In recent years, the benefits of home for infusion treatments have been recognized by physicians, hospitals and other caregivers. We have outlined four reasons that often make home infusion the best option for everyone involved in a patient's care.

1. Enhanced technology of delivery devices and products eases administration of treatments in the home.
2. The comfort of remaining in one's own home while undergoing treatment is irreplaceable and adds to treatment effectiveness.
3. Increasing awareness and knowledge by physicians, hospital and referral sources are improving the treatments and diagnosis for home administration.
4. Cost effectiveness of home infusion and pressure from insurance companies to cut costs increase the need for home infusion in treatment plans.

The professional Home Infusion team at Causey's Pharmacy is lead by Chris Mayeux, registered pharmacist. He is a specialist in home infusion and has experience in every aspect of planning treatments. Causey's Home Infusion Center coordinates with the physician and nursing teams, monitors patient progress through lab work, assists patients to find the most effective patient care, documents results, provides education, and develops treatment programs. In conjunction with Causey's Home Infusion Center, the professional nursing staff at Causey's can administer medication, start IV lines and provide education and support.

We extend our "no-worry" health care services theme to our payment policies. Experts in our reimbursement department bill private insurance companies, Medicare and Medicaid. Because our team at Causey's includes pharmacists and registered nurses, we understand policies and criteria required for home care and most cases are approved within twenty-four hours from the start of care.

Causey's Home Infusion Center: Therapy Information

• Single Daily IV Doses : Instead of lengthy oral doses, make life simpler with single daily IV doses of your oral medication.
• Hydration Therapy : involves prolonged intravenous infusion of saline or other fluids for the purpose of maintaining or reconstituting a person's intravascular fluid volume.
• Antibiotic Therapy : like oral antibiotics, intravensous infusion of antibiotics fights bacteria and infections.
• Antiviral Therapy : treats HIV, hepatitis B and C, chronic hepatitis, along with other viruses.
• Pain Management : effective and safe because of improved technologies, a better understanding of pain physiology, and multiple options to facilitate customized administration fitting every patient's unique needs.

The range of diagnosis for patients seeking pain management treatment services includes:

• Abdominal pain / irritable bowel syndrome
• Arthritis
• Back and Neck Pain
• Cancer
• Carpal Tunnel Syndrome
• Headaches and Migraines
• Neuropathic pain
• Orthopedic pain
• Reflex sympathetic dystrophy (RSD)
• TMJ syndrome

Pain Therapy options range from behavioral strategies to drug delivery systems. Three drug administrated pain therapies offered at Causey's Pharmacy, Inc. are:

1. Intravenous patient-controlled analgesia: uses ambulatory infusion devices with specially designed cassettes containing medication that is locked into the infusion pump. The pump is programmed to deliver a continuous infusion while the patient also administers doses of medication (within programmed limits).
2. Intraspinal analgesia: installs drugs into the epidural (drugs are absorbed via local fat and blood cells) or intrathecal space (contains cerebrospinal fluid allowing medication to cross the blood-brain barrier).
3. Transdermal patches: delivers analgesia to the patient at a constant rate of infusion in order to manage pain.

While there are various methods of managing pain, the objectives of Pain Therapy remain the same. Any pain management program should focus on:

1. Maximizing pain relief.
2. Minimizing central nervous system effects.
3. Preventing and providing early treatment for any adverse effects that do occur.

At Causey's Pharmacy we provide subcutaneus, intravenous and epidual delivery methods for pain management.

Subcutaneuous : A small needle or catheter is placed into the subcutaneous tissue, usually in the abdominal area, although the thigh and upper arm may be used. Advantages of this method include quick catheter placement, ideal for short-term post-operative pain, catheter flush is not required. Disadvantages include volume restrictions, frequent catheter resites, and tissue irritation with high drug concentration.

Intravenous : One method of intravenous pain management is to use a catheter, usually placed in the hand or arm, that is primarily used to deliver pain medication for short or long term (catheter type varies depending on length of use). Another method is surgically placing a catheter under the skin which can be used for pain management of any duration. Advantages of intravenous pain management include rapid pain relief, no volume restrictions, and a wide choice of analgesics. Disadvantages include catheter occlusion, risk of sepsis, and catheter flush may overdose patient.

Epidural : This method is prevalently used as a treatment of chronic back and lower body cancer pain. A catheter is placed in the abdomen and a needle is used for access. Surgically placed epiduaral catheters are used for long-term pain management. Medicine is absorbed into fat or blood cells. Advantages include enhanced potency / pain relief, no catheter flush, prolonged analgesic effect, and catheter placement matched to focus of pain. Disadvantages include risk of meningitis, motor impairment with anesthetics, limited home health support due to interpretation of nursing regulations, and volume restrictions.

AIDS Therapy : Cytovene for AIDS patients suffering with CMV-Retinitis is available and other therapies to combat the AIDS virus and reduce pain.

Chemotherapy Post-Chemotherapy : including anti-emetics and blood modifiers.

Chemotherapy: Advantages of Home Treatment and What to Expect
Cancer is a disease that puts up a strong fight in a long battle. However, technology is learning more about tactics to wage a more even war. Chemotherapy is one of the many weapons that injures the enemy of cancer cells and sometimes it is so potent that the cancer completely retreats. Generals find methods to improvise their weapons in order to achieve the most effective results. Oncologists take the same approach to fight cancer.

Physicians are realizing the significant effects of home chemotherapy treatments. Even though the treatment of cancer is complex, home treatment is increasing in numbers and effect. Over 110,000 cancer patients now use home therapy, and that number is rapidly growing. Oncologist and cancer researchers recognize the effectiveness of home chemotherapy. It is believed that patients heal faster, respond better to treatment, and experience fewer anxieties when supported by family members and treated in familiar surroundings. Patients treated at home also tend to participate more actively in their own care, thus increasing the likelihood of compliance. Also, home treatment is more cost-effective than the inpatient setting. And another benefit of home chemotherapy is the reduced risk of nosocomial infection. However, perhaps the greatest advantage of home chemotherapy is that many patients can resume some of their normal daily activities.

Selection Criteria
Not all patients and chemotherapeutic treatments are appropriate for the home setting. The following selection criteria include:

• Adequate venous access
• Use of chemotherapeutic agent not associated with significant acute side effects
• Use of an agent known to have extended stability characteristics and with established protocols for administration (experimental protocols are not typically appropriate for this setting)
• A continuous infusion regimen (in most cases)
• Access to home health and / or other emergency medical services.

Administering Treatment
If a patient or physician is interested in using home chemotherapy, there is a certain regimen followed in most cases. The patient usually receives his or her first dose of I.V. chemotherapy in a supervised setting to allow for medical observation. This ensures that the patient will not have significant acute side effects. If physician feels comfortable with the patient's response to therapy, subsequent doses may be administered at home.

The physician then provides an order to the pharmacist that includes the name of the medication, route of administration, dosage per body surface area, rate of infusion, type of infusion and frequency. After receiving this information, the home infusion provider develops written policies and procedures addressing the preparation, handling, administration, and disposal of chemotherapeutic agents. The provider also makes arrangements for 24-hour professional emergency support along with education. Education may include information about the disease, self-care techniques, risks of treatment, current therapeutic options, possible side effects, maintenance of the venous access device, and pump operation.

The home health provider has numerous responsibilities. It is essential for the home infusion provider to document the date, time and patient response to chemotherapy for the duration of treatment. Another aspect of achieving successful outcomes is extensive clinical monitoring. The home infusion provider ensures that lab work is drawn and that the physician receives the lab results along with update on the patient's condition.

Collaboration, communication, and education in planning, managing, and providing continuity of care are among the most important components of a successful home chemotherapy program.

• Total Parental Nutrition (TPN) Therapy : is a special liquid food mixture injected into the blood stream with a needle through a vein. The mixture contains all the protein, sugars, fat, vitamins, minerals, and other nutrients needed.
• Enteral Nutrition : provides nutrients via the gastrointestinal tract. A tube, catheter, or stoma delivers nutrients in the stomach or small intestine. Some people may be able to consume some nutrients orally; however, most rely on enteral nutrition for the majority of their nutritional needs.

Consumer Information

Home infusion therapy is one of the most remarkable examples of transferring health care technology and services into the home care setting. When administered by a qualified provider, a home infusion therapy program is similar to a hospital-based regimen. Therapy delivered at home, however, relies on patient and caregiver involvement. The benefit of that involvement is the patient's increased comfort and flexibility throughout the course of treatment.

There are five basic components of a home infusion therapy program:

• Pharmacy Services . Coordinating with the physician and nursing team, the home care pharmacist processes the prescription, prepares the drug, selects the delivery device, and monitors the patient for drug effectiveness and possible drug interactions.
• Nursing Services . Home care and IV nurses perform skilled procedures, such as administering medication and starting IV lines. They also serve in educational and support roles and act as an advocate for the patient.
• Laboratory Services . Home infusion providers ensure that therapy and patient progress is monitored through regular blood draws and laboratory work. Pharmacists review lab results and consult with physicians on possible changes in treatment.
• Ancillary Services . Services such as patient assistance, inventory control, delivery, and pump experts all contribute to a smooth-running provider operation and fast, effective, patient care.
• Administrative Services . Extensive documentation, quality improvement, accreditation status, in-service education, and program development are all spearheaded at the provider level and improve and expand upon patient services.

FAQs on Infusion Therapy

What is Infusion Therapy?
Infusion therapy is a medical therapy involving the prolonged and often repeated administration of pharmaceutical products and nutritional solutions through the bloodstream. Most infusion therapies are administered intramuscularly, intravenously, subcutaneously (under the skin), or epidurally (into tissues and membranes surrounding the spinal cord). Infusion therapy is also often referred to as \"parenteral\" therapy (occurring outside the digestive system).

Common infusion drug therapies include intravenous antibiotics, antifungals and antivirals; pain management products; chemotherapy agents; immune globulin; growth hormones; colony stimulating factors; and other biotechnology and traditional drug products that must, for therapeutic reasons, be administered directly into the bloodstream.

Another common infusion therapy is total parenteral nutrition (also referred to as TPN, or intravenous hyperalimentation). Parenteral nutrition is designed to meet the daily caloric requirements and nutritional needs of patients whose digestive systems do not function sufficiently to absorb nutrients to maintain weight and strength through oral nutritional intake.

Many infusion providers are also involved in providing enteral nutrition, a form of nutrition support provided either orally or through a feeding tube. While enteral nutrition is not administered intravenously, it is often prescribed as an important adjunct to infusion therapies for patients who are nutritionally compromised.

Successful infusion therapy is provided as a team effort by skilled and specially trained clinicians; pharmacists, nurses, physicians, dieticians, and other health care professionals, all working together to ensure cost-effective, quality patient care.

What is meant by the term "alternate site"?
Alternate site is a general term used to describe all non-hospital inpatient settings. Alternate site health care has grown out of a need to decrease health care costs by providing care outside the hospital setting whenever it is safe, clinically appropriate, and cost-effective to do so.

In recent years, tremendous advances have been made to identify new treatment strategies and technologies that can ensure successful patient outcomes outside the hospital. The high-tech field of infusion therapy is a prime example of that accomplishment. Alternate site infusion therapy allows patients to have greater control and independence while undergoing their course of treatment in the comfort of their own homes. Many patients are able to be ambulatory, return to work or school, and continue with other normal life activities while receiving treatment. Equally important, the risk of infection associated with a stay in the hospital is eliminated.

Home care is often considered the most common alternate site for patient care; however, a range of other treatment settings have evolved in recent years to meet the diverse personal and therapeutic needs of patients requiring infusion therapies. Other alternate sites include outpatient clinics, physician offices, and subacute and long-term care facilities.

In some respects, it would be fair to say that hospital inpatient care may soon become the \"alternate site\" of health care, as it becomes possible for many treatments to be provided outside the hospital setting.

How many infusion therapy providers are there?
There are currently some 7,500 infusion therapy sites of service in the United States, including single-site, regional and national companies.

An infusion pharmacy may be a stand-alone business, or it may be affiliated with a home health nursing agency, medical equipment supply company or a hospital or physician office.

How long will it take?
Several factors figure into how fast we can get your medication ready. At Causey's we coordinate patient care with your physician, hospital, nurses and other caregivers. Our goal is to have everything set up and ready to go the minute the patient arrives home from the hospital. Just inform your physician or hospital discharge planner that Causey's Pharmacy is where you want to get all your home health care needs. Also, if you need an insurance provider's approval, we can take care of that for you and get the approval in 24 hours in most cases.

If you need to obtain home infusion services without a hospital stay, contact Causey's Pharmacy by calling us toll free at 1-877-764-0454. We will gladly work with you, your physician and other key providers to help get you on the road to recovery.