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Sociodemographic and clinical factors associated with acceptance of outpatient parenteral antibiotic therapy in a Singapore tertiary hospital from 2014 to 2017

  • Liang En WeeEmail author
  • Mangaikarasi Sundarajoo
  • Way-Fang Quah
  • Ahmad Farhati
  • Jie-ying Huang
  • Ying-Ying Chua
Original Article
  • 31 Downloads

Abstract

Outpatient parenteral antibiotic therapy (OPAT) can facilitate early discharge; however, not all offered OPAT can accept. We assessed factors associated with acceptance of OPAT in a large Asian tertiary hospital cohort. From 2014 to 2017, we reviewed all referrals to Singapore General Hospital’s (SGH) Outpatient Parenteral Antibiotic Therapy (OPAT) service. We compared differences in sociodemographic and clinical factors between patients who opted for OPAT and those who declined, using chi-square test for univariate analysis and logistic regression for multivariate analysis. From 2014 to 2017, a total of 1406 OPAT referrals were made. Of these, 95.9% (1349/1406) were deemed suitable for OPAT. Amongst those suitable, 90.0% (1213/1349) accepted OPAT treatment. On multivariate analysis, being independently ambulant (aOR = 3.46, 95%CI = 2.21–5.37) was independently associated with higher odds of acceptance for OPAT; whereas, patients with peripheral vascular disease had lower odds of accepting OPAT (aOR = 0.32, 95%CI = 0.16–0.62). Lower socioeconomic status (SES) was closely associated with rejection of OPAT, with markers of both individual-level SES (subsidized ward class) and area-level SES (staying in a public rental flat) being independently associated with lower odds of OPAT preference. Distance and travel time were not associated with OPAT acceptance. The top reasons for rejecting OPAT were lack of caregiver (n = 35), mobility issues (n = 24), financial issues (n = 24), and difficulty caring for the line (n = 21). Comorbidities, mobility, and financial issues are important factors to consider when determining suitability for OPAT. More can be done to improve accessibility of OPAT amongst lower-income patients and those staying in lower-SES areas.

Keywords

Outpatient parenteral antibiotic therapy Socioeconomic Acceptability 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

This study involved human participants and was approved by the Singhealth Institutional Review Board (IRB) (approval number: CIRB 2014/151/F). Approval for retrospective analysis of patient data was obtained from the Singhealth IRB.

Informed consent

Waiver of informed consent for retrospective analysis of patient data was obtained from the Singhealth IRB.

References

  1. 1.
    Psaltikidis E, Silva E, Bustorff-Silva J, Moretti M, Resende M (2017) Economic evaluation of outpatient parenteral antimicrobial therapy: a systematic review. Expert Rev Pharmacoecon Outcomes Res 17(4):355–375CrossRefGoogle Scholar
  2. 2.
    MacKenzie M, Rae N, Nathwani D (2014) Outcomes from global adult outpatient parenteral antimicrobial therapy programmes: a review of the last decade. Int J Antimicrob Agents 43(1):7–16CrossRefGoogle Scholar
  3. 3.
    Mitchell E, Czoski MC, Meads D, Minton J, Wright J, Twiddy M (2017) Clinical and cost-effectiveness, safety and acceptability of community intravenous antibiotic service models: CIVAS systematic review. BMJ Open 7(4):e013560CrossRefGoogle Scholar
  4. 4.
    Conant M, Erdman S, Osterholzer D (2014) Mandatory infectious diseases approval of outpatient parenteral antimicrobial therapy (OPAT): clinical and economic outcomes of averted cases. J Antimicrob Chemother 69(6):1695–1700CrossRefGoogle Scholar
  5. 5.
    Heintz B, Halilovic J, Christensen C (2011) Impact of a multidisciplinary team review of potential outpatient parenteral antimicrobial therapy prior to discharge from an academic medical center. Ann Pharmacother 45(11):1329–1337CrossRefGoogle Scholar
  6. 6.
    Fisher D, Michaels J, Hase R, Zhang J, Kataria S, Sim B et al (2017) Outpatient parenteral antibiotic therapy (OPAT) in Asia: missing an opportunity. J Antimicrob Chemother 72(4):1221–1226Google Scholar
  7. 7.
    Fisher D (2017) OPAT in Asia. Int J Antimicrob Agents 50(S2):10–28Google Scholar
  8. 8.
    Chan M, Ooi C, Wong J, Zhong L, Lye D (2017) Role of outpatient parenteral antibiotic therapy in the treatment of community acquired skin and soft tissue infections in Singapore. BMC Infect Dis 17(1):474CrossRefGoogle Scholar
  9. 9.
    Fisher D, Kurup A, Lye D, Tambyah P, Sulaiman Z, Poon E et al (2006) Outpatient parenteral antibiotic therapy in Singapore. Int J Antimicrob Agents 28(6):545–560CrossRefGoogle Scholar
  10. 10.
    Yong C, Fisher D, Sklar G, Li S (2009) A cost analysis of outpatient parenteral antibiotic therapy (OPAT): an Asian perspective. Int J Antimicrob Agents 33(1):46–51CrossRefGoogle Scholar
  11. 11.
    Trad M, Zhong L, Llorin R, Tan S, Chan M, Archuleta S et al (2017) Ertapenem in outpatient parenteral antimicrobial therapy for complicated urinary tract infections. J Chemother 29(1):25–29CrossRefGoogle Scholar
  12. 12.
    Ingram P, Sulaiman Z, Chua A, Fisher D (2007) Comment on: outpatient parenteral antibiotic therapy (OPAT): is it safe for selected patients to self-administer at home? A retrospective analysis of a large cohort over 13 years. J Antimicrob Chemother 61(1):226–227CrossRefGoogle Scholar
  13. 13.
    Seetoh T, Lye D, Cook A, Archuleta S, Chan M, Sulaiman Z et al (2013) An outcomes analysis of outpatient parenteral antibiotic therapy (OPAT) in a large Asian cohort. Int J Antimicrob Agents 41(6):569–573CrossRefGoogle Scholar
  14. 14.
    Matthews P, Conlon C, Berendt A, Kayley J, Jefferies L, Atkins B et al (2007) Outpatient parenteral antimicrobial therapy (OPAT): is it safe for selected patients to self-administer at home? A retrospective analysis of a large cohort over 13 years. J Antimicrob Chemother 60(2):356–362CrossRefGoogle Scholar
  15. 15.
    Lim M (2005) Transforming Singapore health care: public-private partnership. Ann Acad Med Singap 34(7):461–467Google Scholar
  16. 16.
    von Eiff W, Massoro T, Voo Y, Ziegenbein R (2002) Medical savings accounts: a core feature of Singapore's health care system. Eur J Health Econ 3(3):188–195CrossRefGoogle Scholar
  17. 17.
    Ministry of Health S. Medisave Withdrawal Limits Singapore: Government of Singapore; 2017 [Available from: https://www.moh.gov.sg/content/moh_web/home/costs_and_financing/schemes_subsidies/medisave/Withdrawal_Limits.html
  18. 18.
    Chan C, Lee K, Low L (2018) A systematic review of health status, health seeking behaviour and healthcare utilisation of low socioeconomic status populations in urban Singapore. Int J Equity Health 17(1):39CrossRefGoogle Scholar
  19. 19.
    Ingram PR, Sulaiman Z, Chua A, Fisher DA (2008) Comment on: Outpatient parenteral antibiotic therapy (OPAT): is it safe for selected patients to self-administer at home? A retrospective analysis of a large cohort over 13 years. J Antimicrob Chemother 61(1):226–227CrossRefGoogle Scholar
  20. 20.
    OneMap. OneMap Singapore: Introduction Singapore: OneMap Singapore; 2017 [Available from: https://docs.onemap.sg/#introduction
  21. 21.
    Gilchrist M, Franklin B, Patel J (2008) An outpatient parenteral antibiotic therapy (OPAT) map to identify risks associated with an OPAT service. J Antimicrob Chemother 62(1):177–183CrossRefGoogle Scholar
  22. 22.
    Nolet B (1998) Patient selection in outpatient parenteral antimicrobial therapy. Infect Dis Clin N Am 12(4):835–847CrossRefGoogle Scholar
  23. 23.
    Hodgson K, Huynh J, Ibrahim L, Sacks B, Golshevsky D, Layley M et al (2016) The use, appropriateness and outcomes of outpatient parenteral antimicrobial therapy. Arch Dis Child 101(10):886–893CrossRefGoogle Scholar
  24. 24.
    Subedi S, Looke D, McDougall D, Sehu M, Playford E (2015) Supervised self-administration of outpatient parenteral antibiotic therapy: a report from a large tertiary hospital in Australia. Int J Infect Dis 30:161–165CrossRefGoogle Scholar
  25. 25.
    Mirón-Rubio M, González-Ramallo V, Estrada-Cuxart O, Sanroma-Mendizábal P, Segado-Soriano A, Mujal-Martínez A et al (2016) Intravenous antimicrobial therapy in the hospital-at-home setting: data from the Spanish outpatient parenteral antimicrobial therapy registry. Future Microbiol 11(3):375–390CrossRefGoogle Scholar
  26. 26.
    Low L, Vasanwala F, Ng L, Chen C, Lee K, Tan S (2015) Effectiveness of a transitional home care program in reducing acute hospital utilization: a quasi-experimental study. BMC Health Serv Res 15(100)Google Scholar
  27. 27.
    Low L, Tan S, Ng M, Tay W, Ng L, Balasubramaniam K et al (2017) Applying the integrated practice unit concept to a modified virtual ward model of care for patients at highest risk of readmission: a randomized controlled trial. PLoS One 12(1):e0168757CrossRefGoogle Scholar
  28. 28.
    Department of Statistics Singapore. Home Ownership Rate of Resident Households 2015 [updated 2015. Available from: http://www.singstat.gov.sg/statistics/visualising-data/charts/home-ownership-rate-of-resident-households
  29. 29.
    Housing & Development Board Singapore. Rents & Deposits 2013 [updated 15 May 2013. Available from: http://www.hdb.gov.sg/fi10/fi10323p.nsf/w/RentDirectHDBRentDeposit?OpenDocument
  30. 30.
    Wee L, Koh G, Yeo W, Chin R, Wong J, Seow B (2013) Screening for cardiovascular disease risk factors in an urban low-income setting at baseline and post intervention: a prospective intervention study. Eur J Prev Cardiol 20(1):176–188CrossRefGoogle Scholar
  31. 31.
    Wee L, Koh G, Chin R, Yeo W, Seow B, Chua D (2012) Socioeconomic factors affecting colorectal, breast and cervical cancer screening in an Asian urban low-income setting at baseline and post-intervention. Prev Med 55(1):61–67CrossRefGoogle Scholar
  32. 32.
    Ministry of Health S. Extending the use of Medisave. Singapore.: Government of Singapore. 2002 [Available from: https://www.moh.gov.sg/content/moh_web/home/pressRoom/pressRoomItemRelease/2002/extending_the_use_of_medisave.html
  33. 33.
    Ministry of Health S. Healthcare cost inflation Singapore: Government of Singapore. 2018 [Available from: https://www.moh.gov.sg/content/moh_web/home/pressRoom/Parliamentary_QA/2018/healthcare-cost-inflation-.html
  34. 34.
    Ministry of Health S. Medisave uses and withdrawa. 2017Google Scholar
  35. 35.
    Lim A. New Flexi-Medisave scheme: what it can and cannot be used for. Straits Times. 2015 Jan 12th 2015Google Scholar
  36. 36.
    Nolet B (2010) Update and overview of outpatient parenteral antimicrobial therapy regulations and reimbursement. Clinical Infect Dis 51(S2):S216–S219CrossRefGoogle Scholar
  37. 37.
    Marra C, Frighetto L, Goodfellow A, Wai A, Chase M, Nicol R et al (2005) Willingness to pay to assess patient preferences for therapy in a Canadian setting. BMC Health Serv Res 7(5):43CrossRefGoogle Scholar
  38. 38.
    Joynt Maddox K, Orav E, Zheng J, Epstein A (2018) Evaluation of Medicare’s bundled payments initiative for medical conditions. N Engl J Med 379(3):260–269CrossRefGoogle Scholar
  39. 39.
    Madaline T, Nori P, Mowrey W, Zukowski E, Gohil S, Sarwar U et al (2017) Bundle in the Bronx: impact of a transition-of-care outpatient parenteral antibiotic therapy bundle on all-cause 30-day hospital readmissions. Open Forum Infect Dis 4(2) ofx097Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Adjunct Research FellowDuke-NUS Graduate Medical SchoolSingaporeSingapore
  2. 2.Department of Infectious DiseasesSingapore General HospitalSingaporeSingapore

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