First UK home infusion of Remicade®
(infliximab) for RA
Taken from NRAS magazine, Winter 2009
The anti-TNF class of medicines are administered by infusion or injection, which often requires the support of a nurse in a hospital setting. Over time, this can put pressure on resources available and also conflicts with newer NHS policy which is about delivering care closer to home and giving patients greater choice as to how and where they receive their care. Therefore alternative solutions need to be considered.
A successful partnership has been running for a number of years to deliver extra infusion clinic capacity on-site within the NHS. This has been a partnership between a number of NHS Trusts, pharmaceutical company Schering-Plough Ltd and independent healthcare provider Healthcare at Home Ltd (HaH), who have provided experienced nurses with extended intravenous (IV) skills to run the infusion clinics.
Infusion clinics provide patients and clinicians with a valuable choice of administering therapy but still within the confines of a hospital environment. However, the potential to offer patients the opportunity of treatment within a more convenient location, such as their own home, has been met with considerable interest by both patients and clinicians. Although there have been discussions with a number of stakeholders regarding these at-home infusions for this therapy area, it hasn’t been a possibility, until now.
In conjunction with HaH, Schering-Plough explored this concept with a number of forward thinking NHS trusts, which resulted in an initiative to provide infusions of infliximab in a home setting. We were pleased to be part of this project gauging whether administering carefully monitored home infusions would be clinically appropriate. Once all stakeholders had been consulted and were comfortable that the provision of home infusions was safe and appropriate for some patients, a programme was established in North East England.
Discussing the pioneering scheme, Sister Beverley Neville, Rheumatology Specialist Nurse at Harrogate District Hospital said, “In Harrogate we are always looking for innovative ways to enhance services for our patients and this has enabled us to offer choice, which is what everyone wants today. It also addresses individuals’ preferences as to where they would ideally like to have their treatment delivered. This is especially important in Harrogate as we have an ageing population who often struggle to get to the Hospital.”
Sister Neville was speaking from the home of one of her patients, who was the first patient in the UK to experience a home infusion of infliximab for the treatment of her RA. “Joan is not just the first patient to have this treatment at home; she was also the first patient in Harrogate to receive infliximab nearly 10 years ago. As such, she is a great person to be involved in this project.”
Sister Neville sees many potential benefits in providing infusion services at home. She states, “With fine tuning this scheme has the potential to free up valuable resources within the hospital which could allow us to focus on more complex treatments. We currently use a longer infusion regime at home than we do in hospital, but there is potential to increase the infusion rate to the same as the one we use in hospital as confidence in the scheme grows. Teamwork and good communication are pivotal to our success.”
There are financial benefits for the tax payers that fund the NHS too. At present, the home infusion service is funded by Schering-Plough, who manufactures infliximab. However, there is more evidence emerging to show that administering a broad range of drug treatments to patients at home is significantly less expensive than allocating space and staff time within a hospital setting. In addition, the wider costs associated with hospital treatment, such as provision of transport, car parking and time taken off work for patients and their carers to attend hospital appointments, combined with the convenience of receiving treatment at home, makes home infusion a compelling option.