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

Abstract

The clinical homecare sector is often associated with high-cost drug parenteral (injectable) therapy treatments and has been rapidly growing in the United Kingdom (UK) at a 20% annual rate. It was estimated that this could further rise to 60% if extended to all medicines that are considered to be suitable for care at home. The latest data shows that the homecare medicines services sector continues to grow in number and complexity, with over 500,000 patients and a spend of UK£3.2 billion in 2021. Given the extent of the National Health Service (NHS) expenditure and the number of patients involved, it is essential to understand and explore the patients' and HCPs' experiences, views, and perceptions of this therapy. As identified during this literature review, homecare provides opportunities for improved cost savings and improved patient experience, but several issues have already been reported worldwide. Patient education, training, support, and regular supervision, as well as the competency of HCPs to manage these patients, have all been identified as factors that contribute to the success or failure of self-administration of parenteral therapy at home, which might impact treatment outcomes and adherence. This is an area that needs urgent research.

The Experience of Home Parenteral Therapy: A Thematic Analysis of Patient Interviews

“…Currently, little is known about patients' experiences and perceptions about their training and education on self-administering HPT in the UK [4]. Originally exclusively in hospital, training is increasingly being outsourced to commercial clinical homecare providers, and HCPs who initiated patients on the long-term self-administration of HPT might not be directly involved in patients' training and supervision, or the assessment of competence for self-injecting.…”