A Multi-Center Study of Home Infusion Services in Rural Areas

Introduction: Approximately 15% of the U.S. population lives in rural areas. It is recognized that rural Americans have fewer health care opportunities when compared to metropolitan residents. One area of health care is home infusion with approximately 1,000 providers in the U.S. What is not understood is the availability of home infusion to rural patients. This study aimed to determine the annual percentage of home infusion patients living and receiving home infusion services in rural areas. Methodology: This retrospective, multi-center study analyzed patient rural/non-rural status data collected from home infusion providers who utilize the CPR+® and CareTend® platforms for electronic health records. Patients were classified as rural if their zip code fell within the rural designation defined by the Centers for Medicare and Medicaid Services (CMS) DMEPOS Competitive Bidding Program. The analyzed data was from 2018, 2019, and 2020, and included calculating the total number of unique patients and those who were considered rural. From this information, the overall percentage of rural patients was determined. The rural percentage for each provider was coded into 1 of 4 categories (0-10%, 11-25%, 26-49%, and 50% or greater). The frequency and percentage of providers who fell into each category was calculated so that trends could be observed, and data summaries more easily determined. Results: Rural/Non-rural data from 200 individual pharmacy locations was submitted for analysis. For the 3-year period, there were 545,280 unique home infusion patients of which 71,278 were considered rural. Overall, 13.1% of patients served by these home infusion providers lived in rural areas. The number and percentage of rural patients served increased over the 3-year analysis period. Discussion: This is the first study to quantify the use of home infusion in rural populations. It is known that patients in rural areas experience challenges with health care, including increased travel time for physician visits and chronic disease management. Unquestionably, home infusion alleviates patient travel barriers. The study data shows that most home infusion providers are serving patients living in rural areas and the percentage of rural patients has increased from 2018 to 2020. Conclusion: Home infusion use in rural areas is well-established. Home infusion may offer advanced, infusion-based treatments more accessible to patients with limited health care options due to lack of proximity to urban centers. Keywords: Rural population, infusion, health care disparity, access to care, travel barrier