Twiddy Maureen, Czoski Murray Carolyn J, Mason Samantha J, Meads David, Wright Judy M, Mitchell Elizabeth D, Minton Jane
Hull York Medical School, University of Hull, Hull, UK.
Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
BMJ Open. 2018 Jan 10;8(1):e019099. doi: 10.1136/bmjopen-2017-019099.
Outpatient parenteral antimicrobial therapy (OPAT) provides opportunities for improved cost savings, but in the UK, implementation is patchy and a variety of service models are in use. The slow uptake in the UK and Europe is due to a number of clinical, financial and logistical issues, including concern about patient safety. The measurement of patient experience data is commonly used to inform commissioning decisions, but these focus on functional aspects of services and fail to examine the relational aspects of care. This qualitative study examines patients' experiences of OPAT.
In-depth, semistructured interviews.
Purposive sample of OPAT patients recruited from four acute National Health Service (NHS) Trusts in Northern England. These NHS Trusts between them represented both well-established and recently set-up services running nurse at home, hospital outpatient and/or self-administration models.
We undertook 28 semistructured interviews and one focus group (n=4).
Despite good patient outcomes, experiences were coloured by patients' personal situation and material circumstances. Many found looking after themselves at home more difficult than they expected, while others continued to work despite their infection. Expensive car parking, late running services and the inconvenience of waiting in for the nurse to arrive frustrated patients, while efficient services, staffed by nurses with the specialist skills needed to manage intravenous treatment had the opposite effect. Many patients felt a local, general practitioner or community health centre based service would resolve many of the practical difficulties that made OPAT inconvenient. Patients could find OPAT anxiety provoking but this could be ameliorated by staff taking the time to reassure patients and provide tailored information.
Services configurations must accommodate the diversity of the local population. Poor communication can leave patients lacking the confidence needed to be a competent collaborator in their own care and affect their perceptions of the service.
门诊胃肠外抗菌治疗（OPAT）为节省成本提供了契机，但在英国，其实施情况参差不齐，且存在多种服务模式。在英国和欧洲，该治疗方法的采用进展缓慢，原因包括一些临床、财务和后勤问题，其中也包括对患者安全的担忧。患者体验数据的衡量通常用于为委托决策提供信息，但这些数据侧重于服务的功能方面，而未能考察护理的关系方面。这项定性研究考察了患者对OPAT的体验。
深入的半结构化访谈。
从英格兰北部四个急性国民保健服务（NHS）信托机构中选取的OPAT患者的目标样本。这些NHS信托机构代表了既有成熟服务也有近期设立服务的机构，这些服务采用了居家护理、医院门诊和/或自我给药模式。
我们进行了28次半结构化访谈和1次焦点小组访谈（n = 4）。
尽管患者治疗效果良好，但体验却因个人情况和物质条件而受到影响。许多人发现在家照顾自己比预期更困难，而另一些人尽管感染了仍继续工作。昂贵的停车费用、服务延误以及等待护士到来的不便让患者感到沮丧，而高效的服务，由具备管理静脉治疗所需专业技能的护士提供，则产生了相反的效果。许多患者认为基于当地全科医生或社区健康中心的服务可以解决许多使OPAT不便的实际困难。患者可能会觉得OPAT令人焦虑，但工作人员花时间安抚患者并提供量身定制的信息可以缓解这种情况。
服务配置必须适应当地人群的多样性。沟通不畅会使患者缺乏成为自身护理中合格合作者所需的信心，并影响他们对服务的看法。
