Instructies
Uitgangsvraag
Welke wijze van instructie is het meest geschikt voor veilige thuistoediening van medicatie?
Aanbeveling
Instrueer de patiënt passend bij de gezondheidsvaardigheden en de context van de patiënt. Gebruik hierbij instructiematerialen en oefen de handeling met de patiënt.
Toets, evalueer periodiek en leg vast dat de instructie goed heeft plaatsgevonden en de patiënt en/of mantelzorger in staat is om de medicatie veilig toe te dienen.
Overwegingen
Balans tussen gewenste en ongewenste effecten
Voor deze module is een systematische search uitgevoerd. Er zijn zeven studies gevonden die geïncludeerd konden worden (Cirillo, 2020; Fischer-Cartlidge, 2016; Kaplan, 2016; Katz, 2014; Patel, 2017; Smith, 2013; Zhitomirksy, 2023).
De literatuur toont aan dat instructie over thuistoediening van medicatie leidt tot betere kennis, correcte uitvoering van injecties en soms hogere tevredenheid. Kaplan (2016) liet zien dat hands-on training leidde tot significant betere correcte uitvoering van alle stappen bij zelfinjectie (dag 1: 90% vs. 76,7%; maand 3: 96,7% vs. 88,3%). Ook Smith (2013) toonde aan dat vereenvoudigde instructies in duidelijke taal significant meer correcte handelingen opleverden dan standaard instructies.
Wat betreft veiligheid (kritieke uitkomstmaat), rapporteerde Cirillo (2020) geen significante verschillen in ziekenhuisbezoeken voor toxiciteit tussen de groep met intensieve begeleiding en de standaardzorg. Er werden nauwelijks calamiteiten of bijwerkingen gemeld, en waar die voorkwamen (bv. conjunctivitis, neurotoxiciteit), waren het lichte klachten (graad 1).
Sommige vormen van instructie (zoals simulatie of digitale platforms) bleken minder invloed te hebben op zelfvertrouwen of tevredenheid (bijv. Fischer-Cartlidge, 2016; Zhitomirsky, 2023). Daarmee lijken instructies klinisch relevant voor kennis en correct gebruik. De effecten op patiënttevredenheid en reductie van calamiteiten zijn minder eenduidig en verschillen per instructievorm en studie.
Kwaliteit van bewijs
Door de heterogeniteit tussen de interventies van de studies, is er geen gradering middels GRADE methodiek uitgevoerd.
Waarden en voorkeuren van patiënten (en eventueel hun naasten/verzorgers)
De meeste studies lieten zien dat patiënten instructievormen waarderen, ongeacht het medium. Katz (2014) en Patel (2017) rapporteerden hoge tevredenheid met zowel traditionele als digitale instructievormen (gemiddeld 9,9–10 op 10). Fischer-Cartlidge (2016) liet zien dat instructie met simulatie de tevredenheid van verpleegkundigen verhoogde, maar niet van patiënten, en dat het zelfvertrouwen in beide groepen toenam.
Digitale instructieplatforms (Zhitomirsky, 2023) vergrootten kennis, maar scoorden iets lager op tevredenheid dan persoonlijke uitleg. Dit onderstreept dat patiëntvoorkeuren uiteen kunnen lopen, waarbij sommigen behoefte hebben aan persoonlijk contact en anderen meer autonomie wensen via digitale instructies.
De gewenste effecten zijn dus bekend en variëren van klein tot groot, afhankelijk van de instructievorm en uitkomstmaat. De ongewenste effecten zijn bekend en over het algemeen klein tot zeer klein.
Kostenaspecten
Een budget impact analyse (BIA; zie bijlage 6) van chronische therapie met normaal immunoglobulinen (iv/sc) over een periode van vijf jaar, vanuit maatschappelijk perspectief en op basis van prijspeil 2024, laat zien dat thuistoediening van medicatie tot aanzienlijke kostenbesparingen kan leiden. Voor een populatie van 5.000 patiënten per jaar zijn de gemiddelde kosten per patiënt het hoogst bij intraveneuze toediening in het ziekenhuis. Bij intraveneuze thuistoediening dalen de kosten met gemiddeld ruim 10% en bij subcutane zelftoediening worden de laagste kosten gevonden: ruim 30% lager dan bij intraveneuze toediening in het ziekenhuis.
De grootste kostenpost in alle scenario’s betreft materialen en medicatie. De verschillen tussen de scenario’s worden met name veroorzaakt door het wegvallen van dagbehandelingskosten, een lager productiviteitsverlies van patiënten en, in het geval van subcutane toediening, het ontbreken van verpleegkundige inzet per gift. Geaggregeerd over een periode van vijf jaar resulteert dit in substantiële maatschappelijke besparingen. Deze besparingen kunnen vooral gerealiseerd worden bij chronische therapieën waarbij (een gedeelte van) de handelingen overgenomen kunnen worden door de patiënt of mantelzorg.
De sensitiviteitsanalyses tonen aan dat de uitkomsten robuust zijn: ook bij een variatie van ±20% in de totale kosten blijven de thuisscenario’s, met name subcutane toediening, het meest kostenefficiënt. De BIA veronderstelt gelijke effectiviteit en werkingsduur tussen de behandelscenario’s. Bij gelijkblijvende behandeluitkomsten en lagere kosten kan het voordeel van thuistoediening op basis van kosten doorslaggevend zijn.
Gelijkheid ((health) equity/equitable)
Het gebruik van digitale tools of schriftelijke instructies kan gezondheidsverschillen vergroten bij mensen met beperkte digitale vaardigheden of lage gezondheidsvaardigheden. Smith (2013) liet echter zien dat ‘plain language’ instructies ook mensen met beperkte geletterdheid helpen om correct te injecteren. Zhitomirsky (2023) sloot mensen met taalbarrières uit, wat de toepasbaarheid van digitale instructies kan beperken.
Het gebruik van digitale tools of schriftelijke instructies leidt tot een mogelijke toename van gezondheidsgelijkheid als rekening wordt gehouden met taal en leesvaardigheid, maar tot een mogelijke afname van gezondheidsgelijkheid als dit niet gebeurt. Daarom is het cruciaal om instructievormen aan te passen aan de doelgroep.
Aanvaardbaarheid:
Ethische aanvaardbaarheid
Alle geïncludeerde studies rapporteerden een hoge acceptatie van de gekozen instructievorm. Geen enkele studie meldde ernstige bezwaren of weerstand vanuit patiënten. Zowel fysieke als digitale instructievormen werden gewaardeerd.
Het gebruik van digitale tools of schriftelijke instructies lijkt aanvaardbaar voor de betrokkenen. Er zijn geen ethische bezwaren: patiënten waarderen instructie en geven aan zich beter voorbereid te voelen na onderwijs.
Haalbaarheid
De meeste instructievormen lijken goed haalbaar. Video- en webgebaseerde instructies kunnen breed worden ingezet en vereisen beperkte inzet van personeel. Simulatieonderwijs is arbeidsintensiever en mogelijk minder effectief. Uit Smith (2013) blijkt dat goede schriftelijke instructies breed toepasbaar zijn en effectief bij lage gezondheidsvaardigheden.
Het gebruik van digitale tools of schriftelijke instructies lijkt haalbaar. Het gebruik van digitale tools of schriftelijke instructies is over het algemeen al standaardzorg in de praktijk, maar variatie in middelen (zoals toegang tot video of digitale platforms) vereist aandacht bij implementatie.
Het geven van instructie en scholing aan patiënten of mantelzorgers vraagt inzet van zorgprofessionals. In de praktijk kan de bekostiging van deze activiteiten niet altijd eenduidig geregeld zijn, wat bij implementatie aandacht vraagt.
Duurzaamheid
Er zijn geen specifieke data over milieu-impact van verschillende instructievormen. Mogelijke duurzaamheidsaspecten hebben onder andere betrekking op reisbewegingen van zorgverleners en patiënten, het gebruik van printmateriaal en de inzet van digitale middelen. Digitale instructie kan in sommige situaties bijdragen aan vermindering van reisbewegingen of materiaalgebruik, maar hierover zijn momenteel geen harde gegevens beschikbaar. Bij Het gebruik van aanvullende tools of instructies kunnen duurzaamheidsaspecten een rol spelen, zoals het gebruik van digitale, herbruikbare materialen en mogelijk minder reisbewegingen. Bij meer fysieke instructiemomenten kan sprake zijn van extra reisbewegingen of gebruik van printmateriaal.
Kindzorg
Voor de kindzorg specifiek gelden gelijke overwegingen. Echter er dient wel rekening gehouden te worden dat bij kinderen het gehele (gezins)systeem in beeld komt. Stichting Kind en Zorg deed eerder een evaluatie van patiënten met beperkte gezondheidsvaardigheden en concludeerde dat voorlichting over onder meer het verschil in gezondheidszorg, verwachtingen, rechten van de patiënt, samen beslissen, eigen verantwoordelijkheid, en over het concept van huisartsen als poortwachter voor het ziekenhuis essentieel is. Er is grote behoefte aan persoonlijk contact met zorgprofessionals en een gezinsgerichte benadering. Voor kinderen uit de doelgroep is het net als bij alle kinderen goed om met plaatjes, tekeningen en filmpjes te werken, maar bij volwassenen werken die middelen minder goed. De volwassenen gaven aan behoefte te hebben aan persoonlijke gesprekken en overleg in de familiekring.
Rationale van de aanbeveling:
De werkgroep doet een sterke aanbeveling om patiënten instructie te geven die is afgestemd op hun gezondheidsvaardigheden en context, met gebruik van instructiematerialen en oefening van de handeling. Hierbij is overwogen dat dit de kennis, veiligheid en zelfredzaamheid vergroot, terwijl afwijkende instructievormen nodig kunnen zijn voor subgroepen met lage geletterdheid of beperkte digitale vaardigheden.
Instructie over medicatietoediening kan, afhankelijk van de organisatie van zorg, worden gegeven door verschillende zorgverleners binnen de zorgketen (bijvoorbeeld ziekenhuisverpleegkundigen, gespecialiseerde thuiszorgprofessionals of andere betrokken zorgverleners). Wanneer medicatie, doseringen of toedieningsschema’s veranderen, dient de instructie zo nodig te worden herhaald of geactualiseerd.
Onderbouwing
Currently, many patients self-administer medication at home, often supported by written, digital, or face-to-face instructions. However, the effectiveness of these instructional methods varies, and it remains unclear which approach ensures the safest and most reliable administration. This uncertainty can lead to errors, reduced confidence, or preventable complications. Identifying the most suitable form of instruction could improve patient safety, enhance treatment adherence, and increase overall health outcomes.
Summary of Findings
Due to the absence of multiple comparative studies and due to the heterogeneity in interventions, grading of evidence was not possible.
Description of studies
A total of 7 studies were included in the analysis of the literature. Important study characteristics and results are summarized in table 2. The assessment of the risk of bias is summarized in the risk of bias tables (under the tab ‘Evidence tabellen’).
Table 2. Characteristics of included studies
|
Study |
Participants |
Comparison |
Follow-up |
Outcome measures |
Comments |
Risk of bias (per outcome measure)* |
|
Cirillo (2020) |
378 patients (Arm A: 184, Arm B: 194) from 19 Italian oncology centers. Age: Mean (SD) 68.9 (10.9) in Arm A and 69.9 (10.1) in Arm B. Sex: 50% male in both arms. ECOG Performance Status: 0 in 52.7% (A) and 52.1% (B), 1 in 42.9% (A) and 44.3% (B), 2 in 4.3% (A) and 3.6% (B). Tumor sites included colon (27.5%), kidney (16.7%), breast (14.8%), among others. Most patients had metastatic disease (Stage IV: 61.1%). Treatments included oral cytotoxic drugs or targeted therapies (e.g., capecitabine, sorafenib).
Setting: Multicenter, Italy.
Study type: Open-label, multicenter, randomized controlled trial.
Funding/conflicts: Not reported; authors declare no conflicts of interest. |
Intervention: “A nurse briefing to increase patients’ awareness… delivery of a daily record… scheduled phone calls during cycles 1 and 2.” Control: “Patients were followed according to usual clinical practice… physicians gave information and written material about drugs and treatment plan… nurse briefing, phone calls, and patient diary were not included.” |
Duration of follow-up included monitoring during the first two cycles of therapy (regardless of schedule/duration). Completion: 145 (78.8%) in Arm A and 154 (79.4%) in Arm B completed two cycles. Loss-to-follow-up: 2 in Arm A (1.1%), 4 in Arm B (2.1%). Discontinuation: due to disease progression (22 in A, 21 in B) or toxicity (12 in A, 11 in B). Consent withdrawal: 3 in A, 4 in B. Incomplete outcome data: 25 excluded due to missing data, and 20 never started treatment. |
Primary outcome: Improper hospital accesses for grade 1–2 toxicity: 12 patients (6.5%) in Arm A vs. 10 patients (5.2%) in Arm B; Relative Risk (RR) 1.292; 95% CI: 0.59–2.83; p = 0.52.
Total patients with at least one hospital access: 41 (22.3%) in A, 42 (21.6%) in B. Secondary outcomes: Grade >2 toxicity: 38 (21.6%) in A, 30 (16.3%) in B; RR 1.355; 95% CI: 0.877–2.090; p = 0.170.
Nurse adherence to monitoring protocol was high (86.4% of scheduled phone calls completed). Patient compliance: 73.6% of diary pages completed.
No statistically significant differences in most adverse events. Conjunctivitis and neurotoxicity were more reported in Arm A but only as grade 1 events. |
Groups were well balanced in terms of baseline characteristics. The study concluded that the home care nursing program (HCNP) did not significantly reduce improper hospital access or toxicity rates. High nurse compliance and patient diary completion indicated feasibility but not clinical utility. Authors acknowledged that routine clinical care may already provide sufficient information to patients, limiting the added value of the intervention. Study was conducted across multiple experienced oncology centers. No industry funding or conflicts of interest were reported. |
The study does not report formal risk of bias assessment. Open-label design, no blinding of participants or outcome assessors introduces performance and detection bias risk. Centralized randomization reduces selection bias. The authors state that due to the low number of events, multivariate analysis was not possible, limiting deeper interpretation. |
|
Fischer-Cartlidge (2016) |
50 participants (25 control, 25 intervention), consisting of patients with breast cancer undergoing adjuvant or neoadjuvant chemotherapy, and their caregivers at Memorial Sloan Kettering Cancer Center, New York. Eligibility: English-speaking, aged >18, no prior experience with injections, receiving pegfilgrastim. Exclusions: prior injection experience, placebo request, latex allergy, or insurance-related barriers to home injection. Mean age: patients 52.7 years (range 38–67), caregivers 46.6 years (range 26–63).
Funding: Geri and ME Nursing Fund at Memorial Sloan Kettering and NIH/NCI Cancer Center Support Grant P30 CA008748.
Conflicts of interest: None reported. |
Intervention: “Verbal instruction, written handouts, and simulation using an injection model.” Control: “Verbal instruction and written handouts only.” |
Post-teaching (immediately), and after the first injection performed at home. Loss-to-follow-up: 2 excluded post-consent (1 ineligible, 1 taught incorrectly). 50 participants completed the study (25 per arm). Follow-up assessments were conducted via structured questionnaires. No specific reasons for additional missing data points were detailed. |
Primary outcomes: Satisfaction with teaching, self-confidence, and worry levels. No significant difference in patient/caregiver satisfaction (p = 0.15) or self-confidence (p = 0.43) between groups. Nurse satisfaction higher in simulation group (p = 0.03). Learner worry significantly decreased after teaching in both groups (Z = –4.2, p < 0.001). Nurse perceptions of learner confidence were significantly higher than learner-reported confidence (p = 0.005). Postinjection satisfaction decreased in the intervention group (Z = –2.4, p = 0.01). All scores were based on Likert-type self-assessments (scale 1–5). No validated psychometric tools were used. |
Although simulation improved nurse satisfaction, it did not increase learner satisfaction, self-confidence, or reduce worry compared to standard instruction. Nurses tended to overestimate learner confidence. Learner satisfaction dropped after actual injection, particularly in the simulation group. The study was limited by small sample size, single-site design, and lack of validated assessment tools. Authors emphasized that actual injection experience might be more critical for learner confidence than simulation. Study suggests focusing resources on timing of teaching and post-discharge support rather than simulation tools. No industry involvement or conflict of interest was disclosed. |
The study acknowledges limitations including small sample size, single-center setting, non-validated questionnaires, and potential nurse bias (e.g., assumptions that simulation improves learning). The sequential allocation design might introduce bias, although it helped maintain fidelity. Observers were not blinded. No psychometric validation of outcome measures introduces measurement bias. |
|
Kaplan (2016) |
120 healthy women aged 18–45 years, randomized into two groups (60 with training, 60 without). Conducted in Belgium at Erasmus Hospital. Participants were excluded if they had prior experience administering injections, were pregnant/breastfeeding, or had impaired dexterity. Demographic data: mean age 32.5, >90% white. No data reported on education, socioeconomic status, or health literacy. Study sponsored by Pfizer Inc. All authors are employees/shareholders of Pfizer. |
Intervention: “Participants received hands-on training: study staff reviewed the IFU, demonstrated the Uniject system, allowed participant handling and answered questions.” Control: “Participants received only the printed IFU at both visits, with no demonstration or opportunity for questions.” |
Simulated injection was observed at baseline and repeated 3 months later. Loss-to-follow-up: none; all 120 participants completed both visits. Incomplete outcome data: none. A second injection attempt was requested in case of mechanical failure, but these were excluded from primary analysis. |
Primary outcome: Success defined as correct performance of all IFU steps and full dose expulsion. At month 3: 96.7% success in trained group (one-sided 95% CI >80%), 88.3% in untrained group (95% CI >79.8%). At day 1: 90.0% (trained) vs. 76.7% (untrained). Difference at day 1 was statistically significant. Secondary outcomes: Activation and expelling dose were most difficult; 37.5% (trained) and 35.3% (untrained) had difficulty expelling at day 1, reduced to 16.7% and 22.8% at month 3. Median full dose expulsion achieved in ≥81.7% at month 3 in both groups. Time and ease-of-use metrics reported; satisfaction was high across both groups. Trained group required slightly more time initially, particularly for mixing medication. Observers and participants generally rated system usability as “very easy” or “somewhat easy.” No adverse events related to procedure. |
Pfizer-funded study with all authors affiliated. Although general population was sampled, selection bias may exist since participants were compensated. No data on SES or literacy. Training clearly improved early success; experience also mattered—most participants who failed initially succeeded later. The study confirms feasibility of self-injection with simple training. No actual injections of drug occurred; this was a simulated usability study. Results support the role of patient training and supervised initial injection, even with clear IFU materials. |
Authors were Pfizer employees and shareholders, posing a conflict of interest. Study was open-label and unblinded. Simulated use only—no real-world behavioral data or injection outcomes. Participants were not selected for willingness to self-inject in practice, possibly affecting generalizability. Observer bias was minimized by independent assessors, but psychometric properties of tools were not detailed. Overall, potential performance and sponsorship bias noted. |
|
Katz (2014) |
29 rheumatology patients initiating methotrexate self-injection at the University of Alberta Medicine Clinic. Excluded if prior injection experience or lacked English proficiency. 15 in standard teaching group, 14 in intervention (video) group. Mean age ~49 years, gender (11M/18F), educational background balanced. Randomized 1:1 (alternate enrollment). Study period: 6 months (2012–2013).
Funding: not reported. Conflict of interest: not reported. |
Intervention: “A 12-minute web-based methotrexate self-injection education video followed by in-person nurse education focused on questions and practice.” Control: “Standard in-person nurse-led methotrexate self-injection education session.” |
Outcomes recorded immediately after the teaching session. No long-term follow-up or retention testing performed. No loss to follow-up; all 29 patients completed study procedures. |
Primary outcome: Post-education self-confidence for self-injection (VAS 0–10): No difference between groups (8.8 both groups, p=0.93). Secondary outcomes: Change in confidence: +3.3 (control) vs. +4.4 (video), p=0.15. Patient knowledge (score out of 6): 4.7 (control) vs. 5.5 (video), p=0.15. Teaching time: 60 min (control) vs. 44 min (video), p=0.012. Gender-based analysis showed men required significantly more teaching time. Satisfaction high in both groups (mean 9.9–10/10). |
Video-based education achieved equal outcomes in self-confidence, satisfaction, and knowledge compared to traditional teaching but required significantly less nurse time. Small sample size may limit power to detect differences. Not generalizable beyond English-speaking patients. Study was single-blinded; nurses knew group allocation. Results may reflect high quality of baseline teaching. Patient willingness to self-inject or perform in real-world settings not assessed. Video did not cover broader methotrexate education (e.g., side effects). |
Small sample, single-center pilot study. Single-blinded (nurses not blinded), potential for performance bias. No funding or conflict of interest statements. No psychometric validation of assessment tools. Self-reported confidence used as proxy for ability. Generalizability limited by English-only inclusion and specific clinical setting. |
|
Patel (2017)
|
66 infertile English-speaking women aged 18–42 years who required use of injectable gonadotropins were recruited at the Carolinas Medical Center Reproductive Medicine and Infertility clinic in Charlotte, NC, USA, between June 2012 and December 2014. Participants were randomized to web-based video (n=33) or one-on-one teaching (n=33). Participants in the web-based group had a median age of 34.5 (27–42) years; 36.4% White/non-Hispanic. Control group median age 35.1 (28–42) years; 33.3% White/non-Hispanic. BMI: 26.1 (19.3–42.3) in intervention, 24.7 (19.7–41.0) in control. Study type: prospective randomized controlled trial. Setting: academic fertility clinic, USA. Funding: no industry funding reported. Conflicts of interest: “The authors have no connection to any companies or products mentioned in this article.” |
Intervention: “Patients randomized to web-based video teaching were taken to a private room to view a 6-minute instructional video demonstrating the administration of Gonal-F. Patients were given the opportunity to pause, rewind, and fast-forward the recording. The total amount of time required to view the video was noted.” Control: “Patients randomized to one-on-one teaching served as the control group. These patients attended a private didactic session led by one of two well-trained clinical pharmacists who have knowledge about protocols for ovulation induction. The clinical pharmacists were provided with a standardized transcript to follow.” |
Duration of follow-up not explicitly stated. Post-intervention assessments included a 10-question knowledge test immediately after teaching and a satisfaction survey three days after starting gonadotropin injections. Loss-to-follow-up: 17 patients (out of 66; 25.7%) did not complete the satisfaction survey (higher in control group). Incomplete outcome data: The effective sample size for satisfaction outcomes was 49. Frequency of missing values is 17. Reasons for drop-out not fully explained but related to failure to return the survey. No explicit loss-to-follow-up per group, user should verify from study figures |
- Knowledge test scores: Web-based group scored 8.97 (SD not specified) vs. 8.36 for one-on-one (p=0.0391). - Time to teach: Web-based group took 7.00 minutes (6–11), one-on-one took 9.61 minutes (5–16), p=0.0001. - Felt additional teaching needed: 89.7% (web-based) vs. 28.1% (one-on-one), p<0.0001. - Patient preference: 78.6% of web-based group vs. 90.5% of one-on-one group preferred one-on-one (p=0.438). - Comfort with self-administering: 92.9% (web-based) vs. 95.2% (one-on-one), p=1.0. - Felt session prepared them: 96.4% (web-based) vs. 95.2% (one-on-one), p=1.0. Comparative measures include mean differences and p-values; no confidence intervals reported |
Groups were reported to be similar at baseline in age, race, education level, and BMI (Table I, page 4). However, differences in completion of satisfaction surveys (25% higher response in web-based group) may bias results. Authors noted potential confounding due to changes in the gonadotropin pen style during study. Enrollment was stopped after 33 participants due to this change. Authors acknowledge that this could affect generalizability of findings. No industry funding or conflicts of interest were reported |
Risk of bias includes: differential dropout from satisfaction surveys (25% response rate difference), change in medication pen during enrollment may confound results. No blinding described. Study was stopped early for logistical reasons after only 33 per group were enrolled. Unclear if allocation concealment or intention-to-treat analysis was applied |
|
Smith (2013) |
50 adult patients (mean age: ~50 years), recruited from outpatient clinics in Tennessee. Inclusion: aged ≥18, English-speaking, with at least one chronic illness (e.g., RA, Crohn’s disease), but no prior use of pen injectors. Randomized into two groups: 24 standard PIFU, 26 plain language PIFU. Literacy measured using REALM; 28% had marginal/limited health literacy. Funding: Abbott Laboratories. Conflict of interest: Lead author affiliated with Abbott. |
Intervention: “Plain language” Patient Instructions for Use (PIFU-PL), designed according to best practice health literacy principles: simplified language, graphics, step-wise layout, pilot-tested. Control: “Standard” FDA-approved PIFU used with the product. Participants reviewed either version and used a demo pen to simulate injection. Assessment covered preparation, pre-injection, and full self-injection steps. |
No extended follow-up. Outcome assessments conducted immediately after reviewing materials and performing simulated injection during the same visit. |
Correct steps described (outperformed mean ± SD): Preparation (PIFU-PL 4.5 ± 1.3 vs. Standard 3.1 ± 1.5, p=0.01), Pre-injection (2.4 ± 0.8 vs. 1.6 ± 0.6, p=0.01); Correct self-injection steps (13.1 ± 2.1 vs. 10.8 ± 4.4, p=0.05). All participants in the PIFU-PL group chose the short “quick guide” version. PIFU-PL participants consistently the standard group across all steps. Performance evaluated using a structured 15-item checklist by a trained research assistant. |
Pilot study with limited generalizability due to small sample size and convenience sampling. No blinding of assessors to group assignment. Strong health literacy-sensitive design and methods. Highlights importance of instructional format in patient comprehension and procedural accuracy. No adverse events or extended real-world use measured. Results support design of future patient education materials in line with low-literacy principles. |
Open-label design, no blinding of assessors, and small sample (n=50) limit generalizability. Study funded by manufacturer (Abbott), and lead author was affiliated, introducing potential bias. However, methodology was transparent and materials were pilot tested. Results align with broader evidence on health literacy. |
|
Zhitomirsky (2023) |
80 adult patients (40 per group) from three surgical wards at Hadassah Medical Center, Israel, hospitalized and scheduled for home self-injection of enoxaparin sodium. Inclusion: age ≥18, able to consent and complete questionnaires, no prior instruction on self-injection during current hospitalization. Exclusion: language barriers (Hebrew-only instrument), cognitive impairment, or isolation. Randomized cluster sampling. Study conducted June–July 2020. Funding: not reported. Conflicts of interest: none declared. |
Intervention: “Multimodal digital platform” delivered via tablet allowing patient-directed learning through written guide, audio, video, and interactive exercise. Control: standard nurse-led verbal instruction at discharge. Both groups completed pre- and post-tests on knowledge, self-efficacy, and satisfaction. Digital content was self-selected; 70% of users used 2+ modalities, most viewed the video (85%). |
Single in-hospital intervention. Assessments before and after instruction, same day. No extended follow-up or home-based use was evaluated. |
Knowledge acquisition: Digital group improved significantly more than control (mean increase 27% vs. 14%, p<0.01). Final scores: Digital group 85% vs. Control 75.25%, p<0.05. Self-efficacy: No significant difference between groups post-intervention (p=0.84), both groups showed similar modest increases (mean change: 0.13). Patient satisfaction: Control group scored higher (mean 4.70 vs. 4.41, p=0.01). 70% of intervention participants used 2+ learning modes. No interaction effects with age, sex, education, or prior experience. Digital education shown to be more effective for knowledge but less satisfying than in-person nurse teaching. |
Study supports digital education effectiveness for knowledge gain across all ages, including older adults. No superiority for self-efficacy. Patient satisfaction higher with nurse-led teaching, possibly due to social desirability or Hawthorne effects. Intervention was limited to a one-time hospital session; potential home benefits not explored. Hebrew-only design excluded non-Hebrew speakers. Implications: digital tools are effective complements but not substitutes for personal interaction. Encourages multimodal design and learner autonomy. |
Cluster-randomized, single-site design with no blinding. Limited to Hebrew speakers. Short-term assessment only; no real-world behavioral data or long-term outcomes. Validated instruments used. Social desirability bias likely influenced satisfaction ratings. |
*For further details, see risk of bias table in the appendix
Results
Safe administering of medicine at home
Cirillo (2020) reported improper hospital accesses for grade 1–2 toxicity: 12 patients (6.5%) in the intervention group vs. 10 patients (5.2%) in the control group (Relative Risk (RR) 1.292; 95% CI: 0.59–2.83; p = 0.52).
Kaplan (2016) reported correct performance of all IFU steps and full dose expulsion, at month 3: 96.7% success in trained group (one-sided 95% CI >80%), 88.3% in untrained group (95% CI >79.8%). At day 1: 90.0% (trained) vs. 76.7% (untrained). Difference at day 1 was statistically significant.
Smith (2013) reported the number of correct steps described (outperformed mean ± SD): Preparation (PIFU-PL 4.5 ± 1.3 vs. Standard 3.1 ± 1.5, p=0.01), Pre-injection (2.4 ± 0.8 vs. 1.6 ± 0.6, p=0.01); Correct self-injection steps (13.1 ± 2.1 vs. 10.8 ± 4.4, p=0.05).
Calamities/adverse events
Cirillo (2020) reported no statistically significant differences in most adverse events. Conjunctivitis and neurotoxicity were more reported in the intervention group but only as grade 1 events.
Kaplan (2016) reported no adverse events.
Satisfaction
Fischer-Cartlidge (2016) reported no significant difference in patient/caregiver satisfaction (p = 0.15) or self-confidence (p = 0.43) between groups. Nurse satisfaction higher in simulation group (p = 0.03). Postinjection satisfaction decreased in the intervention (including simulation learning) group (Z = –2.4, p = 0.01). All scores were based on Likert-type self-assessments (scale 1–5).
Katz (2014) compared standard teaching to teaching including videos, where satisfaction was high in both groups (mean 9.9 and 10 of 10).
Patel (2017) reported no difference in satisfaction between groups (web-based vs one-on-one instructions).
Zhitomirsky (2023) reported that the control group scored higher in satisfaction compared to the intervention group (mean 4.70 vs. 4.41, p=0.01).
A systematic review of the literature was performed to answer the following question(s): What instructions are best for safe administering of medication at home for patients eligible for home administering of medicine?
Table 1. PICO
| Patients | Patients eligible for home administering of medication |
| Intervention | Instruction X |
| Control | Instruction Y |
| Outcomes | Safe administering of medicine at home, calamities, adverse events, satisfaction |
| Other selection criteria | Study design: systematic reviews and randomized controlled trials, observational studies |
Relevant outcome measures
The guideline panel considered Safe administering of medicine at home, calamities, adverse events as a critical outcome measure for decision making.
A priori, the guideline panel did not define the outcome measures listed above but used the definitions used in the studies.
Search and select (Methods)
A systematic literature search was performed by a medical information specialist using the following bibliographic databases: Embase.com and Ovid/Medline all. Both databases were searched from 2005 to January 27, 2025 for systematic reviews, RCTs and observational studies. Systematic searches were completed using a combination of controlled vocabulary/subject headings (e.g., Emtree-terms, MeSH) wherever they were available and natural language keywords. The overall search strategy was derived from two primary search concepts: (1) home parenteral therapy; (2) instruction. Duplicates were removed using EndNote software. After deduplication a total of 450 records were imported for title/abstract screening. Initially, 160 studies were selected based on title and abstract screening. After reading the full text, 153 studies were excluded (see the exclusion table under the tab ‘Evidence tabellen’), and 7 studies were included.
- Cirillo M, Carlucci L, Legramandi L, Baldini E, Sacco C, Zagonel V, Leo S, Di Fabio F, Tonini G, Meacci ML, Tartarone A, Farci D, Tortora G, Zaninelli M, Valori VM, Cinieri S, Carrozza F, Barbato E, Fabbroni V, Cretella E, Gamucci T, Lunardi G, Zamboni S, Micallo G, Cascinu S, Pinto C, Gori S. Oral anticancer therapy project: Clinical utility of a specific home care nursing programme on behalf of Italian Association of Medical Oncology (AIOM). J Clin Nurs. 2020 Jan;29(1-2):119-129. doi: 10.1111/jocn.15064. Epub 2019 Oct 21. PMID: 31532035.
- Fischer-Cartlidge E, Romanoff S, Thom B, Burrows Walters C. Comparing Self-Injection Teaching Strategies for Patients With Breast Cancer and Their Caregivers: A Pilot Study. Clin J Oncol Nurs. 2016 Oct 1;20(5):515-21. doi: 10.1188/16.CJON.515-521. PMID: 27668371.
- Kaplan I, Ross D, Hilton F, Morgenstern D, Wolter K. The role of training in effective simulated self-injection of subcutaneous depot medroxyprogesterone acetate: observations from a usability study. Contraception. 2016 Oct;94(4):314-20. doi: 10.1016/j.contraception.2016.05.006. Epub 2016 May 27. PMID: 27241898.
- Katz SJ, Leung S. Teaching methotrexate self-injection with a web-based video maintains patient care while reducing healthcare resources: a pilot study. Rheumatol Int. 2015 Jan;35(1):93-6. doi: 10.1007/s00296-014-3076-1. Epub 2014 Jun 21. PMID: 24951881.
- Patel, A., Eskew, A., Marshburn, P., Hurst, B., Usadi, R., & Matthews, M. Effectiveness of Web-Based Video Teaching with Injectable Fertility Medications A Randomized Controlled Trial. JOURNAL OF REPRODUCTIVE MEDICINE, 62(9-10), 481-485Patel, Ankita, et al. "Effectiveness of Web-Based Video Teaching with Injectable Fertility Medications A Randomized Controlled Trial." JOURNAL OF REPRODUCTIVE MEDICINE 62.9-10 (2017): 481-485.
- Smith MY, Wallace LS. Reducing drug self-injection errors: a randomized trial comparing a "standard" versus "plain language" version of Patient Instructions for Use. Res Social Adm Pharm. 2013 Sep-Oct;9(5):621-5. doi: 10.1016/j.sapharm.2012.10.007. Epub 2013 Mar 16. PMID: 23506652.
- Zhitomirsky Y, Aharony N. The Effect of a Patient Education Multimodal Digital Platform on Knowledge Acquisition, Self-efficacy, and Patient Satisfaction. Comput Inform Nurs. 2023 May 1;41(5):356-364. doi: 10.1097/CIN.0000000000000939. PMID: 36071664.
Table of excluded studies
|
Reference |
Reason for exclusion |
|
Abbotts, C. and Salgado-Braga, C. and Audibert-Gros, C. A redesigned follitropin alfa pen injector for infertility: Results of a market research study. Patient Preference and Adherence. 2011; 5 :315-331 |
wrong comparison (not comparing instructions) |
|
Aberer, W. and Maurer, M. and Reshef, A. and Longhurst, H. and Kivity, S. and Bygum, A. and Caballero, T. and Bloom, B. and Nair, N. and Malbrán, A. Open-label, multicenter study of self-administered icatibant for attacks of hereditary angioedema. Allergy: European Journal of Allergy and Clinical Immunology. 2014; 69 (3) :305-314 |
wrong comparison (not comparing instructions) |
|
Agúndez Reigosa, B. and Cabrera López, I. M. and Sánchez Marcos, E. and Galán-Olleros, M. and Sánchez Olivier, M. and Calleja Gero, L. and Jiménez García, R. Hospital at Home Program for the Treatment of Pediatric Osteoarticular Infections. Hospital Pediatrics. 2024; 14 (2) :75-83 |
wrong comparison (not comparing instructions) |
|
Allenet, B. and Chen, C. and Romanet, T. and Vialtel, P. and Calop, J. Assessing a pharmacist-run anaemia educational programme for patients with chronic renal insufficiency. Pharmacy World and Science. 2007; 29 (1) :7-11 |
wrong study design |
|
Aw, J. and Griffiths, H. and Zochling, J. and Lanzafame, A. and Jordan, A. Usability of the certolizumab pegol auto-injection device in australian patients with chronic rheumatic diseases: Results from a market research study. Patient Preference and Adherence. 2021; 15 :1469-1476 |
wrong comparison (not comparing instructions) |
|
Barrière, P. and Avril, C. and Benmahmoud-Zoubir, A. and Bénard, N. and Dejager, S. Patient perceptions and understanding of treatment instructions for ovarian stimulation during infertility treatment. Reproductive Biomedicine and Society Online. 2019; 9 :37-47 |
wrong comparison (not comparing instructions) |
|
Beheshtipour, N. and Cohan, N. and Karimi, M. Home therapy and the effect of educational programmes in Iran; an alternative treatment option in developing countries. Haemophilia. 2009; 15 (4) :966-967 |
wrong publication type (letter to editor) |
|
Berrevoets MAH, Oerlemans AJM, Tromp M, Kullberg BJ, Ten Oever J, Schouten JA, Hulscher ME. Quality of outpatient parenteral antimicrobial therapy (OPAT) care from the patient's perspective: a qualitative study. BMJ Open. 2018 Nov 12;8(11):e024564. doi: 10.1136/bmjopen-2018-024564. PMID: 30420352; PMCID: PMC6252647. |
wrong comparison (not comparing instructions) |
|
Betegnie, A. L. and Gauchet, A. and Lehmann, A. and Grange, L. and Roustit, M. and Baudrant, M. and Bedouch, P. and Allenet, B. Why do patients with chronic inflammatory rheumatic diseases discontinue their biologics? An assessment of patients' adherence using a self-report questionnaire. Journal of Rheumatology. 2016; 43 (4) :724-730 |
wrong comparison (not comparing instructions) |
|
Bhavan KP, Brown LS, Haley RW. Self-Administered Outpatient Antimicrobial Infusion by Uninsured Patients Discharged from a Safety-Net Hospital: A Propensity-Score-Balanced Retrospective Cohort Study. PLoS Med. 2015 Dec 15;12(12):e1001922. doi: 10.1371/journal.pmed.1001922. PMID: 26671467; PMCID: PMC4686020. |
wrong comparison (not comparing instructions) |
|
Bhole, M. V. and Burton, J. and Chapel, H. M. Self-infusion Programmes for Immunoglobulin Replacement at Home: Feasibility, Safety and Efficacy. Immunology and Allergy Clinics of North America. 2008; 28 (4) :821-832 |
wrong comparison (not comparing instructions) |
|
Bodycot, J. and Mashonganyika, L. and Kucziw, N. and Ingham, C. and Bhukera, S. and White, H. A. Maximising the opportunity of a self-administration outpatient parenteral antimicrobial therapy pathway. British journal of nursing (Mark Allen Publishing). 2021; 30 (2) :S4-S10 |
wrong comparison (not comparing instructions) |
|
Burger-Stritt, S. and Eff, A. and Quinkler, M. and Kienitz, T. and Stamm, B. and Willenberg, H. S. and Meyer, G. and Klein, J. and Reisch, N. and Droste, M. and Hahner, S. Standardised patient education in adrenal insufficiency: a prospective multi-centre evaluation. European Journal of Endocrinology. 2020; 183 (2) :119-127 |
wrong study design |
|
Burke, H. M. and Chen, M. and Buluzi, M. and Fuchs, R. and Wevill, S. and Venkatasubramanian, L. and Dal Santo, L. and Ngwira, B. Women's satisfaction, use, storage and disposal of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) during a randomized trial. Contraception. 2018; 98 (5) :418-422 |
wrong comparison (not comparing instructions) |
|
Cani, C. G. and Lopes, Ld aS and Queiroz, M. and Nery, M. Improvement in medication adherence and self-management of diabetes with a clinical pharmacy program: a randomized controlled trial in patients with type 2 diabetes undergoing insulin therapy at a teaching hospital. Clinics (São Paulo, Brazil). 2015; 70 (2) :102-106 |
wrong comparison (not comparing instructions) |
|
Causse, Xavier and D'Alteroche, Louis and Si Ahmed, Si Nafa and Giraudeau, Bruno and Metman, Etienne-Henri Disposal of injection material used for the treatment of hepatitis C: comparison with insulin-dependent diabetes and thromboembolism. Gastroenterologie clinique et biologique. 2005; 29 (1) :63-8 |
wrong comparison (not comparing instructions) |
|
Celik, S. and Cosansu, G. and Erdogan, S. and Kahraman, A. and Isik, S. and Bayrak, G. and Bektas, B. and Olgun, N. Using mobile phone text messages to improve insulin injection technique and glycaemic control in patients with diabetes mellitus: a multi-centre study in Turkey. Journal of clinical nursing. 2015; 24 (11) :1525-1533 |
wrong study design |
|
Cheng, J. W. M. Current perspectives on the role of the pharmacist in heart failure management. Integrated Pharmacy Research and Practice. 2018; 7 :1-11 |
wrong comparison (not comparing instructions) |
|
Çintesun, F. N. İ and Çintesun, E. and Seçilmiş, Ö YouTube as a source of information on gonadotropin self-injections. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2021; 264 :135-140 |
wrong comparison (not comparing instructions) |
|
Collins SP, Storrow A, Liu D, Jenkins CA, Miller KF, Kampe C, Butler J. Examining Whether a Self-Care Program Reduces Healthcare Use and Improves Health among Patients with Acute Heart Failure—The Guided HF Study [Internet]. Washington (DC): Patient-Centered Outcomes Research Institute (PCORI); 2021 Apr. PMID: 38252772. |
wrong comparison (not comparing instructions) |
|
Colwell Jr, C. W. and Pulido, P. and Hardwick, M. E. and Morris, B. A. Patient compliance with outpatient prophylaxis: An observational study. Orthopedics. 2005; 28 (2) :143-147 |
wrong comparison (not comparing instructions) |
|
Corneliess, C. and Cover, J. and Secor, A. and Namagembe, A. and Walugembe, F. Adolescent and Youth Experiences With Contraceptive Self-Injection in Uganda: Results From the Uganda Self-Injection Best Practices Project. Journal of Adolescent Health. 2023; 72 (1) :80-87 |
wrong comparison (not comparing instructions) |
|
Cover, J. and Namagembe, A. and Tumusiime, J. and Lim, J. and Drake, J. K. and Mbonye, A. K. A prospective cohort study of the feasibility and acceptability of depot medroxyprogesterone acetate administered subcutaneously through self-injection. Contraception. 2017; 95 (3) :306-311 |
wrong comparison (not comparing instructions) |
|
Cover, J. and Namagembe, A. and Tumusiime, J. and Nsangi, D. and Lim, J. and Nakiganda-Busiku, D. Continuation of injectable contraception when self-injected vs. administered by a facility-based health worker: a nonrandomized, prospective cohort study in Uganda. Contraception. 2018; 98 (5) :383-388 |
wrong comparison (not comparing instructions) |
|
Coyne, M. and Rinaldi, A. and Brigham, K. and Hawthorne, J. and Katsaros, D. and Perich, M. and Carrara, N. and Pericaud, F. and Franzese, C. and Jones, G. Impact of Routines and Rituals on Burden of Treatment, Patient Training, Cognitive Load, and Anxiety in Self-Injected Biologic Therapy. Patient Preference and Adherence. 2022; 16 :2593-2607 |
wrong comparison (not comparing instructions) |
|
Dagen C, Craig TJ. Treatment of Hereditary Angioedema: items that need to be addressed in practice parameter. Allergy Asthma Clin Immunol. 2010 May 25;6(1):11. doi: 10.1186/1710-1492-6-11. PMID: 20497583; PMCID: PMC2887436. |
wrong comparison (not comparing instructions) |
|
Dashti, H. S. and Rhyner, J. J. and Mogensen, K. M. and Godbole, M. and Saxena, R. and Compher, C. and Winkler, M. F. Infusion timing and sleep habits of adults receiving home parenteral and enteral nutrition: A patient-oriented survey study. Journal of Parenteral and Enteral Nutrition. 2023; 47 (1) :130-139 |
wrong aim (about nutrition) |
|
Devonshire V, Arbizu T, Borre B, Lang M, Lugaresi A, Singer B, Verdun di Cantogno E, Cornelisse P. Patient-rated suitability of a novel electronic device for self-injection of subcutaneous interferon beta-1a in relapsing multiple sclerosis: an international, single-arm, multicentre, Phase IIIb study. BMC Neurol. 2010 Apr 30;10:28. doi: 10.1186/1471-2377-10-28. PMID: 20433746; PMCID: PMC2877661. |
wrong comparison (not comparing instructions) |
|
Dhadge N, Shevade M, Kale N, Narke G, Pathak D, Barne M, Madas S, Salvi S. Monitoring of inhaler use at home with a smartphone video application in a pilot study. NPJ Prim Care Respir Med. 2020 Oct 16;30(1):46. doi: 10.1038/s41533-020-00203-x. PMID: 33067469; PMCID: PMC7567806. |
wrong comparison (not comparing instructions) |
|
Dibb, M. and Teubner, A. and Theis, V. and Shaffer, J. and Lal, S. Review article: The management of long-term parenteral nutrition. Alimentary Pharmacology and Therapeutics. 2013; 37 (6) :587-603 |
wrong study aim (not about parenteral medication) |
|
Divya, A. and Vijayasamundeeswari, P. and Geetha, D. Effectiveness of planned teaching program on knowledge and practice regarding intravenous therapy among paediatric nurses. Journal of Clinical and Diagnostic Research. 2021; 15 (9) :LC13-LC16 |
wrong study design |
|
Diwakar, L. and Heslegrave, J. and Richter, A. G. and Huissoon, A. P. and Krishna, M. T. Self-injectable adrenaline devices: Is training necessary?. Journal of Investigational Allergology and Clinical Immunology. 2010; 20 (5) :452-453 |
wrong publication type (short article) |
|
Dreesen, M. and Foulon, V. and Vanhaecht, K. and De Pourcq, L. and Hiele, M. and Willems, L. Guidelines recommendations on care of adult patients receiving home parenteral nutrition: A systematic review of global practices. Clinical Nutrition. 2012; 31 (5) :602-608 |
wrong aim (about nutrition) |
|
Easaw, J. C. and McCall, S. and Azim, A. ClotAssist: A program to treat cancer-associated thrombosis in an outpatient pharmacy setting. Journal of Oncology Pharmacy Practice. 2019; 25 (4) :818-823 |
wrong comparison (not comparing instructions) |
|
Eaves, K. and Thornton, J. and Chapman, A. L. Patient retention of training in self-administration of intravenous antibiotic therapy in an outpatient parenteral antibiotic therapy service. Journal of clinical nursing. 2014; 23 (9) :1318-1322 |
wrong comparison (not comparing instructions) |
|
Ebhabha, V. and Morrissey, H. and Ball, P. Comparing Patient Preference Between At-home and In-hospital Settings: Systematic Review and Meta-Analysis on Injectable Medications. Archives of Pharmacy Practice. 2023; 14 (3) :98-111 |
wrong comparison (not comparing instructions) |
|
Emery, D. and Pearson, A. and Lopez, R. and Hamilton, C. and Albert, N. M. Voiceover Interactive PowerPoint Catheter Care Education for Home Parenteral Nutrition. Nutrition in Clinical Practice. 2015; 30 (5) :714-719 |
wrong study aim (not about parenteral medication) |
|
Fahim, Christine and Hylton, Danielle and Simunovic, Marko and Agzarian, John and Finley, Christian and Hanna, Wael C. and Shargall, Yaron Development of the IRIS-AR strategy: an intervention to improve rates of accrual and retention for the VTE-PRO randomized controlled trial. Trials. 2019; 20 (1) :447 |
wrong comparison (not comparing instructions) |
|
Feitosa, A. C. R. and Sampaio, L. N. and Batista, A. G. L. and Pinheiro, C. B. Frequency of fear of needles and impact of a multidisciplinary educational approach towards pregnant women with diabetes. Revista Brasileira de Ginecologia e Obstetricia. 2013; 35 (3) :111-116 |
wrong comparison (not comparing instructions) |
|
Figueiredo, M. G. and Gagliano-Jucá, T. and Basaria, S. Testosterone Therapy with Subcutaneous Injections: A Safe, Practical, and Reasonable Option. Journal of Clinical Endocrinology and Metabolism. 2022; 107 (3) :614-626 |
wrong comparison (not comparing instructions) |
|
Foy, K. and Bradley-Springer, L. and Kempner, T. and Stevens, L. and Gahagan, L. Enfuvirtide nursing guidelines: A report from the association of nurses in AIDS care expert panel on enfuvirtide. Journal of the Association of Nurses in AIDS Care. 2005; 16 (2) :2-12 |
wrong comparison (not comparing instructions) |
|
Fu, L. W. and Song, C. and Isaranuwatchai, W. and Betschel, S. Home-based subcutaneous immunoglobulin therapy vs hospital-based intravenous immunoglobulin therapy: A prospective economic analysis. Annals of Allergy, Asthma and Immunology. 2018; 120 (2) :195-199 |
dubbel |
|
Fu, L. W. and Song, C. and Isaranuwatchai, W. and Betschel, S. Home-based subcutaneous immunoglobulin therapy vs hospital-based intravenous immunoglobulin therapy: A prospective economic analysis. Annals of Allergy, Asthma and Immunology. 2018; 120 (2) :195-199 |
wrong comparison (not comparing instructions) |
|
Garrick, V. and Atwal, P. and Barclay, A. R. and McGrogan, P. and Russell, R. K. Successful implementation of a nurse-led teaching programme to independently administer subcutaneous methotrexate in the community setting to children with Crohn's disease. Alimentary pharmacology & therapeutics. 2009; 29 (1) :90-6 |
wrong comparison (not comparing instructions) |
|
Gomez R, Ahmed SF, Maghnie M, Li D, Tanaka T, Miller BS. Treatment Adherence to Injectable Treatments in Pediatric Growth Hormone Deficiency Compared With Injectable Treatments in Other Chronic Pediatric Conditions: A Systematic Literature Review. Front Endocrinol (Lausanne). 2022 Mar 1;13:795224. doi: 10.3389/fendo.2022.795224. PMID: 35299969; PMCID: PMC8921265. |
wrong comparison (not comparing instructions) |
|
Gregory, C. and Landmesser, L. M. and Corrigan, L. and Mariano, D. Feasibility of home infusion and self-administration of nanofiltered C1 esterase inhibitor for routine prophylaxis in patients with hereditary angioedema and characterization of a training and support program. Journal of Infusion Nursing. 2014; 37 (1) :29-34 |
wrong comparison (not comparing instructions) |
|
Gregory, C. and Landmesser, L. M. and Corrigan, L. and Mariano, D. Feasibility of home infusion and self-administration of nanofiltered C1 esterase inhibitor for routine prophylaxis in patients with hereditary angioedema and characterization of a training and support program. Journal of Infusion Nursing. 2014; 37 (1) :29-34 |
dubbel |
|
Gun, C. and Aldinc, H. and Ugur, E. M. and Cadircibasi, E. R. and Yaylaci, S. Should Emergency Physicians and Nurses Direct Their Patients to YouTube for Heparin Self-Injection Training? A Systematic Review of Social Media Videos. Journal of emergency nursing. 2022; 48 (4) :376-389 |
wrong comparison (not comparing instructions) |
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Gupta, Swar and Ramteke, Harshal and Gupta, Shlok and Gupta, Sunil and Gupta, Kavita S. Are People With Type 1 Diabetes Mellitus Appropriately Following Insulin Injection Technique Practices: A Review of Literature. Cureus. 2024; 16 (1) :e51494 |
wrong comparison (not comparing instructions) |
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Hassan, N. M. and Shalaby, S. E. S. and Atalla, A. O. and Younis, E. A. Toward safe environment: injection device disposal among diabetic patients attending tertiary care academic clinic in Middle Delta, Egypt. Environmental science and pollution research international. 2021; 28 (18) :23193-23203 |
wrong comparison (not comparing instructions) |
|
Hawthorne, J. and Katsaros, D. and Rinaldi, A. and Brigham, K. and D’Auria, M. and Bajars, E. and Franzese, C. and Coyne, M. The current paradigm for biologic initiation: a confirmatory quantitative analysis of self-injection training practices. Expert Opinion on Drug Delivery. 2022; 19 (6) :733-742 |
wrong comparison (not comparing instructions) |
|
Hobbs JG, Ryan MK, Ritchie B, Sluggett JK, Sluggett AJ, Ralton L, Reynolds KJ. Protocol for a randomised crossover trial to evaluate patient and nurse satisfaction with electronic and elastomeric portable infusion pumps for the continuous administration of antibiotic therapy in the home: the Comparing Home Infusion Devices (CHID) study. BMJ Open. 2017 Jul 31;7(7):e016763. doi: 10.1136/bmjopen-2017-016763. PMID: 28760798; PMCID: PMC5642663. |
wrong publication type (protocol) |
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Hobbs JG, Ryan MK, Ritchie B, Sluggett JK, Sluggett AJ, Ralton L, Reynolds KJ. Protocol for a randomised crossover trial to evaluate patient and nurse satisfaction with electronic and elastomeric portable infusion pumps for the continuous administration o |
dubbel |
|
Homer, Dawn Using video-based training for button-free auto-injection of subcutaneous methotrexate: A pilot study. Musculoskeletal care. 2019; 17 (3) :247-279 |
wrong publication type (short report) |
|
Honjo S, Koshii Y, Tozaka S, Tateno H, Keidai Y, Seno Y, Iwasaki Y, Iwasaki K, Ayano S, Hamasaki A. Exploratory study on glycemic control improvement for patients with diabetes mellitus by appropriate re-education on insulin self-injection technique during COVID-19 pandemic. Diabetes Res Clin Pract. 2023 Jan;195:110192. doi: 10.1016/j.diabres.2022.110192. Epub 2022 Nov 28. PMID: 36544290; PMCID: PMC9701578. |
wrong comparison (not comparing instructions) |
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Huang I, Delay R, Boulware A, McHugh A, Wong ZJ, Whitaker AK, Stulberg D, Hasselbacher L. Telehealth for contraceptive care: Lessons from staff and clinicians for improving implementation and sustainability in Illinois. Contracept X. 2022 Aug 14;4:100083. doi: 10.1016/j.conx.2022.100083. PMID: 36060498; PMCID: PMC9436702. |
wrong study aim (not about parenteral medication) |
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Huang, M. C. and Hung, C. H. and Yu, C. Y. and Lin, K. C. Multimedia Health Education on Insulin Injection Skills for Patients With Type 2 Diabetes. Hu li za zhi The journal of nursing. 2022; 69 (2) :44-54 |
wrong comparison (comparison of insulin pens, not instruction) |
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Hustad NB, Degerud HM, Hjelmerud I, Fraz MSA, Nordøy I, Trøseid M, Fevang B, Aukrust P, Jørgensen SF. Real-World Experiences With Facilitated Subcutaneous Immunoglobulin Substitution in Patients With Hypogammaglobulinemia, Using a Three-Step Ramp-Up Schedule. Front Immunol. 2021 Apr 27;12:670547. doi: 10.3389/fimmu.2021.670547. PMID: 34012453; PMCID: PMC8127781. |
wrong comparison (not comparing instructions) |
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Ibaraki M, Gruss Z, Wings E, Geronimo JE, Varnes JM, Kammeyer JA. Impact of a nurse practitioner-led dedicated outpatient parenteral antibiotic therapy clinic on patient outcomes and administrative workload: a retrospective cohort study. Ther Adv Infect Dis. 2024 Dec 23;11:20499361241305308. doi: 10.1177/20499361241305308. PMID: 39717489; PMCID: PMC11664517. |
wrong comparison (not comparing instructions) |
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Illingworth, P. J. and Lahoud, R. and Quinn, F. and Chidwick, K. and Wilkinson, C. and Sacks, G. Single-arm, observational study of the ease of use of a redesigned pen device to deliver recombinant human follicle-stimulating hormone (follitropin alfa) for assisted reproductive technology treatment. Patient Preference and Adherence. 2014; 8 :813-826 |
wrong comparison (not comparing instructions) |
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Ishikawa, T. and Sekiguchi, R. and Shimizu, T. and Fukata, Y. and Kanaya, R. and Katsuma, K. Role of a Home-visit Nursing Agency in Supporting Patients with Heart Failure on Continuous Catecholamine Infusion: A Case Series Study. Kobe Journal of Medical Sciences. 2024; 70 (3) :E93-E99 |
wrong comparison (not comparing instructions) |
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Jalloh MB, Osoro I, Januzzi JL, Shaunik A, Bahit MC, Korjian S, Gibson CM, Van Spall HGC. Barriers and facilitators to implementation of intravenous cardiovascular treatments in ambulatory settings. ESC Heart Fail. 2025 Feb;12(1):695-700. doi: 10.1002/ehf2.15076. Epub 2024 Sep 25. PMID: 39323227; PMCID: PMC11769616. |
wrong comparison (not comparing instructions) |
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Jathanakodi, S. and Both, C. and Brueckmann, I. and Rose, L. and Nasseri, N. and Raynauld, J. P. and Narula, N. Patient Experience with the SensoReady® Autoinjector Pen versus a Comparator Device: Results from a Canadian Patient Survey in Rheumatoid Arthritis and Crohn´s Disease. Patient Preference and Adherence. 2024; 18 :1107-1118 |
wrong comparison (comparison of insulin pens, not instruction) |
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Jonaitis L, Marković S, Farkas K, Gheorghe L, Krznarić Ž, Salupere R, Mokricka V, Spassova Z, Gatev D, Grosu I, Lijović A, Mitrović O, Saje M, Schafer E, Uršič V, Roblek T, Drobne D. Intravenous versus subcutaneous delivery of biotherapeutics in IBD: an expert's and patient's perspective. BMC Proc. 2021 Dec 9;15(Suppl 17):25. doi: 10.1186/s12919-021-00230-7. PMID: 34879868; PMCID: PMC8654488. |
wrong comparison (not comparing instructions) |
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Kamrul-Hasan, A. B. M. and Paul, A. K. and Amin, M. N. and Abu Jar Gaffar, Md and Asaduzzaman, Md and Saifuddin, M. and Mustari, M. and Jahangir Alam, Md and Shahid, M. M. and Nahid-Ul-Haque, K. M. and Alam, M. S. and Motiur Rahman, Md and Talukder, S. K. and Abdul Kader, Md and Akter, F. and Hannan, M. A. and Chanda, P. K. and Bakar, M. A. and Selim, S. Insulin injection practice and injection complications - Results from the Bangladesh insulin injection technique survey. European Endocrinology. 2020; 16 (1) :41-48 |
wrong comparison (not comparing instructions) |
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Keininger D, Coteur G. Assessment of self-injection experience in patients with rheumatoid arthritis: psychometric validation of the Self-Injection Assessment Questionnaire (SIAQ). Health Qual Life Outcomes. 2011 Jan 13;9:2. doi: 10.1186/1477-7525-9-2. PMID: 21232106; PMCID: PMC3027089. |
wrong comparison (not comparing instructions) |
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Keshvani, N. and Hon, M. and Gupta, A. and Brown, T. J. and Roy, L. and Marley, E. and Lindsey, S. and Johnson, D. H. and Sadeghi, N. and Li, H. C. Reducing hospitalizations: Institution of outpatient infusional EPOCH-based chemotherapy at a safety net hospital. Journal of Oncology Practice. 2019; 15 (8) :E644-E651 |
wrong comparison (not comparing instructions) |
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Khasal, Q. A., Nasir, A. M., & Jabbar, D. K. Determination of patient’s knowledge with diabetes type 2 for self-management regarding control blood glucose level. |
wrong comparison (not comparing instructions) |
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Kim, C. R. and Fønhus, M. S. and Ganatra, B. Self-administration of injectable contraceptives: a systematic review. BJOG: An International Journal of Obstetrics and Gynaecology. 2017; 124 (2) :200-208 |
wrong comparison (not comparing instructions) |
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Kirmse, J. Subcutaneous administration of immunoglobulin. Journal of Infusion Nursing. 2006; 29 (3) :S15-S20 |
wrong comparison (not comparing instructions) |
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Kivitz, A. and Ellis, A. M. and Shende, V. and Lambert, J. and Tatla, D. Safe and Effective Subcutaneous Self-Injection of Bimekizumab with Safety Syringe and Auto-Injector Devices: Results from a Multicenter, Randomized, Open-Label Study in Patients with Psoriatic Arthritis. Patient Preference and Adherence. 2023; 17 :2451-2461 |
wrong comparison (not comparing instructions) |
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Konrad, D. and Corrigan, M. L. and Hamilton, C. and Steiger, E. and Kirby, D. F. Identification and early treatment of dehydration in home parenteral nutrition and home intravenous fluid patients prevents hospital admissions. Nutrition in Clinical Practice. 2012; 27 (6) :802-807 |
wrong comparison (not comparing instructions) |
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Korytkowski, Mary and Niskanen, Leo and Asakura, Toshinari FlexPen: addressing issues of confidence and convenience in insulin delivery. Clinical therapeutics. 2005; 27 :S89-100 |
wrong comparison (comparison of insulin pens, not instruction) |
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Kosior, Dariusz A. and Marchel, Michal and Torbicki, Adam and Opolski, Grzegorz [Feasibility of home self-administration of low molecular weight heparin by patients with atrial fibrillation recurrence. A new approach to thromboembolic prophyllaxis]. Ocena skutecznosci przyjmowania preparatow heparyn drobnoczasteczkowych w warunkach domowych przez pacjentow z napadowym migotaniem przedsionkow--propozycja nowej strategii profilaktyki przeciwzakrzepowej.. 2005; 114 (6) :1204-11 |
wrong language (article in Polish) |
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LaRue, Susan and Springer, Jane and Noderer, Michael and Meehan, James and Wysham, Carol H. Evaluation of the Use of Exenatide Once-Weekly Suspension Autoinjector Among Patients With Type 2 Diabetes Mellitus and Health Care Professionals. Journal of diabetes science and technology. 2019; 13 (2) :226-234 |
wrong comparison (not comparing instructions) |
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Lebray, P., Delignat, S., Frelicot, A., Carrette, M., Gautier, A., Jamet, N., ... & Liou, A. (2022). Hepatitis B or Delta liver transplant patients at risk of recurrence: Long-term effectiveness and budget impact of low-dose subcutaneous anti-hepatitis B immunoglobulin plus patient education program. Journal of Liver Transplantation, 7, 100088. |
wrong comparison (not comparing instructions) |
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Lenz, F. and Harms, L. The Impact of Patient Support Programs on Adherence to Disease-Modifying Therapies of Patients with Relapsing-Remitting Multiple Sclerosis in Germany: A Non-Interventional, Prospective Study. Advances in Therapy. 2020; 37 (6) :2999-3009 |
wrong comparison (not comparing instructions) |
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Levi, M. and Choi, G. and Picavet, C. and Hack, C. E. Self-administration of C1-inhibitor concentrate in patients with hereditary or acquired angioedema caused by C1-inhibitor deficiency. Journal of Allergy and Clinical Immunology. 2006; 117 (4) :904-908 |
wrong comparison (not comparing instructions) |
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Levine, D. M. and Paz, M. and Burke, K. and Beaumont, R. and Boxer, R. B. and Morris, C. A. and Britton, K. A. and Orav, E. J. and Schnipper, J. L. Remote vs In-home Physician Visits for Hospital-Level Care at Home: A Randomized Clinical Trial. JAMA Network Open. 2022; :E2229067 |
wrong comparison (not comparing instructions) |
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Llahana S, Mulligan K, Hirani SP, Wilson S, Baldeweg SE, Grossman A, Norton C, Sharman P, McBride P, Newman S. Using the behaviour change wheel and person-based approach to develop a digital self-management intervention for patients with adrenal insufficiency: the Support AI study protocol. Front Endocrinol (Lausanne). 2023 Jun 30;14:1207715. doi: 10.3389/fendo.2023.1207715. PMID: 37455898; PMCID: PMC10349524. |
wrong publication type (study protocol) |
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Lugaresi, A. Addressing the need for increased adherence to multiple sclerosis therapy: Can delivery technology enhance patient motivation?. Expert Opinion on Drug Delivery. 2009; 6 (9) :995-1002 |
wrong comparison (not comparing instructions) |
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Mansour, O. and Heslin, J. and Townsend, J. L. Impact of the implementation of a nurse-managed outpatient parenteral antibiotic therapy (OPAT) system in Baltimore: A case study demonstrating cost savings and reduction in re-admission rates. Journal of Antimicrobial Chemotherapy. 2018; 73 (11) :3181-3188 |
wrong comparison (not comparing instructions) |
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Marx, M. Evidence-Based Guidance for Self-Administration of Injectable Contraception. Journal of Midwifery and Women's Health. 2021; 66 (1) :108-112 |
wrong comparison (not comparing instructions) |
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Mercer, R. D. and Jones, C. J. and Smith, H. E. Reviewing the Content and Design of Anaphylaxis Management Plans Published in English. Journal of Allergy and Clinical Immunology: In Practice. 2017; 5 (5) :1288-1294.e4 |
wrong comparison (not comparing instructions) |
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Mills R, Comerford O, Krong R, Baraitser P. Digital support for first time self-injectable contraceptive users in Nairobi, Kenya: A design evaluation. Soc Sci Med. 2023 Nov;336:116285. doi: 10.1016/j.socscimed.2023.116285. Epub 2023 Sep 28. PMID: 37804581. |
wrong comparison (not comparing instructions) |
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Mohr, D. C. and Cox, D. and Merluzzi, N. Self-infection anxiety training: A treatment for patients unable to self-inject injectable medications. Multiple Sclerosis. 2005; 11 (2) :182-185 |
wrong population (only people with anxiety) |
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Moinot, N. and Anne, O. and Devoize, J. L. and Artaut-Uriot, M. S. and Aubert-Cetou, I. and Boissonnot, L. and Debras, C. and Lebras, F. and Loll, P. Y. and Godeneche, G. and Mesnage, V. and Neau, J. P. Multiple sclerosis: Immunomodulators, education, and self-injection. Revue Neurologique. 2007; 163 (12) :1209-1213 |
wrong language (article in french) |
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Morozoff, Chloe and Cover, Jane and Namagembe, Allen and Nsangi, Damalie and Komunyena Tumusiime, Justine and Stout, Auroras and Kidwell Drake, Jennifer Contraceptive self-injection through routine service delivery: Health worker perspectives from Uganda. Frontiers in global women's health. 2022; 3 :890017 |
wrong comparison (not comparing instructions) |
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Murphy E, Donahue C, Omert L, Persons S, Tyma TJ, Chiao J, Lumry W. Training patients for self-administration of a new subcutaneous C1-inhibitor concentrate for hereditary angioedema. Nurs Open. 2018 Aug 28;6(1):126-135. doi: 10.1002/nop2.194. PMID: 30534402; PMCID: PMC6279717. |
wrong comparison (not comparing instructions) |
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Murphy, E. and Vanname, C. and McNeill, R. and Bullock, M. and Barrett, L. and Kafal, A. Infusion parameters and demographics of patients with chronic inflammatory demyelinating polyneuropathy during subcutaneous immunoglobulin self-administration training. Journal of Infusion Nursing. 2021; 44 (5) :289-297 |
wrong comparison (not comparing instructions) |
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Mvundura M, Di Giorgio L, Morozoff C, Cover J, Ndour M, Drake JK. Cost-effectiveness of self-injected DMPA-SC compared with health-worker-injected DMPA-IM in Senegal. Contracept X. 2019;1:100012. doi: 10.1016/j.conx.2019.100012. PMID: 32494776; PMCID: PMC7252428. |
wrong comparison (not comparing instructions) |
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Nakatani, Y. and Matsumura, M. and Monden, T. and Aso, Y. and Nakamoto, T. Improvement of glycemic control by Re-education in insulin injection technique in patients with diabetes mellitus. Advances in Therapy. 2013; 30 (10) :897-906 |
wrong comparison (not comparing instructions) |
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Navarro Parado, Silvia and Gonzalez-Jimenez, Emilio and Yus Lopez, Leticia and Tovar Galvez, Maria Isabel and Montero-Alonso, Miguel Angel [Analysis of knowledge, habits and skills in a diabetic population childhood: nursing intervention]. Analisis de conocimientos, habitos y destrezas en una poblacion diabetica infantil: intervencion de enfermeria.. 2014; 30 (3) :585-93 |
wrong comparison (not comparing instructions) |
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Noghabi, A. A. A. and Zandi, M. and Mehran, A. and Alavian, S. M. and Dehkordi, A. H. The Effect of Education on Quality of Life in Patients under Interferon Therapy. Hepatitis Monthly. 2010; 10 (3) :218-222 |
wrong comparison (not comparing instructions) |
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Onishi, A. and Kaizu, M. and Shirasugi, I. and Yagyu, T. and Ueda, Y. and Sakai, Y. and Miura, Y. and Saegusa, J. Demographic, Physical, and Psychological Determinants of Patient Experience with Subcutaneous Self-Injection in Patients with Rheumatoid Arthritis: Structural Equation Modeling Approach. Patient Preference and Adherence. 2023; 17 :1551-1559 |
wrong comparison (not comparing instructions) |
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Ott, M. J. "I want to do it myself!" Interferon self-injection for children with chronic viral hepatitis. Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates. 2005; 28 (5) :406-409 |
wrong comparison (not comparing instructions) |
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Oyesiku, J. O. O. Home treatment of haemophilia patients with inhibitors. Haemophilia. 2011; 17 (2) :173-178 |
wrong comparison (not comparing instructions) |
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Paassen, P. V. and Pittrow, D. and Scheidegger, C. and Klotsche, J. and Ellerbroek, P. M. Use of recombinant human hyaluronidase-facilitated subcutaneous immunoglobulin in elderly patients. Immunotherapy. 2020; 12 (2) :131-139 |
wrong comparison (not comparing instructions) |
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Peng, Bing and Zhang, Yanlin and Cheng, Liqing and Zhang, Yuping and Lei, Xiaotian and Leng, Weiling and Wang, Jing and Wu, Songwei and Wu, Xiaoqun and Zheng, Yanling Improving insulin self-injection accuracy in patients with diabetes mellitus through a nursing project. Advances in clinical and experimental medicine : official organ Wroclaw Medical University. 2024; 33 (6) :563-572 |
wrong outcome |
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Perraudin, C. and Bourdin, A. and Spertini, F. and Berger, J. and Bugnon, O. Switching Patients to Home-Based Subcutaneous Immunoglobulin: an Economic Evaluation of an Interprofessional Drug Therapy Management Program. Journal of Clinical Immunology. 2016; 36 (5) :502-510 |
wrong comparison (not comparing instructions) |
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Petroulias, Patricia L. Use of Electronic Tablets for Patient Education on Flushing Peripherally Inserted Central Catheters. Journal of infusion nursing : the official publication of the Infusion Nurses Society. 2017; 40 (5) :298-304 |
wrong comparison (not comparing instructions) |
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Polkki, Mari and Prami, Tuire Cross-sectional patient survey of biological medicine users in Finland to investigate the types of guidance needed by patients in order to carry out their treatment successfully. BMJ open. 2025; 15 (1) :e090136 |
wrong comparison (not comparing instructions) |
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Pouls, B. P. H. and Kristensen, L. E. and Petersson, M. and van den Bemt, B. J. F. and Ballerini, L. and Bruggraber, R. and Karlen, H. and Mountian, I. and van Bracht, E. and Wiegratz, S. and Jørgensen, T. S. A pilot study examining patient preference and satisfaction for ava®, a reusable electronic injection device to administer certolizumab pegol. Expert Opinion on Drug Delivery. 2020; 17 (5) :705-711 |
wrong comparison (not comparing instructions) |
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Prabhakaran, S. Self-administration of injectable contraceptives. Contraception. 2008; 77 (5) :315-317 |
wrong comparison (not comparing instructions) |
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Prabhakaran, Sujatha and Sweet, Ashley Self-administration of subcutaneous depot medroxyprogesterone acetate for contraception: feasibility and acceptability. Contraception. 2012; 85 (5) :453-7 |
wrong comparison (not comparing instructions) |
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Prosser, Barbara and Walton, Timothy P. and Miller, Christine Reduction of Infusion Time Using a 10% Intravenous Immunoglobulin Formulation With a 15-Minute Rate Escalation Protocol During Staffing Shortages Due to COVID-19. Journal of infusion nursing : the official publication of the Infusion Nurses Society. 2022; 45 (6) :299-305 |
wrong comparison (not comparing instructions) |
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Puzovic, M. and Morrissey, H. and Ball, P. A. Parenteral Therapy in Domiciliary and Outpatient Setting: A Critical Review of the Literature. Archives of Pharmacy Practice. 2023; 14 (2) :1-12 |
wrong comparison (not comparing instructions) |
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Raphael, Bram P. and Jorina, Maria and Gallotto, Mary and Grullon, Glendalis and Dalton, Meghan and Takvorian-Bene, Melissa and Tascione, Christina and Rosa, Carolyn and McClelland, Jennifer and Gray, Megan and Potemkin, Alexis K. and Glavin, Courtney and Gura, Kathleen M. and Murphy, Margaret K. and Leger, Kierrah and Mahoney, Judith and Kerr, Jessica and Ozonoff, Al and Duggan, Christopher P. Innovative Discharge Process for Families with Pediatric Short Bowel Syndrome: A Prospective Nonrandomized Trial. JPEN. Journal of parenteral and enteral nutrition. 2018; 42 (8) :1295-1303 |
wrong study aim (not about parenteral medication) |
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Rasutis, Vilija M. and Katzberg, Hans D. and Bril, Vera High-Dose Subcutaneous Immunoglobulin in Patients With Multifocal Motor Neuropathy: A Nursing Perspective. Journal of infusion nursing : the official publication of the Infusion Nurses Society. 2017; 40 (5) :305-312 |
wrong comparison (not comparing instructions) |
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Reger, M. A. and Chapman, J. L. and Lutomski, D. M. and Mueller, E. W. Outcomes of a comprehensive, pharmacist-managed injectable anticoagulation discharge program for the prophylaxis and treatment of venous thromboembolism. Journal of Pharmacy Technology. 2011; 27 (5) :199-205 |
wrong comparison (not comparing instructions) |
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Rinaldi, A. and Katsaros, D. and Hawthorne, J. and D’Auria, M. and Brigham, K. and Bajars, E. and Franzese, C. and Coyne, M. The current paradigm for biologic initiation: a mixed-methods exploration of practices, unmet needs, and innovation opportunities in self-injection training. Expert Opinion on Drug Delivery. 2021; 18 (8) :1151-1168 |
wrong comparison (not comparing instructions) |
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Rohrer, T. R. and Horikawa, R. and Kappelgaard, A. M. Growth hormone delivery devices: current features and potential for enhanced treatment adherence. Expert Opinion on Drug Delivery. 2017; 14 (11) :1253-1264 |
wrong comparison (not comparing instructions) |
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Rolland L, Mainguy A, Boissier S, Ki Zerbo M, Tardivel A, Sébillotte M, Cailleaux M, Patrat-Delon S, Revest M, Tattevin P. A pilot project of expert nurses for the follow-up of complex intravenous antimicrobial treatment. Infect Dis Now. 2023 Apr;53(3):104670. doi: 10.1016/j.idnow.2023.104670. Epub 2023 Feb 2. PMID: 36736828. |
wrong comparison (not comparing instructions) |
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Roug, L. I. and Topperzer, M. K. and Michelsen, R. T. and Jarden, M. and Wahlberg, A. and Hjalgrim, L. L. and Hansson, H. Development of an intravenous chemotherapy intervention for children and adolescents with cancer administered by their parents at home (INTACTatHome). BMC health services research. 2023; 23 (1) :664 |
wrong outcome (development of tool) |
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Ruan, X. and Ma, L. and Couch, J. P. and Chen, T. and Bumgarner, G. W. Intractable pruritus during outpatient epidural hydromorphone infusion: A case report and a focused review of the literature. Journal of Opioid Management. 2015; 11 (2) :184-190 |
wrong publication type (case report) |
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Sadler, E. D. and Avdic, E. and Cosgrove, S. E. and Hohl, D. and Grimes, M. and Swarthout, M. and Dzintars, K. and Lippincott, C. K. and Keller, S. C. Failure modes and effects analysis to improve transitions of care in patients discharged on outpatient parenteral antimicrobial therapy. American Journal of Health-System Pharmacy. 2021; 78 (13) :1223-1232 |
wrong comparison (not comparing instructions) |
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Santaella, M. E. and Bloomberg, M. and Anglade, D. Home infusion teaching practices at federally funded hemophilia treatment centers in the United States of America. Research and Practice in Thrombosis and Haemostasis. 2017; 1 (1) :81-89 |
wrong comparison (not comparing instructions) |
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Sauvanet, J. P. and Halimi, S. Insulin injection technique: How diabetic patients proceed in France?. Medecine des Maladies Metaboliques. 2017; 11 (5) :406-415 |
wrong language (article in french) |
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Savoie, M. L. and Nevil, T. J. and Song, K. W. and Forrest, D. L. and Hogge, D. E. and Nantel, S. H. and Shepherd, J. D. and Smith, C. A. and Sutherland, H. J. and Toze, C. L. and Lavoie, J. C. Shifting to outpatient management of acute myeloid leukemia: A prospective experience. Annals of Oncology. 2006; 17 (5) :763-768 |
wrong comparison (not comparing instructions) |
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Schipperus, M. and Kaiafa, G. and Taylor, L. and Wetten, S. and Kreuzbauer, G. and Boshier, A. and Seesaghur, A. Assessment of Self-Administration of Romiplostim in Patients with Immune Thrombocytopenic Purpura after Receipt of Home Administration Training Materials: a Cross-Sectional Study. Drug Safety. 2019; 42 (1) :77-83 |
wrong comparison (not comparing instructions) |
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Schmidt M, Hearn B, Gabriel M, Spencer MD, McCurdy L. Predictors of Unplanned Hospitalization in Patients Receiving Outpatient Parenteral Antimicrobial Therapy Across a Large Integrated Healthcare Network. Open Forum Infect Dis. 2017 Jun 16;4(2):ofx086. doi: 10.1093/ofid/ofx086. PMID: 28638844; PMCID: PMC5473366. |
wrong comparison (not comparing instructions) |
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Schrijvers, L. H. and Beijlevelt-van der Zande, M. and Peters, M. and Schuurmans, M. J. and Fischer, K. Learning intravenous infusion in haemophilia: experience from the Netherlands. Haemophilia : the official journal of the World Federation of Hemophilia. 2012; 18 (4) :516-20 |
wrong comparison (not comparing instructions) |
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Scurati, Silvia and Frati, Franco and Passalacqua, Gianni and Puccinelli, Paola and Hilaire, Cecile and Incorvaia, Cristoforo Adherence issues related to sublingual immunotherapy as perceived by allergists. Patient preference and adherence. 2010; 4 :141-5 |
wrong comparison (not comparing instructions) |
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Sebuhyan, M. and Crichi, B. and Deville, L. and Le Maignan, C. and Bonnet, C. and Marjanovic, Z. and Rueda, J. and Bensaoula, O. and Ndour, A. and Frere, C. and Madeleine, I. and Farge, D. Patient education program at the forefront of cancer-associated thrombosis care. JMV-Journal de Medecine Vasculaire. 2021; 46 (5) :215-223 |
wrong study design |
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Sesmero, J. M. M. Holistic management of home artificial nutrition: Humanization and innovation at patient's service. Anales de la Real Academia Nacional de Farmacia. 2020; 86 (4) :257-268 |
wrong language (article in Spanish) |
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Shaker, M. S. and Wallace, D. V. and Golden, D. B. K. and Oppenheimer, J. and Bernstein, J. A. and Campbell, R. L. and Dinakar, C. and Ellis, A. and Greenhawt, M. and Khan, D. A. and Lang, D. M. and Lang, E. S. and Lieberman, J. A. and Portnoy, J. and Rank, M. A. and Stukus, D. R. and Wang, J. and Riblet, N. and Bobrownicki, A. M. P. and Bontrager, T. and Dusin, J. and Foley, J. and Frederick, B. and Fregene, E. and Hellerstedt, S. and Hassan, F. and Hess, K. and Horner, C. and Huntington, K. and Kasireddy, P. and Keeler, D. and Kim, B. and Lieberman, P. and Lindhorst, E. and McEnany, F. and Milbank, J. and Murphy, H. and Pando, O. and Patel, A. K. and Ratliff, N. and Rhodes, R. and Robertson, K. and Scott, H. and Snell, A. and Sullivan, R. and Trivedi, V. and Wickham, A. Anaphylaxis—a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. Journal of Allergy and Clinical Immunology. 2020; 145 (4) :1082-1123 |
wrong publication type (guideline for anaphylaxis) |
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Shang, J. and Ma, C. and Poghosyan, L. and Dowding, D. and Stone, P. The prevalence of infections and patient risk factors in home health care: A systematic review. American Journal of Infection Control. 2014; 42 (5) :479-484 |
wrong comparison (not comparing instructions) |
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Silverman, Lewis R. and Greenberg, Peter and Raza, Azra and Olnes, Matthew J. and Holland, James F. and Reddy, Premkumar and Maniar, Manoj and Wilhelm, Francois Clinical activity and safety of the dual pathway inhibitor rigosertib for higher risk myelodysplastic syndromes following Dmethyltransferase inhibitor therapy. Hematological oncology. 2015; 33 (2) :57-66 |
wrong comparison (not comparing instructions) |
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Simerlein, Whitney M. and Beeker, Kristin E. and Cruse, David B. and Brittain, Kristy L. Assistance with injectable medications: Implementation of a pharmacist-run specialty pharmacy injection clinic. Journal of the American Pharmacists Association : JAPhA. 2020; 60 (3) :S76-S79 |
wrong comparison (not comparing instructions) |
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Stanwood, N. L. and Eastwood, K. and Carletta, A. Self-injection of monthly combined hormonal contraceptive. Contraception. 2006; 73 (1) :53-55 |
wrong comparison (not comparing instructions) |
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Stenger, F. and König, A. and Ochsendorf, F. and Kaufmann, R. and Pinter, A. Correct performance of subcutaneous injections in plaque psoriasis: comparison of trained and untrained patients with different application systems in routine clinical care. Journal of Dermatological Treatment. 2021; 32 (8) :898-906 |
wrong comparison (not comparing instructions) |
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Stevenson, J. G. and McCabe, D. and McGrath, M. and McBride, A. Pharmacist biosimilar survey reveals knowledge gaps. Journal of the American Pharmacists Association. 2023; 63 (2) :529-537.e7 |
wrong comparison (not comparing instructions) |
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Sweeney, E. and Curtin, N. and de Barra, E. and Burns, K. and O’neill, E. and Feeney, E. and Tuite, H. and Jackson, A. and Gavin, P. and Clarke, S. and O’connell, S. and Muldoon, E. National guidelines on the provision of outpatient parenteral antimicrobial therapy (Opat). Irish Medical Journal. 2020; 113 (7) :1-8 |
wrong comparison (not comparing instructions) |
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Tamone, C. and Fonte, G. and Panico, A. and Molinatti, P. A. and D'Amelio, P. and Isaia, G. C. Impact of a phone follow-up program on persistence with teriparatide or PTH(1-84) treatment. Calcified Tissue International. 2012; 90 (4) :272-278 |
wrong comparison (not comparing instructions) |
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Torimoto, K. and Okada, Y. and Sugino, S. and Tanaka, Y. Determinants of hemoglobin A1c level in patients with type 2 diabetes after in-hospital diabetes education: A study based on continuous glucose monitoring. Journal of Diabetes Investigation. 2017; 8 (3) :314-320 |
wrong comparison (not comparing instructions) |
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Torres-Duran, Maria and Lopez-Campos, Jose Luis and Calle Rubio, Myriam and Montero-Martinez, Carmen and Priegue Carrera, Ana and Amaro Rodriguez, Rosanel and Barrecheguren, Miriam and Barrio Guirado, Maria Angeles and Callejas-Gonzalez, Francisco Javier and Casas-Maldonado, Francisco and Diab-Caceres, Layla and Garcia-Meseguer, Pilar and Hernandez-Perez, Jose Maria and Lazaro-Asegurado, Lourdes and Martinez-Gonzalez, Cristina and Martinez Rivera, Carlos and Michel, Francisco Javier and Montoro-Ronsano, Jose-Bruno and Sanchez, Raquel and Ortiz-Pica, Marta and Parra, Isabel and Quintero Garcia, Jose Pablo and Ruiz-Serrano-de la Espada, Maria Del Rosario and Tortajada-Goitia, Begona and Miravitlles, Marc Recommendations for the Implementation of the Self-Administration of Alpha-1 Antitrypsin. International journal of chronic obstructive pulmonary disease. 2023; 18 :1691-1700 |
wrong comparison (not comparing instructions) |
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Triplitt, C. and Chiquette, E. Exenatide: From the gila monster to the pharmacy. Journal of the American Pharmacists Association. 2006; 46 (1) :44-55 |
wrong comparison (not comparing instructions) |
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Uchida, T. and Ueno, H. and Sekishima, A. and Sekishima, H. and Konagata, A. and Nakamura, T. and Kogo, F. and Nabekura, H. and Tanaka, Y. and Shimizu, K. and Yamaguchi, H. and Shimoda, K. The relationship between DASC-8 categories and the effectiveness of education on insulin self-injection techniques in elderly patients with diabetes. Diabetology International. 2024; 15 (3) :439-446 |
wrong comparison (not comparing instructions) |
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Utsunomiya, Takafumi and Tanaka, Atsushi and Tatsumi, Kenichi and Ezcurra, Diego A questionnaire-based survey to assess patient satisfaction, ease-of-learning, ease-of-use, injection site pain and overall patient satisfaction of the follitropin-alpha (Gonal-f) filled-by-mass (FbM) prefilled pen compared with other systems of gonadotrophin administration. Reproductive biology and endocrinology : RB&E. 2012; 10 :93 |
wrong comparison (comparison of devices, not instruction) |
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van Boxtel, A. J. H. and Fliedner, M. C. and Borst, D. M. and Teunissen, S. C. C. M. Peripherally inserted central venous catheters: First results after the introduction in a Dutch University Medical Center. JAVA - Journal of the Association for Vascular Access. 2008; 13 (3) :128-133 |
wrong comparison (not comparing instructions) |
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Visy, J. M. and Gentin, M. and Bazerque, C. Teaching intramuscular self-injection in patients with multiple sclerosis reaching interferon beta-1a: Evaluation of a descriptive multicenter program. Presse Medicale. 2007; 36 (6) :841-850 |
wrong language (article in french) |
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Waligóra M, Żuławinska B, Tomaszewski M, Roset P, Kopeć G. Patient Satisfaction with a Dedicated Infusion Pump for Subcutaneous Treprostinil to Treat Pulmonary Arterial Hypertension. J Pers Med. 2023 Feb 26;13(3):423. doi: 10.3390/jpm13030423. PMID: 36983605; PMCID: PMC10058864. |
wrong comparison (not comparing instructions) |
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Wechter A, McDonnell AM, Zimdars E, Sakamoto L, Hamm M. Oncology pharmacy staffing survey across practice settings in the United States. J Oncol Pharm Pract. 2024 Jul 23:10781552241266212. doi: 10.1177/10781552241266212. Epub ahead of print. PMID: 39043373. |
wrong comparison (not comparing instructions) |
|
Weiss, N. Gonadotrophin products: Empowering patients to choose the product that meets their needs. Reproductive BioMedicine Online. 2007; 15 (1) :31-37 |
wrong comparison (comparison of devices, not instruction) |
|
Williams, R. L. and Hensel, D. J. and Fortenberry, J. D. Self-administration of subcutaneous depot medroxyprogesterone acetate by adolescent women. Contraception. 2013; 88 (3) :401-407 |
wrong comparison (not comparing instructions) |
|
Wilson, H. and Semaka, A. and Katz, S. J. A Qualitative Analysis of Methotrexate Self-injection Education Videos on YouTube: A Change in the Right Direction. Journal of Clinical Rheumatology. 2022; 28 (5) :240-244 |
wrong comparison (not comparing instructions) |
|
Windegger, T. M. and Nghiem, S. and Nguyen, K. H. and Fung, Y. L. and Scuffham, P. A. Cost–utility analysis comparing hospital-based intravenous immunoglobulin with home-based subcutaneous immunoglobulin in patients with secondary immunodeficiency. Vox Sanguinis. 2019; 114 (3) :237-246 |
wrong comparison (not comparing instructions) |
|
Wolf, D. C. and Jaganathan, S. and Burudpakdee, C. and Seetasith, A. and Low, R. and Lee, E. and Gucky, J. and Yassine, M. and Schwartz, D. A. Adherence rates and health care costs in crohn’s disease patients receiving certolizumab pegol with and without home health nurse assistance: results from a retrospective analysis of patient claims and home health nurse data. Patient Preference and Adherence. 2018; 12 :869-878 |
wrong comparison (not comparing instructions) |
|
Wood S, Roberts E, Stout AA, Kaboré A, Namagembe A, Cover J, Ndiaye MD, Diokh M, Sèye F, Balderston B. Capacity-Building Through Digital Approaches: Evaluating the Feasibility and Effectiveness of eLearning to Introduce Subcutaneous DMPA Self-Injection in Senegal and Uganda. Glob Health Sci Pract. 2024 Oct 29;12(5):e2400019. doi: 10.9745/GHSP-D-24-00019. PMID: 39271289; PMCID: PMC11521551. |
wrong comparison (not comparing instructions) |
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Wood, L. A review on adherence management in patients on oral cancer therapies. European Journal of Oncology Nursing. 2012; 16 (4) :432-438 |
wrong comparison (not comparing instructions) |
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Wray, S. and Armstrong, R. and Herrman, C. and Calkwood, J. and Cascione, M. and Watsky, E. and Hayward, B. and Mercer, B. and Dangond, F. Results from the single-use autoinjector for self-administration of subcutaneous interferon beta-1a in patients with relapsing multiple sclerosis (MOSAIC) study. Expert Opinion on Drug Delivery. 2011; 8 (12) :1543-1553 |
wrong comparison (comparison of insulin pens, not instruction) |
|
Yuenyongviwat A, Wirodwanich T, Jessadapakorn W, Sangsupawanich P. Utility of an educational video on epinephrine prefilled syringe usage for anaphylaxis: a randomized control trial. Asia Pac Allergy. 2020 Jul 27;10(3):e32. doi: 10.5415/apallergy.2020.10.e32. PMID: 32789117; PMCID: PMC7402946. |
wrong population (medical staff/students) |
|
Zworth M, Saleh C, Ball I, Kalles G, Chkaroubo A, Kekewich M, Miller PQ, Dees M, Frolic A, Oczkowski S. Provision of medical assistance in dying: a scoping review. BMJ Open. 2020 Jul 8;10(7):e036054. doi: 10.1136/bmjopen-2019-036054. PMID: 32641328; PMCID: PMC7348461. |
wrong publication type (scoping review) |
Beoordelingsdatum en geldigheid
Publicatiedatum : 21-07-2026
Beoordeeld op geldigheid : 21-07-2026
Algemene gegevens
De ontwikkeling deze richtlijnmodule werd ondersteund door het Kennisinstituut van de Federatie Medisch Specialisten (www.demedischspecialist.nl/kennisinstituut) en werd gefinancierd door de Stichting Kwaliteitsgelden Medisch Specialisten (SKMS). De financier heeft geen enkele invloed gehad op de inhoud van de richtlijnmodule.
Samenstelling werkgroep
Voor het ontwikkelen van de richtlijnmodule is in 2024 een multidisciplinaire werkgroep ingesteld, bestaande uit vertegenwoordigers van alle relevante specialismen (zie hiervoor de Samenstelling van de werkgroep) die betrokken zijn bij de thuisdoening van medicatie.
Werkgroep
- P.J.J.M. Janssen, ziekenhuisapotheker, Nederlandse Vereniging van Ziekenhuisapothekers (NVZA), voorzitter
- A.I. de Bruin, apotheker, Nederlandse Vereniging van Ziekenhuisapothekers (NVZA)
- J. ten Oever, internist-infectioloog, Nederlandse Internisten Vereniging (NIV)
- A. Beeker, internist, Nederlandse Internisten Vereniging (NIV)
- M.A.W. Gorter-Stam, kinderpalliatief specialist, Nederlandse Vereniging voor Kindergeneeskunde (NVK)
- B.A.E. de Koning, kinderarts, Nederlandse Vereniging voor Kindergeneeskunde (NVK)
- Dr. Ir. A.G. van der Giessen, klinisch fysicus, Nederlandse Vereniging voor Klinische Fysica (NVKF)
- C.A.M. Reeuwijk, gespecialiseerd reumaverpleegkundige, Verpleegkundigen & Verzorgenden Nederland (V&VN)
- I. Cornelis BN wijkverpleegkundige, Verpleegkundigen & Verzorgenden Nederland (V&VN)
Klankbordgroep
- R.J.P. van der Wal, orthopedisch chirurg, Nederlandse Orthopaedische Vereniging (NOV)
- Dr. S. de Boer, cardioloog, Nederlandse Vereniging voor Cardiologie (NVvC)
- E. Doganer, Kind en Zorg (K&Z)
Met ondersteuning van
- A. Oost, literatuurspecialist, Kennisinstituut van de Federatie Medisch Specialisten
- Drs. A.E. Sussenbach, adviseur, Kennisinstituut van de Federatie Medisch Specialisten
- Dr. A.J. Versteeg, senior adviseur, Kennisinstituut van de Federatie Medisch Specialisten
Belangenverklaringen
Een overzicht van de belangen van werkgroepleden en het oordeel over het omgaan met eventuele belangen vindt u in onderstaande tabel. De ondertekende belangenverklaringen zijn op te vragen bij het secretariaat van het Kennisinstituut van de Federatie Medisch Specialisten via secretariaat@kennisinstituut.nl.
Gemelde (neven)functies en belangen werkgroepleden
|
Naam |
Hoofdfunctie |
Nevenwerkzaamheden |
Persoonlijke financiële belangen |
Persoonlijke relaties |
Extern gefinancierd onderzoek |
Intellectuele belangen en reputatie |
Overige belangen |
Datum |
Restrictie |
|
P.J.J.M Janssen |
Ziekenhuisapotheker, ErasmusMC |
bestuursfunctie CPF, organisatie gelieerd aan NVZA. CPF verzorgt de collectieve belangenbehartiging voor poliklinische apotheken. Binnen de grenzen van mededingingsrecht werken poliklinische apotheken samen in de zorgverkoop |
Geen |
Geen |
Geen |
Geen |
Geen |
18-04-2024 |
Geen restricties |
|
A.I. de Bruin |
Poliklinisch Apotheker, UMC Utrecht (medisch specialist) |
Lid Adviesraad Collectief Poliklinische Farmacie (CPF); betreft inkoop extramurale farmacie (vacatiegeld); CPF verzorgt de collectieve belangenbehartiging voor poliklinische apotheken. |
Geen |
Geen |
Geen |
Geen |
Geen |
20-06-2024 |
Geen restricties |
|
J. ten Oever |
Radboudumc: internist-infectioloog (betaald), primaire functie, voltijd |
Voorzitter SWAB Werkgroep antimicrobial stewardship, betaald. Lid deelnemersraad SWAB, onbetaald. Lid RCT AMR Zorgnetwerk GAIN, betaald. Via deze functie ook betaalde projecten, zoals regionale A-team meeting en revisie OPAT-praktijkgids Aankomend voorzitter NVII (v.a. 30/5/24), onbetaald Lid commissie kwaliteit NVII, onbetaald. |
Geen |
Geen |
*Pfizer: Onderzoek naar OPAT, projectleider *Pfizer: Microbioomonderzoek bij antibotica *Effectiviteit cefazoline en flucloxacilline bij S. aureusbacteriëlemie *Onderzoek naar OPAT, projectleider *SOD als additionele profylaxe bij eosfagusresectie |
Geen |
Geen |
20-06-2024 |
Geen restricties |
|
A. Beeker |
Internist hemato-oncoloog en medisch manager oncologiecentrum Spaarne Gasthuis |
Lid oncologiecommissie ONconovo +, onbetaald. Lid geneesmiddelen commissie NWH, onbetaald. Lid wetenschapscommissie NWH, onbetaald. Lid redactieraad NTVL, onbetaald Hoofdredacteur medidact oncologie/hematologie, onkostenvergoeding. Lid dagelijks bestuur vakgroep interne geneeskunde-MOL Spaarne Gasthuis, onbetaald. |
Lid Care Coalition, onkostenvergoeding |
Geen |
Geen. |
Geen |
Geen |
02-12-2024 |
Geen restricties |
|
M.A.W. Gorter-Stam |
Medisch Adviseur: KinderThuisZorg Nederland; 16uur -Medisch advies intern -transmurale zorgprojecten diverse -Scholing Medisch Ethische Commissie: Make-A-Wish; 16 uur -Medisch advieswerk -Onderzoek QoL Eigenaar Close Of Life -Scholing -Advieswerk -Kenniscentrum Kinderpalliatieve zorg; diverse projecten |
Advisor to the International Medical Committee Make-A-Wish |
Geen |
Geen |
Geen |
Nee, behoudens dat ik werkzaam ben in het extramurale veld, waarvoor deze richtlijn van belang is om zo de medicatieveiligheid van de patiënten te verhogen |
Geen |
24-06-2024 |
Geen restricties |
|
B.A.E. de Koning |
Kinderarts MDL, ErasmusMC |
Geen |
Geen |
Geen |
MLDS en Zeldzame ziekten fonds, sportinterventie bij patienten met darmfalen, beide projectleider. |
Geen |
Geen |
30-08-2024 |
Geen restricties |
|
Dr. Ir. A.G. van der Giessen |
Algemeen klinisch fysicus- Maxima Medisch Centrum |
Opleider binnen post-master opleiding Qualified Medical Engineering - Technische Universiteit Eindhoven |
Geen |
Geen |
Geen |
Geen vermarkting; Wel mogelijkheid voor reputatie gewin/schade op dit gebied binnen specialisme in verband borgen met de rol van de klinische fysica binnen dit domein |
Geen |
11-06-2024 |
Geen restricties |
|
C.A.M. Reeuwijk |
Reumaverpleegkundige Isala zkh |
V&VN reumatologie (voorzitter) |
Geen |
Geen |
Geen |
Voorzitter V&VN reumatologie |
Geen |
23-05-2024 |
Geen restricties |
|
I. Cornelis |
Gespecialiseerd wijkverpleegkundige bij Groene Kruis Thuiszorg, onderdeel van de Zorggroep |
Bestuurslid V&VN, afdeling TTV (vrijwillig) |
Geen |
Geen |
Geen |
Geen |
Geen |
02-07-2024 |
Geen restricties |
Inbreng patiëntenperspectief
De werkgroep besteedde aandacht aan het patiëntenperspectief door het uitnodigen van de Patiëntenfederatie Nederland (PFNL) voor de schriftelijke knelpuntenanalyse en door het betrekken van een afgevaardigde van stichting Kind & Ziekenhuis in de klankbordgroep. De verkregen input is meegenomen bij het opstellen van de uitgangsvragen, de keuze voor de uitkomstmaten en bij het opstellen van de overwegingen. De conceptrichtlijn is tevens voor commentaar voorgelegd aan de patiëntenvereniging en stichting Kind & Ziekenhuis en de eventueel aangeleverde commentaren zijn bekeken en verwerkt.
Kwalitatieve raming van mogelijke financiële gevolgen in het kader van de Wkkgz
Bij de richtlijnmodule voerde de werkgroep conform de Wet kwaliteit, klachten en geschillen zorg (Wkkgz) een kwalitatieve raming uit om te beoordelen of de aanbevelingen mogelijk leiden tot substantiële financiële gevolgen. Bij het uitvoeren van deze beoordeling is de richtlijnmodule op verschillende domeinen getoetst (zie het stroomschema bij Werkwijze).
Uit de kwalitatieve raming blijkt dat er waarschijnlijk geen substantiële financiële gevolgen zijn, zie onderstaande tabel.
|
Module |
Uitkomst raming |
Toelichting |
|
Instructies |
geen financiële gevolgen |
Hoewel uit de toetsing volgt dat de aanbeveling(en) breed toepasbaar zijn (>40.000 patiënten), volgt uit de toetsing dat het overgrote deel (±90%) van de zorgaanbieders en zorgverleners al aan de norm voldoet. Er worden daarom geen financiële gevolgen verwacht. |
Werkwijze
Voor meer details over de gebruikte richtlijnmethodologie verwijzen wij u naar de Werkwijze.