Skip to main content

Health-related quality of life and its association with outcomes of outpatient parenteral antibiotic therapy

European Journal of Clinical Microbiology & Infectious Diseases volume 39, pages 765–772 (2020)Cite this article

Abstract

While health-related quality of life (HRQoL) is an important component of patient-centred care, few studies have looked at the association between HRQoL and outcomes while on OPAT. From 2014 to 2017, we conducted a prospective cohort study of all patients referred to Singapore General Hospital’s (SGH) OPAT service. At baseline, we collected sociodemographic, clinical, and treatment-related factors for OPAT recipients. We also measured baseline HRQoL using the EuroQoL EQ5D-3 L. We evaluated the association between HRQoL and the following outcomes: complications experienced while on OPAT, early termination requiring readmission during planned course of OPAT, all-cause readmission 30 days after completion of OPAT, and return to work while on OPAT. We used chi-squared test for univariate analysis and cox regression for multivariate analysis. From 2014 to 2017, 1213 patients received OPAT at our centre. Of those, 13.2% (160/1213) developed complications. About 10% (132/1213) of patients were readmitted while on OPAT and OPAT was terminated early. Amongst patients who completed OPAT (N = 1081), about 3.6% (39/1081) were readmitted within 30 days after OPAT completion. About half (50.8%, 278/547) returned to work while on OPAT. On multivariate analysis, patients with perfect health-related quality of life (HRQoL) (adjusted relative risk, aRR = 0.62, 95%CI = 0.45–0.85) were less likely to experience complications, had lower risk of OPAT termination (aRR = 0.57, 95%0.38–0.86), and were more likely to return to work while on OPAT (aRR = 1.94, 95%CI = 1.30–2.89). HRQoL at baseline was significantly associated with lower risk of complications and early OPAT termination, as well as greater likelihood of return to work while on OPAT.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Storck A, Laupland K, Read R, Mah M, Gill J, Nevett D et al (2006) Development of a health-related quality of life questionnaire (HRQL) for patients with extremity soft tissue infections (ESTI). BMC Infect Dis 6:148

    Article  Google Scholar 

  2. Lerner R, Esterhai JJ, Polomono R, Cheatle M, Heppenstall R, Brighton C (1991) Psychosocial, functional, and quality of life assessment of patients with posttraumatic fracture nonunion, chronic refractory osteomyelitis, and lower extremity amputation. Arch Phys Med Rehabil 72(2):122–126

    CAS  PubMed  Google Scholar 

  3. Verhagen D, Hermanides J, Korevaar J, Bossuyt P, van den Brink R, Speelman P et al (2009) Health-related quality of life and posttraumatic stress disorder among survivors of left-sided native valve endocarditis. Clinical Infect Dis. 48(11):1559–1565

    Article  Google Scholar 

  4. Zhang K, Mao X, Fang Q, Jin Y, Cheng B, Xie G et al (2013) Impaired long-term quality of life in survivors of severe sepsis: Chinese multicenter study over 6 years. Anaesthesist. 62(12):995–1002

    CAS  Article  Google Scholar 

  5. Dalager-Pedersen M, Thomsen R, Schønheyder H, Nielsen H (2016) Functional status and quality of life after community-acquired bacteraemia: a matched cohort study. Clin Microbiol Infect 22(1):1–8

    Article  Google Scholar 

  6. Dalager-Pedersen M, Koch K, Thomsen R, Schønheyder H, Nielsen H (2014) The effect of community-acquired bacteraemia on return to workforce, risk of sick leave, permanent disability pension and death: a Danish population-based cohort study. BMJ Open 4(1):e004208

    Article  Google Scholar 

  7. 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):355–375

    Article  Google Scholar 

  8. 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):7–16

    CAS  Article  Google Scholar 

  9. Mitchell E, C Czoski M, 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):e013560

    CAS  Article  Google Scholar 

  10. Goodfellow A, Wai A, Frighetto L, Marra C, Ferreira B, Chase M et al (2002) Quality-of-life assessment in an outpatient parenteral antibiotic program. Ann Pharmacother 36(12):1851–1855

    Article  Google Scholar 

  11. 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):1221–1226

    CAS  PubMed  Google Scholar 

  12. 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):46–51

    CAS  Article  Google Scholar 

  13. 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):474

    Article  Google Scholar 

  14. 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):545–560

    CAS  Article  Google Scholar 

  15. 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):569–573

    CAS  Article  Google Scholar 

  16. 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):39

    Article  Google Scholar 

  17. Luo N, Chew L, Fong K, Koh D, Ng S, Yoon K et al (2003) Validity and reliability of the EQ-5D self-report questionnaire in English-speaking Asian patients with rheumatic diseases in Singapore. Qual Life Res 12:87–92

    CAS  Article  Google Scholar 

  18. Luo N, Chew L, Fong K, Koh D, Ng S, Yoon K et al (2003) Validity and reliability of the EQ-5D self-report questionnaire in Chinese-speaking patients with rheumatic diseases in Singapore. Ann Acad Med Singap 32:685–690

    CAS  PubMed  Google Scholar 

  19. Wee H, Loke W, Li S, Fong K, Cheung Y, Machin D et al (2007) Cross-cultural adaptation and validation of Singapore Malay and Tamil versions of the EQ-5D. Ann Acad Med Singap 36:403–408

    PubMed  Google Scholar 

  20. Huang V, Ruhe J, Lerner P, Fedorenko M (2018) Risk factors for readmission in patients discharged with outpatient parenteral antimicrobial therapy: a retrospective cohort study. BMC Pharmacol Toxicol 19(1):50

    Article  Google Scholar 

  21. Allison G, Muldoon E, Kent D, Paulus J, Ruthazer R, Ren A et al (2014) Prediction model for 30-day hospital readmissions among patients discharged receiving outpatient parenteral antibiotic therapy. Clinical Infect Dis 58:812–819

    CAS  Article  Google Scholar 

  22. Means L, Bleasdale S, Sikka M, Gross A (2016) Predictors of hospital readmission in patients receiving outpatient parenteral antimicrobial therapy. Pharmacotherapy. 36:934–939

    Article  Google Scholar 

  23. Marie Y, Marion E, Andrew E, Daneman N (2016) Patient characteristics and outcomes of outpatient parenteral antimicrobial therapy: a retrospective study. Can J Infect Dis Med Microbiol:1–5

  24. Keller S, Williams D, Gavgani M, Hirsch D, Adamovich J, Hohl D et al (2018) Rates of and risk factors for adverse drug events in outpatient parenteral antimicrobial therapy. Clin Infect Dis 66(1):11–19

    CAS  Article  Google Scholar 

  25. Felder K, Marshall L, Vaz L, Barnes P (2016) Risk factors for complications during outpatient parenteral antimicrobial therapy for adult orthopedic and neurosurgical infections. South Med J 109(1):53–60

    CAS  Article  Google Scholar 

  26. Kehrer M, Hallas J, Bælum J, Jensen T, Pedersen C, Lassen A (2017) Reduced ability to work both before and after infectious spondylodiscitis in working-age patients. Infect Dis (Lond) 49(2):95–103

    Article  Google Scholar 

  27. Durojaiye O, Bell H, Andrews D, Ntziora F, Cartwright K (2018) Clinical efficacy, cost analysis and patient acceptability of outpatient parenteral antibiotic therapy (OPAT): a decade of Sheffield (UK) OPAT service. Int J Antimicrob Agents 51(1):26–32

    CAS  Article  Google Scholar 

  28. Saillen L, Arensdorff L, Moulin E, Voumard R, Cochet C, Boillat-Blanco N et al (2017) Patient satisfaction in an outpatient parenteral antimicrobial therapy (OPAT) unit practising predominantly self-administration of antibiotics with elastomeric pumps. Eur J Clin Microbiol Infect Dis 36(8):1387–1392

    CAS  Article  Google Scholar 

  29. Wee L, Daniel P, Sim A, Lee R, Tay S, Luo N et al (2018) Health-related quality of life in a low-socioeconomic status public rental-flat population in Singapore. Appl Res Qual Life 13:179–195

    Article  Google Scholar 

  30. Bouwman L, Eeltink C, Visser O, Janssen J, Maaskant J (2017) Prevalence and associated factors of medication non-adherence in hematological-oncological patients in their home situation. BMC Cancer 17(1):739

    Article  Google Scholar 

  31. Twiddy M, Czoski Murray C, Mason S, Meads D, Wright J, Mitchell E et al (2018) A qualitative study of patients’ feedback about outpatient parenteral antimicrobial therapy (OPAT) services in Northern England: implications for service improvement. BMJ Open 10(8):e019099

    Article  Google Scholar 

  32. Pham Q, Li S, Williams B (2016) Risk factors and effects of care management on hospital readmissions among high users at an Academic Medical Center. Care Manag J 17(3):134–139

    Article  Google Scholar 

  33. Janssen M, Bonsel G, Luo N (2018) Is EQ-5D-5L better than EQ-5D-3L? A head-to-head comparison of descriptive systems and value sets from seven countries. Pharmacoeconomics. 36(6):675–697

    Article  Google Scholar 

Download references

Funding

This study was not grant-funded.

Author information

Affiliations

  1. Duke-NUS Graduate Medical School, Singapore, Singapore

    Liang En Wee

  2. Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore

    Liang En Wee, Mangaikarasi Sundarajoo, Way-Fang Quah, Ahmad Farhati, Jie-ying Huang & Ying-Ying Chua

Authors
  1. Liang En Wee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mangaikarasi Sundarajoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Way-Fang Quah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ahmad Farhati
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jie-ying Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ying-Ying Chua
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Liang En Wee.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wee, L.E., Sundarajoo, M., Quah, WF. et al. Health-related quality of life and its association with outcomes of outpatient parenteral antibiotic therapy. Eur J Clin Microbiol Infect Dis 39, 765–772 (2020). https://doi.org/10.1007/s10096-019-03787-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-019-03787-6

Keywords

  • Outpatient antibiotics service
  • Quality of life
  • Complications
  • Readmission