OPAT in the UK - an overview of service provision
OPAT in the UK - an overview of service provision
OPAT in the UK 2011
WHAT IS OPAT?
Outpatient Parenteral Antibiotic Therapy (OPAT)
• a method for delivering intravenous antibiotics without requirement for inpatient stay
• in the community or outpatient setting
• infections where requirement for IV antimicrobials is only reason for admission to or barrier to discharge from hospital
• has been used in many countries for over 30 years - evidence shows its clinical and cost effectiveness
Models of delivering OPAT
• Ambulatory patient with attendance at health care facility– Hospital clinic/day unit– A+E
• Self or carer administration• Visiting nurse– NHS– private
Examples within greater London
• GSTT– District nurses– Self/carer administration– Pilot community ‘virtual ward’
• UCH– Daily hospital attendance
• SGH– Private healthcare provider
WHY CONDUCT AN AUDIT?
• The implementation of OPAT services within the UK is still in the early stages
• To collect data on OPAT services in the UK -where they may or may not exist
• To assess current barriers to OPAT development and service provision
• The responses from the audit can form the benchmark for future audit
METHODOLOGYContact list derived from:
• A list of current microbiologists within the UK
• Delegate list from a previous OPAT meetings (March 2011 and Dec 2011)
• Contact details of hospitals who have either expressed an interest in or implemented an OPAT database
OR
All responses collected between 3rd November and 9th December 2011
SAMPLEOriginal sample = 193 Trusts and Health Boards
Responses = 127 Trusts and Health Boards (66% of original sample)
Respondents include consultants in Microbiology and Infectious Diseases, Antimicrobial Pharmacists, specialist OPAT nurses.
Response
• 193 centres contacted• 127 responded (66%)
• Total of 296 health care professionals– 166 complete questionnaires– 130 incomplete questionnaires
Does your centre currently have an OPAT service?
10764%
5936%
Yes No
N = 166
OPAT =
Which model(s) of OPAT do you use?
In home by an NHS provider
In home by a private homecare provider
In home by patient/carer
In NHS clinic
In a private clinic
In an intermediate care setting
0 10 20 30 40 50 60 70 80
75
16
43
51
0
19
N = 204
Why have you chosen those particular models?
0
10
20
30
40
50
60 50
26
2
N = 78
Would you like to extend your service?
8586%
1414%
Yes No
N = 99
Which patients would you like to extend to?
AspergillosisBacteraemia / blood stream infection/ Septicaemia
Bacterial meningitisBronchiectasis
CellulitisCystic fibrosis - infective episode
Diabetic foot infection (no osteomyelitis)Discitis/vertebral osteomyelitis - metalwork
Discitis/vertebral osteomyelitis - no metalworkEndocarditis
Intraabdominal abscessLine related infection - systemic
Lyme (Neuro)Osteomyelitis - diabetic footOsteomyelitis - non surgical
Osteomyelitis - surgically relatedOther
Prosthetic joint - kneeProsthetic joint - other
Prosthetic joint- hipRespiratory tract infection - other
Septic arthritisSkin and soft tissue infection
TuberculosisUrinary tract infection
Vascular graft infectionWound Infection - post-surgical
0 10 20 30 40 50 60 70
What are the barriers to extending your current service provision?
Frequency of antibiotics needed
Cost
Business Case Application
Nursing resource
Clinician resource
Lack of understanding
Lack of experience
Lack of buy-in from other departments
0 5 10 15 20 25 30 35 40 45 50
26
21
23
46
43
18
9
24
N = 210
OPAT SOFTWARE
Do you have a database for monitoring patient outcomes?
5157%
3943%
YesNo
N = 90
Which database are you using?
Hospital own database
BSAC database0
10
20
30
40
50
60
49
1
OPAT =
Would you like to develop an OPAT service?
4881%
1119% Yes No
N = 59
What is the main reason for not having an opat service?
No clinici
an re
source
Lack
of nursi
ng reso
urce Cost
Time to
develop th
e business
case
Do not see th
e need
Frequency
of antibiotics
needed0
0.51
1.52
2.53
3.54
4.5
2
1
4
1 1
0
N = 9
All patientsActinomycosis
Bacteraemia / blood stream infection/ SepticaemiaBronchiectasis
CellulitisCerebral abscess
Cystic fibrosis - infective episodeDiabetic foot infection (no osteomyelitis)
Discitis/vertebral osteomyelitis - metalworkDiscitis/vertebral osteomyelitis - no metalwork
EmpyemaEndocarditis
Hepatic abscessIntraabdominal abscess
Line related infection - systemicLyme (Neuro)
MAI (Non-tuberculous mycobacteria)Nocardiosis
Osteomyelitis - diabetic footOsteomyelitis - non surgical
Osteomyelitis - surgically relatedPelvic Abcess
Prosthetic joint - kneeProsthetic joint - other
Prosthetic joint- hipRespiratory tract infection - other
Septic arthritisSkin and soft tissue infection
Urinary tract infectionVascular graft infection
Wound Infection - post-surgical
0 1 2 3 4 5 6 7
Who would you like to develop an OPAT service for?
Which model(s) of OPAT would you consider using?
In home by an NHS provider
In home by a private homecare provider
In home by patient/carer
In NHS clinic
In a private clinic
In an intermediate care setting
0 5 10 15 20 25 30 35 40
38
12
21
37
1
18
N = 127
What are the important considerations when choosing your OPAT model?
Cost
Clinica
l Gove
rnan
ce
Ease of a
dministrati
on
Patient s
atisfa
ction
Training f
or nursi
ng staff
101520253035404550 48
45 43 43 43
N = 222
What stage of development are you currently at?
0
5
10
15
20
25
21 21
4
10
1
N = 48
What are the barriers to moving the process forward?
Business Case Application
Nursing resource
Clinician resource
Lack of understanding
Lack of experience
Lack of buy-in from other departments
0 5 10 15 20 25 30
22
25
26
10
13
13
N = 109
OPAT =
CONCLUSION AND RECOMMENDATIONS
• The majority use an NHS model (62%), many use an ‘In home by patient/carer’ model (21%), and only 8% currently use a private homecare provider
• Only 2 out of 70 claimed their choice of OPAT model was due to the fact they were unaware of alternatives, the majority chose ‘model already exists’ (50), and many said it was the cheapest (26)
• 86% wish to extend there current service
• Biggest barrier to extending = nurse/clinician resource (43%)
• Majority use database (57%), however nearly all uses a hospital version (98%)
OPAT =
CONCLUSION AND RECOMMENDATIONS
• 80% said they would like to develop a service
• The majority claimed the most important reason for not having a service was ‘cost’
• The majority would choose an NHS model (59%), and only 9% would choose a private homecare provider
• When asked about important considerations when choosing models ALL were of similar importance
• Majority at early stages of development (88%), if at all. Very few centres are in the final stages
• Main barrier = nurse/clinician resource (47%) or difficulty forming a business case application (22%)