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Conclusion:    Click on the link at left to go to your desired page:  Introduction  Page 2  Page 3  Study 1  Study 2  Study 3  Study 4  Conclusion  Implications for Social Workers  Post-Test 

Respiratory syncytial virus (RSV) can be devastating to premature infants, children with chronic lung disease and congenital heart disease. It infects almost all children by two years of age, resulting in a large number of hospital admissions in infants. It has been proven that the incidence of serious RSV illness can be reduced with prophylaxis and therefore, seems prudent for those patients in the high-risk group. palivizumab (Synagis) is the preferred drug because of its ease of administration, safety and effectiveness. 

However, several issues complicate its use and effectiveness. Cost is at the top of the list.  This journal club reinforces the use of prophylaxis proving that it is not only less costly on the health care system, but also greatly improves the quality of life of those patients who fall prey to RSV.

Of note, this journal club brings to light what is perhaps the most telling debate over the use of palivizumab to date. Not whether to use it or how to administer it, but where to administer it. The medical community sees this as a home injection therapy. The payers see this as a depot-type product that should be administered in a physician's or homecare office. And paradoxically, the patient and their family see their satisfaction levels higher when they are more involved and having to bring their infant into the office for their monthly injections. However, in the Paul study, compliance levels were found to be higher with the home injection group due to the author's assumption that a measure of control was taken out of the parent's hands by bringing the nurse to the home to give the injections. But this is also the study that found higher satisfaction levels in the group that brought their children into the local homecare or physician's office for injections.

And lastly, that compliance issue. With palivizumab, success was found to be directly tied to compliance. If an infant received all of their injections in their series, they had a very low chance of contracting RSV. And with each injection that was poorly timed or missed altogether, the infant's chances of succumbing to infection increased sharply. Parents that had more control (therefore, those that brought their children into an office setting for their injections), had lower compliance due to the parent's decision to opt their child out of therapy. Parents that were financially challenged by the therapy's cost were more likely to forgo a larger percentage of the injections when having to bring their child in for therapy, as opposed to those that were visited by the nurse at home. And transportation issues also played a part in some children missing injections. On the other side of the debate, those children that were visited at home for their injections had a higher chance of other factors causing them not to comply with the full course of therapy for reasons that go somewhat unexplained. Reasons mentioned, but not fully explained, point to the fact that parents that did not get the full court press on the benefits of palivizumab therapy and the necessity of following through with the full series of injections, (like they did more often at the homecare or physician's office) were more likely to miss injections, and in some cases to not complete therapy after just the first or second injection.

All authors laud the effectiveness of palivizumab therapy. And all authors point to a need for payers to reform their thinking on this issue and recognize the need for home injections of palivizumab. Paul et al. demonstrate the need for further research in the area of non-compliance triggers, so that a formalized strategy can be developed further supporting adherence to the full course of therapy, therefore avoiding hospitalization. Schrand et al. points cost-effectiveness realized in her study when injections were given in a hospital (office) setting.

And while Garzon et al. do not broach the financial implications of palivizumab therapy, they do emphasize the ease of administration and minimal impact on the patient's quality of life.

Simoes et al. also do not examine the financial implications of palivizumab therapy, but do look at the effectiveness of the drug, ease of administration and the importance of compliance. These authors point out the importance of preventing the infant's first exposure to RSV from progressing to clinical symptomatology of RSV infection. Many children are re-exposed to RSV, as are older children, adults and the elderly. And with this re-exposure come further complications (pneumonia and bronchiolitis) that may affect quality of life and overall healthcare costs.

 

Implications for Social Workers

Click on the link at left to go to your desired page:  Introduction  Page 2  Page 3  Study 1  Study 2  Study 3  Study 4  Conclusion  Implications for Social Workers  Post-Test

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