Patient Preferences & Quality of Life Assessment for Outpatient Parenteral Antibiotic Therapy (OPAT) in the Home Setting

A Preliminary Analysis

Context

Select inpatients are candidates for parenteral antimicrobial therapy in the home setting.  To facilitate this type of treatment delivery, we introduced an Outpatient Antimicrobial Treatment (OPAT) Program at Vancouver Hospital and Health Sciences Centre in 1995.  Satisfaction surveys collected over the ensuing years have shown favourable patient response; however no in depth evaluation has been accomplished. To our knowledge, there are no published formal assessments of patient preferences and quality of life of patients enrolled in an OPAT Program. The objectives of this study were to measure patient preference and willingness to pay for treatment setting and to measure change in quality of life for patients enrolled in this OPAT Program.

Design

A prospective single Centre survey-based study involving contingent valuation (willingness to pay) and quality of life questionnaires.

Setting

A major Canadian tertiary care teaching hospital.

Subjects

Adult inpatients who were candidates for the OPAT program were considered eligible to complete the willingness to pay (WTP) questionnaire.  Patients enrolled in the OPAT program were considered eligible to complete the quality of life assessment.  All participants provided informed consent.

Intervention

During the initial 7-month study period, consenting OPAT Program candidates completed the WTP questionnaire.  Marginal willingness to pay for preferred treatment location (hospital versus home settings) was assessed using hypothetical scenarios outlining the probabilities of various outcomes for each location. Those consenting patients who were subsequently enrolled in the OPAT program also completed a Short Form-36 (SF-36) questionnaire for the quality of life assessment component of the study. This latter instrument was administered prior to discharge and repeated 4 weeks later.

Main Outcome Measures

Patient preference for treatment setting, willingness to pay for this preferred treatment setting, and changes in the patient’s reported quality of life.

Results

Of the initial 67 patients surveyed, 83% reported a preference to be treated in the home setting while 13% preferred to remain in hospital.  The balance had no preference.  Fifty-two patients provided an interpretable response to the  WTP scenarios with a mean of $1,076 and median of $470 (range $10-$6,250).  While role-physical and general health domain scores tended to decline; bodily pain, social functioning and role-emotional scores improved subsequent to discharge.  Most domain scores were below the published U.S. population averages with the exception of mental status.

Conclusions

Preliminary data suggests that most adult inpatients in our hospital with infections prefer to be treated in the home setting and are willing to pay for this preference.  Quality of life appears to improve for patients who are enrolled in the program and discharged home, but this seems to be domain-dependent.

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