OPAT in the UK - an overview of service provision

1. OPAT in the UK - an overview of service provision

2. OPAT in the UK 2011

3. 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

4. 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

5. Examples within greater London • GSTT • District nurses • Self/carer administration • Pilot community ‘virtual ward’ • UCH • Daily hospital attendance • SGH • Private healthcare provider

6. 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

7. METHODOLOGY Contact 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

8. OR All responses collected between 3rdNovember and 9th December 2011

10. SAMPLE Original 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.

11. Response • 193 centres contacted • 127 responded (66%) • Total of 296 health care professionals • 166 complete questionnaires • 130 incomplete questionnaires

12. Does your centre currently have an OPAT service?

13. OPAT =

14. Which model(s) of OPAT do you use? N = 204

15. Why have you chosen those particular models? N = 78

16. Would you like to extend your service?

17. Which patients would you like to extend to?

18. What are the barriers to extending your current service provision?

19. OPAT SOFTWARE Do you have a database for monitoring patient outcomes? Which database are you using?

20. OPAT =

21. Would you like to develop an OPAT service? N = 59

22. What is the main reason for not having an opat service?

23. Who would you like to develop an OPAT service for?

24. Which model(s) of OPAT would you consider using?

25. What are the important considerations when choosing your OPAT model? N = 222

26. What stage of development are you currently at? N = 48

27. What are the barriers to moving the process forward? N = 109

28. Conclusion and recommendations OPAT =

29. 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%)

30. Conclusion and recommendations OPAT =

31. 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%)