Safety and patient satisfaction of infliximab administration in an extramural setting supervised by a rheumatology specialist nurse.

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doi: 10.1136/ard.2005.036566
2006 65: 276Ann Rheum Dis

Y van Eijk, A Boonen, G Schulpen, et al.
supervised by a rheumatology specialist nurse
administration in an extramural setting
Safety and patient satisfaction of infliximab

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Safety and patient satisfaction of infliximab administration
in an extramural setting supervised by a rheumatology
specialist nurse
Y van Eijk, A Boonen, G Schulpen, V Schrijnemaekers, H Fiolet, Sj van der Linden
...............................................................................................................................
Ann Rheum Dis 2006;65:276. doi: 10.1136/ard.2005.036566
A
insufficient capacity at their hospital’s day care centre to
administer the drug. Therefore, we explored the possibility of
administering infliximab in an extramural setting supervised
by a rheumatology specialist nurse (RSN).
A vacant room in a nursing home 5 km from the hospital
was prepared as the infusion facility. Two nurses and the
nursing home physician were given details of the clinical
aspects of RA, with emphasis on treatment with infliximab.
The hospital infliximab protocol, including the screening
before each infusion, the preparation and administration of
infliximab, and the safety procedure, was adapted. A form to
guarantee communication between the hospital and the
extramural setting was developed. Arrangements with the
hospital pharmacy were made to assure punctual delivery of
the exact number of infliximab vials to the extramural setting
on the day of the infusion. The infusions were organised and
supervised by the RSN once a week.
At the start of the project, all patients with RA attending
the day care centre for infliximab infusions completed a
questionnaire and an interview was carried out. Information
was obtained on demographic and disease characteristics,
previous problems related to the infusion treatment, the EQ-
5D,2
and satisfactionwith
Satisfaction with treatment was measured on a visual
analogue scale (0–100; higher values better satisfaction)
and by a self composed questionnaire comprising 33 items
(four point Likert scale) over seven domains covering
information, accessibility, professionalism, courtesy of per-
sonnel, recreation possibilities, accommodation, and conti-
nuity of care. At the new infusion centre, all administrative
and clinical events connected with the administration of
infliximab were recorded prospectively. After 6 months, the
patients again completed the EQ-5D and satisfaction ques-
tions.
After a pilot with eight patients, all 57 remaining patients
with RA who had received at least four infusions in the
hospital completed the screening questionnaire in September
and October 2002. Forty (70%) patients were female, with a
mean (SD) age of 54 (14.8) years, mean disease duration 12.3
(10.3) years, mean duration of infliximab administration
13.1 (6.8) months. Four patients were not considered eligible
by the rheumatologist owing to events during one of the
previous infusions or comorbidity, 13 refused extramural
treatment for personal reasons, and nine had stopped the
infusions before continuing extramurally because of the
inefficacy of infliximab. Overall, the patients not participat-
ing were older (56 (17.3)) than the other patients (51 (12.7)).
Of those who refused to change to the extramural setting, the
schedule of a weekday infusion was unsuitable (54%) or they
were resistant to change for non-obvious reasons (46%).
Those with personal reasons for resistance were older (58
fter introduction of reimbursement of the cost of
infliximab for the treatment of patients with active
rheumatoid arthritis (RA),1
several hospitals had
infliximab administration.
(18.5)) than those who had a practical reason (45 (14.9)). No
differences in comorbidity were found between these two
groups.
In September 2004, 24 of the initial 31 patients were still
receiving infusions. All other patients stopped the infusion
because of lack of efficacy. After telephone consultation with
the rheumatology nurse, a planned infusion was postponed
on 10 occasions because the patient had a minor infection. A
total of 341 infusions were carried out, and the nursing home
physician was contacted 24 times. Twice the infusion was
postponed, twice an allergic skin reaction was treated with H1
antagonists and three times the infusion speed was reduced
because of uncomplicated illness. Twenty three patients
completed the 6 months’ evaluation.
Patients reported increased satisfaction with information
provided about the treatment and its safety, and the
increased possibility for contact with peers. Global satisfac-
tion with infliximab administration improved from 74 (SD
12) to 81 (21) (paired t test: p=0.05) and the EQ-5D from
0.44 (0.33) to 0.60 (0.25) (paired t test: p=0.09).
Administration of infliximab organised and supervised by
an RSN in an extramural setting is feasible and safe. Older
patients, especially,resisted
patients participating in the project reported improved
satisfaction, especially with information on several aspects
of the treatment. This shows that intramural treatment can
be improved by giving more and better information about
treatment. Although treatment by an RSN was initially begun
because the hospital had insufficient capacity, fewer patients
than expected started intravenous infliximab infusions,
because subcutaneous products became available. However,
the success of treatment in an extramural setting will be
generalised to administration of infliximab for other condi-
tions and other intravenous drugs.
the change. Nevertheless,
Authors’ affiliations
Y van Eijk, G Schulpen, V Schrijnemaekers, H Fiolet, Department of
Integrated Care, University Hospital, Maastricht, The Netherlands
A Boonen, Sj van der Linden, Department of Internal Medicine, Division
of Rheumatology, Caphri Research Institute, University Hospital
Maastricht, The Netherlands
.....................
Correspondence to: Ms Y van Eijk, Department of Integrated Care,
University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The
Netherlands; yve@sint.azm.nl
Accepted 18 June 2005
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Therapy Study Group. N Engl J Med 2000;343:1594–602.
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related quality of life. Health Policy 1990;16:199–208.
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