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Mohammed SA, Cotta MO, Assefa GM, Erku D, Sime F. Barriers and facilitators for the implementation and expansion of outpatient parenteral antimicrobial therapy: a systematic review. J Hosp Infect 2024; 147:1-16. [PMID: 38423135 DOI: 10.1016/j.jhin.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) has been expanding in recent years and serves as a viable solution in reducing the shortage of hospital beds. However, the wider implementation of OPAT faces numerous challenges. This review aimed to assess implementation barriers and facilitators of OPAT services. Studies describing barriers and facilitators of the OPAT service were retrieved from PubMed, Scopus, MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Science Proceedings, International Pharmaceutical Abstracts and PsycINFO. All types of study designs published in the English language were included. Studies that did not mention any barrier or facilitator, did not differentiate OPAT and inpatient, focused on specific antimicrobials or diseases, and made no distinction between parenteral and other treatments were excluded. Qualitative analysis was performed using the 'best-fit' framework approach and the Consolidated Framework for Implementation Research (CFIR). The review was PROSPERO registered (CRD42023441083). A total of 8761 studies were screened for eligibility and 147 studies were included. Problems in patient selection, lack of awareness, poor communication and co-ordination, lack of support, lack of structured service and inappropriate prescriptions were identified. OPAT provides safe, effective and efficient treatment while maintaining patients' privacy and comfort, resulting in less daily life disruption, and reducing the risk of infection. Satisfaction and preference for OPAT were very high. Initiatives in strengthening OPAT such as antimicrobial stewardship and telemedicine are beneficial. Challenges to and facilitators of OPAT were identified among patients, health professionals, OPAT service providers and healthcare administrators. Understanding them is crucial to designing targeted initiatives for successful OPAT service implementation.
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Affiliation(s)
- S A Mohammed
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Department of Pharmacy, Wollo University, Dessie, Ethiopia
| | - M O Cotta
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Australia
| | - G M Assefa
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Department of Pharmacy, Wollo University, Dessie, Ethiopia
| | - D Erku
- Centre for Applied Health Economics, Griffith University, Nathan, Australia
| | - F Sime
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia.
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Scopazzini MS, Cave RNR, Mutch CP, Ross DA, Bularga A, Chase-Topping M, Woolhouse M, Koch O, Perry MR, Mackintosh CL. Scottish Index of Multiple Deprivation (SIMD) indicators as predictors of mortality among patients hospitalised with COVID-19 disease in the Lothian Region, Scotland during the first wave: a cohort study. Int J Equity Health 2023; 22:205. [PMID: 37794428 PMCID: PMC10552319 DOI: 10.1186/s12939-023-02017-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 09/18/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Sars-CoV-2, the causative agent of COVID-19, has led to more than 226,000 deaths in the UK and multiple risk factors for mortality including age, sex and deprivation have been identified. This study aimed to identify which individual indicators of the Scottish Index of Multiple Deprivation (SIMD), an area-based deprivation index, were predictive of mortality. METHODS This was a prospective cohort study of anonymised electronic health records of 710 consecutive patients hospitalised with Covid-19 disease between March and June 2020 in the Lothian Region of Southeast Scotland. Data sources included automatically extracted data from national electronic platforms and manually extracted data from individual admission records. Exposure variables of interest were SIMD quintiles and 12 indicators of deprivation deemed clinically relevant selected from the SIMD. Our primary outcome was mortality. Age and sex adjusted univariable and multivariable analyses were used to determine measures of association between exposures of interest and the primary outcome. RESULTS After adjusting for age and sex, we found an increased risk of mortality in the more deprived SIMD quintiles 1 and 3 (OR 1.75, CI 0.99-3.08, p = 0.053 and OR 2.17, CI 1.22-3.86, p = 0.009, respectively), but this association was not upheld in our multivariable model containing age, sex, Performance Status and clinical parameters of severity at admission. Of the 12 pre-selected indicators of deprivation, two were associated with greater mortality in our multivariable analysis: income deprivation rate categorised by quartile (Q4 (most deprived): 2.11 (1.20-3.77) p = 0.011)) and greater than expected hospitalisations due to alcohol per SIMD data zone (1.96 (1.28-3.00) p = 0.002)). CONCLUSIONS SIMD as an aggregate measure of deprivation was not predictive of mortality in our cohort when other exposure measures were accounted for. However, we identified a two-fold increased risk of mortality in patients residing in areas with greater income-deprivation and/or number of hospitalisations due to alcohol. In areas where aggregate measures fail to capture pockets of deprivation, exploring the impact of specific SIMD indicators may be helpful in targeting resources to residents at risk of poorer outcomes from Covid-19.
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Affiliation(s)
- Marcello S Scopazzini
- Clinical Infection Research Group, NHS Lothian Infection Service, Western General Hospital, Edinburgh, UK.
- London School of Hygiene and Tropical Medicine, London, UK.
| | | | - Callum P Mutch
- Clinical Infection Research Group, NHS Lothian Infection Service, Western General Hospital, Edinburgh, UK
| | - Daniella A Ross
- Clinical Infection Research Group, NHS Lothian Infection Service, Western General Hospital, Edinburgh, UK
| | - Anda Bularga
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Margo Chase-Topping
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | | | - Oliver Koch
- Clinical Infection Research Group, NHS Lothian Infection Service, Western General Hospital, Edinburgh, UK
| | - Meghan R Perry
- Clinical Infection Research Group, NHS Lothian Infection Service, Western General Hospital, Edinburgh, UK
| | - Claire L Mackintosh
- Clinical Infection Research Group, NHS Lothian Infection Service, Western General Hospital, Edinburgh, UK
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Walpole SC, Eii MN, Lyons T, Aldridge C. Improving Antimicrobial Use to Protect the Environment: What Is the Role of Infection Specialists? Antibiotics (Basel) 2023; 12:antibiotics12040640. [PMID: 37107002 PMCID: PMC10134973 DOI: 10.3390/antibiotics12040640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
Anthropogenic environmental changes are causing severe damage to the natural and social systems on which human health depends. The environmental impacts of the manufacture, use, and disposal of antimicrobials cannot be underestimated. This article explores the meaning of environmental sustainability and four sustainability principles (prevention, patient engagement, lean service delivery, and low carbon alternatives) that infection specialists can apply to support environmental sustainability in health systems. To prevent inappropriate use of antimicrobials and consequent antimicrobial resistance (AMR) requires international, national, and local surveillance plans and action supporting antimicrobial stewardship (AMS). Engaging patients in addressing environmental sustainability, for example through public awareness campaigns about the appropriate disposal of unused and expired antimicrobials, could drive environmentally sustainable changes. Streamlining service delivery may include using innovative methods such as C-reactive protein (CRP), procalcitonin (PCT), or genotype-guided point of care testing (POCT) to reduce unnecessary antimicrobial prescribing and risk of adverse effects. Infection specialists can assess and advise on lower carbon alternatives such as choosing oral (PO) over intravenous (IV) antimicrobials where clinically appropriate. By applying sustainability principles, infection specialists can promote the effective use of healthcare resources, improve care quality, protect the environment, and prevent harm to current and future generations.
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Affiliation(s)
- Sarah Catherine Walpole
- Newcastle University, Newcastle upon Tyne NE1 7RU, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - Min Na Eii
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland SR4 7TP, UK
| | - Tracy Lyons
- NHS Dorset Integrated Care Board, Bournemouth BH12 5AG, UK
| | - Catherine Aldridge
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
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Tan KK, Hino G, Zhou AY, Al-Fayiz H, Rodriguez S, Abdul-Mutakabbir JC. Identifying the potential impact of a multidisciplinary outpatient antimicrobial therapy program in an area of high social vulnerability. Ther Adv Infect Dis 2023; 10:20499361231194257. [PMID: 37636217 PMCID: PMC10460041 DOI: 10.1177/20499361231194257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Background Outpatient parenteral antimicrobial therapy (OPAT) and complex outpatient antimicrobial therapy (COpAT) are common practice in the management of infectious diseases (IDs). However, providing OPAT/COpAT can pose significant challenges pre- and post-discharge, particularly in vulnerable patient populations. Objectives The objective of this study is to assess outpatient complications related to OPAT/COpAT in patients discharged with a home health services referral and to identify pre- and post-discharge intervention opportunities and the associated cost-savings that could be achieved with a multidisciplinary ID team-run OPAT/COpAT program. Design/methods This is a retrospective cohort study of patients who were discharged with OPAT/COpAT through home health services over a 3-month study period. Data on potential pre-discharge interventions and post-discharge complications were recorded. Results Medication-related issues were the most common pre-discharge complications, accounting for more than 50% of identified intervention opportunities. More than half of the included patients experienced at least one documented outpatient complication post-discharge with peripherally inserted central catheter-line-related complication (20.7%) being the most common issue. Using previously published cost-estimates, the implementation of a designated pre- and post-discharge OPAT/COpAT program could have saved over $100,000 over the 3-month study period. Conclusion A multidisciplinary OPAT/COpAT program located in a high social vulnerable area can help reduce complications related to a patient's antimicrobial therapy. Medication-related issues represent a major area for potential intervention. Our findings suggest that a multidisciplinary ID team will have ample opportunities to improve the transition of care, at both pre- and post-discharge, for patients requiring antimicrobial therapy.
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Affiliation(s)
- Karen K. Tan
- Department of Pharmacy, Loma Linda University Medical Center, 24745 Stewart Street, Loma Linda, CA 92354, USA
- Loma Linda University School of Pharmacy, Loma Linda, CA, USA
| | - Garret Hino
- Department of Pharmacy, Loma Linda University Medical Center, Loma Linda, CA, USA
- Loma Linda University School of Pharmacy, Loma Linda, CA, USA
| | - Anna Y. Zhou
- Department of Pharmacy, Loma Linda University Medical Center, Loma Linda, CA, USA
- Loma Linda University School of Pharmacy, Loma Linda, CA, USA
| | - Hadeel Al-Fayiz
- Loma Linda University School of Pharmacy, Loma Linda, CA, USA
| | - Sasha Rodriguez
- Loma Linda University School of Pharmacy, Loma Linda, CA, USA
| | - Jacinda C. Abdul-Mutakabbir
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
- Division of the Black Diaspora and African American Studies, University of California San Diego, La Jolla, CA, USA
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Emilie C, De Nocker P, Saïdani N, Gilchrist M, Seaton RA, Patel S, Beraud G, Kofteridis D, Schouten J, Thilly N, Berrevoets M, Hulscher M, Buyle F, Pulcini C. Survey of delivery of parenteral antimicrobials in non-inpatient settings across Europe. Int J Antimicrob Agents 2022; 59:106559. [DOI: 10.1016/j.ijantimicag.2022.106559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 01/23/2022] [Accepted: 02/20/2022] [Indexed: 11/05/2022]
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