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Clinical and cost-effectiveness, safety and acceptability of community intravenous antibiotic service models: CIVAS systematic review

Murray, C. Czoski; Mitchell, E. D.; Czoski Murray, C; Meads, D.; Minton, J.; Wright, J.; Twiddy, M.

Authors

C. Czoski Murray

E. D. Mitchell

C Czoski Murray

D. Meads

J. Minton

J. Wright



Abstract

OBJECTIVE:
Evaluate evidence of the efficacy, safety, acceptability and cost-effectiveness of outpatient parenteral antimicrobial therapy (OPAT) models.
DESIGN:
A systematic review.
DATA SOURCES:
MEDLINE, EMBASE, CINAHL, Cochrane Library, National Health Service (NHS) Economic Evaluation Database (EED), Research Papers in Economics (RePEc), Tufts Cost-Effectiveness Analysis (CEA) Registry, Health Business Elite, Health Information Management Consortium (HMIC), Web of Science Proceedings, International Pharmaceutical Abstracts, British Society for Antimicrobial Chemotherapy website. Searches were undertaken from 1993 to 2015.
STUDY SELECTION:
All studies, except case reports, considering adult patients or practitioners involved in the delivery of OPAT were included. Studies combining outcomes for adults and children or non-intravenous (IV) and IV antibiotic groups were excluded, as were those focused on process of delivery or clinical effectiveness of 1 antibiotic over another. Titles/abstracts were screened by 1 reviewer (20% verified). 2 authors independently screened studies for inclusion.
RESULTS:
128 studies involving >60 000 OPAT episodes were included. 22 studies (17%) did not indicate the OPAT model used; only 29 involved a comparator (23%). There was little difference in duration of OPAT treatment compared with inpatient therapy, and overall OPAT appeared to produce superior cure/improvement rates. However, when models were considered individually, outpatient delivery appeared to be less effective, and self-administration and specialist nurse delivery more effective. Drug side effects, deaths and hospital readmissions were similar to those for inpatient treatment, but there were more line-related complications. Patient satisfaction was high, with advantages seen in being able to resume daily activities and having greater freedom and control. However, most professionals perceived challenges in providing OPAT.
CONCLUSIONS:
There were no systematic differences related to the impact of OPAT on treatment duration or adverse events. However, evidence of its clinical benefit compared with traditional inpatient treatment is lacking, primarily due to the dearth of good quality comparative studies. There was high patient satisfaction with OPAT use but the few studies considering practitioner acceptability highlighted organisational and logistic barriers to its delivery.

Citation

Murray, C. C., Mitchell, E. D., Czoski Murray, C., 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), https://doi.org/10.1136/bmjopen-2016-013560

Journal Article Type Article
Acceptance Date Feb 10, 2017
Online Publication Date Apr 20, 2017
Publication Date Apr 1, 2017
Deposit Date Dec 11, 2017
Publicly Available Date Dec 11, 2017
Journal BMJ Open
Print ISSN 2044-6055
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 7
Issue 4
Article Number e013560
DOI https://doi.org/10.1136/bmjopen-2016-013560
Keywords General Medicine
Public URL https://hull-repository.worktribe.com/output/499624
Copyright Statement This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/. This is a copy of an open access article published in BMJ Open, 2017, v.7 article number e013560.

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Copyright Statement
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/. This is a copy of an open access article published in BMJ Open, 2017, v.7 article number e013560.



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