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The focus on the patient

The coronavirus has turned the whole world upside down, including the healthcare system. Patients complained about difficult access to treatment, or they canceled their visits out of fear. Was it like that everywhere? No. Some medical institutions have set themselves the goal of continuing all research, providing patients with support and a sense of security. We talk to Aneta Soliło-Mierzejewska, director of the Pratia Medical Center in Warsaw, and Monika Charuza, Head of the Recruitment Support Department in Clinical Research, about a prescription for good management of a medical facility, not only in the era of coronavirus.

Aneta, the Pratia Medical Center in Warsaw, which you run, received the "Orły Medycyny" [Eagles of Medicine award] two years in a row in 2018 and 2019. This distinction is awarded by the voice of patients to the best medical institutions. Please tell me how does it feel to run a center which is rated so highly by patients?

Aneta Soliło-Mierzejewska: "Orły Medycyny" is a nationwide poll which selects the best entrepreneurs in the medical industry, providing medical services of the highest quality. The Pratia Center in Warsaw was selected from over 234,000 companies. Each time we got a maximum score of 10 out of 10 points. The companies that receive this honorable title have been checked by about 2 million patients over the course of the year. I am very proud of it. We did not strive for this title, patients themselves submitted our center to the plebiscite and we received the aforementioned prestigious awards thanks to their votes. This is the best review of our work and a sign that our vision of how patient care in a clinical trial center should look like is in line with what patients expect.

So the patients gave you an excellent rating, and a year later the coronavirus appeared. It turned the world upside down. How did your center deal with this situation?

Aneta Soliło-Mierzejewska: The appearance of the coronavirus could not stop the clinical trials that were already underway. Patients who take part in the study can never be left without care and pharmacological supervision, which is why we immediately focused on introducing solutions that will ensure their safety, and our staff’ safety and thus allow us to continue our work. That is why we were in constant contact with patients, we informed them about our safety activities and procedures, we enabled them to talk to doctors and coordinators, we made it possible to make home deliveries of medicines to those who, for example, could not leave their apartments.
Today, we do not only continue the previously started projects, but also launch new ones, of course in compliance with all safety procedures.

If you had not introduced home delivery of medicines, some patients would have had to withdraw from participating in the clinical trials?

Aneta Soliło-Mierzejewska: We must remember that patients who take part in clinical trials are a special group of people, often these are people with immunodeficiency or elderly, so they could not be exposed to the risk of lack of therapy. In situations where it was necessary to maintain the continuity of the study, the patient had medicines delivered to their home.

Monika Charuza: The introduction of the epidemic in Poland at the end of March was a very stressful situation for everyone, and for people who are our patients - i.e. people struggling with the disease - it was even more difficult. For fear of the virus, some patients were willing to suspend their visits to our centers. We fully understood these concerns, which is why we were looking for a solution that would protect their health, eliminate the risk and enable the continuation of treatment. Hence the idea of ​​delivering medicines to patients' homes.

It should be emphasized that such a supply of drugs had to be performed with all safety precautions. How did you deal with this new situation?

Monika Charuza: We had to secure a whole series of situations so that the entire "operation" was safe. We created procedures, prepared instructions for the preparation of the study drug and documentation, and we secured the drugs for the duration of transport. Medicines were transported to the patient's home under controlled conditions, i.e. at the right temperature. Our employee, who at that time undertook to deliver the medication to the patient's home, came to the center and put on personal protective equipment (protective apron, mask, gloves). The study coordinator dispensed the drug to him and assured that the proper temperature was set in a special container for transporting the drug. The driver took the medicine and delivered it safely to the address provided. The drug was handed over without direct contact between the patient and the driver. The method of drug delivery was previously agreed with the patient, and the driver was in constant contact with the patient by phone. Together with the drugs, the patient received documentation, which they were obliged to fill in and return to the driver. We delivered only tablets to the patient's home, medicines requiring injections (IVs, drips) could only be administered at the center.

Once again, your efforts have been noticed - in the satisfaction survey (NPS) of patients of Pratia Medical Centers in the COVID-19 era you received a very high rating.

Monika Charuza: We started to study the level of satisfaction with the services provided (NPS [Net Promoter Score]) in our centers three years ago. We normally test the satisfaction index on a quarterly basis, but when the coronavirus threat emerged, we decided to check how patients rate the actions we had taken - our safety procedures and services. That is why we changed the questions in the questionnaire and the target groups - we wanted to examine whether the patients during the epidemic feel safe with us, whether, in the patient's opinion, the epidemic has affected the quality of our work, and whether the actions we have taken to protect the patient in as thorough way as it was possible gave them a sense of being cared for.
We did our first research in this new, "covid" reality at the end of March. During this difficult time, patients assessed the level of our service very highly - it turned out that 85 percent of them would recommend our center to other patients.

Tell me more about the NPS survey, i.e. the satisfaction survey. What is the methodology of this study?

Monika Charuza: If we use the services of a bank or, for example, companies offering private medical care, then after visiting a facility, we are asked to rate this service on a scale of 0-10. People satisfied with the service, called "ambassadors" in the NPS methodology, are people who gave a score of 9-10. On the other hand, "critics" are people who give a score of 0-6. The NPS algorithm is calculated by subtracting ambassadors (those giving a score of 9 and 10) from the critics (those giving a grade of 0-6). So, as you can see, grades 7-8 don't really count at all in this study. This shows how difficult it is to get the result we got in the NPS survey.

Why are you doing satisfaction surveys?

Monika Charuza: NPS is recognized as an indicator of the company's success, in the US more than half of large companies such as Apple, Harley-Davidson, Amazon, American Express use this method to test the company's condition. In the case of these companies, the NPS remains at the level of 50-70 percent.
Our NPS has been at a high level for 3 years, i.e. 70-80 percent. And the result we obtained during the epidemic was even higher - 85 percent. At that time, we wanted to obtain the opinion of all our patients - both those who already took part in the clinical research, those who came to us only once, during the so-called screening visit (it was a one-time visit, because due to factors beyond our control, they could not take part in the study), as well as those patients who canceled the visit at the center.
We asked patients to rate on a 0-10 scale the service provided by individual teams working in the center (nurses, study coordinators), and also to rate solutions that were introduced to increase their safety or were a response to their needs (waiting room conditions, telephone contact with the center). We also wanted to ask patients who canceled their visit to the center about the reason for this decision. It turned out that in most cases the visit was canceled due to the patient's fear.

Patients appreciated your efforts to ensure their safety in this particular period - the supply of masks and disinfectants, and the protection of staff.

Aneta Soliło-Mierzejewska: We acted very quickly as soon as the guidelines of the Chief Sanitary Inspector were published, and the safety procedures in our center in Warsaw were established in February 2020. We informed our patients that we had masks, gloves, and disinfectants prepared for them. As I mentioned - our patients are a special group, so we had to make sure that their visit to our center was safe for them. That is why our team was properly secured and subjected to security procedures - we implemented, among others daily body temperature measurement, questionnaires on health and potential contacts with people who might have been infected.
We made sure that there was time for disinfection between admitting patients. We knew that this sanitary regime was extremely important. We have imposed very high standards of operation on ourselves, we have implemented many more security measures than recommended. But in the end it paid off - fortunately, none of our patients and employees fell ill, and the patients themselves admit that they feel safe with us.

In addition to delivering the drugs to the patient's home, Pratia also offered patients assistance in getting to the center. Can you tell us more about this service?

Monika Charuza: Patients in some parts of the country, such as Katowice, for understandable reasons, were afraid of traveling to our center by public transport. We provided assistance to people who raised such concerns - a car was sent for them and a driver wearing personal protective equipment took such patients to the center, and then collected them from it.

Patients also rated very highly the telephone contact with the center.

Aneta Soliło-Mierzejewska: We attach great importance to ensuring that patients can contact us without any problems. We answer calls from 7.00 a.m. to 8.00 p.m., the entire team assigned to this task is very involved. I am glad that the results of the study confirm this.

Monika Charuza: At the end of March, our helplines for patients of the center were very “hot” - the telephone basically did not stop ringing. Seeing that patients have a much greater need to contact the center, we launched an additional helpline. Patients sought contact, they wanted to know about their clinical trial or study drug - thanks to the additional hotline, they had no problem contacting us.

Let's go back to the satisfaction survey. Congratulations on the high rating, but has it been possible to keep it at the same level?

Monika Charuza: We repeated the same survey in May, when the country was already exiting the lockdown. We got a very high result again - 84 percent. Patients appreciated all the safety elements implemented by us. Since mid-May, we have also observed a significant increase in patient visits to our centers, which shows that patients feel safe with us. Due to the fact that patients willingly visit us in the center, we have already given up the service of delivering medicines to the patient's home.

Aneta, if you were to write a prescription for such a high assessment of a medical center by patients, what would you include in it?

Aneta Soliło-Mierzejewska: Professional staff committed to their work, meeting the needs of patients, plus a large dose of empathy and understanding. We often see patients who have many concerns, for example related to the coronavirus. You need to talk frankly with such a patient, clarify doubts and allow them to make decisions based on knowledge, not beliefs. This applies to all our patients - we conduct clinical trials - our patients need patience and understanding, because they often come to us knowing very little about the clinical research.

Monika Charuza: During this difficult time, we established even stronger relationships with patients. The fact that we go through stressful situations together makes us closer to each other than before, in times that were easier.

What studies are conducted at Pratia Medical Centers?

Monika Charuza: Pratia comprises eight professional medical facilities located in the largest cities in Poland. Each of the centers has been successful in conducting population studies such as: influenza, RA, AD, PsA, chronic cough, acne, diabetes, hypertension, as well as difficult disease entities in the field of oncology, hemato-oncology and gastrology.
For more information, please visit our website - www.pratia.com

The only thing that remains for us to explain is what clinical trials are.
Aneta Soliło-Mierzejewska: The definition of clinical trials is provided in the Pharmaceutical Law. Simply put, it invites patients to participate in a project to determine the safety and efficacy of new therapies. A patient who participates in such a project gains access to usually the latest diagnostic methods and the latest drugs, as well as access to a specialist doctor throughout the duration of the study. Clinical trials are often the possibility of using a unique treatment in the event of, for example, exhaustion of therapies available on the market.

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