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%)