Table 4 Quotes.
Quote | Participant group | |
|---|---|---|
Theme 1: Perceived benefits | ||
1 | “We must be very realistic that some of the patients do not want to be patients, and that they don’t want to be constantly confronted with their disease. And that they don’t like it when they receive emails.” | HCP |
2 | “But then I would like it to be researched, that it really works well, and that pulmonologists support it, and not when you come up with symptoms, that they say: “Yeah, that app doesn’t work well anyway, so we don’t do anything with it”.” | Patient |
3 | “And then of course the question arises: what exactly is the cost-effectiveness and what is the added value? And the second question is: do you need such a device permanently or it is temporary? Because that is also important to me.” | Policy maker |
Theme 2: Usability | ||
2.1. User-friendliness | ||
4 | “[A reason not to use it is] if it is a very complicated app and I have to put in a lot of effort to complete everything. It really must be a tool that is easy to use. Because otherwise, I know that I might use it fanatically for a few days, and then I’ll quit. So that’s really a requirement for me.” | Patient |
5 | “For example, if you are on a drug that you don’t have to take every day, you shouldn’t get a reminder every day. If that [taking medication every day] is very important, then yes. And then it would be good if certain messages are sent, but I think it should be adapted to what you want to achieve for that patient.” | Developer |
6 | “We’re working with pharmacies, we’re working with hospitals, we’re working with GPs, we’re working with insurance companies. I mean, the delivery and implementation of the system, it has to include all of them and, you know. All of these different stakeholders are part of the feedback loop basically, eventually, and of the product development process.” | Developer |
2.2. Compatibility | ||
7 | “There are a lot of different inhalers, and if there are actually a lot of different smart inhalers with all kinds of functionalities and different apps, well, I think it will quickly get tiresome to get started. There has to be some sort of uniformity.” | HCP |
8 | “I think if you want to implement it, you need to have an overview of which inhalers are most prescribed. And that you develop a smart inhaler for those [inhalers]. Because there are many types of inhalers, and I think it’s better to have a few good smart inhalers, then to make one for all the dozens of types of inhalers out there.” | HCP |
2.3. Education and support | ||
9 | “Well, I think its easiest to contact the pulmonary nurse [in the general practice] for that [in case of problems with smart inhalers]. Or the general practitioner. I think it is cumbersome to contact the manufacturer. And that it is less easy to connect with them [the manufacturers]. So, I wouldn’t really need that.” | Patient |
10 | “I think training for the whole team [is needed]. I think it would be good, if you decide to go for it, that everyone tries to prescribe it [smart inhalers]. And I think that it should be clear who people should turn to in case of problems. At least, someone should be responsible.” | HCP |
Theme 3: Feasibility | ||
11 | “I wouldn’t necessarily have a problem with it [using the app] being every day, as long as it really doesn’t take much time. If you can just, say, with one push on a button register “okay, I’ve now taken my medication”, that’s okay, if that happens every day. But you don’t want to spend ten extra minutes every day. Because it is something that is part of your routine […] Then I don’t have time for that [using the app] and I don’t feel like it.” | Patient |
12 | “I’m always very concerned about the amount of time it would take if I were to prescribe it to every patient. Not to mention the costs. Because if the app doesn’t work, or the device doesn’t work, or the patient doesn’t understand, they will come to me with all those questions. […] So, I’m worried about the time investment of the doctor or the practice nurse.” | HCP |
13 | “I think, it is useful if a company start this [developing smart inhalers], that they show responsibility regarding reuse of materials, or collection and careful processing; the environmental aspect. […] I think companies could distinguish themselves positively with that, and that it is very important.” | HCP |
14 | “What I think is important: is the world ready? […] And if I look at, for example, patients with COPD as a target group. I don’t know. Somehow it seems like the target audience just isn’t ready for that [implementation of smart inhalers] yet. Or wants to use it. […] That could also have something to do with it. That the moment just hasn’t come yet.” | Developer |
15 | “How do you get these devices, these digital solutions in the hands of patients? Like, in practice, how does that work? Because a drug you just write on a piece of paper or on your digital tool. The fact that, you know, there is a certain code for the drug and then the person goes to the pharmacy and gets the drug and everything is automatic, right? I mean, there is an entire industry behind it that moves drugs around, that allows patients to get access to these drugs. It’s not the same for these solutions [smart inhalers].” | Developer |
THEME 4: Payment and reimbursement | ||
16 | “I don’t think I would use it if it was very expensive. Because I think my asthma medication is expensive enough.” | Patient |
17 | “I don’t know if it is a onetime fee […]. People might be willing to pay some money for it, but they shouldn’t have to buy a new smart inhaler every time they receive a new inhaler.” | HCP |
18 | “So, it’s like: do you want to spend a lot of money on it or not. If you don’t know whether something will work, then of course, you don’t want to spend too much on it. See, if you know it really suits you and it really helps you, then you’re willing to pay more than if it’s completely unknown.” | Patient |
19 | “Well, a lot of innovations lead to less production. And less production means less money. And then of course, the old way of thinking is that you pay for treatments, and that must change somehow. A new way of financing must be created.” | Policy maker |
Theme 5: Data safety and ownership | ||
20 | “You know, if it [smart inhaler] can only be dispensed by medical personnel, then you assume it [data privacy] is all covered and that there is no commercial interest in distributing my medical data.” | Patient |
21 | “But it is patient data. And what do they [manufacturers] do with it? How safe is that? And whose data is it anyway? In the end, they [manufacturers] use it, so I think it is an ethical issue.” | Policy maker |
22 | “For example, we noticed that the patient [who used a smart inhaler] took it [medication] every time at 4 am and 2 pm. So, it turned out that he went out every night. It can be annoying for many people if they have to share that with someone.” | HCP |
23 | “I’m wondering to what extent it is feasible for a doctor to keep track of all data in such a portal. I think it would be nice [to share data], for example, when you have an asthma exacerbation or the medication regimen isn’t quite right. But I think the doctor receives a lot of useless information when things are going well.” | Patient |
24 | “I think it could be used well to start a conversation with the patient about its use [of medication]. What I often see with glucose monitors in diabetics, which is of course something that people keep track of themselves and that [data] is not sent to HCPs, that it does help to get insight. If they [patients] say “well, here’s the data, what do you think?” you can continue with that.” | HCP |
25 | “I think I would like to share it [data], because it is an extra push that I take it [medication]. Because for me it is very often the case that when I think: “I’m doing very well, I don’t really have any symptoms”, that I think: “Okay, I would like to halve my dose”. And then [when data is shared] we can discuss: “how is it going and is it possible [to change dose]?”.” | Patient |
