Author: Alexandra Wilson Pecci
Uninsured patients requiring prolonged courses of treatment with intravenous antibiotics can be trained to treat themselves at home and achieve outcomes comparable to patients who receive treatment in traditional settings, data shows.
Teaching uninsured patients how to self-administer IV antibiotics for outpatient parenteral antimicrobial therapy (OPAT) has paid off for Parkland Hospital, a safety-net hospital serving Dallas County, Texas.
The program has resulted in similar or better clinical outcomes than healthcare provider-administered OPAT and 47% lower 30-day readmission rates over a four-year period, according to a recent study published by PLOS.
Lead study author Kavita Bhavan, MD, medical director of the Infectious Diseases OPAT Clinic at Parkland, and assistant professor of internal medicine at the University of Texas Southwestern Medical Center, explains the program, in an interview with HealthLeaders. This is the first of two parts. The transcript of her remarks has been lightly edited.
About the program:
The program is for uninsured patients to self-administer antibiotics at home as an alternative to remaining in the hospital or a traditional healthcare setting to complete their therapy. Patients who receive OPAT services are typically those who have been diagnosed in the hospital with an infection that requires a prolonged course of antibiotics.
This is done for more invasive infections, whether it’s osteomyelitis (an infection of the bone) or endocarditis, a heart valve infection, for example.
OPAT has been around since the late 1970s, was initially shown to work in pediatric populations, and then in adult populations. We started this program in 2009. I’m proud to say that Parkland is the first to publish outcomes of doing this kind of model. We don’t know who else is doing something similar to this.
On why Parkland started the program:
We started the OPAT program because we recognized that patients with infections who require long-term antibiotics typically receive concentrated diagnostics and therapeutic services.
The first couple of days is when we’re really busy trying to figure out what’s wrong with the [patients], trying to figure out a diagnosis, getting a treatment plan going—there’s a lot of stuff happening. But once they’re stable—simply because they have no other place to go—safety-net hospitals would simply just absorb that and have them stay in the hospital or discharge them to another setting to receive care, but not home, necessarily.
We talk about healthcare disparities in this country, and see that the patients who are insured have the option to be discharged early to home or to a lower-cost nursing facility to complete their therapy. But unfunded patients don’t typically receive these options and they usually remain in the hospital.
On improving resource utilization:
The United States leads all other developed countries in healthcare expenditures. I think the data says in 2013 we spent almost $3 trillion—that’s almost the entire GDP of France. And yet with all that we spend we don’t necessarily do well with things like resource utilization.
Safety-net hospitals like Parkland are charged with taking care of those who are uninsured. We have a large population of Medicaid and uninsured patients, for example. We find that our emergency room gets full fast, and our hospital gets full fast.