Supervised Patient-Management of Hemophilia

Abstract

Forty-five patients with hemophilia A and B were formally instructed in the management of their bleeding problems. Home infusion was permitted without prior consultation with a physician. Data from 12 months of this program were compared with results from the previous year. There was 74% reduction in absenteeism, 89% reduction in days hospitalized, 76% reduction in outpatient visits, and 45% decrease in health care costs. Use of factor VIII or IX decreased slightly. No patients had morbidity attributable to this program. The only important hazard was the exposure of family members to hepatitis from contaminated needles; one case occurred. These results, coupled with a gratifying trend towards more normal life patterns, suggest that the more widespread application of this form of therapy is justified. Hemophilia self-therapy may provide a useful model for improving the delivery of health care in certain other chronic illnesses.