22. Home Infusion Specialty Drugs: Pharmacist Patient Care Tasks and Time

Background: Specialty infusion and injection medications are key growth areas in home infusion services. According to the National Home Infusion Association (NHIA), over 315,000 specialty patients were served by home infusion pharmacies in 2019, with specialty infusions consistently representing approximately 10% of total patients. Despite the well-documented positive impact of specialty pharmacists on clinical and non-clinical patient outcomes, there is a lack of data on the specific tasks and time that pharmacists dedicate to furnishing specialty medications in home infusion settings.

Purpose: Using task categories, the study objective is to quantify the time spent by home infusion pharmacists caring for patients receiving specialty medications.

Methods: A descriptive, multi-center study was conducted by the National Home Infusion Foundation (NHIF). An expert committee determined the specialty therapy types included in the study, dispensing cycles, and pharmacist task categories (Figure 1). Pharmacists from self-selected participating home infusion providers reported time spent on clinical and administrative tasks using standardized tracking spreadsheets. The study tracked pharmacist time from the patient referral to the completion of 2 dispensing cycles, with tasks categorized based on clinical care activities, including drug preparation, patient assessments, and care planning.

Results: Pharmacist time caring for 72 specialty drug patients from 6 states was tracked. The most common specialty therapy type was infused monoclonal antibody followed by intravenous immunoglobulin (Table 1). • There were 563 pharmacist tasks for the 72 patients.
• Mean number of pharmacist tasks per patient = 7.82 (SD = 3.404).
• Drug preparation and compounding activities were the most frequent tasks, followed by patient assessments and care planning (Figure 2).
• Mean pharmacist time per patient = 2 hours and 31 minutes (SD = 1:21).
• Subcutaneous immunoglobulin took the most overall patient time (3:06 SD=1:31) while intravenous immunoglobulin and self-injected non-oncology specialty medication took the least (2:10 SD=1:31 and :30) (Table 2).
• 71.58% of pharmacist tasks was for patient care, 24.82% were drug preparation and compounding (Figure 2).
• Developing, implementing, and documenting the care plan task took the most amount of single task time (21:54) followed by drug preparation and compounding (21:07) (Table 3).

Discussion: This study highlights the intensive pharmacist clinical involvement required for infused and injected specialty medications. The study also showed little difference in the overall pharmacist time between administration methods. However, care planning and patient assessments were more prominent for self-injectable drugs, indicating a higher degree of clinical management. The findings of this study underscore the critical role of pharmacists in furnishing specialty infusion services, with implications for staffing and reimbursement policy decisions. The data suggests a significant pharmacist workload associated with clinical tasks and care coordination.

Conclusions: This study is the first to systematically quantify and categorize the professional work of home infusion pharmacists caring for specialty infusion medication patients. The results emphasize the substantial commitment of pharmacist time to clinical care, underscoring the complexity of specialty infusion medications and their management in home settings.