Barriers and facilitators for the implementation and expansion of outpatient parenteral antimicrobial therapy: a systematic review

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Mohammed, SA
Cotta, MO
Assefa, GM
Erku, D
Sime, F
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2024
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Abstract

Outpatient parenteral antimicrobial therapy (OPAT) has been expanding in recent years and serves as a viable solution in reducing the shortage of hospital beds. However, the wider implementation of OPAT faces numerous challenges. This review aimed to assess implementation barriers and facilitators of OPAT services. Studies describing barriers and facilitators of the OPAT service were retrieved from PubMed, Scopus, MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Science Proceedings, International Pharmaceutical Abstracts and PsycINFO. All types of study designs published in the English language were included. Studies that did not mention any barrier or facilitator, did not differentiate OPAT and inpatient, focused on specific antimicrobials or diseases, and made no distinction between parenteral and other treatments were excluded. Qualitative analysis was performed using the 'best-fit' framework approach and the Consolidated Framework for Implementation Research (CFIR). The review was PROSPERO registered (CRD42023441083). A total of 8761 studies were screened for eligibility and 147 studies were included. Problems in patient selection, lack of awareness, poor communication and co-ordination, lack of support, lack of structured service and inappropriate prescriptions were identified. OPAT provides safe, effective and efficient treatment while maintaining patients' privacy and comfort, resulting in less daily life disruption, and reducing the risk of infection. Satisfaction and preference for OPAT were very high. Initiatives in strengthening OPAT such as antimicrobial stewardship and telemedicine are beneficial. Challenges to and facilitators of OPAT were identified among patients, health professionals, OPAT service providers and healthcare administrators. Understanding them is crucial to designing targeted initiatives for successful OPAT service implementation.

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Journal of Hospital Infection

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147

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© 2024 The Author(s). Published by Elsevier Ltd on behalf of The Healthcare Infection Society. This is an open access article distributed under the terms of the Creative Commons CC-BY license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. You are not required to obtain permission to reuse this article.

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Subject

Medical bacteriology

Infectious diseases

Health policy

Clinical sciences

Epidemiology

Public health

Antimicrobial therapy

Barrier

Facilitator

OPAT

Outpatient

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Mohammed, SA; Cotta, MO; Assefa, GM; Erku, D; Sime, F, Barriers and facilitators for the implementation and expansion of outpatient parenteral antimicrobial therapy: a systematic review., Journal of Hospital Infection, 2024, 147, pp. 1-16

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