Neurologist pilots program that treats patients at home

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, arranging childcare, losing a full day to tend to household chores, and the feeling of loneliness that comes from being at a hospital all day alone. It’s why she agreed to be part of a study looking at whether it was safe and feasible to treat patients with her condition 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. Results were published in the Canadian Journal of Neurological Sciences in May 2013.

CIDP is an auto-immune disorder that involves 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,” Katzberg says.  “In healthcare, you are always looking for ways to deliver patient-centered care as efficiently as possible, and sometimes this requires adapting a model that has already been proven to work elsewhere.”

Learning from U.S., European models
IVIG is a blood product and the standard therapy that is given to patients with CIDP to help decrease the severity of their auto-immune disorder. Available in Europe and the U.S. in home and nursing-centre based settings for the last 20 years, IVIG is only administered in a hospital setting in Canada. 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 long.

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 goal is really two-fold,” says Katzberg. “We need to free up resources in the hospital for those who need it and also find ways of providing the same quality care to patients– who might not necessarily need to be physically here at the hospital.”

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, 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 Canadian Blood Services.