Effectiveness and safety of outpatient parenteral antimicrobial therapy in acute exacerbation of chronic obstructive pulmonary disease

González, Miguel Ángel Ponce; Rubio, Manuel Mirón; Martínez, Albert Gallifa; Estrada, Oriol; Pérez, Dolores Fíuza; Reinoso, L. Salas; Fabrellas, Estrella Fernández; Vives, Eusebi Chiner

doi:10.1111/ijcp.13022

Cited by 13 publications

(5 citation statements)

References 28 publications

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“…The clinical efficacy of OPAT compared with inpatient care appears equivalent, 1 placing an onus on ensuring that OPAT services are delivered safely, by quantifying the rate of adverse events (AEs), including those related to the use of intravenous (iv) catheters, and the antimicrobials administered 2 . Both have been widely reported but often as an absolute proportion over the entirety of the OPAT care episode, 3–6 which is overly simplistic given the heterogeneity of OPAT indications, as risk is clearly related to the duration of the OPAT care episode 7 , 8 …”

Section: Introductionmentioning

confidence: 99%

Intravenous catheter-related adverse events exceed drug-related adverse events in outpatient parenteral antimicrobial therapy

Underwood

Marks

Collins

et al. 2018

Journal of Antimicrobial Chemotherapy

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BackgroundDrug-related adverse events (AEs) are reported to be common amongst patients receiving outpatient parenteral antimicrobial therapy (OPAT). However, comparative data regarding intravenous (iv) catheter-related AEs are lacking.ObjectivesTo compare drug- and iv catheter-related AEs from a large UK OPAT centre.Patients and methodsWe reviewed 544 OPAT episodes [median (IQR) age: 57 (39–71) years, 60% male, 13% with diabetes] with a median (IQR) duration of 7 (2–18) days. Clinically significant drug- and iv catheter-related AEs were calculated as a percentage of OPAT episodes with an AE and also as AEs per 1000 iv drug/catheter days.ResultsDrug-related AEs complicated 13 (2.4%) OPAT episodes at 1.7 (95% CI 0.9–2.9) per 1000 drug days. Catheter-related AEs occurred more frequently, complicating 32 (5.9%) episodes at 5.7 (95% CI 4.2–7.9) per 1000 iv catheter days (χ2 test for difference in AE rate: P < 0.001). Non-radiologically guided midline catheters were associated with the most frequent AEs (n = 23) at 15.6 (95% CI 10.3–23.4) per 1000 iv catheter days compared with other types of iv catheters (HR 8.4, 95% CI 2.4–51.9, P < 0.004), and self-administration was associated with a higher rate of catheter-related AEs at 12.0 (95% CI 6.0–23.9) per 1000 iv catheter days (HR 4.15, 95% CI 1.7–9.1, P = 0.007).ConclusionsClinically significant iv catheter-related AEs occurred more frequently than drug-related AEs, especially when using non-radiologically guided midline catheters. Regular review of the need for iv therapy and switching to oral antimicrobials when appropriate is likely to minimize OPAT-related AEs.

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Section: Introductionmentioning

confidence: 99%

Intravenous catheter-related adverse events exceed drug-related adverse events in outpatient parenteral antimicrobial therapy

Underwood

Marks

Collins

et al. 2018

Journal of Antimicrobial Chemotherapy

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“…Our findings are in the upper range of care quality of HaH studies in Europe [32,33] US [34][35][36], and Australia [37][38][39][40], taking into account the heterogeneity of services in the type of care, reimbursement regimes, and adoption strategies. Furthermore, the maturity of both integrated care and digital support may strongly influence the success of implementation and adoption strategies [16].…”

Section: Healthcare Costsmentioning

confidence: 74%

The Value of Admission Avoidance: Cost-Consequence Analysis of One-Year Activity in a Consolidated Service

Hernández

Herranz

Baltaxe

et al. 2023

Preprint

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Background: Many advantages of hospital at home (HaH), as a modality of acute care, have been highlighted, but controversies exist regarding the cost-benefit trade-offs. Objective: To assess health outcomes and analytical costs of hospital avoidance (HaH-HA) in a consolidated service with over ten years of delivery of HaH in Barcelona (Spain). Methods: A retrospective cost-consequence analysis of all first episodes of HaH-HA, directly admitted from the emergency room (ER) between 2017 and 2018, was carried out. HaH-HA was compared with a propensity-score-matched group of contemporary patients admitted to conventional hospitalization (Controls). Mortality, re-admissions, ER visits, and direct healthcare costs were evaluated. Registration: ClinicalTrials.gov (26/04/2017;NCT03130283). Results: HaH-HA and Controls (n=441 each) were comparable in terms of age (73 [SD16] vs 74 [16]), gender (male, 57% vs 59%), multimorbidity, healthcare expenditure during the previous year, case mix index of the acute episode, and main diagnosis at discharge. HaH-HA presented lower mortality during the episode (0 vs. 19 (4.3%); p < 0.001). At 30 days post-discharge, HaH-HA and Controls showed similar re-admission rates; however, ER visits were lower in HaH-HA than in Controls (28 (6.3%) vs 34 (8.1%); p = 0.044). Average costs per patient during the episode were lower in the HaH-HA group (1,078 EUR) than in Controls (2,171 EUR). Likewise, healthcare costs within the 30 days post-discharge were also lower in HaH-Ha than in Controls (p < 0.001). Conclusions: The study showed higher performance and cost reductions of HaH-HA in a real-world setting. The identification of sources of savings facilitates scaling of hospital avoidance. Funding: This article was funded by JADECARE project- HP-JA-2019 - Grant Agreement number 951442 (2020-2023), a European Union Health Program 2014-2020. Keywords: Hospital at home; Early readmissions; Health Services Research; Implementation science; Transitional Care.

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“…The health outcomes of the current study are in the upper range of care quality of HaH studies in Europe [ 45 , 46 ] US [ 6 , 47 , 48 ], and Australia [ 7 – 10 ]. Furthermore, the maturity of both integrated care and digital support in Catalonia may positively influence the success of implementation and adoption strategies [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

The value of admission avoidance: cost-consequence analysis of one-year activity in a consolidated service

Hernandez,

Herranz,

Baltaxe

et al. 2024

Cost Eff Resour Alloc

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Background Many advantages of hospital at home (HaH), as a modality of acute care, have been highlighted, but controversies exist regarding the cost-benefit trade-offs. The objective is to assess health outcomes and analytical costs of hospital avoidance (HaH-HA) in a consolidated service with over ten years of delivery of HaH in Barcelona (Spain). Methods A retrospective cost-consequence analysis of all first episodes of HaH-HA, directly admitted from the emergency room (ER) in 2017–2018, was carried out with a health system perspective. HaH-HA was compared with a propensity-score-matched group of contemporary patients admitted to conventional hospitalization (Controls). Mortality, re-admissions, ER visits, and direct healthcare costs were evaluated. Results HaH-HA and Controls (n = 441 each) were comparable in terms of age (73 [SD16] vs. 74 [SD16]), gender (male, 57% vs. 59%), multimorbidity, healthcare expenditure during the previous year, case mix index of the acute episode, and main diagnosis at discharge. HaH-HA presented lower mortality during the episode (0 vs. 19 (4.3%); p < 0.001). At 30 days post-discharge, HaH-HA and Controls showed similar re-admission rates; however, ER visits were lower in HaH-HA than in Controls (28 (6.3%) vs. 34 (8.1%); p = 0.044). Average costs per patient during the episode were lower in the HaH-HA group (€ 1,078) than in Controls (€ 2,171). Likewise, healthcare costs within the 30 days post-discharge were also lower in HaH-Ha than in Controls (p < 0.001). Conclusions The study showed higher performance and cost reductions of HaH-HA in a real-world setting. The identification of sources of savings facilitates scaling of hospital avoidance. Registration ClinicalTrials.gov (26/04/2017; NCT03130283).

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Effectiveness and safety of outpatient parenteral antimicrobial therapy in acute exacerbation of chronic obstructive pulmonary disease

Abstract: Patients with AECOPD who require parenteral antimicrobial therapy can be managed effectively and safely in HHU, avoiding hospital stays, readmissions and complications.

Cited by 13 publications

References 28 publications

Intravenous catheter-related adverse events exceed drug-related adverse events in outpatient parenteral antimicrobial therapy

Intravenous catheter-related adverse events exceed drug-related adverse events in outpatient parenteral antimicrobial therapy

The Value of Admission Avoidance: Cost-Consequence Analysis of One-Year Activity in a Consolidated Service

The value of admission avoidance: cost-consequence analysis of one-year activity in a consolidated service

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