Outpatient Parenteral Antimicrobial Therapy (OPAT) in the Kingdom of Bahrain: Efficacy, Patient Satisfaction and Cost Effectiveness

Abstract

Outpatient parenteral antimicrobial therapy (OPAT) is an alternative method to deliver intravenous antimicrobial agents to patients requiring parenteral therapy without an overnight hospital stay. The aim of this study was to review the OPAT services, to explore patient satisfaction with the services provided, and to determine cost effectiveness. A retrospective review for the raw data collected in the OPAT clinic between February 2012 and January 2013 was included. Patients' variables including age, sex, type of infection, and service costs were analyzed with descriptive statistics. Each patient's eligibility was assessed by an infectious disease physician (ID), and a family physician. Patient's satisfaction was measured by a modified short version patient satisfaction questionnaire. Cost was calculated for each patient in the OPAT clinic and compared to the actual cost if the same patient was admitted and treated in the hospital. During the last 12 months, 101 patients, 92 adults, and nine children were treated in our OPAT clinic. Half (50%) of the patients were referred from general practitioner services and our emergency department. Ceftriaxone was the most frequently used antibiotic, prescribed to 76% of the patients. Successful cure was achieved in 97 treated patients. Patients were highly satisfied with the OPAT service with the mean rating of 4.41 SD + 0.31. Cost was reduced from $75, 000 to $30, 000 over one year. This retrospective study suggested that OPAT service is safe and potentially a cost saving approach for the health care system. OPAT service is acceptable and well tolerated among patients receiving intravenous antimicrobial agents.

Hospital adoption of antimicrobial stewardship programmes in Gulf Cooperation Council countries: A review of existing evidence

“…Only three studies reported on the impact of ASPs on length of stay and/ or mortality metrics [31,32,48]. Bahrain studies on adoption of ASPs in the outpatient department of a military hospital reported that the outpatient service prevented admissions to hospital (2 out of 101 in 2013 and 6 out of 97 in 2015) as a result of their antimicrobial stewardship practices [31,32]. Another study in a Saudi hospital reported reduction of hospital stay to 376 defined daily doses (DDD) compared to 2404 DDD pre-ASP adoption [48].…”

“…Two studies from Bahrain reported increased use of broad spectrum antibiotics like ceftriaxone due to resistance to first and second line options [31,32]. One Omani study reported that 90% of antibiotic prescriptions were for broad spectrum antibiotics due to lack of adherence with antimicrobial guidelines and policies [40].…”

The Community IntraVenous Antibiotic Study (CIVAS): a mixed-methods evaluation of patient preferences for and cost-effectiveness of different service models for delivering outpatient parenteral antimicrobial therapy

“…56 Of the remaining studies that considered acceptability in OPAT patients only, most involved multiple OPAT models (and did not differentiate between them in their findings), or did not specify the model(s) under study. In general, satisfaction with treatment was very high, 2,13,27,36,[67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83] including when patients had to have frequent attendance at hospital. 5,84 Commonly perceived advantages of OPAT included the ability to resume daily activities, 2,27,71,73 feelings of improved self-esteem or greater freedom and control, 67,71,73,85,86 and not having to remain in or attend hospital.…”

“…5,84 Commonly perceived advantages of OPAT included the ability to resume daily activities, 2,27,71,73 feelings of improved self-esteem or greater freedom and control, 67,71,73,85,86 and not having to remain in or attend hospital. 2,71,82,85,87 The main disadvantages most commonly related to infusion equipment, and included anxiety about the device and its sterility, 35,37,78 the discomfort and limitations imposed by pump devices, 36,37 and issues related to storage. 88 Two studies found that younger patients were better able to use infusion devices, and required less support to do so than older patients.…”

“…The initial review in 2013 identified 34 studies that examined patients' acceptability of OPAT, but, of these, 21 were quantitative surveys assessing satisfaction with the service and provided little information about patients' own perceptions of the benefits and disadvantages of OPAT. 5,12,13,15,25,27,36,41,67,68,70,73,[75][76][77][78][80][81][82]86,89 Only six interview-based studies were identified by the review. 35,37,79,85,88,99 The literature indicates that patients generally view OPAT very positively.…”