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. 2023 Dec 13:10:20499361231214901.
doi: 10.1177/20499361231214901. eCollection 2023 Jan-Dec.

Best practices, implementation and challenges of outpatient parenteral antimicrobial therapy: results of a worldwide survey among healthcare providers

Moska Hassanzai  1 , Fadime Adanç  2 , Birgit C P Koch  2   3 , Nelianne J Verkaik  4 , Jakob van Oldenrijk  5 , Jorg L de Bruin  6 , Brenda C M de Winter  2   3 , Hein A W van Onzenoort  7   8
Affiliations

Best practices, implementation and challenges of outpatient parenteral antimicrobial therapy: results of a worldwide survey among healthcare providers

Moska Hassanzai et al. Ther Adv Infect Dis. .

Abstract

Background: Outpatient Parenteral Antimicrobial Therapy (OPAT) is considered a patient-friendly and cost-effective practice. Patients in the OPAT service can be at risk for developing adverse events. Due to extensive variations in practice, guidelines have been developed to minimize the risks.

Objectives: In this first worldwide survey on OPAT, we explored the current OPAT services around the world, adherence to recommendations and identified best practices and challenges from different perspectives.

Methods: An e-survey was conducted and consisted of questions about demographics, characteristics of the OPAT service, role of pharmacy, future developments, and respondents' views on improvements as well as best practices.

Results: A total of 126 responses from 28 countries were included. Seventy-eight percent (78%) of the respondents stated that their facility provides antimicrobial therapy in the outpatient setting, whereas 22% did not. Forty-two percent (42%) of the hospitals with OPAT services had a specialized OPAT service, while 14% lacked specialized services and 22% had a partially specialized team in place. In facilities with a specialized OPAT service, the number of mandatory infectious disease (ID) consultations before discharge and clinical monitoring by an ID specialist or OPAT team member, the frequency of monitoring, and the availability of an OPAT registry were higher. A multidisciplinary team's presence was commonly noted as best practices. On the other hand, respondents experienced difficulties with reimbursement and lack of standardization in the screening, follow-up and monitoring of patients.

Conclusion: This survey provides a better understanding of the implementation and practices of OPAT services globally and describes best practices and the challenges from different professionals.

Keywords: OPAT; Outpatient Parenteral Antimicrobial Therapy; antibiotics; infectious diseases; patient safety; survey.

Plain language summary

Best practices, implementation and challenges of outpatient parenteral antimicrobial therapy: results of a worldwide survey among healthcare providers.

Background: Outpatient parenteral antimicrobial therapy (OPAT) is defined as ‘the administration of parenteral antimicrobial therapy in at least 2 doses on different days without intervening hospitalization’National and continental studies show a great proportion of unregulated OPAT services with the implementation of a specialized OPAT team varying extensively.Besides the perspectives of infectious disease specialists, the perspectives of other healthcare workers involved with OPAT is under investigated.

Method: An electronic e-survey was conducted with questions about demographics, characteristics of OPAT service, the role of the pharmacy in OPAT, future developments and best-practices and challenges.

Results: OPAT services have a high global adoption rate of 78%, however only 42% of healthcare facilities offer formal OPAT servicesFacilities with formal OPAT services have higher requirements for infectious disease consultation before discharge, clinical monitoring by an OPAT team member, monitoring frequency, and availability of an OPAT registryBest practices include a multidisciplinary OPAT team and the use of elastomer pumpsCommon challenges in OPAT involve reimbursement issues and lack of standardization in patient screening, follow-up, and monitoring.

Conclusion: This is the first worldwide study exploring the implementation of OPAT services and perspectives of different professionals.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Countries represented by respondents: Argentina (n = 2), Aruba (n = 1), Australia (n = 6), Belgium (n = 34), Canada (n = 2), China (n = 14), Curaçao (n = 1), Denmark (n = 1), Estonia (n = 1), France (n = 2), Germany (n = 1), India (n = 1), Japan (n = 2), Lithuania (n = 1), The Netherlands (n = 10), New Zealand (n = 13), Nigeria (n = 1), Philippines (n = 5), Saudi Arabia (n = 1), Slovenia (n = 1), South Africa (n = 1), Spain (n = 1), Sweden (n = 2), Switzerland (n = 4), The United Kingdom (n = 6), Uruguay (n = 2), and The United States (n = 1). N = 9 were anonymous respondents.
Figure 2.
Figure 2.
Comparison of overall response and response from facilities with specialized OPAT services with a designated team.
See this image and copyright information in PMC

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