A Systematic Review of Patients’ Perspectives on the Subcutaneous Route of Medication Administration
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Subcutaneous injections allow for self-administration, but consideration of patients’ perspectives on treatment choice is important to ensure adherence. Previous systematic reviews have been limited in their scope for assessing preferences in relation to other routes of administration.
Our objective was to examine patients’ perspectives on subcutaneously administered self-injectable medications when compared with other routes or methods of administration for the same medicines.
Nine electronic databases were searched for publications since 2000 using terms pertaining to methods of administration, choice behavior, and adverse effects. Eligibility for inclusion was determined through reference to specific criteria by two independent reviewers. Results were described narratively.
Of the 1726 papers screened, 85 met the inclusion criteria. Studies were focused mainly on methods of insulin administration for diabetes but also included treatments for pediatric growth disorders, multiple sclerosis, HIV, and migraine. Pen devices and autoinjectors were favored over administration with needle and syringe, particularly with respect to ergonomics, convenience, and portability. Inhalation appeared to be more acceptable than subcutaneous injection (in the case of insulin), but how subcutaneous infusion, intramuscular injection, and needle-free injection devices compare with subcutaneous injections in terms of patient preference is less certain.
The review identified a number of studies showing the importance of the methods and routes of drug delivery on patient choice. However, studies were prone to bias, and further robust evidence based on methodologically sound approaches is required to demonstrate how patient choice might translate to improved adherence.
KeywordsMigraine Sumatriptan Subcutaneous Administration Growth Hormone Therapy Medroxyprogesterone Acetate
This research is supported the Medical Research Council North West Hub in Trials Methodology Research: G0800792.
CR and DH contributed substantially to the conception and design of the work. All authors made contributions to the acquisition, analysis, or interpretation of data. CR and LT drafted and DH redrafted the paper; all authors revised it critically for important intellectual content, and gave their final approval of the version to be published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Compliance with Ethical Standards
Conflict of interest
CR, DD, LT, and DH declare no conflicts of interest. All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare the following: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.
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