Understanding Patient Journey

The renewed focus on patient experience in recent years stems from growing trends in healthcare consumerization and value-based care initiatives. To remain competitive, providers are beginning to consider patients more as customers and, consequently, are working to improve the overall healthcare experience and keep patients within their networks. However, the best way to understand the end-to-end customer experience and determine areas for improvement is by mapping the entire patient journey.

A journey map is not a process map. The two should run in parallel, but ‘process’ focuses on actions undertaken by a business, and ‘journey’ focuses on either the current experience or the patient’s ideal/future state experience.  A patient journey represents the entire sequence of events that a patient experiences within a given healthcare system or across providers, from scheduling an appointment for a regular checkup to receiving treatment for an illness or injury.                                                                                                                                 

A patient journey is an ongoing process that incorporates all parts of the healthcare ecosystem, from hospitals to physicians, specialty care, and outpatient therapy. While it is easy to think about a patient’s journey as those interactions you have with them before, during, and after an appointment, many other touchpoints drive their overall journey. A comprehensive patient engagement strategy touches on all aspects of a patient’s relationship with a healthcare provider, including:

• Onboarding and Access
• Awareness
• Education
• Diagnosis and Treatment
• Adherence to Lifestyle or Behavioral Changes
• Ongoing and Proactive Health (Wellness)
• Referrals and Loyalty

By understanding the patient journey, providers can build a hyper-targeted experience that addresses each patient’s unique needs and delivers more successful patient outcomes. Improved patient experiences can also save providers money — for example, by reducing the average time to diagnosis.

Benefits of journey mapping

• Create personalized experiences for each patient by deeply understanding their needs and preferences.
• Provide seamless, continuous care for your patients. Unfortunately, there are often gaps in the patient journey because of poorly coordinated technology and resources. Patient journey maps allow care providers to identify gaps and work on solutions that ensure a seamless patient journey.
• Reduce pain points by spotting problems with ease.

• Unlock opportunities to improve pre-and post-clinical patient engagement through timely, targeted outreach efforts and boost retention rates by reinforcing long-term patient relationships
• Improve communication between patients and their care providers. Healthcare journey maps help to eliminate uncertainties and inconsistent communications.
• Provide continuous improvements for the care process using insights from the care journey.
• A better understanding of patient experiences throughout each stage of interaction with the health system.
• Keep up with shifting market forces to ensure high patient acquisition and retention rates.

Patient journey support

According to Eyeforpharma, there are four ways to show support in the patient journey: educational, emotional, behavioral, and practical.

• Educational support refers to improving patients’ information about their diagnosis, disease, and course of treatment. There are multiple ways to achieve this, with traditional print material as the most prevalent method. However, animated explainer videos have improved patient literacy and education.
• Emotional support refers to providing patients with a way to cope with their illness. This can be done through counseling, phone support, and other initiatives.
• Behavioral change support is a beyond-the-pill solution that helps patients change their routines. This can be done with various apps that track relevant patients’ data and plan their activities regarding medication adherence.
• Finally, practical support refers to the actual access that patients have to treatment.

Example of patient journey on Rheumatology patient

Like any other disease, the RA patient’s journey involves four distinct stages: onset of symptoms to consultation (lag1) was 3.41 months with a range of 0–5.7 months, consultation to rheumatology referral or definite RA diagnosis (lag2) was 2.13 months with a range of 0.5–6.6 months, and diagnosis to proper treatment (lag3) was 2.91 months with a range of 0–5 months. (Lag4) data for initiation of DMARD therapy to the diagnosis of RA was 2.14 months with a range of 0–2.2 months.16, These lag times have been of interest to rheumatologists and have been reported by numerous studies, with some studies focusing specifically on the factors that contribute to these delays and measures undertaken to overcome these.

Evidence is accumulating that very early RA (within the first 12 weeks) may be a distinct immunopathological phase of the disease. Thus, a “window of opportunity” may exist during which introducing DMARDs may have different effects than treatment at a later date, including prevention of erosions and possibly complete switching off of the disease.

It was found that the strongest predictor of improvements in disease activity (according to the American College of Rheumatology definition) was shorter disease duration at the start of treatment.

Gaps in care begin with the person’s recognition of the symptoms and the action of visiting a family physician (FP). If RA is suspected, the FP refers the person to a rheumatologist who provides a diagnosis and prescribes appropriate medications. Next, the person will be periodically assessed by a rheumatologist.

Gaps of delaying

Delay is probably due to a combination of patient-related and physician-related factors. Evaluating the time since the beginning of the disease and the visit to the FP, the time since this and the referral to the rheumatologist, and the time to onset of DMARD treatment, only in 19% of patients, DMARDs were started in the first three months after disease onset and that

Delays in the diagnosis and management of RA may stem from slow diagnosis by physicians rather than postponed medical consultations by patients. This may be because patients with RA often do not seek the advice of rheumatologists at the onset of their symptoms, and non-rheumatologists fail to refer RA patients to rheumatologists soon enough

• The delay in the prescription of DMARDs was mainly due to the delay in referral from family medicine to the rheumatologist.
• In addition to the assumption of incompetency and poor knowledge, qualitative research on osteoarthritis (OA) and RA patients
• General practitioner visits are rated as disappointing due to poor communication and a focus merely on pain control. The journey that a patient undergoes before seeking medical advice is frequently long and emotionally exhausting.40

It is thus believed that delayed specialist referrals constitute a principal reason for late diagnosis and subsequent treatment.

Possible interventions

• It is necessary to implement measures that act on early diagnosis and treatment of RA through the diffusion of knowledge relating to the disease in the general population, advertising campaigns as well as an increase in the level of knowledge regarding RA in primary care physicians.
• A successful intervention mainly depends on the availability of local programs and the coordination among the rheumatologist, the FP, and other health professionals. Moving from one level of care to the next involves a potential wait period.
• General practitioner education sessions with an associated distribution of referral guidelines and reminding triaging rheumatology clinicians about the available prognostic factors often present in general practitioner referrals that assist with correct triage.
• Triage systems, including triage clinics, helped prioritize appointments for patients with IA. In addition, the use of referral forms standardized the information required, further optimizing the triage process.
• Clinical criteria would facilitate early referral of the patient with suspected RA to a rheumatologist for definitive diagnosis and initiation of DMARD treatment. Validation of the variables that may aid in the design of referral criteria. These are based on musculoskeletal examination techniques to assess the presence of arthritis by primary care physicians in “target” joints; wrists, second and third metacarpophalangeal, and third proximal interphalangeal joints.45 This is in addition to positive rheumatoid factor and anti-citrullinated protein antibody (anti-cyclic citrullinated peptide).This may be supported by the presence of persistent joint swelling in more than one joint, early morning stiffness ≥30 minutes, or involvement of metacarpophalangeal or metatarsophalangeal joints.

Finally, Patient centricity is becoming one of the prevalent trends in pharma, and for a good reason. For proper closed-loop marketing, it’s necessary to provide solutions that benefit all stakeholders, including pharma brands, physicians, and patients. A patient journey is one tool that puts patients at the center of attention.

References

• What is patient journey mapping? (no date) Mercury Healthcare. Available at: https://www.mercuryhealthcare.com/faq/what-is-patient-journey-mapping (Accessed: December 4, 2022).
• Patient journey (no date) Definitive Healthcare. Available at: https://www.definitivehc.com/resources/glossary/patient-journey (Accessed: December 4, 2022).
• Groszewski, W. (2021) The patient journey: What it is and why it matters, Silverline. Available at: https://silverlinecrm.com/blog/healthcare/provider/the-patient-engagement-journey-what-it-is-and-why-it-matters/ (Accessed: December 4, 2022).
• Patient journey and how to use it for Pharma Marketing (no date) BlueNovius Medical and scientific explainer videos. Available at: https://www.bluenovius.com/healthcare-marketing/patient-journey/ (Accessed: December 4, 2022).
• Barhamain, A.S. et al. (2017) The journey of rheumatoid arthritis patients: A review of reported lag: OARRR, Open Access Rheumatology: Research and Reviews. Dove Press. Available at: https://www.dovepress.com/the-journey-of-rheumatoid-arthritis-patients-a-review-of-reported-lag–peer-reviewed-fulltext-article-OARRR (Accessed: December 4, 2022).