Ageing populations and an increasing number of people living with long term chronic conditions are prompting healthcare systems worldwide to look again at how – and where – they provide care. The motivations for this are two-fold:

• An imperative to operate within constrained healthcare budgets without impacting quality or access to care
• A recognition that existing provider systems are rarely as patient-centric as we would want

The pressures of meeting the demand for increased care play out not just on physicians, medical support personnel and pharmacies, but also scheduling and administrative functions. These challenges are driving the development of innovative patient-centric care models, a key strand of which is increasing the quantity of care delivered outside of the hospital.

Two examples demonstrate the need to make the best possible use of scarce healthcare resources:

• Shortage of hospital beds: In the UK, King’s Fund research found that “in 2016/17, overnight general and acute bed occupancy averaged 90.3 per cent, and regularly exceeded 95 per cent in winter, well above the level many consider safe” [1]
• Medical talent is a scarce resource: Retirements in the US are projected to create a shortage of 90,000 physicians by 2025, extending wait times to see a specialist

Direct-to-Patient (DtP) services can help alleviate these burdens. By shifting outpatient procedures from hospital to home, healthcare resources can be redeployed to the more pressing priorities of acute patients.

Pharmacies

Pharmacies are not spared the pressures felt by the rest of the system. The storage of sensitive therapeutic product – in conjunction with the associated real-time temperature monitoring, data reporting and inventory control – can challenge the pharmacy infrastructure in many locations worldwide.

“Every pharmacy department that I've ever been to in the UK has huge problems with storing investigating Medicinal Product (IMP)” says Helena Baker, VP of Global Nursing at Medical Research Network (MRN). “With the increased number of biologicals requiring cold chain storage, etc., taking the patients out to the home environment can make a huge difference to the pharmacy workload as well as the site workload.”

With DtP, pharmacy dispensing may be centralized. This reduces the storage burden for investigator site pharmacies and also eliminates their involvement in shipping out the drug. Sites typically do not have the capacity to manage temperature controlled packaging and monitors, nor do they have space to store the Investigational Medicinal Product (IMP).

Although most DtP shipments today still rely on the investigator sites, there are strong trends towards centralization by a few companies. The drug is stored regionally to serve a specific geographic area or entirely centrally in a few cases within the US.

Centralization can be complex given dispensing licensing, so it’s not as simple as shipping across international borders (even within the EU) or from one state to another, without having proper authorization. But access to patients when they travel can be simplified if there is already an established distribution channel in place.

Pressures on the healthcare system are only intensifying. Direct-to-patient services have a role to play in supporting the shift of healthcare out of hospitals and into the home, thereby lowering the burden on hospitals and pharmacies.

For more information about the impact DtP can have on the healthcare industry, please download our Direct-to-Patient Services ebook.

[1] https://www.kingsfund.org.uk/publications/nhs-hospital-bed-numbers