Andrew Seaton is a consultant in infectious diseases in NHS Greater Glasgow and Clyde and Honorary Clinical Associate Professor at the University of Glasgow. He is chair of the Scottish Antimicrobial Prescribing Group in Healthcare Improvement Scotland and he co-leads the British Society for Antimicrobial Chemotherapy OPAT initiative.
MOST will be aware of the unprecedented pressure hospitals and general practice are under in the aftermath of the Covid-19 pandemic. More patients are arriving and being admitted for emergency care than ever before and it is increasingly difficult to discharge recovering patients into an overloaded social care system.
At the same time, best treatments may be complex and require specialist oversight. This is particularly true of serious infectious diseases and antibiotic treatments, which, if used without great care may lead to complications including antibiotic resistance. Innovative ways of delivering care to patients with these conditions within current limited resources is necessary. OPAT, outpatient parenteral antibiotic therapy, is an example of such innovative care and it is currently expanding and developing at pace across Scotland.
Infections in hospital range from the familiar chest and urinary tract infections needing short courses of tablet antibiotics, to life-threatening blood poisoning needing IV (intravenous, into the vein) antibiotics and intensive care. In between these there are a range of infections that need short courses of IV therapy (like the common skin infection cellulitis) or more complicated infections including those in the bones and internal organs that need longer treatment. Although patients with these infections may feel well enough to be at home they need to stay in hospital in order to start or complete the IV treatment. OPAT is the specialist infectious disease service that can provide this treatment on an outpatient basis.
Following a careful assessment in the hospital or clinic the antibiotic is given through an IV line. Further treatment is given in the clinic or at home, often by patients or their carers following training and progress is monitored closely. Antibiotics are used very carefully in the OPAT setting, not just to ensure best outcomes but also to minimise side-effects and reduce risk of antibiotic resistance. Whenever feasible, IV therapy is switched to treatments that can be taken by mouth.
The recent national focus in supporting and investing in alternatives to hospital admission has driven OPAT service expansion across Scotland. Over the last nine months in the largest health board, NHS Greater Glasgow and Clyde, more than 800 patients have been assessed for OPAT and at least 12,000 overnight stays in hospital have been avoided. Scotland-wide OPAT has led to 52,000 less overnight stays over the same period.
Research in Scotland has shown OPAT to not only be safe, effective and highly acceptable to patients but also that care can be delivered at a fraction of the cost of an equivalent hospital stay. There are real opportunities to widen access to OPAT across Scotland and importantly to develop services to meet the needs of all potential patients irrespective of age, geography or social circumstances.
Outpatient Parenteral Antimicrobial Therapy (OPAT) (sapg.scot)
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