Honey Grace R.

Francisco

Patient administered antimicrobial infusions at home may allow shorter

hospital stays
Published: Wednesday 16 December 2015

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 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 HOPAT.
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."