Cutting-Edge Option Care Research Presented at NHIA Finds Home IV Antibiotic Method Can Affect Adherence, Cost

New research by Option
Care Enterprises, Inc. (“Option Care”), the nation’s leading
provider of home and alternate site infusion therapy services, suggests
the method of antibiotic intravenous (IV) administration can improve
patient compliance while decreasing costs. The study¹ was
presented today at the National Home Infusion Association (NHIA) Annual
Conference and is a finalist for the “Outstanding Abstract Achievement
Award.”

The researchers analyzed patient compliance by comparing four techniques
for antibiotic self-administration and determined ease of providing
therapy was a significant factor. They concluded patients were
significantly more likely to comply with therapy if they used the
elastomeric pump or IV push than if they used the gravity/mini bag or
electronic pump. Additionally, in many cases IV push and elastomeric
pump are less costly.

“There’s a common perception that the gravity/mini bag is the least
expensive method, but our research shows not only are IV push and
elastomeric pump often more cost-effective, but patients find them
easier to use, decreasing the likelihood that they will skip doses,
which can lead to failed therapy and hospital readmission,” said Julie
Wurdeman, PharmD, an Option Care infusion pharmacist and primary author
of the study. “Our findings have implications for helping establish the
most appropriate method of administration and underscore the value of
collaboration among patients and the care team.”

The type of IV antibiotic therapy typically is chosen by the pharmacist
in collaboration with the physician and determined by several factors
including the medication, frequency of therapy (typically one to three
times a day), rate of infusion as well as provider preference, patient
lifestyle and age. The research suggests that patient compliance and
cost should be factored into the equation.

Researchers studied treatment compliance in 688 Option Care home
infusion patients who were treated between October 2017 and October 2018
and who missed one or more doses of IV antibiotics. They found the
percentage of doses missed by technique was: 2.6 percent elastomeric
pump, 2.7 percent IV push, 5 percent mini bag and 8.6 percent electronic
pump.

There is a wide variation between methods in the cost of administration
(factoring in equipment, compounding and patient education, but not
medication), including a 209 percent difference between the
least-expensive, IV push, and the most-expensive, electronic pump. The
cost varies depending on the number of times per day and the rate at
which the antibiotic is provided, as well as whether equipment can be
reused and other factors.

In home antibiotic therapy, the patient infuses the medication through a
catheter (placed by a nurse in a vein, usually in the hand or arm). The
medication typically is administered one of four ways:

• IV push: The patient injects the medication via a syringe. This
  process is easy to learn, portable and fast.
• Elastomeric pump: The tennis ball-sized device comes pre-filled with
  the medication and self-squeezes it through tubing into a port the
  patient inserts into the catheter. This technique is easy to learn,
  precise and portable.
• Gravity/mini bag: The patient hangs the bag of medication on a pole
  and inserts the end of the tube into the catheter. The equipment
  involves set-up and is bulky, so it is not easily portable.
• Electronic pump: The patient connects the medication to the pump as
  well as the tube into the catheter and turns on the pump. The
  equipment involves set-up and is bulky, requiring the patient to carry
  the pump wherever he or she goes.

“While the type of antibiotic and rate of administration are the most
important factors in determining the method of administration, in many
cases there is flexibility,” said Wurdeman. “It’s important to consider
all factors – including patient preference – which can help improve
compliance and decrease costs.”

For its first Outstanding Abstract Achievement Award, the National Home
Infusion Foundation chose abstracts that examine an innovative approach
to clinical practice; identify a best practice or improve quality; are
relevant to a current challenge, issue or question facing the home
infusion industry; employ an effective study design/methodology to
achieve results and have the ability to be expanded to a larger study.

Another Option Care study² being presented at NHIA compared
results associated with frequency of therapeutic drug monitoring (TDM)
among 100 patients treated with home infusion of high-dose vancomycin (a
commonly prescribed antibiotic), half of whom were monitored weekly and
half twice weekly. Researchers detected a potential trend that major
events such as emergency department visits or hospital admissions were
less prevalent among patients 55 and older who received high-dose
vancomycin with twice-weekly TDM.

About Option Care

Option Care Enterprises, Inc. (Option Care) is the nation’s leading and
most trusted provider of home and alternate site infusion services.
Holding accreditations from industry quality organizations ACHC, PCAB,
ASHP and URAC,* the company draws on nearly 40 years of clinical care
experience to offer patient-centered therapy management. Option Care’s
signature infusion services include the clinical management of infusion
medicines, nursing support and care coordination. Option Care’s
multidisciplinary team of more than 1,800 clinicians – including
pharmacists, nurses and dietitians – are able to provide infusion
service coverage for nearly all patients across the United States
needing treatment for complex and chronic conditions. Learn more at www.OptionCare.com.

* Accreditation Commission for Health Care (ACHC), Pharmacy Compounding
Accreditation Board (PCAB), American Society of Health-System
Pharmacists (ASHP) and URAC

1. Wurdeman J, Decaminada G, Andrusko-Furphy K, et al. Comparison of
   compliance and comprehensive cost for various methods of
   administration of intravenous antibiotics in a home infusion setting.
   Poster presented at the National Home Infusion Association (NHIA)
   Annual Conference; March 9-13, 2019, Orlando, Fla.
2. Cheung K, Rout T, Banerjee U, et al. A Retrospective Evaluation of the
   Frequency of Vancomycin Monitoring and its Effects on Home Infusion
   Patients. Poster presented at the National Home Infusion Association
   (NHIA) Annual Conference; March 9-13, 2019, Orlando, Fla.

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