She increased the probability of success by having her patients bring a friend or family member along for the teaching sessions, so that the patient had back-up. The HMO never advocated self-infusion for more complex and precarious infusions, such as amphotericin, pentamidine or blood products. For these drugs, the patients received home health nurse visits or came in to the infusion center. Patients tended to develop good relationships with their nurses, who were usually the first to know when problems developed. But for home care to be an attractive option, an array of services must be available, including hospitalization and home services.
Some patients require all services at different times for the same illness.
A patient with early cryptococcal disease, for example, could be admitted for stabilization in the hospital for a few days, then receive IV amphotericin from the home care team, follow-up with an outpatient lumbar puncture in the clinic, and then receive oral medication for continued suppression while continuing to have periodic management visits with the primary nurse practitioner. A new opportunistic infection may mean that the patient will need more support due to increased physical or mental limitations. In this case, skilled nursing services must be offered in conjunction with housekeeping help, assistance with food or errands, and a host of other support services to preserve as much independence for the patient as possible. Social workers can help patients find some community resources, but it is often the nurse case manager who can identify the other services that will allow the patient to follow the required medical regimen. The nurse practitioner must remain involved with ordering and monitoring lab results, as well as watching for side effects, toxicity, efficacy and impact on the patient's well-being.