What is infusion therapy?
What diseases are treated with infusion therapy?
What is specialty infusion therapy?
Why are infusions performed at home?
What is a home infusion therapy provider?
What alternate-site care settings are appropriate for infusion therapy in addition a patient’s home?
Infusion therapy involves the administration of medication through a needle or catheter. It is prescribed when a patient’s condition is so severe that it cannot be treated effectively by oral medications. Typically, “infusion therapy” means that a drug is administered intravenously, but the term also may refer to situations where drugs are provided through other non-oral routes, such as intramuscular injections and epidural routes (into the membranes surrounding the spinal cord).
“Traditional” prescription drug therapies commonly administered via infusion include antibiotic, antifungal, antiviral, chemotherapy, hydration, pain management and parenteral nutrition.
Infusion therapy is also provided to patients for treating a wide assortment of often chronic and sometimes rare diseases for which “specialty” infusion medications are effective. While some have been available for many years, others are newer drugs and biologics. Examples include blood factors, corticosteroids, erythropoietin, infliximab, inotropic heart medications, growth hormones, immunoglobulin, natalizumab and many others.
Diseases commonly requiring infusion therapy include infections that are unresponsive to oral antibiotics, cancer and cancer-related pain, dehydration, gastrointestinal diseases or disorders which prevent normal functioning of the gastrointestinal system, and more. Other conditions treated with specialty infusion therapies may include cancers, congestive heart failure, Crohn’s Disease, hemophilia, immune deficiencies, multiple sclerosis, rheumatoid arthritis, and more.
By far, the major home infusion therapies are IV antibiotics, prescribed primarily for such diagnoses as cellulitis, sepsis, and osteomyelitis; other diagnoses include urinary tract infections, pneumonia, sinusitis and more.
“Specialty infusion therapy” is a term in use when “specialty” infusion medications are administered. However, it also is used to reflect the highly specialized services and level of care that an infusion pharmacy provides to its infusion therapy patients. While there are some infusion pharmacy organizations that focus on providing a limited set of specialty infusion therapies, others provide the wide spectrum of traditional and specialty infusion therapies. The distinction, if any, between the meaning of “specialty infusion therapy” and “infusion therapy” is related to the context of their use.
Until the 1980s, patients receiving infusion therapy had to remain in the inpatient setting for the duration of their therapy. Heightened emphasis on cost-containment in health care, as well as developments in the clinical administration of the therapy, led to strategies to administer infusion therapy in alternate settings. For individuals requiring long-term therapy, inpatient care is not only tremendously expensive but also prevents the individual from resuming normal lifestyle and work activities.
The technological advances that enabled safe and effective administration of infusion therapies in the home, the desire of patients to resume normal lifestyles and work activities while recovering from illness, and the cost-effectiveness of home care are important. Consequently, home infusion therapy has evolved into a comprehensive medical therapy that is a much less costly alternative to inpatient treatment in a hospital or skilled nursing facility.
Home infusion has been proven to be a safe and effective alternative to inpatient care for many disease states and therapies. For many patients, receiving treatment at home or in an outpatient infusion suite setting is preferable to inpatient care. A thorough patient assessment and home assessment are performed before initiating infusion therapy at home to ensure that the patient is an appropriate candidate for home care.
An infusion therapy provider is most normally a “closed-door”, state-licensed pharmacy that specializes in provision of infusion therapies to patients in their homes or other alternate-sites. The infusion therapy always originates with a prescription order from a qualified physician who is overseeing the care of the patient.
A nationally-accepted, technical definition of a home infusion therapy pharmacy is a:
Pharmacy-based, decentralized patient care organization with expertise in USP 797-compliant sterile drug compounding that provides care to patients with acute or chronic conditions generally pertaining to parenteral administration of drugs, biologics and nutritional formulae administered through catheters and/or needles in home and alternate sites. Extensive professional pharmacy services, care coordination, infusion nursing services, supplies and equipment are provided to optimize efficacy and compliance.
Qualified infusion pharmacies must satisfy licensing and other regulatory requirements imposed by state pharmacy boards as well as accreditation standards required by most third-party payers. Home infusion pharmacies may also provide additional professional therapies and services, including enteral nutrition therapy, inhalation therapies using nebulizers, and disease state and care management services.
Pharmacy organizations providing infusion therapy include local, regional, and national organizations. Some are independent pharmacies. Others are affiliated with hospitals, home nursing agencies, traditional retail pharmacies, respiratory therapy suppliers or other health care providers.
Patients may shorten or avoid stays in institutions such as hospitals and nursing homes when their infusion therapy can be provided in alternate-site settings including their homes and ambulatory infusion centers.
Many home infusion therapy providers operate a health care facility called the Ambulatory Infusion Suite of the home infusion therapy provider, or AIS. The AIS is a setting where the clinical care provided pursuant to physician orders is managed and performed by RNs and registered pharmacists that are highly skilled in provision of infusion/specialty drug administration. Due to the cost-effectiveness of this care and its appropriateness for use with certain patient-therapy situations, there is significant growth in openings of new AIS facilities.
The AIS is one of three types of Ambulatory Infusion Centers (AICs):
- Ambulatory Infusion Suite of the home infusion therapy provider (AIS).
- Physician-based infusion clinic.
- Hospital-based infusion clinic.