As providers look for new ways to decrease costs and improve outcomes, some have found success with self-administered care programs.
Parkland Health & Hospitals System in Dallas, for example, launched a program at its Parkland Memorial Hospital that allows patients to administer intravenous antibiotics at home as a possible solution to the growing trend of healthcare overuse and disparities in care delivery, according to an article from Hospitals & Health Networks.
Uninsured patients who need outpatient IV antibiotics may not have access to home healthcare, so at Parkland they were treated as inpatients. The self-administration program screened this group for patients who could be trained to perform the treatments on their own at home; criteria included no history of IV drug abuse, access to a refrigerator and telephone and the ability to visit Parkland weekly. Before patients are sent home with a supply of antibiotics, clinicians train them via the teach-back method and ask patients to demonstrate the technique at least three times.
The program has led to cost savings and a reduction in unnecessary visits. The hospital studied more than 1,100 patients performing the procedure at home between 2009 and 2013. In that window and population, the readmission rate dropped by 47% and the system saved $40 million in care cost because the patients avoided nearly 28,000 inpatient days.
Providers looking to implement a similar program may need to first take a look at their internal culture, according to a second article from H&HN. Physicians in particular are not used to—and may not be comfortable with—giving up control over patient care to that degree.
“They can't get over what I call a paternalistic approach,” Edward Jones, M.D., a nephrologist at Delaware Valley Nephrology & Hypertension Associates PC, told the publication. “You've got to give the patient the leeway. If you try to intercede, it doesn't let the culture work.”
Patients engaged in self-administered care must have around-the-clock access to supportive clinicians—which could mean additional infrastructure to identify potential problems quickly and refill prescriptions when needed.