Decentralized Clinical Trials Represent the Decentralization of Care - What That Means for Patients

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Many older adults lament the disappearance of the house call, when a trusted doctor would tote a black bag full of medications and diagnostic tools to a patient’s home, providing care on site while the patient rested comfortably in bed. By 1980, however, house calls had all but vanished. Instead, we began requiring sick people to get dressed and transport themselves to a hospital, clinic or private office to receive care. This model, known as centralized care, emphasized convenience for the provider and not the patient.


Fortunately, in the past five decades, there has been a move back toward decentralized, patient-focused care. Ambulatory surgery centers for uncomplicated procedures began popping up in the 1970s. In the ’90s, home-based health care grew substantially, particularly for seniors and disabled adults who were too well for facility-based skilled nursing but needed some support in their homes. Then, in the 2000s and 2010s, when home delivery of everything from movies to food became standard, entrepreneurs saw the possibilities for home delivery of urgent care, launching services like Pager and Dispatch Health. In the past 10 years or so, even site-based physicians started dipping their toes into telehealth.


But nothing has accelerated the adoption of decentralized care like the COVID-19 pandemic. Suddenly, it seemed everyone was using video calls in place of in-person appointments — and liking it. In fact, use of telehealth skyrocketed by 50 percent in the first quarter of 2020 compared with the same period in 2019, according to the Centers for Disease Control, and it now accounts for 17 percent of all outpatient visits. In a January 2021 survey, about 40 percent of people said they expect to continue using telehealth after the pandemic ends.


This transformation of service delivery didn’t occur just in direct patient care, however. At the beginning of the pandemic, thousands of clinical trials were suspended for the safety of investigators and participants alike. Soon, however, the FDA issued guidance for conducting trials virtually, and the industry enthusiastically embraced them as their benefits became immediately apparent.


Patient challenges

After all, even during “normal” times, patients face numerous challenges in accessing traditional site-based clinical trials. Seventy percent of potential participants live more than two hours away from trial sites. This in turn creates additional burdens for patients, like:

  • Finding transportation that accommodates their schedules and their mobility needs
  • Finding and paying for child-care
  • Rescheduling or getting time off from work

Clearly, the ability for patients to participate in traditional site-based trials can become seriously impractical. The upshot? People who might benefit the most from a potentially life-saving treatment can’t access it. And those who live in rural or medically underserved communities may not even be aware such trials exist.


Patient solutions

With decentralized clinical trials, however, the model is flipped. DCTs literally meet patients where they are. Here’s how:

  • Those who are most clinically appropriate, rather than just those who live nearby, can enroll and benefit from investigational treatments.
  • Participants no longer have to endure the discomforts of traveling while feeling unwell.
  • Drugs and other therapies can be delivered directly to patients’ homes.
  • Visits from home-health providers can be scheduled when necessary.
  • Patients can provide investigators with real-time updates to changes in their clinical signs and symptoms using familiar technology. Modifications to patients’ treatments can be made swiftly, if necessary, keeping participants safe — and still enrolled in the study.
  • Perhaps most importantly, DCTs make novel therapies available to a much wider cross-section of people.

In short, DCTs represent the apex of inclusivity and patient-centric care.


Medable, the recognized leader in DCTs, offers technology solutions that can be customized for any patient population, study design or drug type. Tools like eConsent, ePRO and televisits provide enhanced education and better monitoring of patient health. And Medable’s patient advisory council offers insights and guidance on trials, keeping the focus on the patient experience every step of the way.


Contact Medable today to see how our digital solutions can help your team transform patient recruitment, enrollment and retention, and advance medicine in the best interests of everyone.