Vicky is a 22 year old who has Cystic Fibrosis (CF). As a consequence of this genetic disorder her lungs are very susceptible to infections. She has to have daily antibiotics to keep the infections at bay and physiotherapy to clear the sticky mucus from her lungs. As part of her treatment regime she has regular intra venous (IV) infusions of antibiotics every three months, twice a day for two weeks. This is to help prevent her lungs becoming more infected by pseudomonas aurogenosa a particularly nasty bacteria which is a problem for patients with CF.
Every three months Vicky had to take time off from her job and attend her CF centre, where the clinical team would administer the IV infusions twice a day.
Now Vicky's CF centre utilises the services of a clinical homecare provider. They support Vicky by arranging the supply of IV antibiotics at home. The homecare team liaise with Vicky's CF Team to obtain her prescription, arrange for the medicines to be made up in a registered manufacturing unit (to ensure sterility of product), and delivered to her home together with all the equipment and consumables needed. Vicky has been fully trained by the CF centre on how to administer the medicines so with the help of her parents she is able to look after her own treatment.
Once the treatment is finished the homecare company arranges for all the clinical waste to be removed together with any equipment no longer needed.
The use of a homecare provider has enabled Vicky to carry on her normal routine in her own home. Her schedule is altered over those two weeks to fit in the IV infusions, however she is able to carry on working and living almost normally.
A professional homecare service can work in partnership with the clinical team and the patient to help improve the quality of life of the patient.
National Hospital for Neurology and Neurosurgery, London
Intravenous steroids are used routinely in the treatment of disabling relapses in multiple sclerosis. Patients who had a clinically significant relapse within 4 weeks of onset were randomly assigned to receive a 3-day regimen of intravenous methylprednisolone either in an outpatient clinic (n=69) or at home (n=69). The MS relapse management scale (MSRMS) was developed by the NationalHospitalfor Neurology and Neurosurgery in order to measure patients' experiences of relapse management as the primary outcome. Efficacy of the two treatment modalities was compared in terms of both traditional measures and economic cost. A cost-minimisation analysis was also done. Analysis was by intention to treat.
Home versus outpatient administration of intravenous steroids for multiple-sclerosis relapses: a randomised controlled trial. Published online May 17, 2006 DOI:10.1016/S1474-4422(06)70450-1.
NHS Trust aimed to cut clinic waiting times and reduce costs by delivering medication direct to 500 of its HIV patients.
Here's why the trust chose Homecare:
Pressures of time and money
"All healthcare trusts are under increasing pressure simultaneously to save money and improve the service offered to patients by cutting waiting times,' says senior HIV pharmacist. 'Clinical appointments can take a lot of time because, after seeing the doctor, patients have to wait for their medication. The home delivery process removes the need to wait, and is targeted at stable patients on repeat medications at 3-4 month intervals,' says senior HIV pharmacist. 'They are always seen by the doctor, so do not receive a lesser service, but they don't have to wait for their medication to be dispensed."
Understanding patients' needs
Our primary concerns are patient welfare and confidentiality. But any worries we may have had were quickly allayed by the tremendous sensitivity shown by the Patient Services Team and their willingness to adapt and adjust to meet our precise needs. The Homecare company have vast experience of delivering medication for all manner of conditions and have a real understanding of patient care. We soon built up a great rapport with the team and they demonstrated that they understood the issues and were keen to work with us to provide exactly what we and our patients need.
The big worry for HIV sufferers is confidentiality,' says senior HIV pharmacist. ' Our Homecare company assured us that their drivers would not be aware of what medicines they were delivering, that they would be operating in unmarked vans and with unmarked product boxes.
A guiding hand
Patients had some understandable concerns about the switch-over, but our Homecare Company provided Patient Information Booklets and a helpline number. This helped to reassure everyone that the transition would be smooth and that the new system would be a great improvement.
Fitting in with patients' lifestyle
Efficiency and specific delivery times are crucial for patients trying to maintain a normal life. With a homecare service, patients can contact the patient services teams on the morning of the delivery to get an estimated arrival time, and don't have to wait for hours to take delivery of their prescription.
The transition took little more than a month,' says senior HIV pharmacist. 'Now, 40% of our patients are receiving the service and there is a steady and constant uptake of new patients who welcome the convenience of having their medication brought direct to their door. The service has proved so successful and popular that we are recruiting more than any other trust.
Counting the savings
Ongoing workloads have been considerably reduced given that the Patient Services Team deal directly with the patients concerning delivery, freeing doctors to spend more time on patient care. Meanwhile, waiting times have been cut in half.