Ambulatory Infusion Therapy

SEPTEMBER 14, 2015
Kathleen Kenny, PharmD, RPh
Ambulatory infusion therapy is a flourishing nationwide trend. Due to a confluence of health care trends, such as an upsurge in specialty medications that require expert-level administration, a population increasing in age, and steep health care costs, a challenging, but lucrative opportunity for pharmacies and pharmacists alike has begun to emerge.

The ambulatory infusion therapy market is currently estimated to represent between $9 billion and $11 billion in annual US health care expenditures.1 According to CVS/caremark’s Insights 2013 Specialty Drug Trend Report, infused drugs make up roughly $35 billion of the specialty drug market. In addition, specialty medications are expected to increase from $92 billion in 2012 to $235 billion by 2018.2 Many retail pharmacies are taking advantage of these opportunities by offering both home infusion services and alternate-site infusion.

This heightened emphasis on cost effectiveness and cost containment has prompted a necessary change from long, expensive hospital stays for the duration of infusion therapy. Technological advances have enabled safe and effective alternative methods for obtaining these infusions. Ambulatory infusion therapy enables patients to decrease or totally avoid hospital or nursing home stays and resume normal routines and work behaviors while still treating their illnesses.1

Home infusion therapies may be provided by a variety of organizations, such as hospitals, community pharmacies, hospices, and home health agencies. They may provide all of the following and more: infusion therapies, specialty pharmacy services, respiratory equipment and clinical respiratory services (including oxygen), home medical equipment and supplies, and enteral products and supplies.3

Ambulatory infusion allows management of chronic and complex conditions such as cancer and cancer-related pain, congestive heart failure, Crohn’s disease, hemophilia, immune deficiencies, rheumatoid arthritis, hepatitis C virus infection, multiple sclerosis, chronic inflammatory disease, dehydration, and malnutrition. By far, however, the chief infusion therapies are intravenous (IV) antibiotics prescribed for cellulitis, sepsis, osteomyelitis, urinary tract infections, pneumonia, sinusitis, and more.

Pharmacist Duties
In most cases of alternate-site or home infusion, patients are being discharged from an inpatient facility, such as a hospital or nursing home, and require extensive coordination of care. Pharmacists are an important part of the patient care team focused on providing effective transitional and continual care. Once the referral for alternate-site or home infusion therapy has been approved by the third-party payer and a doctor’s order has been secured, pharmacists can begin the alternate-site or home infusion process.

Managing infusion therapies requires specialized facilities and expertise. The infusion pharmacy must ensure that infusion drugs are compounded in a sterile environment by maintaining an atmosphere conducive to keeping drugs sterile and stable and ensuring the suitability of vascular access sites based on the pH, osmolarity, and osmolality of medications, as well as the duration of therapy. Drugs must be administered with the appropriate drug-delivery device and flushed with the proper solutions between doses. Infusion pharmacists are also responsible for identifying potential drug–drug, drug–dose, or drug–catheter incompatibilities.1

Pharmacists must perform comprehensive patient assessments, including patient history; current prescription and OTC medications; physical, emotional, and mental status; lab results; and support networks. They must also educate patients on treatment plan expectations and patient-specific goals.4