their allergies instead of being supportive, Eid said. But while this had a big impact on quality of life for teenagers, she continued, the college students seemed better able to manage this teasing.
Education is problematic too, Eid said.
“Primary care providers? They defer to the pharmacist. Pharmacists report not having time to educate. And then allergists provide some education, but defer to the allergy nurses, primarily,” she said.
One of the primary care providers said that epinephrine autoinjector package inserts include a lot of information, Eid said.
“They do have a lot of information,” she agreed, “but I hope you’re looking at it.”
The study was limited by the small number of interviewees, Eid said, making generalization challenging.
“But going forward, we hope to utilize customer discovery to really see what those barriers to carriage are and see how we can leverage what our customers do and say they are already doing to improve carriage,” she said.
Eid said that the biggest thing that allergists can do to improve carriage is to not only ask their patients if they carry their pen, but also how they carry it.
“Asking them ‘Are you carrying it?’ and ‘How are you carrying it?’ raises awareness of, yes, you need to carry it, but how are you going to do that,” she said, “to help them figure out ways that they can carry it.”