Home-Based Treatment with Immunoglobulins: an Evaluation from the Perspective of Patients and Healthcare Professionals

Abstract

PurposeThis study aims to evaluate home-based treatment with immunoglobulin (IgG) by assessing and comparing the experiences and perceived value of patients and healthcare professionals, and potential differences in experiences between subcutaneous (SCIg) and intravenous (IVIg) modes of administration. As choices on the location and type of treatment are determined in a shared decision-making process, we evaluated the home-based treatment from the perspectives of both patients and professionals.MethodsA questionnaire study was conducted among 205 patients, 44 informal caregivers, 43 hospital professionals, and 21 nurses of the Sanquin Home Service (SHS) that provides home treatment with immunoglobulins in the Netherlands. Experiences, perceived benefits, and effects on the patients’ quality of life and overall ratings were assessed.ResultsBoth patients and professionals were predominantly positive about the home treatment, irrespective of the administration mode. The home-based treatment with Ig contributed to the patients’ autonomy, participation, and perceived health. Patients and informal caregivers valued the treatment with a global rating of 8.84, and professionals with 8.32 (on a scale from 0 “worst” to 10 “best possible care”). SCIg and IVIg patient groups differed in their experiences regarding the accessibility and communication of the home treatment service. Furthermore, hospital professionals reported lower effects on quality of life than patients themselves.ConclusionsHome-based treatment with immunoglobulins is highly valued because of its personalized and effective character, meeting the needs and preferences of patients. Nonetheless, patients and professionals do have different perspectives on the value of this type of care.Electronic supplementary materialThe online version of this article (10.1007/s10875-018-0566-z) contains supplementary material, which is available to authorized users.

Willingness and concerns of transfusion-dependent hematological patients toward the option of home transfusion therapy

“…A self-administered anonymous questionnaire that was developed by hematology clinicians based on their prior knowledge of patient attitudes and the scientific literature on the subject, 6 , 8 , 9 was tested initially on a small sample of patients ( n = 20) in two hospitals. The questionnaire, which was available in three prevalent languages in Israel (Hebrew, Arabic, and Russian), consisted of minimal demographic information (age, gender, place of residence, and level of education) and a 14-item multiple-choice questionnaire.…”

Inborn Errors of Immunity with Predominant Antibody Deficiencies: Epidemiology, Diagnosis, and Therapy

“…Безусловно, необходимо предварительное обучение квалифицированным медицинским персоналом методике подкожного введения иммуноглобулина и предварительное согласие пациента на такой вариант лечения. При этом пациент становится менее зависим от лечебного учреждения, более мобилен и при правильном контроле и своевременном получении препарата в целом при анкетировании пациенты констатируют улучшение качества жизни [20][21][22][23][24][25]. Существуют исследования, которые доказывают, что ранняя диагностика и затем качественная заместительная терапия, которая начата максимально рано, способствуют снижению эпизодов инфекционных осложнений, более мягкому их течению, снижают нагрузку на учреждения здравоохранения, а также возможно снижение активности аутоиммунных проявлений с коррекцией иммуносупрессивной терапии и предположительным сдвигом вероятности манифестации новообразований по временной шкале в более отдаленные сроки [26][27][28].…”

Parenteral Therapy in Domiciliary and Outpatient Setting: A Critical Review of the Literature

“…IRT aims to raise the IgG levels in serum to normal concentrations, increase immune protection, reduce infections, improve QoL, and slowly reduce or arrest the progression of associated organ damage [22]. They can be administered either IV (IVIg) or SC (SCIg), and both can be performed in the home setting, although SCIg is more common in home care and IVIg is more common in hospitals [4,22,23]. SCIg is administered in smaller weekly doses, which results in lower peak and higher IgG trough levels compared to the higher doses of IVIg infusions with longer intervals between [21].…”

“…Such complex therapies require an aseptic technique, care of the central venous catheter (CVC), and the use of infusion control devices. Treatment in the home is considered convenient, comfortable, and flexible leading to greater independence compared to inpatient hospital treatment [4]. Home therapy can reduce unplanned hospital readmissions.…”