Parenteral medication use in hospital at home: Challenges and opportunities

Hospital at home (HaH) is an integrated system providing acute hospital-level care in patients’ homes,^1,2 thus avoiding inpatient care entirely or moving patients from traditional hospital settings earlier to home hospital settings.³ Preliminary comparisons have recommended prioritizing inpatient admission avoidance over early supported discharge due to better clinical outcomes and cost benefits.³

The first systemic implementation of HaH in 1957 by the public hospital system of Paris is currently considered equal to a full healthcare facility under French law.^4,5 Globally, HaH comprises an integrated system of service providers operating within a multidisciplinary team (MDT) managed by experienced clinicians.^6,7 Patients are key to HaH implementation, with patients having more involvement in their own care and actively participating in decision-making. MDTs usually consist of caregivers, physicians, nurses, and pharmacists, potentially extending to physician’s assistants, paramedics, therapists, social workers, and third-party companies^7-11 offering services (eg, regular monitoring, diagnostic tests, courier services, technological support).^8,12,13 Appropriate patient assessment and selection is critical in HaH. Key inclusion^7,10,14 and exclusion^8,10 considerations are listed in Box 1, and key workflow steps are outlined in eFigure 1. HaH involves routine daily home visits by healthcare professionals (HCPs) based on patients’ clinical needs and hospital policies.^2,15

Box 1. Key Criteria for Patient Selection for Hospital at Home^7,8,10,14,16.

Inclusion criteria
• Patient consent for HaH • Suitable home environment • Referring practitioner agrees that the medical condition can be managed outside a hospital • Absence of unstable comorbidities • No history of substance abuse • Possibility to have access to an appropriate IV formulation (if oral therapy was ineffective and the patient’s condition demands parenteral administration) • Accessible distance of patient’s home from hospital (in case of frequent visits) • Patient accessibility through internet and telephone
Exclusion criteria
• Medically unstable patients • Provisional diagnosis unclear • Complex care required exceeding capacity of HaH service • Patients not to be enrolled due to threat of self-discharge • Inaccessible remote location from hospital • Patients physically incapacitated or cognitively impaired with no caregiver • Patients who demonstrate poor compliance with medical treatment • Patients in preadmission care for a noncomplex clinical condition who can be managed in the outpatient setting • Patients who do not require daily visits and medical governance and can be managed in the outpatient setting

Abbreviations: HaH, hospital at home, IV, intravenous.

HaH in the US.

US healthcare providers from the schools of medicine and public health of Johns Hopkins University took early initiatives and conducted research on acute hospital care at home, demonstrating its safety and cost effectiveness. Johns Hopkins developed its HaH program to focus on treating elderly patients who either refused hospital admission or had high risks of hospital-acquired infections and other adverse events, so that physicians could recommend home care for their safety.^17,18 The success of this model led to its adoption in 2002 and utilization since then.^9,13,19-21

During the coronavirus disease 2019 (COVID-19) pandemic, the Centers for Medicare and Medicaid Services (CMS) issued waivers for HaH, providing full Medicare and applicable add-on payments to encourage this initiative.^13,16 The number of CMS-approved HaH facilities is frequently updated, and CMS-approved payment was available in 129 health systems (305 hospitals in 37 states) as of November 2023.²²

Benefits and opportunities.

HaH studies have demonstrated favorable outcomes. Leff et al¹ compared patient/caregiver satisfaction among elderly patients receiving treatment with HaH (n = 84) and from an acute care hospital (n = 130). The study described higher satisfaction across multiple care domains (including physicians and staff, comfort and convenience, admission processes, and overall care experience) with HaH implementation compared to in-hospital care. Cryer et al⁹ reported benefits from an HaH model implemented by the New Mexico–based Presbyterian Healthcare Services. The study described higher satisfaction scores (90.7 vs 83.9) and about 19% greater cost savings (mainly due to reduced length of stay and clinical testing) among HaH patients (n = 323) compared to inpatients (n = 2,405). HaH patients also experienced low fall rates (0% vs 0.8%). Levine et al¹⁹ reported a randomized controlled trial of 91 adult patients (43 allocated for HaH care and 48 under traditional hospital care). The study demonstrated that adjusted mean cost for HaH patients was 38% (95% confidence interval, 24% to 49%; P < 0.001) lower than for inpatients. Reduced healthcare utilization, 30-day readmission, and length of stay were observed for HaH patients in comparison to inpatients. A study by Mendoza et al²³ analyzed patients aged 65 years or older with decompensated heart failure, of whom 34 were admitted to cardiology and 37 were under HaH care. The study reported cost reduction in initial admission (mean [SD], €2,541 [€1,334] vs €4,502 [€2,153]; P < 0.001) and during 1 year of follow-up (€3,425 [€4,948] vs €4,619 [€7,679]) among HaH patients compared to inpatients. No significant differences were observed in clinical outcomes, functional status, or quality of life (QoL) between the patient groups. Another study compared functional outcomes among patients aged 65 years or older, 84 of whom were admitted to HaH and 130 of whom were admitted to an acute care hospital. A higher proportion of HaH patients experienced improvements in functional outcomes compared to inpatients, including in activity of daily living (44% vs 25%) and instrumental activity of daily living (46% vs 17%).²⁴ Another study assessing 442 adult patients eligible for HaH admission reported that 66.7% accepted HaH care, which was preferred mainly because of comfort at home and proximity to family.²⁵ A prospective randomized controlled trial evaluating patients aged 75 years or older with acute decompensation of chronic heart failure included 53 patients admitted to a general medical ward and 48 patients assigned to a geriatric home hospitalization service (GHHS). The GHHS patients experienced lower rates of complications (delirium and infections) and had a longer time to first additional admission. Further, nutritional status, depression, and QoL scores improved in GHHS patients.²⁶ Interacting with patients and caregivers also provides useful insights and opportunities to build fruitful provider-patient relationships.²⁷ HaH has now expanded to other adult and pediatric populations. It is commonly implemented for infections and chronic conditions, deep vein thrombosis, and cancers.^19,28-31 Over time, the range and acuity of the conditions included have increased substantially.²

Opportunities for clinical pharmacists in HaH.

Clinical pharmacists play a crucial role in medication management in HaH settings, including in medication selection, dose adjustments, and frequency of medication delivery, which are tailored to patients’ needs and program logistics.^32,33 Key activities involving pharmacy include clinical consultation, obtaining medication history, medication reconciliation, and dispensing. A French observational study of clinical pharmacists in the HaH setting described the role of pharmacists in evaluation of pharmaceutical interventions that was critical in detecting a high level of drug-related problems and avoiding complications in patients.³⁴ Another study on the HaH care model implemented at Victoria General Hospital in British Columbia suggested a positive impact of pharmacists on patient care based on patient, caregiver, and stakeholder perceptions, thereby supporting the integration of pharmacy services.³⁵ Creative solutions have also evolved such as “first-dose” kits for urgent medication administration to prevent patient deterioration (eg, antihypertensives, nebulizers, antipyretics, analgesics, and anaphylaxis kits).^11,32,33 The first-dose kit is usually stored in a temperature-controlled environment and available with the provider to facilitate bedside administration of medicines.³³

Unmet need and objectives.

The COVID-19 pandemic led to an increase in home-based care to effectively support capacity expansion, avoid hospital admission, and address hospital staffing shortages.^3,36,37 In the US, supportive technologies such as telehealth facilities³⁸ and hospital incident command systems/centers³⁹ were utilized to accommodate the surge, leading to rapid adoption of HaH.^40,41 However, several key challenges with parenteral medications in HaH (eTable 1) may impact HaH capacity.^14,33

Our commentary aims to provide insights on current practices and challenges with parenteral medications in the HaH setting and potential solutions based on a literature review and real-world clinical experiences.

Challenges with parenteral medications in HaH and potential solutions.

Various challenges associated with using parenteral medications in HaH settings and potential solutions for successful implementation are summarized in Table 1.

Table 1.

Parenteral Challenges and Potential Solutions in Hospital at Home Based on Clinical Experience and Previously Published Literature

Challenges	Solutions	Specific examples in HaH setting
Dosing frequency, duration, and formulation
Intermittent or frequent dosing; frequent home visits by HCPs	Use of 24-hour CI in HaH setting or an IV bolus; use of loop diuretics and antibiotics; use of portable pumps to administer 24-hour CIs	Loop diuretics: bumetanide42,43 25 mg/250 mL, furosemide44-46 500 mg/250 mL Antibiotics: cefazolin47 6 g/500 mL, cefepime48 4 g/500 mL and 6 g/500 mL, ceftazidime49 6 g/500 mL, piperacillin/tazobactam50,51 18 g/250 mL, 13.5 g/250 mL, 9 g/250 mL, and 6.75 g/100 mL, ampicillin/sulbactam52,53 12 g/600 mL and 6 g/300 mL, and nafcillin54 12 g/500 mL, 12 g/600 mL, 8 g/400 mL, 6 g/300 mL, and 4 g/200 mL Piperacillin/tazobactam: Piperacillin/tazobactam has a short half-life and frequent dosing interval (every 6-8 hours),55 suited to in-hospital administration. In HaH, it is prepared and administered as a 24-hour CI51,56: (a) 24-hour CI of piperacillin/tazobactam 8 g/1 g on day 1 and 12 g/1.5 g on day 2 and thereafter (both diluted in 500 mL of 0.9% sodium chloride)51 or (b) dilution of 13.5 g in 250 mL of 0.9% sodium chloride administered at a CI rate of 10.4 mL/h. Portable pumps: Portable pumps, eg, Sapphire pumps (manufactured by Eitan Medical), allow 24-hour CIs. They can be kept in the patient’s pocket instead of being hooked to an infusion line all day, helping patients to remain ambulatory.33 Challenge: After changes in medication dosing and formulation, self-administration of parenteral medications by patients/caregivers is not permitted (because of the potential challenges they may face), necessitating recurring in-home HCP visits. Solution: Patient/caregiver education and training for drug administration with minimal professional monitoring; consider alternative medications and other methods of administration (eg, CI from an elastomeric or smart pump). Challenge: With mealtime insulin, when patients are provided with an insulin vial/syringe based on a sliding-scale method (where the insulin dose varies based on blood glucose level), there is a requirement for additional visits by in-home clinicians for all insulin administrations as patients may not be aware of the dosage due to the lack of a standard regimen. Solution: Restart oral medications for diabetes management of patients followed by use of insulin pens/vials/syringes to ensure that medications are self-administered by patients or administered with the help of a caregiver under virtual HCP supervision.
Difficulty in preparation of specific formulation for HaH	Use of alternative drugs; provision of stability data by pharmaceutical manufacturers; maintaining quality of ingredients for preparation and necessary temperatures during preparation and storage	Compounding piperacillin/tazobactam to 24-hour CI formula: This raises concerns due to diversion from standard practice for the hospital IV pharmacy team and the built-in corresponding EHR. An alternative drug may be used if clinically warranted (eg, ceftriaxone 2 g IV every 24 hours or levofloxacin 750 mg every 24 hours). Stability of 21 of 34 currently used cancer drugs (<30 hours): These drugs cannot be used for HaH setting (post-preparation drug stability: weekday administration, within 30 hours; weekend administration following preparation on a weekday, 78 hours). Stability data for compounded anticancer drugs should be provided by the pharmaceutical manufacturer and stability standards for HaH drugs must be established.57 Antibiotics: These are temperature dependent and rapidly degrade at room temperature (eg, benzylpenicillin). The antibiotic should be compounded with a buffer to avoid rapid degradation and a refrigerator may be used to help extend the stability period.14 Admixtures of vancomycin (vancomycin in 0.9% sodium chloride): These are isotonic solutions but mostly have an acidic pH; stability at this pH is a concern. Stability periods at room temperature can be extended using elastomeric infusion devices (24 hours to 17 days) and ethyl vinyl acetate containers (30 days at 4 °C and 7 days at 23 °C); ready-to-use mixtures (premix bags) can also be used.58
Increased duration of infusion at home	Use of IV push (3-5 minutes) vs intermittent infusions (15-30 minutes) in HaH; use of antibiotics, dietary supplements, antipsychotics, and antiepileptics; use of preprogrammed ambulatory pumps33	Antibiotics: daptomycin, meropenem, cefotaxime, cefazolin, cefoxitin, ceftazidime, ceftriaxone, ampicillin, aztreonam, colistimethate sodium, chloramphenicol Dietary supplements: thiamine Antipsychotics and antiepileptics: valproate, levetiracetam, olanzapine
Drug flow rate
Inconsistent flow rate by roller clamps–controlled gravity infusion58	Volumetric pumps (preferred over gravity infusions due to their safety, precision, and additional advantage of delivering medication at a predetermined rate)58	Example volumetric pumps: mechanical elastomeric balloons, disposable pumps58 DripAssist: This aids in achieving precision with infusion rates and volumes for gravity-based infusions.59 CI bumetanide: Severe myalgia (when the infusion rate was >1 mg/h) and electrolyte and acid/base changes have been observed. The infusion rate should be kept below 1 mg/h.43,60
Challenges with administration
Syringe- and pump-related challenges; extravasation of surrounding tissue; hypersensitivity reactions	Provide patients/caregivers with skilled technical training; use medications and premedications before or during administration to prevent anaphylactic reactions61,62; limit use to selected patients and re-evaluate indication regularly	Challenges with vancomycin: 58,61 • Anaphylactoid reaction: “Red man syndrome” due to rapid infusion.58,63 The dose should be administered over a longer period and diphenhydramine can be used as premedication.61 • Administration: low pH of vancomycin (<5); not advisable to administer it via peripheral veins. Use of central venous catheters is recommended; peripherally inserted central catheters are preferred.58,61 • Drug incompatibility: leads to precipitate formation. Examples of medications incompatible with vancomycin58: ◦ When admixed in the same container: amobarbital, chloramphenicol, sodium bicarbonate ◦ When given through Y-injection site: heparin, aztreonam, foscarnet, piperacillin, amphotericin B, several cephalosporins, numerous antineoplastic agents • Adequate flushing is necessary to prevent the risk of lumen occlusion and drug precipitate accumulation. Patient treatment should be well documented, and the MDT should communicate to ensure no incompatible drugs are prescribed together. • Extravasation of vancomycin. An antidote could be supplied, but this is not financially feasible. Alternative approaches (eg, compresses) should be explored for treatment of extravasation. Example medications with potential anaphylactic reactions and adverse drug events: epinephrine, diphenhydramine Example premedication to be given before infusion of some drugs:61,62 diphenhydramine, acetaminophen
Urgent need for injectables
If patients experience sudden acute symptoms demanding urgent access to specific IV medications	Formulary of medications provided to in-home clinicians to include the examples given. The route of administration and product supplied should be taken into consideration to meet the immediate requirements of the patient.	Antibiotics: ampicillin/sulbactam, cefepime, ceftazidime, ceftriaxone, ciprofloxacin, vancomycin, metronidazole Analgesics: ibuprofen, acetaminophen, ketorolac Antiemetics: ondansetron Anticholinergics: atropine Antihypertensives: diltiazem, labetalol, metoprolol Anticoagulants: heparin Antiallergics: diphenhydramine, epinephrine, phenylephrine Diuretics: furosemide Antihyperglycemics: insulin Antipsychotics: haloperidol Anesthetics: lidocaine Miscellaneous: 5% and 50% dextrose, magnesium sulfate, methylprednisolone succinate, naloxone, potassium chloride, 0.9% sodium chloride If delivered directly at home, then small quantities of supplies are preferred (eg, epinephrine, diphenhydramine, naloxone).
Monitoring of controlled substances
DEA controlled substances require proper storage and monitoring of inventory for the safety of patients and others in the home.33	Development of cost-effective, secure storage and inventory tracking equipment and software33; standardized protocol for transport and inventory of these substances; limited duration of treatment and dosing dispensed	Lockable storage containers and infusion pumps: After dispensing, the controlled substance should be packed in a locked box by pharmacist; an unlocking code accessible only to patients and those involved in patient care needs to be provided. A controlled drug record utilized by patients and medical staff should be maintained for a perpetual drug inventory.33 Enhanced HCP monitoring: Other partners in the MDT (including other HCPs) should be witnessed; the management of controlled substance medications should be overseen according to guidelines proposed by regulatory bodies.
Supplies, transportation, and storage
Logistics for supplies (such as IV pumps, home infusion pharmacy vs durable medical equipment or other alternative solutions); storage challenges due to temperature variations impacting medication shelf-life64	Predetermine the supply needs and storage requirement before HaH implementation; select an ideal transfer device (eg, vial2bag, mini bag plus, etc) to help maintain the integrity of medications	IV supplies: These are not available in the home setting, unlike the traditional hospital setting (eg, flushes, tubing, alcohol wipes, needleless connectors, etc). Cold chain management: Complex, temperature-controlled supply chains, are used to store and transport pharmaceutical products to overcome the impact of environmental changes on temperature-sensitive ingredients.65,66Challenges: Include transportation of ultra-low-temperature storage, an inability to always reach the end user, space concerns, a lack of transparency, and recycling of cold chain packaging.66 Solutions: Educate individuals involved in cold chain management processes; collaborate across stakeholders to achieve transparency; lead conversations with USP on further chapter clarifications; develop specialized programs to build expertise; and leverage partnerships with pharmaceutical industry and health systems66 Examples of medications with potential storage/stability issues: methylprednisolone, cefepime, ceftazidime, micafungin, remdesivir, vancomycin, aztreonam
Infection control
Lack of validated data analyzing the incidence and associated risk factors of acquired infection at home; cross-contamination and infections may arise from visitors (HaH staff and others)	Specialized infection control certification should be obtained by MDT members who are in contact with patients	Ensure appropriate basic hygiene measures, including handwashing and garbing stations, are present at home entrances with signs indicating patient precautions.
Waste management
Risk of polluting the environment	Health providers working at home should be provided with all necessary equipment for safe disposal. Hospitals should be responsible for handling overall medication waste, while pharmacist involvement may reduce medication waste through proper dispensing.	For controlled substances, medications for home disposal should be combined with a substance that makes the drug ineffective; disposals should be witnessed by licensed staff.33 Limit the duration of treatment and dosing dispensed. Products utilizing a drug deactivation system are available on the market for disposal of medications/pharmaceutical waste (eg, Deterra, Rx Destroyer, Stericycle’s CsRx).
Additional challenges at the pharmacy
No visibility at central pharmacy for medications dispensed for HaH vs those already available at home; lack of automation; HCPs attending to multiple patients simultaneously	Implement different logistics for HaH vs hospitals; creative solutions/workflows for accessing and syncing of EHR; patients/caregivers should be educated on how to record parenteral administrations on the MAR in the absence of trained staff	Logistics surrounding patients transferring from the hospital to the HaH setting introduce challenges related to medication distribution and may require providers to adjudicate medication lists to ensure new orders are placed for HaH-specific admixtures. Given the different admixtures and dispensing implementation used in the HaH setting, transferring patients on medications can be complicated. Different-looking user-friendly labels for caregivers at home could ease the task of drug identification and administration.

Abbreviations: CI, continuous infusion; DEA, US Drug Enforcement Administration; EHR, electronic health record; HaH, hospital at home; HCP, healthcare practitioner; IV, intravenous; MAR, medication administration record; MDT, multidisciplinary team; USP, United States Pharmacopeia.

Dosing frequency, duration, and formulation.

Administration of parenteral medications in HaH may be challenging due to intermittent or frequent dosing and difficulty preparing specific formulations. This also leads to several logistical (additional visits, medication storage/delivery, and reformulation) and financial challenges. Dosing durations (lengths of infusion) impact patients managed per day, increasing HaH costs and adding to staffing concerns.

To manage the logistics of frequent dosing, medications could be made accessible to HaH settings by compounding (eg, medication converted to a 24-hour infusion or an intravenous [IV] bolus). Administration of higher but less frequent doses based on pharmacokinetic profiles may also be useful. Substantial evidence exists regarding the superior efficacy and tolerability of loop diuretics and time-dependent antibiotics when these are administered as continuous infusions (CIs) instead of intermittent boluses.^45,51,67-71

To maintain stability for compounded medications, standards provided by United States Pharmacopeia General Chapter <797> could act as a guide. Stability can also be extended by considering temperature fluctuations and use of specific infusion devices and storage containers.^14,58

For challenges with dosing duration, utilization of IV push could allow administration in small volumes of fluid.⁷² Use of preprogrammed ambulatory pumps administering infusions at the desired frequency could also be leveraged³³ for common medication classes.⁷³ Several portable pumps enable 24-hour infusions, allowing patients to remain mobile and continue regular activities, thereby improving their QoL. However, remotely manageable ambulatory pumps may pose cybersecurity risks and should be considered with caution.⁷⁴

Flow rate

. The flow rate of medications is an important parameter impacting parenteral administration. Commonly used roller clamps with controlled gravity infusions require frequent monitoring due to inconsistent flow rates, affected by catheter tip positioning in the wall of the vein, fluid container height, patient movement, and solution temperature.⁵⁸ Improper flow rate can cause unfavorable effects in the patient (eg, with CI bumetanide).^43,60

Volumetric pumps or ambulatory pumps are preferable.⁵⁸ If ambulatory pumps are unavailable, DripAssist can be used.⁵⁹

Administration challenges.

These include pump failure, partial disconnection at exit channels, needle disconnection from catheter ports, incomplete plunger activation (resulting in partial dosing), and syringe breakage. Deviation from vascular pathways may also cause necrosis and extravasation into surrounding tissues.^30,61,75 Further, some medications cause hypersensitivity reactions (chills, fever, hypotension, erythematous rash, and itching) when administered.^58,63,76

Educating patients and caregivers on drug/product use for successful administration of parenteral medications should be considered. Medications for potential anaphylactic reactions and adverse drug events should be kept at hand. Premedication may be necessary before infusion to avoid such reactions.^61,62

Acute/urgent need for injectables.

The need for injectables when patients experience acute symptoms demands urgent access to specific IV medications. However, the usual time needed to process and courier over an order (estimated at around 4 hours)³³ is not appropriate in such scenarios.

Supplying in-home clinicians with a set formulary of medications for such urgent needs would be very useful.

Handling controlled substances.

The use of parenteral controlled substances (US Drug Enforcement Administration [DEA] classification II-V) is a concern.³³ HaH has grappled with maintaining secure storage, inventory documentation (administration and wastage), and meeting regulatory chain of custody requirements.³³

To ensure proper compliance, development of a working protocol for controlled substances in collaboration with the regional DEA office and the state board of pharmacy is recommended.³³ Lockable storage containers and infusion pumps may be employed to avoid misuse/inadvertent use at home,³³ with enhanced HCP monitoring.

Supplies, transportation, and storage.

Logistics for essential supplies remain a challenge in HaH settings, requiring coordination between teams to ensure timely delivery.³³ Temperature variations can also impact medication shelf-life.⁶⁴

Medications could be stored in home refrigerators in protective bags or bins, segregated from food items to limit potential contamination.³³ Direct transfer of medications to the patient’s home would be crucial.⁶⁴ Educating and training individuals involved in pharmaceutical cold chain management to closely monitor the validity of medications and product integrity would be useful.^65,66

Infection control.

Infection control at home remains a challenge due to the lack of validated data and control models.⁷⁷

Redefining home care to limit acquired infections and developing practical surveillance methods would facilitate better infection control.⁷⁷

Waste management.

Improper disposal of medications risks environmental pollution.⁷⁸ Guidelines from environmental bodies such as the US Environmental Protection Agency and state laws that protect human health and the environment include requirements for medication disposal that HaH settings must follow.⁷⁹

Provision of pharmaceutical waste bins and a sharps disposal container would be useful.⁸⁰ Developing appropriate strategies is crucial in reducing medication waste.⁷⁸

Additional challenges at the pharmacy.

On the basis of local facilities, pharmacies need to decide how best to support the HaH setting and determine the packaging capabilities of the dispensing pharmacy.³³

Creative solutions and workflows to access and sync the electronic health record (EHR), pharmacy staffing, sterile product compounding, and operational setup within the pharmacy department are essential for HaH settings when patients transition from a hospital setting. Medication reconciliation and coordination with inpatient pharmacies for daily dispensing of drugs are crucial.³²

Future directions.

HaH offers opportunities for parenteral medications. Measures taken toward resolving the challenges listed could improve workflows, creating a positive impact on HaH implementation. The proposed solutions including patient/caregiver training, ambulatory/portable pumps, medication formulations, appropriate storage, transportation, waste management, supply logistics, proper infection control, and better coordination of the pharmacy team are all areas for improvement.

Antibiotic stewardship and steps to minimize home visits by transitioning from parenteral to oral medications are key areas that clinical pharmacists can support to enhance HaH implementation. Additionally, integrating appropriate EHR access with HaH workflows would significantly improve functionality and reduce logistical challenges. Developing technologies for secure storage of medications at home should allow inventory tracking (restocking and dispensing) and patient access to medication. Utilizing technological innovations for remote control of infusions with drug information updated in real time would also be useful.

Best practices may include interacting with and collating insights from patients, clinicians, and other key stakeholders to identify technologies, services, and products focused on HaH care. Active patient and caregiver participation in decision-making would empower them and promote long-term partnerships with HCPs and other MDT members.

Of note, the standard of care provided for HaH patients does not differ from that for traditional inpatients and must be aligned to antimicrobial resistance policies and stewardship measures. Provision of patient-centered care remains a key goal for HaH without much dependence on the caregiver. If required, caregivers should be involved in the decision-making process and should be adequately supported through appropriate training and specific patient education to avoid possible medication errors and caregiver burnout.

Conclusions.

HaH can provide enhanced patient care and clinical outcomes. Effective patient/caregiver training, enhancing MDT skill sets, reporting experiential learning, standardizing care, regulatory developments, and efficient use of parenteral medications are essential steps in overcoming existing implementation challenges. Pharmaceutical manufacturers can support innovation opportunities by customizing formulations for HaH use, rethinking medication-use processes, and redesigning product presentations. This would increase opportunities for wider, more successful adoption of HaH, including in remote areas with limited access to acute care. To ensure best practices are implemented, it is critical for HCPs and patient-focused organizations to establish uniform treatment and monitoring guidelines to develop customized technologies, services, and products for HaH settings.

Data availability

No new data were generated or analyzed in support of this article.

Disclosures

Pfizer, Inc., supported the development of this review article. Dr. Peinovich is currently a full-time employee of Medically Home and has declared no other potential conflicts of interest. Dr. DeGrado and Dr. Cotugno are full-time employees of Brigham and Women’s Hospital and provided consulting services to Pfizer. Dr. Hey-Hadavi, and Dr. Gokani are current employees of Pfizer and hold stock/stock options with Pfizer. Dr. Shetty was an employee of Pfizer when this analysis was conducted and holds stock/stock options with Pfizer. Dr. Wilks is a former Rutgers Institute for Pharmaceutical Industry Fellows (RPIF) Pfizer fellow and has declared no other potential conflicts of interest.