Remote Medication Therapy


Author: Anna Cunningham, Pharm.D., Clinical Affairs Director


There are many diseases and illnesses that require treatment using medication infusions, or drugs given through a catheter or needle. When oral medication options are unavailable or ineffective, but a costly hospital admission is unwarranted, home infusion is a cost-effective, safe, and patient preferred treatment option.

Prior to the 1980s, treatment of diseases with medication infusion therapy required hospital admission for the duration of therapy. Developments in pharmaceutical and medical device technologies, along with a heightened emphasis on patient-centered care and cost-containment in a dynamic reimbursement landscape, have influenced the transition of medication infusions from the traditional inpatient hospital setting to the outpatient infusion clinic and even the patient home. The administration of medication therapy in the outpatient setting allows for safe and easy drug administration. There are medications, therapies, diseases, and patients that will necessitate hospital admission, but decades of science indicate that outpatient medication infusion and treatment can reduce healthcare costs, improve patient outcomes, increase patient satisfaction, lower infection rates, improve patient psychological well-being and improve patient quality of life.

The National Home Infusion Association1 lists diseases commonly treated in the outpatient setting including:

Diseases Commonly Treated in the Outpatient Setting
• Infections
• Cancer
• Pain
• Crohn’s Disease
• Congestive Heart Failure
• Hemophilia
• Immune Deficiencies
• Multiple Sclerosis
• Rheumatoid Arthritis
• Gastrointestinal Diseases or Disorders

Ambulatory infusion requires a durable, light-weight, small, and portable device that can move with a patient during their activities of daily living. Commonly disposable elastomeric infusion pumps, and gravity-based infusion flow-regulators are used in the outpatient setting for ambulatory medication infusion.

Outpatient medication infusion therapy may improve patient quality of life.

An outpatient infusion pharmacy will work with the prescriber to determine the most appropriate pump or device to use for the medication prescribed. Common considerations in pump selection include reimbursement, patient preference, medication characteristics, the safety and accuracy profile of the device in use, cost, and the patient’s home care environment. Comprehensive education and training, simplicity, and safety in design and patient preference are critical considerations when selecting an infusion modality for use in the patients’ homes. Accuracy, performance, and safety of the device should be confirmed and considered in device selection.

Advancements in design technology and manufacturing processes in recent years have raised the standard for ambulatory infusion pumps. SMARTeZ® Elastomeric pumps, for example, utilize a transparent drug reservoir to ensure visualization of the infusion solution during pharmacist inspection, have a container closure design to protect sterility, contain air and particulate filtration in the tubing and are made using state-of-the-art automated manufacturing processes that include individual pump testing to ensure pump performance.

Outpatient medication infusion can avoid costly inpatient hospital admissions, but the financial motivation to transition to outpatient infusion is also about improving healthcare costs overall and navigating a dynamic and limited reimbursement environment. The University of Arizona Cancer Centers and Banner-University Medical Centers implemented a pharmacy-managed program for the transition of chemotherapy to the outpatient setting. They concluded that the transition of chemotherapy from the hospital to the outpatient setting “enhanced access to care, decreased bed utilization in the hospital, and improved clinical and financial metrics.”>2 Eighteen rituximab-containing regimens and 14 chemotherapy protocols were transitioned to the outpatient setting resulting in a two year realized cumulative cost savings of more than $3,000,000. The benefits to the patients and the healthcare systems extended far beyond financial gains and included improved alignment with patient preferences and enhanced physical comfort and psychological well-being.

A focus on improving patient outcomes, increasing patient satisfaction, and improving patient quality of life has directed healthcare providers to outpatient, ambulatory medication infusion. Avoiding hospital admission can be more meaningful than merely the less expensive and patient preferred option. The 2018 Infectious Diseases Society of America Clinical Practice Guideline for the Management of Outpatient Parenteral Antimicrobial Therapy3 references studies showing that outpatient medication infusion benefits the healthcare system and the patient. “Potential benefits of outpatient medication infusion to the healthcare system include shorter or avoided hospital stays, prevention of hospital-associated conditions, and significant cost savings. Advantages to the patient include the ability to return to work or school faster, care for children or dependents, and generally resume activities of daily living with minimal interruption in their lives.”

While treatment guidelines from national professional organizations and decades of science show the benefits and advantages of outpatient medication infusion therapy, the reimbursement landscape is challenging, leading groups like the National Home Infusion Association and others to advocate for legislative changes to align the reimbursement with the evidence of benefit to the patient and the healthcare system. It seems an easy decision if choosing between hospital admission and receiving a medication infusion from your home, possibly on the couch watching Netflix with a bowl of your care-giver’s perfect chicken noodle soup. At a minimum, it should be part of the treatment plan discussion with your healthcare provider. When outpatient medication infusion could lead to improving patient outcomes, reducing cost and improving patient happiness, then there really is no place like home.

References:
1.About Infusion Therapy. http://www.nhia.org/about-home-infusion.cfm
2.Mcbride A, Campen CJ, Camamo J, et al. Implementation of a pharmacy-managed program for the transition of chemotherapy to the outpatient setting. American Journal of Health-System Pharmacy. 2018;75(9):e246-e258. doi:10.2146/ajhp170138
3. Norris AH, Shrestha NK, Allison GM, et al. 2018 Infectious Diseases Society of America Clinical Practice Guideline for the Management of Outpatient Parenteral Antimicrobial Therapya. Clinical Infectious Diseases. 2018;68(1). doi:10.1093/cid/ciy745.