Implementation and Pilot Evaluation of A Pharmacist-Led Optimization Tool for Subcutaneous Immune Globulin Administration in the Home Setting

Background This study aimed to develop a standardized method and timeline for home infusion pharmacists to assess subcutaneous immune globulin (SCIG) regimens and perform interventions to optimize infusions based on patient tolerance and preference. A tool was built within the electronic patient management platform at a health system-affiliated home infusion pharmacy to aid in standardizing patient assessments and capturing interventions. This tool was tested over a period of 2 months. Methods Two patient assessment questionnaires were created and embedded within the home infusion pharmacy’s patient management platform. The first was an initial assessment to review current SCIG infusions and patient interest in infusion optimization and the second was a follow-up assessment 30 days following changes to SCIG regimen. These questionnaires were used by the pharmacist to assess adherence, tolerance, infusion optimization preferences, and patient satisfaction. Tasks within the patient management platform were designed to automatically trigger outreach tasks for the pharmacist to assess new SCIG patients. To identify patients who might benefit from SCIG infusion optimization, a review of the current census was performed. The pharmacist attempted to contact all patients receiving SCIG therapy dispensed by the health system home infusion pharmacy. Results During the 2-month period from November 2024 to January 2025, 35 patients were contacted and assessed using the tool. Of the patients contacted, 29 (83%) were interested in pharmacist-led interventions to optimize their SCIG infusions. Patient infusion optimization preference was divided between reducing the number of needles, reducing infusion time, and reducing both the number of needles and infusion time. Nineteen patients completed 30 days of their optimized SCIG infusions during the study period and were contacted for follow-up assessment. Of these, 18 patients (94.7%) reported no new systemic or local reactions and were satisfied with the changes made. No patients reported a change in adherence. Discussion The use of tasks and questionnaires embedded in the EMR assisted in identification of patients who were likely to benefit from SCIG infusion optimizations. The majority of patients contacted by the pharmacist were interested in implementing changes to optimize their SCIG infusions. After pharmacist interventions to optimize infusions, a majority of SCIG patients reported no new drug-related reactions and expressed satisfaction with the changes. Conclusions The testing of this tool demonstrated the substantial opportunity for home infusion pharmacist-led interventions to optimize SCIG infusions according to patient preferences, resulting in high patient satisfaction rates. Embedding this tool in the patient management platform provided an efficient method for identifying patients receiving SCIG and facilitated assessment by a pharmacist.