Background: The number of osteoporotic fractures continues to increase in the UK, and although there are effective oral treatments, their long-term persistence remains poor. Intravenous bisphosphonates offer an attractive alternative although administration often requires a day-hospital or day-case admission.
Innovation: We are one of the first in the country to have developed an innovative intravenous zolendronic acid at home service. A formal contractual agreement was undertaken with Healthcare at Home. The patient pathway comprised of assessment in the outpatient clinic, consent and routine blood tests. A prescription is then sent to Healthcare at Home, who administered the 1st and subsequent infusions, directly in the patient's home, within 4 weeks. A system re-call ensured appropriate follow up.
Evaluation: A telephone questionnaire was undertaken in 52 patients who had attended the day hospital the previous year for their 1st infusion and who had been referred to Healthcare at home for their 2nd infusion. On a scale of 1-not convenient to 5-very convenient, when asked how convenient was the service, day-hospital median score was 3 and at home service, 5. On rating the service 1-very poor to 5-excellent, the median score for the day hospital service was 3 and at home, 5 and given the choice 51/52 patients preferred the at home service. There were no reported adverse events and overall cost savings of £ 292 per patient (day hospital tariff + drug cost minus Healthcare at home service + drug cost).
Conclusion: This services offers an innovative, safe and cost-effective delivery of intravenous bisphosphonate at home. Patient preference and patient satisfaction was high. Clearly as generic intravenous zoledronic acid becomes available this year, drug delivery will become an important issue.