ABSTRACT
Background: In December 2020, thanks to the collaboration among the U.O.C. Oncologia, Roche Italia, and our Association, was set up a project for the domiciliation of antiblastic treatment titled “HER Home”, at the ASP 7 Ragusa in Sicily. The project involving patients with HER2 positive breast cancer concerns treatment at home with subcutaneous antiblastic therapy. Aims include the enhancement of patients' quality of life reducing the need for travel and visits to the hospital and making them more comfortable to receive the therapy. During the current pandemic situation, this means a greater safety for patients who are fragile subjects and may be more exposed to the risk of infection;and, also, the improvement in organizational efficiency. Materials and methods: Admission of patients takes place according to the evaluation of the Medical Oncologists who establish the schedule of treatments and prescribe the drug. The drug is prepared and dispensed by the hospital pharmacy. Our Association, already active for home palliative care, deals with the transport of the drug from the hospital pharmacy to the patients' home, where our Doctor, after a clinical evaluation of the patient, administers the drug. The project foresees the participation of 20 women and about 240 administrations. Quality of life will be assessed at baseline and every 4 administrations, using patient's self-reported outcome measures (PROMs). Results: To date, have been assisted 4 patients and carried out 13 administrations. No adverse events have occurred and no organizational criticalities were recorded. All administrations were performed safely, within the foreseen times and methods. Conclusions: The project has allowed the patients involved to have more free time since there are no needs for transfers and waiting times in the Day Hospital and so allowing them don't change the course of their daily routine;we, also, expect a measurable improvement in the quality of life. For the regional health system, this project achieved a simplification of the pathways and a reduction in the crowding of the Hospital, both essential during the COVID-19 pandemic. From the economic point of view, the project reduced costs and resources applied for about 30% less. The potential shown by this preliminary project could be fully realized in the evaluation of the possibility of home administration of other antiblastic therapies favoring above all the patients who lead a very active working and family life.
ABSTRACT
Background: About 5-10% of patients who develop coronavirus disease need hospital care, even in the Intensive Care Unit, and also those who have passed the acute phase and may remain at home rather than hospitalized often continue to need home care, regardless of previous condition. Aim: The COVID-19 pandemic is upsetting the living conditions of everyone and especially of those affected by chronic and advanced diseases who have special health needs. We worked to assist patients who needs home care or social needs or palliative care or blood transfusions at home and are in a condition of isolation or quarantine. Methods: Our Associations have set up 4 dedicated palliative and home care teams in the Province of Ragusa involving: 2 Doctors, 5 Nurses and 6 Social Health Operators, provided with adequate Personal Protective Equipment (e.g. protective clothing, face shield and safety glasses, gloves, shoes, FFP2 / FFP3 masks);coordinated by 2 Operational Centers. Dedicated vans are used, with isolated areas for carrying out the dressing/ undressing procedures. Procedures for sanitation are used and the disposal of special waste is guaranteed. Results: From 17th November 2020 to 13th February 2021, the teams assisted 134 patients with 859 home interventions and took 748 hours excluding travel times and dressing/undressing procedures. Among the interventions were given: 378 pharmacological therapies;100 personal care hygiene interventions and 20 blood transfusions. Conclusion: The strengthening of palliative and home care services with these teams has allowed to ensure continuity of care for COVID-19 patients with urgent needs for home and palliative care and for whom hospitalization is no longer appropriate and thus freeing hospital resources. This experience also increased the synergy with General Practitioners (GPs) for the evaluation and clinical/care management of patients and support to family members for any shared care planning.