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Patient-administered antimicrobial infusions at home may allow shorter hospital stays

PLOS

Patients trained to administer their own intravenous antibiotics at home (self-administered outpatient parenteral antimicrobial therapy or S-OPAT), achieved similar or better outcomes compared to patients who received healthcare-delivered OPAT (H-OPAT) with assistance from a home-care nurse or skilled nursing facility, according to a paper published this week in PLOS Medicine. The study, by Kavita P. Bhavan MD, MHS of the University of Texas Southwestern Medical Center, Dallas, Texas, and colleagues, found that uninsured patients taught to perform S-OPAT had lower rates of hospital readmission and similar rates of mortality when compared with insured patients who received H-OPAT.

The research was performed at Parkland Hospital, a safety-net hospital serving Dallas County, Texas. The study included 944 uninsured patients who received care in the S-OPAT program, which included training and weekly monitoring in an outpatient clinic, but who administered their antimicrobials on their own at home. The program also analyzed 224 insured patients who were discharged to receive H-OPAT services. Bhavan and colleagues found the rate of hospital readmission within 30 days was 16.7% in the S-OPAT group, compared to 23.7% in the H-OPAT group. When the researchers used a propensity score to take into account preexisting differences between patients in the two programs and adjusted for several confounding factors, they calculated the risk of readmission for S-OPAT patients to be about half that of H-OPAT patients. They also found the risk of dying within one year of hospital discharge did not differ significantly between the two groups, though the study did not include enough patients to be able to detect a small difference in mortality between groups. The authors note that despite the propensity score levelling and adjustment for known confounders, these results may still be affected by unmeasured differences between the two patient groups, and a randomized controlled trial would be required to determine whether S-OPAT actually improves outcomes compared to H-OPAT.

Nevertheless, these findings suggest that S-OPAT may allow medically stable patients to administer their own intravenous antibiotics safely at home, shortening their hospital stays and making hospital beds available for other patients with more intensive needs. In this study S-OPAT was estimated to have averted a median of 26 inpatient days per patient, and a total of 27,666 days over the 4 years of the study.

The authors say that their findings "have important implications for healthcare financing agencies and for improving resource utilization in safety-net hospitals and other resource-limited settings that care for uninsured patients."

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Research Article

Funding:

The authors received no specific funding for this work.

Competing Interests:

The authors have declared that no competing interests exist.

Citation:

Bhavan KP, Brown LS, Haley RW (2015) Self-Administered Outpatient Antimicrobial Infusion by Uninsured Patients Discharged from a Safety-Net Hospital: A Propensity-Score-Balanced Retrospective Cohort Study. PLoS Med 12(12): e1001922. doi:10.1371/journal.pmed.1001922

Author Affiliations:

Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Center, Dallas, Texas, United States of America

Parkland Health and Hospital System, Dallas, Texas, United States of America

Division of Epidemiology, Department of Internal Medicine, University of Texas Medical Center, Dallas, Texas, United States of America

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001922

Contact:

Kavita P. Bhavan MD, MHS
UT Southwestern Medical Center
Department of Internal Medicine
5323 Harry Hines Blvd
Dallas, TX 75390-9113
UNITED STATES
314-413-8846
kavita.bhavan@utsouthwestern.edu

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