Case study 8

Title Chemotherapy in the Home Setting
Category Healthcare research
Client Baxter Compounding
Research objective  To explore and identify the main drivers of a trend towards increasing delivery of chemotherapy to cancer patients in the home setting.
Research approach The research involved ten, sixty minute qualitative depth interviews with a selection of stakeholders involved with chemotherapy administered in the home setting.The fieldwork was conducted in August 2018.
Key findings Models of in-home chemotherapy services: Respondents came from three distinct organisation types delivering chemotherapy in the home setting, Model 1: Public hospital HITH services providing in-home chemotherapy, Model 2: Private hospital HITH services providing in-home chemotherapy and Model 3: Private independent HITH / infusion services providing in-home chemotherapy. Each model had slightly different drivers of uptake and use including different funding models and different sources of patients.

The nature of chemotherapy being administered in the home setting: Most chemotherapy being administered in the home involved funded intravenous treatment, that could be administered in a short period of time, to stable patients, within a defined geographical boundary. Most treatment was sourced from hospital pharmacies and was transported and administered by highly experienced nurses. Two private independent services also sourced treatment from independent manufacturing pharmacies who delivered to a central store or the patient home.

Drivers of uptake of chemotherapy administered in the home setting: The main drivers of uptake were said to be: Patient choice / demand, positive patient experience, private health insurance funds (PHI) - Funding the private sector, generating consumer awareness and demand, helping overcome hospital infusion capacity problems (facilitates growth without capital expenditure on new facilities), support from specialists (in-homes services are dependant on specialist referral), and public HITH services being cheaper / cost effective compared to in-hospital services.

Barriers to uptake of chemotherapy administered in the home setting: The main barriers to uptake were said to be lack of support from specialists (lack of patient referrals), economics and funding limitations (limited by PHI / public funding, the need for service efficiencies, and the need to be economically viable and sustainable), lack of skilled staff (said to be hard to find and recruit), underutilisation of hospital facilities (priority to fill hospital capacity before use of in-home services), in-home service limitations (not long or high risk infusions, are geographic, risk and resource limitations), and hospital administration resistance (don’t support the concept - Both private and public hospitals).

Critical success factors for chemotherapy administered in the home setting: Critical success factors for services administering chemotherapy in the home setting were said to include having an adequate funding model (both private and public sectors), if in-home services can generate savings (for PHI Funds, for public hospitals, for government), if services can illustrate positive outcomes (low readmission rates, high quality care, high patient satisfaction, few problems), driving public awareness (consumer awareness creates demand. If PHI Funds continue to generate awareness), Specialist education / gaining specialist support (essential to drive patients referrals), ability to get appropriate skilled staff (basic requirement for in-home services), integration with hospital cancer services (fitting in with / complimenting day oncology and other hospital cancer services), national haematology / oncology consensus guidelines on chemotherapy administered in the home setting.

Conclusions: We concluded the future for in-home cancer treatment appears to be positive, albeit early days in the development of this new cancer treatment delivery approach. We also concluded there are a number of unknowns that could impact on the longer term potential of this emerging sector.

The challenge for all stakeholders is to develop and implement best practice service delivery models backed by appropriate funding mechanisms to meet the needs of appropriate private and public cancer patients across Australia.

More detailed findings and conclusions are shown in the summary report.

Chemotherapy administered in the home setting- Summary Report