Optimize Outcomes for Pediatric Patients Who Need Infusion Therapy

Pediatric patients in need of infusion therapy face the same access barriers as their adult counterparts. But, they also deal with the added challenges offinding sites of care and infusion providers that are accustomed to caring for children

Robert Dracker, MD, MHA, MBA, CPI, medical director of Summerwood Pediatrics & Infusacare Medical Services in Liverpool, New York, spoke on these issues at the 2022 National Infusion Center Association (NICA) Annual Conference, held June 17 to 18, 2022 in New Orleans.

In his seminar, Dracker discussed considerations and developmentally appropriate interventions to promote high quality, patient-centered pediatric infusion care.

“What is infusion medicine?” he began. Dracker explained there’s no standard definition so he crafted his own, drawing on his decades of experience in the field. He defined this growing sector as, “the healthcare specialty involved with the clinical science and practice of administering parenteral fluids, medications, biologic, and cellular therapies to adults and children.”

He then delved into the essential attributes of an infusion facility, which include parking, facility access, patient privacy, a drug preparation space, a private consultation area, lab support, and emergency cart and room for allowing ease of emergency transportation.

Dracker moved his talk to the unique needs of children who will be receiving IV or parenteral medications. As compared to an emergency room visit or for a hospitalized child, outpatient infusion therapy is semi-elective and scheduled, allowing time to preparethe child for the therapy.

“This is a very difficult thing to do for a child in general, however,” he said. “A dermatologist should explain the need for the therapy and obtain an informed consent in some cases, particularly with regards to some of the newer biologic therapies for diagnoses like eczema and psoriasis.”

He compared general therapy considerations with important concerns specific to dealing with pediatric patients, reminding health care professionals that children are not just tiny adults. Things to know and factor into the care include the age of the child and any developmental issues, how ill the child is (acute vs chronic), who is with the child at the visit, any pre-existing conditions that could complicate the therapeutic intervention, and the child’s understanding of the treatment and informed consent.

Dracker spoke about the importance of establishing a relationship between a dermatologist and an infusion site’s team as there needs to be open communication between both for such issues like special needs of a particular patient, who will be monitoring the response and follow up labs if necessary, and how to partner medically with regards to new emerging therapies.

Furthermore, Dracker noted that treating a child may raise the medical team’s anxiety level, so a collaborative approach is helpful in discussing the start of a child’s therapy. He stressed the need for an open, interactive relationship between a dermatology practice and the administering therapy site is critical for care.

“There should obviously be communication between both regarding currently available and emerging therapies, the needs for prior authorization, follow up lab work required, and the fact that the infusion center staff will commonly see the patient during treatment more often than the dermatologist, which means that the response to treatment, or lack thereof should also be conveyed back to the referring office,” he said.

In his opinion, a sound treatment preparation would involve familiarizing a child with the environment, explaining what you are going to do (regardless of age), and surrounding them with love, affection and even “bribes” such as cartoons, books, and snacks.

Dracker mentioned that parents typically are fairly motivated to ensure that their child receives any thetherapy on a scheduled basis. It is important to provide a reminder to parents for an upcoming appointment with regards to date and time, he stated, and urged infusion providers to make an attempt to accommodate a child’s needs, especially related to school and activities.

Other key points of his talk included vascular access issues that one might face, the importance of being honest with children and he introduced some noteworthy clinical research, including what the FDA is doing to assure pediatric patients have access to safe and effective medical products.

At the conclusion of his talk, Dracker returned to his thesis of the unique needs of children and hoped attended walked away with the understanding that children have special needs in understanding their treatments and that in many ways, the dermatologists are treating the whole family, which can be negative or positive depending upon the efforts made and the accommodations provided.

Reference

Dracker R. Not just tiny adults: considerations for a pediatric population. Presented at: 2022 National Infusion Center Association Annual Conference; June 17-18, 2022, New Orleans, Louisiana.