Maximising the benefits of at-home IV infusions
As demand for health and social care grows, the need to alleviate pressure on hospital resources – including space, staff, and equipment – is urgent.
Increasingly, medical care is shifting to home and community settings to free-up hospital resources and save costs. This includes intravenous (IV) infusions, which deliver fluids, medicine, and nutrients into the bloodstream.
Research suggests that in-hospital IV infusions may be subject to a substantial shift to homecare, saving payers up to 52% on medical and pharmacy costs, particularly on infusions for multiple sclerosis, immune deficiencies, rheumatoid arthritis, inflammatory bowel disease, and cancer. The benefits of having IV infusions at-home are clear. From a patient perspective, home infusion therapy cuts travel costs, reduces hospital admissions, and limits the likelihood of hospital-acquired infections – ultimately creating more positive patient outcomes. Home infusion therapy can also improve end-of-life care by increasing the time patients can spend with their family at home.
While there is an opportunity to accelerate growth in the home infusion therapy market, improving both the service offering and the usability of the devices in the home setting will be critical to realising the value to both patients and the healthcare system.
To demonstrate value, leaders should understand what makes medical devices work well for at-home users, how digital services are improving the way health and social care providers engage and monitor users remotely, and how patients are gaining the skills needed for self-administration. By learning from past experience, speaking to users, building skills, and deploying digital tools, drug delivery device designers can drive the adoption of safe, effective at-home IV infusions.
1. Learning from experience
The key to successful and safe integration of medical devices and products into a new service is to provide patients, carers, and healthcare professionals with the right equipment, training, and support. There are a range of initiatives which are enabling some patients to have infusion therapy from home, each with their own story.
For example, one of our colleagues at PA cared for her son after a sports injury which led to him needing to take long-term antibiotics by an electronic IV syringe pump from home. Home infusion therapy enabled her son to live a relatively normal teenage life while undergoing treatment, but there were limitations. Trailing wires, having to mix the drugs for immediate use during early morning and late-night hours, difficulty loading the syringe, and very loud alarms made the process challenging.
Device manufacturers have designed some home infusion therapy devices to be easier for patients to use, allowing greater mobility by focusing on essential features. Take elastomeric outpatient parenteral antimicrobial therapy (OPAT) infusion pumps. These pumps have been deskilled for those living with chronic conditions such as bronchiectasis and made mobile enough for easy, power-free at-home use. Learnings from OPAT deployment and other devices can be applied to the co-creation of new home infusion therapy products that are easy to use, while also capturing the value of insights from data to make improvements.
2. Unlocking the value of UX testing and human-centred design
To protect at-home users, solutions need to be compatible with the capabilities and home environment of the target user. UX testing at the product development stage can help manufacturers ensure IV infusion devices are right for their target users, improving the patient experience and avoiding recall issues post-launch.
We helped a biotech client to develop a device to replicate the drug administration experience via our anthropometric measurement instrument (AMI), collecting and analysing user trials data to inform design. Through the use of a linear actuator and closed loop control, the AMI is able to simulate the flow of a Newtonian fluid through a syringe and measure the force profile applied by the user in the process. The system allows the collection of user trials data without human intervention, error, or bias. This innovative approach to determining user needs led to a better-designed drug delivery device for patients, and accelerated the commercial launch by smoothing out the regulatory review process.
We also applied user insights to co-develop a novel patient-controlled therapy for terminally ill patients with pain and breathing difficulties due to fluid build-up in their chest. Designed in partnership with Bearpac Medical, the Passio™ device provides pain management while enabling patients to live at home with medical support. Through user research, we identified patients’ needs and experiences to rapidly iterate a new device, improving comfort by using a lower vacuum pressure to remove chest fluid than alternatives. We developed a handheld device for users to adjust flow and pressure, putting control quite literally into their hands.
3. Building critical skills
As healthcare increasingly focuses on self-administered procedures, making sure users have a sound understanding of equipment and its safe use is imperative. When designing a successful home infusion therapy service, it is important to consider the development of patient training services and education materials. Accessible and inclusive websites and tools, both digital and in print, communicate the benefits and support available to patients throughout the treatment pathway, from informed consent to managing their ongoing care from home. By reviewing progress on the care plan on a weekly basis and ensuring the patients gain confidence in their skills, the Guy’s and St Thomas' home IV therapy service was able to continuously improve, saving 5,000 hospital bed days and £1.5 million over two years.
To date, some infusion device manufacturers have co-ordinated regional nurse-led home infusion therapy services registered with the Care Quality Commission giving patients and carers the skills, confidence, and reliable equipment needed to take their medication safely while opening up new opportunities for manufacturers to have more direct relationships with patients. This poses an opportunity for more device manufacturers to develop new and existing service models which are scalable via knowledge transfer between sites and by collaborating with experienced partners who can accelerate device integration and service roll-out at a national scale.
4. Deploying digital
As demand for social care rises, there’s a growing realisation that technology can help to fill the void. Digital enablers will be key to safely integrating home-based IV infusion devices into a home infusion therapy service. According to ECRI, the majority of in-hospital smart infusion pump errors could be prevented by digital integration with Electronic Health Records (EHR) via open standards, allowing pump programming to be checked against medication orders and removing many manual documentation tasks. So, it makes sense that IV infusion devices for homecare should incorporate digital and data features, but what’s the best way of delivering these in the home?
For around a decade, our managed care technology service, Argenti Care Technology, has continued to grow, having co-designed and integrated flexible care technology solutions around the individual needs of more than 40,000 people receiving care support, improving their autonomy, wellbeing, and safety.
By taking a partnership approach with local authorities, their communities and the third sector, this has delivered outcome focussed care technology services, adding value for service users and taxpayers. In addition, by taking an integrated service approach that is device agnostic, Argenti embeds workable technology to address the whole package of care from referral to response, improving continuity for service users.
Managed care technology services like Argenti will become increasingly important to freeing-up capacity in hospitals by discharging risk-assessed patients as service users and improving outcomes.
By learning from experience, using human-centred design principles, and deploying digital and data, designers and manufacturers can accelerate the safe use of IV infusions in home and community environments. Not only will this deliver a better experience for carers, patients, and healthcare professionals, but it will improve the resilience of healthcare systems and ensure demand is met.