Clinic- and Hospital-Based Home Care, Outpatient Parenteral Antimicrobial Therapy (OPAT) and the Evolving Clinical Responsibilities of the Pharmacist

Abstract

Clinic- and hospital-based home care describes models of care where services commonly associated with hospital inpatient care are provided at the patient’s home or in an outpatient or community-based clinic. Hospital in the Home (HITH), also termed Hospital at Home (HaH) in parts of Europe and America, is a common and important example of this type of care. Other examples include infusion centers, skilled nursing facilities (particularly in the USA), self-administration models (including home infusion services) and administration through outpatient or community clinics. Different models of HITH care are used internationally and these encompass a wide range of services. Medication administration, particularly outpatient parenteral antimicrobial therapy (OPAT), is an important element in many of these models of care. There is a key role for pharmacists since the provision of medication is integral in this model of patient care outside the hospital setting. Data on the growing importance of HITH and OPAT as well as the administration of medications suited to clinic- and hospital-based home care, including subcutaneous and intramuscular injectables, immunoglobulins and other blood fractions, cancer chemotherapy, total parenteral nutrition, biologicals/biosimilars, vasopressors and enzymes, using differing service models, are described. The pharmacist’s role is evolving from that involved primarily with dose preparation and supply of medications. Their clinical expertise in medication management ensures that they are an integral member and leader in these models of care. Their role ensures the safe and quality use of medicines, particularly across transitions of care, with the pharmacist taking on the roles of educator and consultant to patients and health professional colleagues. Activities such as antimicrobial stewardship and ongoing monitoring of patients and outcomes is fundamental to ensure quality patient outcomes in these settings.

Impact of Pharmacist-Led Implementation of a Community Hospital-Based Outpatient Parenteral Antimicrobial Therapy on Clinical Outcomes in Thailand

“…Theoretically, OPAT is the administration of intravenous antibiotics outside of the acute care hospital setting without intervening hospitalization. However, OPAT is an alternative to inpatient care administered in various settings, including at infusion centers, at home with health care professional services or caregiver(s), or in skilled nursing facilities [ 13 ]. A community hospital is a primary hospital, and more than 700 community hospitals are located across Thailand.…”

“…Pharmacists, as members of an ASP team, can improve antimicrobial use and patient care [ 13 ]. According to The American Society of Health-System Pharmacists (ASHP) guidelines, pharmacists should participate in the process of OPAT patient care, which includes reviewing patient laboratory results, checking drug interactions, monitoring renal function, and following up on patient allergies [ 27 ].…”

“…Pharmacists, as members of ASP teams, could significantly improve patient care in CohPAT. Most notably, pharmacists have demonstrated positive contributions in the areas of clinical monitoring, antimicrobial dosing adjustment, and adverse drug monitoring among patients receiving OPAT and medication reconciliation during care transitions [ 13 ] Pharmacists play an important role in CohPAT, and they may have a positive effect on clinical outcomes.…”

Successful Integration of Clinical Pharmacists in an OPAT Program: A Real-Life Multidisciplinary Circuit

“…In summary, the positive results of including a clinical pharmacist in an OPAT multidisciplinary team can be divided into three categories: (i) intervention in antimicrobial stewardship programs (ASP) to optimize OPAT prescriptions, (ii) pharmacotherapeutic patient follow-up, and (iii) OPAT-specialized pharmacist technical counselling [ 70 , 71 , 72 , 73 ] ( Figure 2 ). The pharmacist’s role in these categories is further developed in the following sections.…”

Impact of a clinical pharmacist on medication safety in mental health Hospital-in-the-Home: a retrospective analysis

“…With the integration of a CP, HiTH can provide important services across a variety of medical specialties, such as infectious diseases, cardiology and respiratory medicine [ 22 – 25 ]. MH-HiTH has evolved in recent times as a “non-traditional” practice setting for CPs.…”