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.
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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[12]. doi: 10.1371/journal.pmed.1001922).
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