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Since its introduction in the early 1970s, home intravenous antimicrobial therapy has seen tremendous growth, due in large part to the AIDS epidemic and Lyme’s disease. Home intravenous antimicrobial therapy is also the largest single component of home infusion therapy-accounting for the largest number of I.V. patients and also often representing the greatest cost for a home infusion company.
Home antimicrobial therapy is a safe, effective, and less expensive alternative to the hospital environment. It is also preferred by most patients. These four factors have lead to its success. In fact, economic benefits show a 25 to 75 percent reduction in treatment costs compared to inpatient costs, and up to 70 percent of patients prefer home care to other environments. For some patients, such as those with HIV, AIDS, or who are immunocompromised, home intravenous antimicrobial therapy is believed to be safer than hospital administration due to the increasing prevalence of antimicrobial resistant microorganisms and risk of contracting nosocomial infections in the hospital.
How Success Arrives
The success of a patient on home intravenous antimicrobial therapy depends considerably on individual patient care planning. Patients receiving antimicrobials are not only the most prevalent population in most home infusion companies, but also the most diverse. These patients present with multiple disease states, ages, and medication, as well as varying types of vascular accesses and infusion devices.
What's Ahead
With morbidity and mortality associated with infectious disease on the rise the utilization of antimicrobials in the home is certain to continue. While HIV/AIDS treatment has made tremendous leaps in the past year, HIV/AIDS-related treatment of infectious disease is still likely to have a significant impact on the future of the infusion industry.
Treatment duration can also be expected to rise as therapies of increasing complexity are initiated in the home setting that once was only administered in the inpatient setting. Similarly, with rising antibiotic resistance and increasing types and severity of infections being treated in the home, more combination antimicrobial regimens can be expected.
Factors Affecting the Infectious Disease Process
It is well-known that cancer and its treatment, as well as autoimmune disease and immunoactive drug agents, can mimic infection and substantially increase the risk of infection.
It is not often considered, however, that a great number of other common chronic conditions can also predispose a person to infection. These include:
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Osteoarthritis and other musculoskeletal disorders
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Cardiovascular disease, including high blood pressure, congestive heart failure angina pectoris, or past myocardial infarction or stroke
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Hiatal hernia, diverticulosis, constipation and other gastrointestinal disturbances
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Diseases of the endocrine system such as diabetes mellitus or thyroid disease
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Neuropsychiatric disorders such as seizures, Parkinsonism, dementia, and depression
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Genitourinary disorders, such as incontinence or benign prostatic hypertrophy
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Skin diseases, ranging from dryness to decubitus ulcers
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Pulmonary system disorders, such as chronic obstructive pulmonary disease
Considering that the average elderly adult may have as many as five of these predisposing conditions, the risk of infection is greatly increased. Equally important, treatment of these chronic conditions generally involves drug therapy, raising the likelihood of additional complications due to polypharmacy.
Anti-infectives have been one of the primary classes of I.V. drug therapies used in the home setting over the past 15 years. Due to limited coverage of these therapies under Medicare Part B, the patient base for these therapies has been for the most part a younger, non-Medicare population. However, based on current developments in both private health plans and in Medicare and Medicaid, the demographic profile of alternate site I.V. antibiotic patients could shift dramatically in the coming years.
A growing number of ambulatory infusion centers also offer an opportunity to serve an increasing number of elderly patients.
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