ABSTRACT
Introduction & Objectives: Intravesical instillations of GAG-layer replacement are utilised in a number of benign bladder conditions and are traditionally delivered in an outpatient setting. Our unit was considering the feasibility of an at-home service when the COVID-19 pandemic resulted in the sudden cancellation of non-essential services. This provided impetus to rapidly change service delivery so this effective therapy could continue to be available. Here we outline the implementation of an at-home intravesical therapy service & report on early patient satisfaction outcomes. Materials & Methods: The product was chosen based on local use and practical advantages. Collaboration with the company ensured optimal planning and initiation. Review of regulations & cost-effective analysis led to dispensation via a community pharmacy after appropriate tuition. Patients were identified via the unit's intravesical treatment database. Inclusion criteria were the willingness to learn intermittent catheterisation, to have the medication administered at home, and to conduct telephone review. Tuition was delivered by qualified urology nurses in a single 30-60 minute session, utilising video and diagrams. Patients that were shielding were instructed by community bladder nurses. PROMS data were collected via a unit-designed questionnaire. Clinical outcome data were collected from follow-up notes. Results: Between March 2020 and January 2021, 65 patients (mean age 50 years) commenced at-home therapy. 22 (88%) were female. The first patient was instructed 11 days after compulsory cessation of outpatient instillations. Efficacy was 65%-83% across different indications (bladder pain, recurrent UTIs, chemical cystitis, radiation cystitis & ketamine bladder). 25 patients returned the PROMS questionnaire. 20 had previously had outpatient nurse-delivered instillations, 5 were treatment naive. 20 performed self-catheterisation, 1 used the adapter, 4 received assistance from a relative/carer. Whilst some patients reported difficulty with catheter insertion, medicine instillation and/or UTI following administration, 72% completed the course at home. 11/20 experiencing both service models preferred at-home administration;9/20 preferred the hospital option. Positive feedback for at-home treatment included convenience, time saved, and privacy. Concerns were centred on technical aspects. Overall satisfaction was reported as very good, good or satisfactory by 18 (72%), and was linked to ability to continue treatment. Savings in our unit per treatment course or treatment year ranged between £180 & £470, dependent on the number of overall treatments. Conclusions: This study shows radical service change can be implemented quickly, safely and effectively. Careful patient selection and tuition enables cost-savings, freeing of outpatient space and improved patient satisfaction. We encourage other institutions to consider commencement of an at-home instillation service.