Balancing act

‘Diagnostic blocks, poor access to information and closeness to services mean there are missing patients that pharma could help’

This focus on healthcare equity has not been without controversy, as to properly address these inequalities, some areas will require a bigger resource envelope, which in turn means more affluent areas would have to give it up. Funding mechanisms for healthcare equity are very much a work in progress.

However, many of our pharma clients at Wilmington Healthcare are taking an interest in this now, wanting to know how they can align with and support this agenda.

The first element is to properly understand healthcare inequity – what regions and systems it is affecting, what the discrepancies in access and outcomes are for patients in your therapy area, and what the total system costs are for inaction.

For example, poorer access to diagnosis services in cancer are connected with patients entering the system with later-stage tumours – which are more difficult to treat and require far more use of healthcare resources.

It’s advisable to engage with the NHS on the likelihood of patients with inequality markers appearing at more advanced disease stages, and to be able to explain the impact this will have on services relating to your therapy area going forwards and how a further wave may continue to build a bubble of patients that remain uninvestigated and untreated.

Wilmington Healthcare has been creating dashboards for our clients demonstrating such inequity, allowing them to visualise, interpret, assess and engage around the impact of the inequities on the NHS.

Using this type of tool can help you benchmark a target system against the national picture – or other organisations – to demonstrate value in providing effective care in the most appropriate setting, freeing up capacity for secondary care providers to perform surgery and other priority treatment that have been put on hold up until now.

These also make it possible to understand the areas where patients accessing certain services have changed since the pandemic, what populations are going back to old flows, where access may still be an issue.

Among providers, you can view admission rate difference between those most and least deprived appearing in your target organisation, to start conversing around access, and community care options.

One client, with in interest in COPD, was shown that avoidable mortality from COPD is roughly 2.5 times higher in the most deprived quintile, compared with the least deprived quintile.

The rate of emergency admissions (per 100,000 population) in the most deprived quintile is roughly three times higher than in the least deprived quintile.

We’ve already seen that reducing unnecessary admissions to hospital is uppermost in NHS minds. So it becomes simpler to argue that earlier and more accurate diagnosis, increasing access to pulmonary rehabilitation, encouraging better disease control and enabling better self-management will improve outcomes and reduce exacerbations.

All these are areas pharma can leverage, by showing ideal pathways, supporting disease awareness and patient education, identifying appropriate patient groups, and of course through the appropriate use of drugs and disease management therapies.

There are three major benefits to pharma from aligning with the health equity agenda.

Firstly, it’s about both NHS and industry needing to identify patients. Diagnostic blocks, poor access to information and closeness to services mean there are missing patients that pharma could help and the NHS must treat.

Better diagnostic throughput, via more accurate testing, more appropriate staffing and more evidence-based parameters suits both sides, and we’re now aware that these blocks disproportionately affect deprived communities.

So, through disease awareness campaigning, and data management via the use of such tools as Wilmington’s Healthcare’s Inequalities Dashboard, patients can be brought forward.

Secondly, it’s about outcomes. Medicine’s overall benefit is better realised when used at the appropriate point in patients’ journeys, and when they turn up late, as is happening, they’re less effective.

We’re finding that rural communities are particularly hard to reach. Many patients are coming into the system far later than they should, when medical interventions are less effective.

Certain ethnic groups may have barriers in language that may also affect their understanding of their treatment plan. Deprived communities often suffer poorer mental health that creates barriers to effective self-management.

Thirdly, it’s about partnership. This is an agenda that is super-important to the NHS, but there isn’t always the bandwidth or capacity there to properly address it within systems.

Pharma, with its data management skills, patient mapping, pathway flow information and awareness of unnecessary variation can really collaborate with the health service here on one of its most pressing needs, doing the heavy lifting on research to create a compelling story for NHS decision-makers to drive forward in their own systems.

Feedback from our clients and NHS networks reveals that communicating on healthcare equity can make all the difference when engaging with decision-makers – it really is an area of shared interest and a way of starting – and continuing – vital conversations with your customers.