Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia.
School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia.
J Antimicrob Chemother. 2017 Oct 1;72(10):2898-2901. doi: 10.1093/jac/dkx203.
Most outpatient parenteral antimicrobial therapy (OPAT) services use a hospital-based model of care in which patients remain in proximity to large hospitals facilitating clinical review. We aimed to evaluate clinical outcomes and complication rates for patients living in geographically isolated locations managed by telemedicine-supported OPAT. Methods: This was a retrospective cohort study.
Between 2011 and 2015, we delivered 88 episodes of care involving 83 adult patients resulting in 2261 days of OPAT. The median age was 56 years, 8 of 83 (10%) were indigenous Australian and the median Charlson comorbidity index score was 2 (IQR 1-4). The median distance of patients' residence from our hospital was 288 km (IQR 201-715) and the median duration on the programme was 26 days (IQR 14-34). Bone and joint infections accounted for 75% of infections treated. Favourable clinical outcomes (improvement or cure) were achieved in 87% of patients and the unplanned, OPAT-related readmission rate was 8%. Nineteen percent and 10% of patients had drug-related and line-related adverse effects, respectively.
Despite a complex case mix, our adverse event and readmission rates are similar to the published literature describing a non-telemedicine model to deliver OPAT. High rates of favourable clinical outcomes and likely cost benefits suggest that telemedicine-supported OPAT is an efficacious and safe substitute for inpatient care in our setting.
大多数门诊患者的静脉用抗菌药物治疗（OPAT）服务采用基于医院的护理模式，在此模式下，患者仍与大型医院保持近距离，便于临床评估。我们旨在评估通过远程医疗支持的 OPAT 进行管理的居住在地理位置偏远的患者的临床结局和并发症发生率。方法：这是一项回顾性队列研究。
在 2011 年至 2015 年期间，我们提供了 88 例护理疗程，涉及 83 名成年患者，共进行了 2261 天的 OPAT。患者的中位年龄为 56 岁，83 人中 8 人（10%）为澳大利亚原住民，Charlson 合并症指数中位数为 2（IQR 1-4）。患者居住地与我们医院的中位数距离为 288 公里（IQR 201-715），中位数疗程为 26 天（IQR 14-34）。骨骼和关节感染占治疗感染的 75%。87%的患者获得了良好的临床结局（改善或治愈），非计划的、与 OPAT 相关的再入院率为 8%。19%和 10%的患者分别出现药物相关和管路相关的不良反应。
尽管患者病情复杂，但我们的不良事件和再入院率与描述非远程医疗模式下进行 OPAT 的已发表文献相似。高比例的良好临床结局和可能的成本效益表明，远程医疗支持的 OPAT 是我们治疗环境中替代住院治疗的有效且安全的替代方法。
