A qualitative study of patients’ feedback about Outpatient Parenteral Antimicrobial Therapy (OPAT) services in Northern England: implications for service improvement

Abstract

ObjectiveOutpatient parenteral antimicrobial therapy (OPAT) provides opportunities for improved cost savings, but in the UK, implementation is patchy and a variety of service models are in use. The slow uptake in the UK and Europe is due to a number of clinical, financial and logistical issues, including concern about patient safety. The measurement of patient experience data is commonly used to inform commissioning decisions, but these focus on functional aspects of services and fail to examine the relational aspects of care. This qualitative study examines patients’ experiences of OPAT.DesignIn-depth, semistructured interviews.SettingPurposive sample of OPAT patients recruited from four acute National Health Service (NHS) Trusts in Northern England. These NHS Trusts between them represented both well-established and recently set-up services running nurse at home, hospital outpatient and/or self-administration models.ParticipantsWe undertook 28 semistructured interviews and one focus group (n=4).ResultsDespite good patient outcomes, experiences were coloured by patients’ personal situation and material circumstances. Many found looking after themselves at home more difficult than they expected, while others continued to work despite their infection. Expensive car parking, late running services and the inconvenience of waiting in for the nurse to arrive frustrated patients, while efficient services, staffed by nurses with the specialist skills needed to manage intravenous treatment had the opposite effect. Many patients felt a local, general practitioner or community health centre based service would resolve many of the practical difficulties that made OPAT inconvenient. Patients could find OPAT anxiety provoking but this could be ameliorated by staff taking the time to reassure patients and provide tailored information.ConclusionServices configurations must accommodate the diversity of the local population. Poor communication can leave patients lacking the confidence needed to be a competent collaborator in their own care and affect their perceptions of the service.

Being ‘at-home’ on outpatient parenteral antimicrobial therapy (OPAT): a qualitative study of parents’ experiences of paediatric OPAT

“…The suggested standardised survey for routinely collecting patient/parent satisfaction1 is unlikely to generate the range and depth of experience that will illuminate practice. While material and personal circumstances have been shown to be influential for adult patients,15 this was not evident in our findings. Previous research reports parental reluctance to go home,20 this was not the case in this study.…”

“…For the most part, OPAT allowed the family to sink back into familiar routines and regain a sense of integrity and ‘normality’. ‘Coupling constraints’ (times when the nurses and the parent/child needed to be in the same place)23 created some ‘minor inconveniences’ rather than the ‘wild’ disruptions associated with in-patient care, as seen with some adult services 15. Other home-based services for children reveal similar reductions in stress and disruption to daily family life 24.…”

“…However, there is a lack of consensus about what constitutes success, the definition and reporting of adverse events, and the evidence base for the economic benefits of paediatric OPAT 12. Across all OPAT literature, patient experience is mostly limited to survey data;13 14 the limited robust qualitative evidence in adults reveals that despite good clinical outcomes, some OPAT experiences can be troubled and challenging 15…”

Quality of outpatient parenteral antimicrobial therapy (OPAT) care from the patient’s perspective: a qualitative study

“…Other studies also stressed the need for better communication about infection and treatment options in patients treated with antibiotics. 6 7 9 Recently, Twiddy et al showed that many OPAT patients found looking after themselves more difficult than they had expected. 6 Good communication and information by medical staff is needed to create this (self)confidence.…”

“…Previous studies that focused on patient experiences and perceptions showed that the safety of treatment at home is of great importance for OPAT patients. 6–9 Several other factors were found to be important (such as clear communication, coordination and integration of medical care and respect for patient preferences) highly depending on the social and cultural background of patients. Those studies did not systematically assess all domains of patient-centredness.…”