Safety and effectiveness of ‘hospital in the home’ and ‘outpatient parenteral antimicrobial therapy’ in different age groups: A systematic review of observational studies

Sriskandarajah, Shanthy; Hobbs, Jodie G; Roughead, Elizabeth E.; Ryan, Melissa; Reynolds, Karen

doi:10.1111/ijcp.13216

Cited by 27 publications

(29 citation statements)

References 58 publications

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“…The growing evidence about the clinical outcomes of OPAT for children2 5 10 has overlooked the perspectives and experiences of children and their parents12 and a mix of methodological issues and the age of the studies limits the utility of this evidence to current practice. The suggested standardised survey for routinely collecting patient/parent satisfaction1 is unlikely to generate the range and depth of experience that will illuminate practice.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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ObjectiveTo better understand the factors that facilitate and hinder a positive experience of paediatric outpatient parenteral antimicrobial therapy (OPAT).DesignQualitative study using semistructured interviews.SettingA dedicated paediatric consultant-led hospital-based, outreach OPAT service in England.ParticipantsParticipants were primarily parents of children who had received OPAT; one child participated.MethodsChildren and parents of children who received OPAT and who had participated in the survey phase of the larger study were invited to be interviewed.Results12 parents (10 mothers and 2 fathers) of 10 children participated; one child (aged 15 years). Data analysis resulted in one meta-theme, ‘At-homeness’ with OPAT, this reflected the overall sense of home being a place in which the children and their parents could be where they wanted to be. Four key themes were identified that reflect the ways in which parents and children experienced being at-home on OPAT: ‘Comfort, security, freedom, and control’; ‘Faith, trust and confidence’; ‘Explanations and communication’ and ‘Concerns, restrictions and inconveniences’.ConclusionsDespite feeling anxious at times, parents reported that they and their children generally had a positive experience of OPAT; being at-home brought many benefits compared with in-patient care. Recommendations arising from the study include a ‘whole-system’ approach to discharge home that includes support related to return to school/nursery, reduction in disruptions to home-based routines, more clarity on choice and preparation for managing potential anxiety, better consideration of dose timing and enhanced preparation and information.

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Section: Discussionmentioning

confidence: 99%

“…Children are most commonly referred to OPAT after a period of hospitalisation, but in some cases directly from the emergency department. Although cure or improvement rates of 88% or above have been recorded for children receiving OPAT,7–9 higher rates of adverse events and readmission are reported in children than adults 10…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…Providing hospital-equivalent care to patients outside the hospital setting is therefore an important consideration for governments and policy makers for healthcare in the future. HITH and OPAT programs are safe [ 11 , 12 , 13 ], cost-effective [ 13 , 14 , 15 , 16 ] and result in positive patient outcomes [ 13 , 15 , 17 , 18 ]. Most patients also report a preference for HITH treatment compared to an inpatient hospital stay [ 13 , 19 , 20 , 21 , 22 ].…”

Section: Why Have Clinic- and Hospital-based Home Care Such As Himentioning

confidence: 99%

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

2020

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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.

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“…The most concerning complications are IV catheter-related infections and thrombophlebitis ( 4 , 5 ). In a systematic review of the literature, adverse event rates associated with vascular access devices ranged from 0 to 29% ( 6 ). In a single-center study evaluating 8,263 patients on OPAT over a 4-year period, 381 (4.6%) had at least one visit to the emergency department within 30 days of imitating OPAT and 104 ED visits (54% of OPAT-related ED visits and 27% of all ED visits) were due to occlusions and dislodgement of the intravenous catheter ( 7 ).…”

Section: Limitations Associated With Intravenous Administration Of Anmentioning

confidence: 99%

Outpatient Subcutaneous Antimicrobial Therapy (OSCAT) as a Measure to Improve the Quality and Efficiency of Healthcare Delivery for Patients With Serious Bacterial Infections

et al. 2020

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Since the 1970s, outpatient parenteral antimicrobial therapy (OPAT) has been a viable option for patients who require intravenous antibiotics when hospitalization is not warranted. While the benefits of OPAT as a measure to improve the efficiency of healthcare delivery (i.e., reduced hospital days) and patient satisfaction are well-documented, OPAT is associated with a number of challenges, including line complications and reliance on daily healthcare interactions in some cases at home or in a clinic. To minimize the continued need for intensive healthcare services in the outpatient setting, there is trend toward patients self-administering antibiotics at home without the presence of healthcare workers, after adequate training. In most cases, patients administer the antibiotics through an established intravenous catheter. While this OPAT practice is becoming more accepted as a standard of care, the potential for line complications still exists. Outpatient subcutaneous antimicrobial therapy (OSCAT) has become an increasingly accepted alternative route of administration of antibiotics to IV by French infectious diseases physicians and geriatricians; however, currently, no antibiotics are approved to be administered subcutaneously. Antibiotics with longer half-lives that are completely absorbed and have a favorable local tolerability profile are ideal candidates for OSCAT and have the potential to maximize the quality and efficiency of parenteral antibiotic delivery in the outpatient setting. The increasing development of wearable, on-body subcutaneous delivery systems make OSCAT even more viable as they increase patient independence while avoiding line complications and potentially removing the need for direct healthcare professional observation.

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Safety and effectiveness of ‘hospital in the home’ and ‘outpatient parenteral antimicrobial therapy’ in different age groups: A systematic review of observational studies

Cited by 27 publications

References 58 publications

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

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

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

Outpatient Subcutaneous Antimicrobial Therapy (OSCAT) as a Measure to Improve the Quality and Efficiency of Healthcare Delivery for Patients With Serious Bacterial Infections

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