Self-Administration of IV Antibiotics a Viable Option

Researchers at Parkland Health and Hospital System (Dallas, TX, USA) and the University of Texas (UT) Southwestern Medical Center (Dallas, TX, USA) conducted a four-year study involving 1,168 patients. Uninsured patients were enrolled in a self-administered outpatient parenteral antimicrobial therapy (S-OPAT) program, while insured patients received healthcare-administered outpatient parenteral antimicrobial therapy OPAT (H-OPAT). In all, 81% of the patients were managed in the S-OPAT program and 19% by H-OPAT services.

S-OPAT patients were trained through multilingual instruction to self-administer IV antimicrobials by gravity, were tested for competency before discharge, and were thereafter followed at designated intervals. The primary outcome was 30 day all-cause readmission, and the secondary outcome was one year all-cause mortality. Clinical, sociodemographic, and outcome data were collected from the Parkland Hospital electronic medical record (EMR) and the US census, which constituted as a historical prospective cohort.

The results showed that the 30 day readmission rate was 47% lower in the S-OPAT group, while one year mortality rate did not differ significantly between groups. Overall, the S-OPAT program shifted a median 26 days of inpatient IV infusion per patient to the outpatient setting, thus offsetting 27,666 inpatient days, the equivalent of adding 26 inpatient beds. According to the researchers, patient empowerment and engagement in their own health care contributed to a lower rate of readmission among those who self-administered their drugs. The study was published on December 15, 2015, in PLOS Medicine.

“Requiring these patients to be hospitalized for several weeks means loss of personal freedom for the patients and a delay in activities of daily living, such as returning to work and caring for children at home,” said lead author Kavita Bhavan, MD, of Parkland Health. “This really taps into human potential, giving a voice to the uninsured at the same time that it offers an opportunity for enormous cost savings to hospitals.”

Infections such as endocarditis and osteomyelitis may require treatment with IV antibiotics for up to six weeks, or even longer. While insured patients typically have their daily dose of IV antibiotics administered by a healthcare worker in their own home or at a nursing home, it has been standard practice for uninsured patients to remain in hospitalized settings for the entire treatment course.

Related Links:
Parkland Health and Hospital System
University of Texas Southwestern Medical Center