Department of Pharmacy, Yale New Haven Health, New Haven, CT, USA.
Department of Nursing, Yale New Haven Health, New Haven, CT, USA.
Am J Health Syst Pharm. 2021 Jun 7;78(12):1112-1117. doi: 10.1093/ajhp/zxab072.
Intravenous immune globulin (IVIG) therapy is used in patients with hypogammaglobulinemia to lower the risk of infections. IVIG and subcutaneous IVIG (SCIG) therapy have been to shown to be safe and effective when administered as clinic-based infusions. Concern from both patients and providers for increased transmission of the coronavirus disease 2019 (COVID-19) virus to immunosuppressed patients with scheduled medical visits and procedures made it necessary for us to reassess our process of how we manage patient care in general and chronic clinic infusions in particular. Here we describe our experience of transitioning patients from clinic-based to home based IVIG and/or SCIG infusions to decrease the risk of COVID-19 exposure.
Criteria were developed to identify high-risk immunosuppressed patients who would be appropriate candidates for potential conversion to home based IVIG infusions. Data were collected via chart review, and cost analysis was performed using Medicare Part B reimbursement data. A patient outcome questionnaire was developed for administration through follow-up phone calls.
From March to May 2020, 45 patients met criteria for home-based infusion, with 27 patients (60%) agreeing to home-based infusion. Posttransition patient outcomes assessment, conducted in 26 patients (96%), demonstrated good patient understanding of the home-based infusion process. No infusion-related complications were reported, and 24 patients (92%) had no concerns about receiving future IVIG and/or SCIG doses at home. No patient tested positive for COVID-19 during the study period. Clinic infusion visits decreased by 26.6 visits per month, resulting in a total of 106 hours of additional available infusion chair time per month and associated cost savings of $12,877.
Transition of clinic based to home based IVIG/SCIG infusion can be successfully done to decrease potential exposure during a pandemic in a high-risk immunosuppressed population, with no impact on patient satisfaction, adherence, or efficacy. The home-based infusion initiative was associated with a reduction in costs to patients and an increase in available chair time in the infusion clinic.
静脉注射免疫球蛋白（IVIG）疗法用于治疗低丙种球蛋白血症患者，以降低感染风险。IVIG 和皮下 IVIG（SCIG）疗法已被证明在作为门诊输注给药时是安全有效的。由于预约门诊和接受治疗的免疫功能低下的患者对 2019 年冠状病毒病（COVID-19）病毒传播的担忧增加，我们有必要重新评估我们管理患者护理的流程，特别是慢性门诊输注。在这里，我们描述了将患者从门诊转为家庭 IVIG 和/或 SCIG 输注的经验，以降低 COVID-19 暴露风险。
制定了标准，以确定哪些高危免疫抑制患者适合转为家庭 IVIG 输注。通过病历回顾收集数据，并使用医疗保险 B 部分报销数据进行成本分析。为通过随访电话进行的患者结果问卷调查制定了方案。
2020 年 3 月至 5 月，45 名患者符合家庭输注标准，其中 27 名（60%）患者同意进行家庭输注。对 26 名（96%）患者进行了过渡后患者结果评估，结果表明患者对家庭输注过程有很好的理解。没有报告与输注相关的并发症，24 名（92%）患者对在家中接受未来的 IVIG 和/或 SCIG 剂量没有顾虑。在研究期间，没有患者 COVID-19 检测呈阳性。门诊输注就诊次数每月减少 26.6 次，每月增加 106 小时的可用输注椅时间，相关成本节约 12877 美元。
在高危免疫抑制人群中，将门诊 IVIG/SCIG 输注转为家庭输注可以成功降低大流行期间的潜在暴露风险，而不会影响患者满意度、依从性或疗效。家庭输注计划与患者成本降低和输注诊所可用椅时间增加有关。
