Self-administered outpatient parenteral antimicrobial therapy: a report of three years experience in the Irish healthcare setting

Abstract

Outpatient parenteral antibiotic therapy (OPAT) was first reported in 1972. OPAT programmes are not well established in Ireland, with no reported outcomes in the literature. An OPAT programme was established at St. James Hospital in 2006. Demographics, diagnoses and outcomes of the first 60 courses are reported. A retrospective analysis of prospectively recorded data was performed on patients treated from March 2006 to February 2009. The data was analysed using SPSS v.17. Sixty OPAT courses were administered to 56 patients, 57 percent of which were male. The median age was 50 years, the median inpatient stay was 19 days, the median duration of OPAT was 16 days and 1,289 inpatient bed days were saved. The additional cost per day of OPAT was 167.60 euros. Vancomycin was the most prescribed antimicrobial, administered to 35%. Musculoskeletal infection was the indication for treatment in 50%. Confirmatory microbiological diagnosis was identified in 72%, most frequently due to Staphylococcus aureus (68%). Only minor adverse events were recorded. Clinical cure was achieved in 92.8%. A patient satisfaction survey showed high satisfaction. OPAT is a safe and effective way of providing parenteral antibiotic therapy in the Irish healthcare system. Better integration of funding and the appointment of Infectious Diseases specialists will facilitate its expansion.

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.…”

“…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. 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.…”

“…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 main benefits relate to the comfort of the home environment 56,85,86,99 and increased freedom and autonomy. 2,56,71,73,86 Some patients reported that OPAT provides a sense of ownership over their illness and increased involvement in their treatment. 67 Kieran et al 2 found that patients trained to self-administer their treatment were happy with this and that over three-quarters would be content with telephone follow-up or less frequent outpatient reviews, providing that the care of their i.v.…”

“…While acutely ill, most patients preferred to be cared for in hospital but, once stabilised, most but not all patients preferred to recover at home, a finding echoed by other studies. 2,15,85,105 Not all patients are suitable for OPAT and are generally selected on the basis of their ability to cope in the community, and the availability of suitable antimicrobials, and these caveats were echoed by patients. 35 In line with other studies, patients felt that they benefited from being in their own homes, 56,85,86 but this also required them to be more active in their own care, and the willingness of patients to do this needs to be assessed.…”