Department of Public Health and Policy, NHS Lothian, Waverley Gate, Edinburgh, UK.
The University of Edinburgh Centre for Inflammation Research, Edinburgh, Edinburgh, UK; NHS Lothian, Regional Infectious Diseases Unit, Edinburgh, UK.
Int J Equity Health. 2020 Sep 1;19(1):150. doi: 10.1186/s12939-020-01261-w.
To assess whether Outpatient Parenteral Antimicrobial Therapy (OPAT) is provided equitably across gender and social groups in a tertiary care setting.
OPAT is a widely used and growing approach in high income countries to early discharge or admission avoidance for patients requiring intravenous antimicrobials. There is however a risk that equitable access to healthcare could be eroded unintentionally by expansion of outpatient or ambulatory approaches such as this. Anecdotal evidence in our service, and from published studies, have identified a gender and social group equity gap in outpatient services.
Service data on inpatient cellulitis episodes over a seven-year period were matched to OPAT referral data to create a retrospective cross-sectional linked dataset. All individuals admitted from 2012 to 2017 inclusive for a primary diagnosis of cellulitis were included: 6295 admissions of 4944 individuals. Demographics, number of co-morbidities, length of hospital stay, number of admissions, distance from OPAT unit and Scottish Index of Multiple Deprivation (SIMD; as a metric of deprivation) were recorded. Adjusted odds of a referral to OPAT across SIMD quintiles and for females compared to males were calculated using multiple logistic regression.
Inequitable access to OPAT was identified. Deprivation was negatively associated with likelihood of OPAT referral. Inpatients from the most affluent SIMD quintile were more than twice as likely to have received an OPAT referral compared to those resident in the most deprived quintile (adjusted OR 2.08, 95% CI: 1.60-2.71, p < 0.0001). Women were almost a third less likely to receive an OPAT referral than men (adjusted OR 0.69, 95% CI: 0.58 to 0.82, p < 0.001). Results were adjusted for age, number of co-morbidities, admissions, length of stay, distance from nearest OPAT unit, time since first admission, deprivation and gender.
OPAT services and other ambulatory care programmes should routinely evaluate the equity of their service provision and consider how they can reduce any identified imbalance. It is a critical responsibility of service planning to ensure an inequitable system does not develop, with those least able to access ambulatory care dispossessed of the associated benefits.
评估在三级保健环境中，是否存在针对不同性别和社会群体的门诊肠外抗菌治疗（OPAT）提供的公平性。
OPAT 是一种在高收入国家广泛使用且不断发展的方法，用于对需要静脉内抗菌药物治疗的患者进行早期出院或避免住院。然而，通过这种门诊或流动方式的扩展，可能会无意中破坏公平获得医疗保健的机会。我们服务中的一些轶事证据以及已发表的研究表明，在门诊服务中存在性别和社会群体公平性差距。
对过去七年中住院患者蜂窝织炎发作的服务数据与 OPAT 转诊数据进行匹配，创建了回顾性横断面关联数据集。纳入了 2012 年至 2017 年期间所有因原发性蜂窝织炎入院的患者：共 4944 名患者的 6295 次入院。记录了人口统计学、合并症数量、住院时间、入院次数、距 OPAT 单位的距离和苏格兰多重剥夺指数（SIMD；作为贫困指标）。使用多变量逻辑回归计算了按 SIMD 五分位数和女性与男性比较的接受 OPAT 转诊的调整比值比。
发现 OPAT 获得存在不公平现象。贫困与接受 OPAT 转诊的可能性呈负相关。来自最富裕 SIMD 五分位数的住院患者接受 OPAT 转诊的可能性是最贫困五分位数居民的两倍多（调整后的比值比 2.08，95%置信区间：1.60-2.71，p<0.0001）。女性接受 OPAT 转诊的可能性比男性低近三分之一（调整后的比值比 0.69，95%置信区间：0.58 至 0.82，p<0.001）。结果经过年龄、合并症数量、入院次数、住院时间、距最近 OPAT 单位的距离、首次入院时间、贫困和性别调整。
OPAT 服务和其他流动护理计划应定期评估其服务提供的公平性，并考虑如何减少任何发现的不平衡。确保不会出现不公平的系统，让最无力获得流动护理的人无法获得相关益处，这是服务规划的一项关键责任。
