A ‘home first’ approach empowers patients to take ownership of their own care where appropriate. The outpatients at the Denosumab clinic are a shining example of how successful this approach can be.
Denosumab is a bi-yearly subcutaneous injection that reduces the risk of broken bones in outpatients with osteoporosis. The Denosumab clinic at Cardiff and Vale University Health Board gives this injection to around 1000 patients every six months as part of a programme of ongoing treatment. However, the travel, waiting time and leave from work associated with recurrent appointments can often be inconvenient for patients and uses a considerable amount of hospital resource.
Following the results of focus groups with both patients and clinicians, Denosumab was confirmed as a treatment that could be comfortably self-administered by patients and their carers in their own homes. It’s a stable and safe drug, so patients and carers can inject it at a time that’s most convenient for them within the confines of a week.
Transformation in Action
Patients are now taught how to inject Denosumab at their bi-yearly clinic, and given a training booklet with a clear pictorial step-by-step guide to aid future injections. When it’s time for the next round of treatment, forms are sent in the post for patients to attend their GP surgery for blood tests; if the results are normal, the individual is then sent a prescription through the post so that they can pick their injection up from their local pharmacy.
This change is allowing outpatients attending Denosumab clinics to reduce their visits from every 6 months to every 3 years, with yearly phone assessments to ensure that patients are given all of the help, guidance and support that they need to carry on managing their own care. If patients are concerned at any time, there is a help line number they can call to speak to the Fracture Liaison team.
As well as empowering outpatients to deliver their own treatment, the change in the injection process for Denosumab delivers on another of the aims within our Shaping Our Future Wellbeing strategy: to reduce costs and improve efficiency without compromising on care. There’s a cost saving of £25 per injection for each of the 1000 people who require the twice-yearly injection, with a projected saving of of £50,000 per annum.
Nicky Hughes is the locality Lead Nurse at Cardiff and Vale University Health Board and has been caring for patients for many years. She championed the change for Denosumab self-injection alongside Professor Michael Stone, Director of Bone Research, after speaking to patients in her clinics.
“The main driver for this change is to improve patient experience. We’ve had such a positive response from our patients, many of whom have been requesting the chance to administer their own treatment for some time. To date, 100 people have been successfully taught to administer Denosumab with many more on the waiting list.
“It takes around 30 minutes to teach each patient how to inject themselves safely and give them the confidence they need to carry the treatment forward themselves. We’re introducing new patients to the scheme in phases, making sure that this new pathway to care is sustainable and that all patients are happy.
“There are patients with dexterity and vision problems who are able to receive treatment in the comfort of their home thanks to their amazing carers who’ve been trained to give the injection. It’s been a hugely positive step and we’re hoping to carry the momentum forward to other clinics that dispense Denosumab, with a view to eventually extending self-administration through to other suitable treatments.”