Background

The enrolment of patients to an outpatient parenteral antimicrobial therapy (OPAT) service can be a means of mitigating financial burdens related to the provision of care and optimisation of hospital bed management.

Objective

This study aimed to identify the clinical benefit of the Maltese OPAT service and to quantify the costs incurred to run it.

Methods

The study period ran for 156 weeks during 1st October 2016 to 1st October 2019. Patient demographics, infection type, referring care team, antimicrobial agent/s used, type of vascular access device (VAD) available and service completion status (defined as provision of care without re-hospitalisation) were recorded. Time allocated for OPAT service delivery and expenses incurred were collected and an activity-based costing exercise was performed.

Results

The patient population who benefited from the service was of 117, 15 of whom used the service twice, for a total of 132 episodes. Patients received 149 antimicrobial treatment courses, with ceftriaxone being the most common single agent used (n = 52, 34.9%). Teicoplanin with ertapenem was the most common regimen selected for combination therapy (n = 9, 52.9%). A total of 23 episodes (17.4%) resulted in a readmission, 6 (30%) of which were because of patient deterioration. The mean service running weekly cost was €455.47/$538.68 and a total of 3287 days of hospital stay were avoided. This effectively illustrates that the OPAT service optimised hospital bed availability without compromising care delivery.

Conclusion

The national OPAT service proved to be a safe and effective alternative for patient management to promote patient-centred care without hospitalisation.

中文翻译：

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门诊胃肠外抗菌治疗服务的临床收益和成本

背景

将患者纳入门诊胃肠外抗菌治疗 (OPAT) 服务可以成为减轻与提供护理和优化病床管理相关的经济负担的一种手段。

客观的

本研究旨在确定马耳他 OPAT 服务的临床益处并量化运行该服务所产生的成本。

方法

研究期从 2016 年 10 月 1 日至 2019 年 10 月 1 日持续 156 周。没有再住院的护理）被记录下来。收集分配给 OPAT 服务交付的时间和发生的费用，并进行基于活动的成本计算。

结果

受益于该服务的患者人数为 117 人，其中 15 人使用该服务两次，共计 132 次。患者接受了 149 个抗菌治疗疗程，头孢曲松是最常用的单一药物（n = 52，34.9%）。替考拉宁联合厄他培南是最常用的联合治疗方案（n = 9, 52.9%）。共有 23 次发作 (17.4%) 导致再次入院，其中 6 次 (30%) 是因为患者病情恶化。每周平均服务费用为 455.47 欧元/538.68 美元，总共避免了 3287 天的住院时间。这有效地说明了 OPAT 服务优化了病床可用性而不影响护理服务。

结论

事实证明，国家 OPAT 服务是一种安全有效的患者管理替代方案，可促进无需住院的以患者为中心的护理。