Why Patient Understanding Matters More Than Ever
Biosimilars are becoming a standard part of modern pharmacy practice across Canada. They improve access, reduce costs, and expand treatment options, especially for complex therapies like insulin and biologics.
However, as biosimilars become more common, a new and often overlooked risk is emerging:
Patient confusion.
Without proper education and clear communication, biosimilars can unintentionally contribute to medication incidents, particularly in busy community pharmacy settings.
Why Biosimilars Can Create Confusion
Biosimilars are designed to be highly similar to reference biologic products, but they are not identical.
From a clinical standpoint, this is well understood.
From a patient perspective, it is not.
Patients may notice:
- Different brand names
- Different packaging or labeling
- Different devices or administration methods
- Changes in strength or concentration presentation
These differences can lead patients to believe they are receiving a completely different medication.
Where the Risk Happens in Daily Workflow
In a busy pharmacy, risks do not arise from one single error. They develop through small gaps in communication and system processes.
1. Switching Without Clear Explanation
When patients are transitioned to a biosimilar:
- They may not understand the reason for the change
- They may assume the medication is new or different
- They may question effectiveness or safety
This uncertainty can lead to hesitation, incorrect use, or refusal of therapy.
2. Differences in Devices and Administration
Some biosimilars involve:
- Different injection devices
- Different dosing increments
- Different administration techniques
If patients are not shown how to use the new device properly, errors can occur even when dispensing is accurate.
3. Profile and Medication Reconciliation Gaps
One of the most common system-level risks is:
- Previous medications not being inactivated
- Duplicate therapies appearing active
- Old prescriptions being inadvertently refilled
When medication profiles are not clearly updated, the risk of selecting the wrong product increases significantly
4. Product Similarity and Selection Errors
Look-alike:
- Names
- Packaging
- Strength variations
Combined with workflow pressure, these factors increase the likelihood of selecting the wrong product, especially when multiple similar options exist.
5. Misinterpretation of Dose or Concentration
Some products may differ in:
- Concentration
- Delivery mechanism
- Dose increments
If not clearly explained, patients may:
- Use incorrect doses
- Adjust dosing incorrectly
- Misinterpret instructions
Why Patient Education Is a Safety Intervention
Patient education is often treated as a final step. In reality, it is a critical control point in preventing medication incidents.
Effective education helps to:
- Confirm the correct medication is dispensed
- Reinforce proper administration
- Identify discrepancies early
- Improve adherence and outcomes
- Build trust in pharmacy care
Without this step, even a perfectly dispensed prescription can lead to harm.
Practical Strategies for Busy Pharmacies
The goal is not to slow down workflow, but to make safety steps simple, consistent, and sustainable.
1. Standardize Biosimilar Counseling
Every biosimilar switch should include:
- “This is a biosimilar to your previous medication”
- “It works the same way”
- “Here is what is different (if anything)”
Consistency is key.
2. Use “Show and Tell” for Devices
For injectable or device-based therapies:
- Demonstrate usage
- Highlight differences
- Use teach-back to confirm understanding
Even a 30-second demonstration can prevent significant errors.
3. Maintain Clean Patient Profiles
Always:
- Inactivate discontinued medications
- Avoid copying old prescriptions without review
- Clearly document changes
This is one of the most effective ways to prevent selection errors.
4. Improve Workflow Awareness
Teams should be aware of:
- Look-alike products
- Multiple concentrations
- Storage organization challenges
Simple steps like physical separation and labeling can reduce risk.
5. Communicate Changes Clearly
Patients should always know:
- What changed
- Why it changed
- What to expect
Clear communication reduces confusion and builds confidence.
The Role of Safety Culture
A strong safety culture recognizes that:
- Confusion is predictable, not accidental
- Systems should support clarity
- Education is part of workflow, not an extra task
Pharmacies that embed these principles reduce both incidents and stress within their teams.
How PhIX Supports Safer Biosimilar Use
PhIX (Pharmacy Incident Exchange) helps pharmacies identify, analyze, and prevent risks associated with biosimilars and other complex therapies.
Key Features and Capabilities
Medication incident and close call reporting
Capture real-world events related to biosimilars, including confusion, selection errors, and workflow issues.
Contributing factor analysis
Identify root causes such as:
- workflow gaps
- communication breakdowns
- product-related confusion
CQI meeting tools
Discuss biosimilar-related incidents and develop practical, team-based solutions.
Trend analytics and insights
Identify recurring risks such as:
- duplicate therapy issues
- device-related errors
- product mix-ups
Action plan tracking
Implement and monitor improvements, such as standardized counseling or profile cleanup processes.
SPPSA (Safety Self-Assessment)
Generate:
- targeted action plans
- benchmarking insights
- prioritized safety improvements
Supports Canadian pharmacy programs
Aligned with:
- Alberta CQI+
- BC CIRCL
- Ontario AIMS
- Saskatchewan COMPASS
- Manitoba Safety IQ
Moving Forward: Safety Through Clarity
Biosimilars are an important advancement in healthcare.
But like any advancement, they require systems, workflows, and communication to evolve alongside them.
The key takeaway is simple:
When patients understand their medications, safety improves.
By combining:
- clear patient education
- strong workflow processes
- accurate documentation
- continuous learning
pharmacies can reduce risk and deliver safer, more confident care.
