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treatments for IVIG would be easier for patient Deborah Farquhar, who
travels an hour each way from Richmond Hill to TGH for the monthly
appointment. (Photo: UHN)
doesn’t always look forward to her monthly visits to the Toronto General
Hospital, where she goes for her IVIG (intravenous immunoglobulin)
Each appointment involves travelling an hour each way from her home
in Richmond Hill, arranging childcare for her two kids, losing a full
day to tend to household errands and chores, and the feeling of
loneliness that comes from being at a hospital all day on her own.
It’s why she’s a supporter of at-home treatment, if made possible,
and why she agreed to be part of a study that looked at whether or not
it was safe and feasible to treat patients in their homes.
First Canadian study
Dr. Hans Katzberg, a neurologist at the University Health Network,
has conducted the first Canadian study on home-based IVIG treatment for
chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), with
the assistance of Vilija Rasutis, RN.
CIDP is an auto-immune disorder that involves the swelling and
inflammation of the nerves, which leads to loss of strength and
sensation, mostly in the arms and legs.
It can strike at any age and affects both men and women. If left untreated CIDP could potentially lead to paralysis.
“Working in a busy acute care setting like Toronto General, you can
see the need for hospital care is outpacing our ability to see patients.
In health care, where you are always looking for ways in delivering
patient-centred care in the most efficient way possible, sometimes you
need to see what other jurisdictions are doing and adapt a model that
has already been proven to work somewhere else,” Katzberg said.
Learning from U.S., European models
IVIG is a blood product that is given to patients with CIDP to help decrease the severity of their auto-immune disorder.
IVIG is the standard therapy for CIDP, but is only administered in a hospital setting in Canada.
For the last 20 years, Europe and the U.S. have been providing this
kind of care for patients in a home-based and nursing-centre based
Katzberg hopes to show his colleagues that Canada can learn from the
U.S. and European model, which redirects stable patient care out of
“Our goals are really two-fold,” said Katzberg. “We need to free up
resources in the hospital for those who need it and also to find ways of
providing the same quality care to patients– who might not necessarily
need to be physically here at the hospital”.
‘Takes a toll’
Patients who currently require IVIG must come to the hospital once a
month for 3-6 hours at a time. In addition, wait times for IVIG in day
units are becoming increasingly longer.
“All the little stresses that result from having to travel to the
hospital for treatment really take a toll on my health,” said Farquhar.
“With stress being one of the factors that aggravates CIDP, I just felt
much better overall when receiving the treatment at home.”
“We are already seeing a number of benefits to the patients who have
participated in the pilot,” Rasutis said. “It is extremely convenient,
which means more patients are likely to get the treatment, instead of
rescheduling or forgetting appointments, it minimizes travel and
childcare costs and lost employment time.”
At-home treatment favoured
The pilot study involved 10 patients, who were treated for six
months. The objective was to determine the safety and feasibility of
out-of-hospital IVIG for maintenance therapy in patients with CIDP.
The study found that home IVIG treatment for maintenance therapy in patients with CIDP was well-tolerated.
All patients were very satisfied and supportive of the home IVIG
program and almost all of the patients preferred home infusion to
hospital based treatment.
With these results in hand, the next step will be to determine how a
program like this would work on a larger scale and to engage with
partners, such as Ontario Home Care services and the Canadian Blood