The march of medicinal progress can hardly be described as a straight line; since the term “modern medicine” was coined in the last century, those of us on the journey have experienced sharp turns, false starts, and downright falsehood perpetrated by ill-designed studies. 

Historical studies of the evolution of medicine from the 20th century onward are equal parts inspiration and exasperation. Let’s talk about one of the more interesting aspects of medical history: the movement toward hospital care and then the shift toward home care. 

In the early 20th century, hospitals were ill-equipped with the kinds of technology we would expect in a modern hospital today; hence, hospitals were often called “convalescence homes”, in which people would spend days (even weeks) recuperating under the care of dutiful nurses, with or without the administration of any meaningful therapy. The general consensus was that “a change of air” would be good for patients, never mind the absence of targeted antibiotics, optimized nutrition, and the like.


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As health care became more accessible to all, it was no longer sustainable for patients to spend weeks at a time occupying a hospital bed, so every effort was made to get patients in suitable shape to continue receiving care outside a hospital setting. The average number of nights spent by a patient dropped drastically, and better drugs and protocols meant faster recoveries. 

Still, the reliance on receiving medical care in a hospital setting continued to be embedded in the popular imagination. The problem was that hospitals were not growing much larger, and soon enough they became inundated with (sometimes angry and impatient) patients, especially in the emergency department, where many seek medical help for nonemergencies. 

A Pandemic Pivot to Home Care

The COVID-19 pandemic from 2020 onward rocked the world, and for once in a century, hospitals were (correctly) viewed as high-risk places in which people can catch infectious diseases, the main worry being the COVID-19 virus. The public perception of hospitals as high-risk infection zones grew steadily, and the number of visitors dropped accordingly. 

Now that the enthusiasm for hospital visits has dampened considerably, people are wondering whether they can get the same care at home, away from potentially deadly bacteria and viruses, and without any compromise in quality of care. It is at this point in medical history that we currently find ourselves living in: the emergence of home care as the gold standard for nonemergency treatment. 

One condition that potentially can be treated at home is alpha-1 antitrypsin deficiency (AATD). The mainstay of AATD treatment today consists of the intravenous injection of AAT protein augmentation therapy. During the COVID-19 pandemic, carers informed their patients that self-infusion was an option, meaning that the bulk of treatment can now take place at home. 

Read more about AATD etiology 

In a study published in Pulmonary Therapy, Colello and colleagues listed some of the hesitations that patients expressed about the notion of self-infusing AAT augmentation therapy: 

  • Fear of consequences if improperly injected
  • Lack of dexterity required for self-administration
  • Worry about financial restraints
  • Fear of mismanaging infusion supplies
  • Worry about poor venous access
  • Fear of disruption from current nurse-administered infusions. 

Despite the fears of patients switching from hospital-based treatment to home therapy, patients generally feel more confident once they have been educated on how home therapy works and the guidelines that are in place to ensure they do not accidentally harm themselves. 

Read more about AATD treatment 

As published in Frontiers in Pharmacology, Annunziata and colleagues conducted a study investigating home therapy for AATD. “Home-based administration is safe and demonstrates no side effects. According to the results of other studies, home care is also practicable for several years,” they wrote. 

In other words, once patients understand how to self-administer AAT augmentation therapy the right way, they realize that the program is safe, well-tolerated, and convenient. “Convenience for the patient is viewed as the most important advantage of home treatment,” with “the quality of life of our patients being the main objective,” Annunziata and colleagues wrote.

Changing the Treatment Paradigm

Perhaps in the not-too-distant future, when home therapy becomes the standard operating procedure for the administration of AAT augmentation therapy, patients may begin to ask, “Why did we bother going to the hospital for something as straightforward as this?” Keep in mind, in-person follow-ups are still conducted, giving patients the opportunity to discuss with their physicians any concerns that they might have. 

The big bold question next is: “How do we utilize home therapy across various disease categories in a smart, safe, and economical way?” Time will tell. 

References

Colello J, Ptasinski A, Zhan X, Kaur S, Craig T. Assessment of patient perspectives and barriers to self-infusion of augmentation therapy for alpha-1 antitrypsin deficiency during the COVID-19 pandemicPulm Ther. 2022;8(1):95-103. doi:10.1007/s41030-022-00182-z

Annunziata A, Lanza M, Coppola A, Andreozzi P, Spinelli S, Fiorentino G. Alpha-1 antitrypsin deficiency: home therapyFront Pharmacol. 2021;12:575402. Published April 15, 2021. doi:10.3389/fphar.2021.575402