Applicability of Quality Indicators for Appropriate Antibiotic use in Outpatient Parenteral Antimicrobial Therapy (OPAT): A Point Prevalence Survey.

Pablo March-López,Inés Arancibia Freixa,Montserrat Carrasco Sanchez,Mireia Martinez Gil,Júlia Pardo,Elisabeth Cecilia Paredes,Lidia Ortega Polonio,Cristina Sangrador,Jordi Nicolás,Gastón Araujo Espinoza,Esther Calbo

doi:10.3389/fphar.2021.713882

Abstract

The ability to measure the quality of antibiotic prescription is a critical element in any antimicrobial stewardship programme. The aim of this study was to evaluate the clinimetric properties of 33 quality indicators (QIs) developed to assess Outpatient Parenteral Antimicrobial Therapy (OPAT) and to identify potential room for improvement in a hospital-at-home (HaH) unit. Study performed in a healthcare district in Barcelona, Spain with 260,657 inhabitants, nine primary healthcare centres, a 400-bed acute care teaching hospital, and an HaH unit. We studied 33 QIs on appropriate antibiotic use and classified them as qualitative or quantitative. Quantitative QIs were further categorized as measurable or non-measurable depending on the availability of data in the patients’ medical records. Data from 202 OPAT episodes in 192 patients were assessed. Adherence was found for 22 of the 24 qualitative QIs analyzed; the other two showed room for improvement. Four of the nine quantitative indicators were non-measurable. High adherence rates were achieved for QI-17 “The OPAT plan should be documented” (84.65%), QI-26 “The OPAT treatment plan should include choice, dose, frequency, duration and follow-up plan” (79.70%), and QI-33 “The team should document clinical response” (94.55%). Adverse events were documented in just 1.98% of cases (QI-32) and 92.57% patients were classified as alive on discharge (QI-24). The QIs evaluated were applicable to clinical practice and proved useful for identifying areas with room for improvement in our setting and for guiding the design of future interventions with specific objectives.

Highlights

Outpatient parenteral antimicrobial therapy (OPAT) has been defined as the provision of parenteral antimicrobial therapy in at least two doses on different days without intervening hospitalization (Tice et al, 2004)
The 33 quality indicators (QIs) on appropriate antibiotic use developed by Berrevoets et al (Berrevoets et al, 2020) were classified as qualitative or quantitative
We have evaluated adherence and room for improvement for a set of QIs in a cohort of Outpatient Parenteral Antimicrobial Therapy (OPAT) patients treated in Spain, a highincome country with a national public health system

Summary

Introduction

Outpatient parenteral antimicrobial therapy (OPAT) has been defined as the provision of parenteral antimicrobial therapy in at least two doses on different days without intervening hospitalization (Tice et al, 2004). It allows patients who would typically need to be hospitalized to receive parenteral antimicrobials at home, thereby increasing the availability of hospital beds by shortening or even eliminating hospital stays (Barr et al, 2012). In Spain, the first HaH unit was created by Hospital Gregorio Marañón in Madrid in 1981. The foundation of the Spanish Society for Home Hospitalization (SEHAD) in 2006 represented an important step forward in the development of HaH programmes across the country. As of January 2021, there were 105 active HaH units in Spain (Sociedad Española de HospitalizaciónDomiciliaria, 2020)

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