Deborah Farquhar

 

At-home 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)

Deborah Farquhar doesn’t always look forward to her monthly visits to the Toronto General Hospital, where she goes for her IVIG (intravenous immunoglobulin) treatment.

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 setting.

Katzberg hopes to show his colleagues that Canada can learn from the U.S. and European model, which redirects stable patient care out of acute-care hospitals.

“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 Services.

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