Living Labs: Helping health innovation work in the real world
Liverpool John Moores University (LJMU) and Liverpool City Region Local Enterprise Partnership (LCR LEP) have been awarded Interreg Europe funding to support a pan-European programme called HELIUM. HELIUM builds on successful LCR programmes, such as LJMU’s Centre for Collaborative Innovation in Dementia that uses a "Living Lab" approach to bring together industry, universities, the healthcare and public sectors, and end users, patients and the public to successfully develop new, innovative products.
Modern medicine has changed the way we live our lives in myriad ways, with technological advancements providing new drugs, vaccines and diagnostic tests. But as technology develops, there is a greater need to consider the impact of these advancements on patients’ lives. All too frequently, new tests or treatments are conceived, developed and licensed without research into how, or even whether, they may be acceptable to end users. What if the requirements for widespread use in the ‘real world’ were instead built in to new technologies up front? How could this be done?
Co-creating health tech
This week we dropped in to a co-creation group in Liverpool, run by HELIUM, which aimed to find out just that. How might new medical technologies impact on a patient’s ability to make informed choices about their own health? What are the considerations for clinicians, scientists and policy makers to ensure these technologies are acceptable to patients?
The group arose from LJMU research into Liverpool City Region health-focused economic policy, which highlighted regional strengths in precision medicine and infectious disease research. To investigate this further, LJMU and LCR LEP organised a Precision Medicine “Living Lab” event, with a focus on DNA testing and antibiotic resistance.
We were invited to take part in the antibiotic resistance co-creation group. Participants were asked to consider what the challenges are around antibiotic resistance, and what the possible solutions to these challenges may be. The perceived challenges that arose were wide-ranging and included:
- How to reduce stockpiling of antibiotics
- How to reduce patients not finishing prescriptions
- How to ensure that patients are confident in the clinical decisions made by their GP
- How to educate people about antibiotic resistance.
Trust in tests
Diagnostic tests were a focal point of discussions, representing a key way to reassure patients that the treatment they are being offered is correct whilst reducing inappropriate prescribing of antibiotics. One interesting aspect was whether a test could be used outside a GP setting by patients themselves, and if so what that test would need to do to allow patients to be confident enough to act on the result.
One surprising aspect of how successful a self-test could be was GP validation: some patients simply feel they need to see a GP in order to be confident that their treatment, or no treatment if a viral infection, is correct. The discussions revealed that even if a test were completely accurate and was used in the same way by the patient as the doctor, there will likely always be some patients who feel they need to see their GP, be that for reassurance that the test is carried out properly, or just for a conversation about the process and test result. The suggestion of providing access to a triage process for queries about the results with alternative healthcare professionals did not quell this concern.
Some good suggestions were made about what might be acceptable for a self-test. For example, a self-test available in a GP surgery where patients would be able to directly access clinical help if they’re unsure about the result would likely be reassuring to patients. Alternatively, pharmacies were suggested as being a good setting for a self-test.
Overall it seemed that even if a test for a bacterial infection were incredibly accurate and easy-to-use, giving patients the confidence to act on its results is not straightforward, be that accessing antibiotic treatment following a positive result, or not seeking antibiotic treatment following a negative result.
One thing that was clear, however, is that a positive result indicating a bacterial infection should lead to a GP appointment rather than the patient accessing treatment themselves, directly from a pharmacy.
The take-home message for the Longitude Prize team was that those developing new innovations perhaps often only consider the science behind the technology as an indicator of success and don’t give due consideration to how that technology may work in practice, and whether the public will even want to use it. In order to ensure that new innovations are not just scientifically sound, but will also be taken up in the ‘real world’, listening to the public about their concerns and possible solutions is paramount, particularly when the innovations in question are being developed to curb significant global health issues such as antibiotic resistance.