Patient perceptions of epinephrine auto-injectors: Exploring barriers to use

Abstract

Background: In recent years, government initiatives have proposed that patient self-care should serve as a key resource in response to the anticipated increase in global demand for health care. However, if patients are to be empowered as self-carers, barriers to engagement must be identified and overcome. Anaphylaxis is an increasingly common life threatening allergic reaction. Patients at risk of anaphylaxis are prescribed epinephrine auto-injectors and play a crucial role in delivering their own care and management of this condition. One key recommendation is that patients routinely carry an epinephrine auto-injector with them, and deploy the device when needed. However, only a small proportion of patients that require epinephrine actually receive it. Objective: To explore the reasons why patients who have been prescribed epinephrine auto-injectors fail to adhere to self-care and management recommendations. Methods: In-depth interviews with 15 adults who have been prescribed epinephrine auto-injectors were carried out to explore the barriers that exist in the provision of effective self-care and management of anaphylaxis. Results: Inconsistent health professional advice, perceived stigma of carrying a ‘weapon-like’ device, poor device design and limited patient training were identified as barriers to carriage or use. Patients were reluctant to carry devices in public because of perceived and observed stigma and suspicion. They were happy to ignore expiry dates and some participants were confident that the emergency services would provide them with the appropriate care they needed, and therefore did not carry the device in urban areas. Conclusions and clinical implications: Improved training of patients, the public and health professionals around both the carriage and use of auto-injectors are areas for urgent attention if improved levels of self-care are to be attained. The design of epinephrine auto-injectors should also receive attention as patients often fail to carry them due to size and aesthetics. Key words: Adherence, allergy, anaphylaxis, empowerment, epinephrine, self-care, self-management, patient perspectives