Flexible care: what are its key success factors and its impact on patients’ quality of life?

What is flexible care in Europe?

Although there are different definitions of flexible care, common ground is that the term is used to describe treatment that is administered outside the hospital setting, whether it is a patient’s home or a retirement/nursing home.

There are several initiatives in Europe to shift care from the hospital to where the patient lives.

Example of flexible care in the Netherlands

The Dutch initiative ‘The right care, on the right place’ (De Juiste Zorg op de Juiste Plek) works on replacing care from the medical specialists in the hospital to a location closer to patients. An example is the program of the ‘Flevo hospital’, which aims to treat severe infections patients with antibiotics. Often, these patients had to be admitted to the hospital for 14 days to administer the antibiotics via an IV. The hospital has set up an OPAT-team (outpatient Parenteral Antimicrobial Treatment). The team consists of an infectiologist, a specialized nurse, a pharmacist and a transfer nurse and checks if the patient can finalize his treatment at home. In this way, patients can leave the hospital earlier and finish their treatment in a homecare environment.

Example of flexible care in Belgium

In 2013 and 2014, the BELIS study has been conducted in Belgium. For this study, patients with breast cancer received subcutaneous administration of Trastuzumab at home instead of being treated in the hospital. The results of the study showed that the patients can safely be treated at home, and all patients (100%) considered the home setting beneficial. Since the study, several pilots have been conducted in Belgium and other European countries. In the Netherlands, the St. Antonius hospital started offering flexible care in March 2020, bringing treatment to patients’ homes via specialized oncology nurses.

Learn more about our experience in Homecare >

How patients’ quality of life will benefit from the implementation of flexible care

Studies show that moving care from a medical environment to an environment where a patient feels more at home (it being home, workplace, or mobile cancer units) has advantages for both the healthcare professionals, the healthcare systems and the patients. Healthcare systems and hospitals need fewer beds and could potentially treat more patients.

However, the largest effect of flexible care is expected for patients. Patients spend less time in the hospital, reducing their exposure to infections in the hospital.

Furthermore, patients don’t have to travel to receive their medication; thus, the travel burden gets reduced. This means patients not only save time but also don’t need to be confronted with patients who might be in a further stage of disease than they are.

Furthermore, patients feel more comfortable and at ease in a home-like setting. The BELIS study shows that many breast cancer patients prefer to receive treatment at a place closer to home. This might even affect treatment adherence in the long term.

Another positive aspect of flexible care is the fact that it is less vulnerable to events like a pandemic, as the covid-19 pandemic proved.

Key success factors of flexible care

To change the status quo and move care from a hospital setting to a home care setting, we identified 3 key success factors:

Policy directions and a financial framework

Current care policies often don’t address the possibility of flexible care. Consequently, it might be hard to organize the finances needed to implement flexible care.

For example, hospitals need to invest in a specialized nurse that is traveling to a patient but in the meantime, they do not receive any more payments for hospital care. Therefore, addressing the finances coming along with flexible care is critical to speed up its implementation and incentivize hospitals.

A support base and close collaboration from both the medical specialist, GP, specialized nurse, or physician assistant

For flexible care to work and for patients to receive high-quality care, the medical specialist needs to be actively involved and discuss with the health care professional who administers the care at home about the patients’ status, treatment decisions, etc. The patient also needs to be able to still talk and discuss with his medical specialist on a regular base, being a video conference or a face-to-face consultation.

Impact measurement

As flexible care is in its early days, some specialists still have to be convinced of its added value. Even though some first studies are done, it remains to be discovered for which indications and treatment types flexible care is of most added value. To answer that question, impact measurement is of key importance.

To conclude, flexible care might be a solution to overcome current challenges in the administration of treatment and have a positive effect on the patient at the same time. Of course, implementation takes time and it is critical to work on the key success factors related to policy, finances, collaboration and impact measurement. Alcimed will continue to follow the developments of homecare and flexible care closely and keep you up to date!

About the author, 

Hannah, Consultant Alcimed’s Life Sciences team in France