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Wee LE, Sundarajoo M, Quah WF, Farhati A, Huang JY, Chua YY. Sociodemographic and clinical factors associated with acceptance of outpatient parenteral antibiotic therapy in a Singapore tertiary hospital from 2014 to 2017. Eur J Clin Microbiol Infect Dis 2018; 38:277-284. [PMID: 30430375 DOI: 10.1007/s10096-018-3424-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/06/2018] [Indexed: 11/26/2022]
Abstract
Outpatient parenteral antibiotic therapy (OPAT) can facilitate early discharge; however, not all offered OPAT can accept. We assessed factors associated with acceptance of OPAT in a large Asian tertiary hospital cohort. From 2014 to 2017, we reviewed all referrals to Singapore General Hospital's (SGH) Outpatient Parenteral Antibiotic Therapy (OPAT) service. We compared differences in sociodemographic and clinical factors between patients who opted for OPAT and those who declined, using chi-square test for univariate analysis and logistic regression for multivariate analysis. From 2014 to 2017, a total of 1406 OPAT referrals were made. Of these, 95.9% (1349/1406) were deemed suitable for OPAT. Amongst those suitable, 90.0% (1213/1349) accepted OPAT treatment. On multivariate analysis, being independently ambulant (aOR = 3.46, 95%CI = 2.21-5.37) was independently associated with higher odds of acceptance for OPAT; whereas, patients with peripheral vascular disease had lower odds of accepting OPAT (aOR = 0.32, 95%CI = 0.16-0.62). Lower socioeconomic status (SES) was closely associated with rejection of OPAT, with markers of both individual-level SES (subsidized ward class) and area-level SES (staying in a public rental flat) being independently associated with lower odds of OPAT preference. Distance and travel time were not associated with OPAT acceptance. The top reasons for rejecting OPAT were lack of caregiver (n = 35), mobility issues (n = 24), financial issues (n = 24), and difficulty caring for the line (n = 21). Comorbidities, mobility, and financial issues are important factors to consider when determining suitability for OPAT. More can be done to improve accessibility of OPAT amongst lower-income patients and those staying in lower-SES areas.
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Affiliation(s)
- Liang En Wee
- Adjunct Research Fellow, Duke-NUS Graduate Medical School, Singapore, Singapore.
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore.
| | | | - Way-Fang Quah
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Ahmad Farhati
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Jie-Ying Huang
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Ying-Ying Chua
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
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Fisher D, Michaels J, Hase R, Zhang J, Kataria S, Sim B, Tsang JKY, Pollard J, Chan M, Swaminathan S. Outpatient parenteral antibiotic therapy (OPAT) in Asia: missing an opportunity. J Antimicrob Chemother 2017; 72:1221-1226. [PMID: 28077673 DOI: 10.1093/jac/dkw551] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/21/2016] [Indexed: 01/28/2023] Open
Abstract
Objectives Healthcare facilities internationally have grown outpatient parenteral antibiotic administration services for the last few decades. The literature contains publications from dozens of countries describing systematized processes with specialist oversight and their levels of service provision and outcomes. Such descriptions are absent in the majority of Asian countries. We sought to elucidate the extent and nature of outpatient parenteral antibiotic therapy (OPAT) in Asia and to consider the ramifications and opportunities for improvement. Methods Utilizing colleagues and their personal networks, we surveyed healthcare facilities across 17 countries in Asia to ascertain the current means (if any) of providing OPAT. In that survey we also sought to explore the capacity and interest of these facilities in developing systematized OPAT services. Results Responses were received from 171 different healthcare facilities from 17 countries. Most (97/171, 57%) stated that they administer outpatient parenteral antibiotics, but only 5 of 162 facilities (3%) outside of Singapore described comprehensive services with specialist oversight. Conclusions There is very likely a large unrecognized problem of unchecked outpatient parenteral antibiotic administration in Asia. Developing comprehensive and systematized OPAT in Asia is needed as a priority in an environment in which the infectious diseases community is demanding broad stewardship approaches. There are nonetheless challenges in establishing and sustaining OPAT programmes. Local champions and leverage off identified local incentives and needs are key to regional advancement.
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Affiliation(s)
- Dale Fisher
- Infectious Disease Division, Department of Medicine, National University Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jessica Michaels
- Infectious Disease Division, Department of Medicine, National University Hospital, Singapore
| | - Ryota Hase
- Department of Infectious Diseases, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Jing Zhang
- Department of Pulmonary Medicine, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Sushila Kataria
- Division of Internal Medicine and Geriatrics, Medanta the Medicity, India
| | - Benedict Sim
- Department of Medicine, Hospital Sungai Buloh, Selangor, Malaysia
| | | | - James Pollard
- Department of Infectious Diseases and Hospital in the Home, Barwon Health, Geelong, Australia
| | - Monica Chan
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Subramanian Swaminathan
- Department of Infectious Diseases, Global Health City, Cheran Nagar, Perumbakkam, Chennai 100, India
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Pajarón M, Fernández-Miera MF, Allende I, Arnaiz AM, Gutiérrez-Cuadra M, Cobo-Belaustegui M, Armiñanzas C, de Berrazueta JR, Fariñas MC, Sanroma P. Self-administered outpatient parenteral antimicrobial therapy (S-OPAT) for infective endocarditis: a safe and effective model. Eur J Intern Med 2015; 26:131-6. [PMID: 25596808 DOI: 10.1016/j.ejim.2015.01.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/01/2015] [Accepted: 01/04/2015] [Indexed: 01/11/2023]
Abstract
The safety and efficacy of treatment of infectious endocarditis (IE) was evaluated within a program of hospital-in-home (HIH) based on self-administered outpatient parenteral antimicrobial therapy (S-OPAT). IE episodes (n=48 in 45 patients; 71% middle-aged males) were recruited into the HIH program between 1998 and 2012. Following treatment stabilization at the hospital they returned home for HIH in which a physician and/or a nurse supervised the S-OPAT. Safety and efficacy were evaluated as mortality, re-occurrence, and unexpected re-admission to hospital. Of the episodes of IE, 83.3% had comorbidities with a mean score of 2.3 on the Charlson index and 1.5 on the Profund index; 60.4% had pre-existing valve disease (58.6% having had surgical intervention); 8.3% of patients had suffered a previous IE episode; 62.5% of all episodes affected a native valve; 45.8% being mitral; 70.8% of infection derived from the community. In 75% of the episodes there was micro-organism growth, of which 83.3% were Gram positive. Overall duration of antibiotic treatment was 4.8 weeks; 60.4% of this time corresponding to HIH. Re-admission occurred in 12.5% of episodes of which 33.3% returned to HIH to complete the S-OPAT. No deaths occurred during HIH. One year after discharge, 2 patients had recurrence and 5 patients died, in 2 of whom previous IE as cause-of-death could not be excluded. In conclusion, the S-OPAT schedule of hospital-in-home is safe and efficacious in selected patients with IE.
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Affiliation(s)
- Marcos Pajarón
- Unidad de Hospitalización a Domicilio Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, 39008 Santander, Spain.
| | - Manuel F Fernández-Miera
- Unidad de Hospitalización a Domicilio Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, 39008 Santander, Spain.
| | - Iciar Allende
- Dept. Medicina de Atención Primaria y Comunitaria, Area de Salud I. C/ San Fernando 15 Sta. Cruz de Bezana, 39100 Cantabria, Spain.
| | - Ana M Arnaiz
- Dept. Medicina Interna, Unidad de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, 39008 Santander, Spain.
| | - Manuel Gutiérrez-Cuadra
- Dept. Medicina Interna, Unidad de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, 39008 Santander, Spain.
| | - Manuel Cobo-Belaustegui
- Intensive Care Unit, Dept. Cardiología, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, 39008 Santander, Spain.
| | - Carlos Armiñanzas
- Dept. Medicina Interna, Unidad de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, 39008 Santander, Spain.
| | - Jose R de Berrazueta
- Dept. Cardiology Universidad de Cantabria, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, 39008 Santander, Spain.
| | - Maria C Fariñas
- Dept. Medicina Interna, Unidad de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, 39008 Santander, Spain.
| | - Pedro Sanroma
- Unidad de Hospitalización a Domicilio Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, 39008 Santander, Spain.
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Gilchrist M, Seaton RA. Outpatient parenteral antimicrobial therapy and antimicrobial stewardship: challenges and checklists. J Antimicrob Chemother 2014; 70:965-70. [PMID: 25538169 DOI: 10.1093/jac/dku517] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) has become, for many countries, an established form of healthcare delivery. At the same time, there have been calls to ensure the prudent use of the existing antimicrobial armamentarium. For OPAT, this presents a dilemma. On one hand, stewardship principles look for the most effective agent with minimal collateral effects. In OPAT, whilst the aims of the service are similar, convenience of dosing to optimize early hospital discharge or admission avoidance may take precedence over an agent's spectrum of activity. This brief article aims to highlight the importance and explore the challenges of antimicrobial stewardship in the context of OPAT. Within the UK, the safe and effective use of antimicrobials is modelled around the IDSA/Society for Healthcare Epidemiology of America stewardship practice guidelines with local customization where appropriate. Current UK stewardship practice principles were compared with published good practice recommendations for OPAT to identify how OPAT could support the broader antimicrobial stewardship agenda. It is essential that antimicrobial stewardship teams should understand the challenges faced in the non-inpatient setting and the potential benefits/lower risks associated with avoided admission or shortened hospital stay in this population. Within its limitations, OPAT should practise stewardship principles, including optimization of intravenous to oral switch and the reporting of outcomes, healthcare-associated infections and re-admission rates. OPAT should report to the antimicrobial stewardship team. Ideally the OPAT team should be formally represented within the stewardship framework. A checklist has been proposed to aid OPAT services in ensuring they meet their stewardship agenda.
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Affiliation(s)
- M Gilchrist
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - R A Seaton
- NHS Greater Glasgow and Clyde, Brownlee Centre, Gartnavel General Hospital, Glasgow G12 0YN, UK
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Abstract
Up to 4% of inpatients are in hospital solely to receive intravenous antimicrobial therapy. Outpatient parenteral antimicrobial therapy (OPAT) offers the opportunity for improved efficiency and patient choice through early discharge from hospital or admission avoidance, while maintaining quality of care. OPAT aligns well with key priorities in the new NHS and in this article I explore how new developments in the national healthcare context might be exploited to promote the ongoing evolution of OPAT in the UK.
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Affiliation(s)
- Ann L N Chapman
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield.
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Chapman ALN, Seaton RA, Cooper MA, Hedderwick S, Goodall V, Reed C, Sanderson F, Nathwani D. Good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults in the UK: a consensus statement. J Antimicrob Chemother 2012; 67:1053-62. [PMID: 22298347 DOI: 10.1093/jac/dks003] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
These good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) are an update to a previous consensus statement on OPAT in the UK published in 1998. They are based on previous national and international guidelines, but have been further developed through an extensive consultation process, and are underpinned by evidence from published literature on OPAT. They provide pragmatic guidance on the development and delivery of OPAT services, looking at all aspects of service design, care delivery, outcome monitoring and quality assurance, with the aim of ensuring that OPAT services provide high-quality, low-risk care, whatever the healthcare setting. They will provide a useful resource for teams developing new services, as well as a practical set of quality indicators for existing services.
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Affiliation(s)
- Ann L N Chapman
- Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield, UK.
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Maraqa NF, Rathore MH. Pediatric outpatient parenteral antimicrobial therapy: an update. Adv Pediatr 2010; 57:219-45. [PMID: 21056740 DOI: 10.1016/j.yapd.2010.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Nizar F Maraqa
- Pediatric Infectious Diseases and Immunology, University of Florida-Jacksonville, 653-1 West 8th Street, LRC-3, Pediatrics, L-13, Jacksonville, FL 32209, USA
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Chapman ALN, Dixon S, Andrews D, Lillie PJ, Bazaz R, Patchett JD. Clinical efficacy and cost-effectiveness of outpatient parenteral antibiotic therapy (OPAT): a UK perspective. J Antimicrob Chemother 2009; 64:1316-24. [PMID: 19767623 DOI: 10.1093/jac/dkp343] [Citation(s) in RCA: 176] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Outpatient parenteral antibiotic therapy (OPAT) is an effective treatment strategy for a wide variety of infections as long as clinical risk is minimized by conforming to practice guidelines. However, its cost-effectiveness has not been established in the setting of the UK National Health Service. We examined the clinical efficacy and cost-effectiveness of an OPAT service based in a large UK teaching hospital, predominantly using the outpatient 'infusion centre' and patient/carer administration models of service delivery. PATIENTS AND METHODS Data on clinical activity and outcomes were collected prospectively on 334 episodes of treatment administered by the Sheffield OPAT service between January 2006 and January 2008. Cost-effectiveness was calculated by comparing real costs of OPAT with estimated inpatient costs for these patient episodes incorporating two additional sensitivity analyses. RESULTS Of the OPAT episodes, 87% resulted in cure or improvement on completion of intravenous therapy. The readmission rate was 6.3%, and patient satisfaction was high. OPAT cost 41% of equivalent inpatient costs for an Infectious Diseases Unit, 47% of equivalent inpatient costs using national average costs and 61% of inpatient costs using minimum inpatient costs for each diagnosis. CONCLUSIONS Using this service model, OPAT is safe and clinically effective, with low rates of complications/readmissions and high levels of patient satisfaction. OPAT is cost-effective when compared with equivalent inpatient care in the UK healthcare setting.
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Affiliation(s)
- Ann L N Chapman
- Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield, UK.
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Coenen S, Muller A, Adriaenssens N, Vankerckhoven V, Hendrickx E, Goossens H. European Surveillance of Antimicrobial Consumption (ESAC): outpatient parenteral antibiotic treatment in Europe. J Antimicrob Chemother 2009; 64:200-5. [DOI: 10.1093/jac/dkp135] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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A cost analysis of Outpatient Parenteral Antibiotic Therapy (OPAT): an Asian perspective. Int J Antimicrob Agents 2008; 33:46-51. [PMID: 18823759 DOI: 10.1016/j.ijantimicag.2008.07.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 07/04/2008] [Accepted: 07/09/2008] [Indexed: 11/21/2022]
Abstract
The concept of Outpatient Parenteral Antibiotic Therapy (OPAT) is relatively new in Asia. This study compared the actual costs and outcomes of care involving OPAT with conventional inpatient-only care at a university hospital in Singapore. Actual costs were obtained for selected patients enrolled in OPAT after 1 January 2005 and these costs were directly compared with those of age-, gender- and diagnosis-matched patients managed as inpatients only prior to the availability of OPAT in the preceding 12 months. Outcomes of patients were also considered. The OPAT and inpatient-only groups comprised 72 and 93 enrollments, respectively. Mean treatment duration for OPAT patients was 42.5 days versus 19 days for those receiving inpatient-only care (P < 0.001). The mean total treatment cost for OPAT and inpatient-only care was US$12 736 and $12 403, respectively (P = 0.706). Mean cost per day for care including an OPAT episode was US$278 versus $457 per day for inpatient-only care (P < 0.001). There was no difference in outcomes between the two groups. OPAT is a viable alternative to inpatient care as it is safe, effective and results in lower daily costs. The trend to longer treatment courses is worthy of further review.
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