Development of a patient-centred model of community-based OPAT (CoPAT) service in Singapore

Abstract

There is a growing trend of expanding Outpatient Parenteral Antibiotics Therapy (OPAT) services to the community as it is more cost-effective for both patients and healthcare organisations. At the Singapore General Hospital (SGH), frail patients requiring intravenous (IV) antibiotics often have to prolong their hospitalisation to complete the course of treatment. Community OPAT (CoPAT) service is a joint effort between SGH Community Nursing and Department of Infectious Diseases. With the new CoPAT service, patients have the options of receiving their IV antibiotics at home rather than receiving treatment at the hospital or outpatient clinic. This case study described the process of providing CoPAT services in the community, its challenges and learning points and the positive outcomes of cost saving and improved patient experience. Early preliminary screening of suitable patients and good communication link among hospitals and community teams are essential in ensuring its success. *Correspondence to: Xu Yi, Senior Nurse Clinician (Community Nurse), RHSCommunity Nursing, Singapore General Hospital, Singapore, E-mail: xu.yi@ sgh.com.sg Received: August 27, 2019; Accepted: September 09, 2019; Published: September 12, 2019 Introduction Outpatient Parenteral Antibiotic Therapy (OPAT) refers to the approach for delivering intravenous (IV) antimicrobials in the outpatient setting or community [1]. OPAT service was first described in the United States in 1974 and was subsequently introduced to Singapore in 2002 [2]. This service requires a multidisciplinary team with expertise and experience in antimicrobial therapy for safety and long-term sustainability [3]. It is further recommended that the OPAT team provides an extension of services including laboratory testing, catheter care, regular nursing and physician assessments, follow-up, and adjustments as part of the optimal care to the existing primary illness, comorbidities and emerging complications [2]. Globally, there is a growing trend of expanding OPAT services to the community as it is cost-effective, and it also provides greater comfort to the patient when he/she receives the IV antibiotic at home [4]. OPAT improves patient’s satisfaction as it provides him/her the advantages of being able to resume his/her daily activities and having greater freedom and control at a familiar environment [5]. In additon, administering IV antibiotic at home reduces the risk of nosocomial complications as a result of prolonged hospitalisation [4]. In Singapore, OPAT services are mainly provided at specific outpatient clinics within acute hospitals. This service may not be accessible to patients who are frail or with limited mobility as it requires them to travel daily to the outpatient clinic and also incurs transportation costs. As a result, many of them would prefer to remain in the hospital till they receive the full course of IV antibiotics. This paper aims to describe the development of a patient-centred model of community-based OPAT (CoPAT) service in Singapore using a case study approach.