FROM PLOS MEDICINE
Uninsured patients can be trained to safely and efficiently self-administer long-term intravenous antibiotics, according to a 4-year outcomes study published in PLOS Medicine.
Between 2010 and 2013, 994 uninsured patients at Parkland Hospital in Dallas were enrolled in a self-administered outpatient parenteral antimicrobial therapy (S-OPAT) program, and 224 insured patients were discharged to a health care–administered OPAT program. Patients in the S-OPAT group were trained to self-administer intravenous antimicrobials, tested for their ability to treat themselves before discharge, and then monitored by weekly visits to the S-OPAT outpatient clinic. The 224 insured patients in the H-OPAT program had antibiotics administered by a health care worker.
A research team led by Dr. Kavita Bhavan of University of Texas Southwestern Medical Center, Dallas, estimated the effect of S-OPAT versus H-OPAT on 30-day all-cause readmission and 1-year all-cause mortality after controlling for selection bias with a propensity score developed using baseline clinical and sociodemographic information collected from the patients.
The 30-day readmission rate was 47% lower in the S-OPAT group than in the H-OPAT group, and the 1-year mortality rate did not differ significantly between the two groups. Because the S-OPAT program resulted in patients spending fewer days having inpatient infusions, 27,666 inpatient days were avoided over the study period.
Thus, S-OPAT was associated with similar or better outcomes than H-OPAT, meaning S-OPAT may be an acceptable model of treatment for uninsured, medically stable patients to complete extended courses of intravenous antimicrobials at home.
Read the full study online at PLOS Medicine ( PLoS Med. 2015 Dec 15;12. doi: 10.1371/journal.pmed.1001922 ).
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