Recommendation for NHSScotland

Outpatient parenteral antimicrobial therapy (OPAT) services should be offered to clinically appropriate patients with serious infections who do not require hospitalisation beyond their need for antimicrobial therapy.

NHSScotland Boards should aim to offer a flexible OPAT service with multiple care pathways designed to meet individual patient needs within the context of local resources and geography. Alternative care pathways include outpatient clinics, nurse visits to patients’ homes, or patient or carer self-administration at home.

All OPAT services should ensure clear, ongoing communication with patients and their carers throughout their care. This will ensure that any concerns and risks associated with home-based OPAT are managed as part of the service.

NHSScotland is required to consider the Scottish Health Technologies Group (SHTG) advice.

What were we asked to look at?

We were asked by the Scottish Antimicrobial Prescribing Group (SAPG) and the British Society of Antimicrobial Chemotherapy (BSAC) to provide advice on the use of outpatient parenteral antimicrobial therapy (OPAT) in Scotland. In addition to a review of the published evidence comparing OPAT with inpatient parenteral antimicrobial therapy, we were also asked to compare different models of care for delivery of OPAT services. In particular, we were asked to evaluate the cost effectiveness of OPAT service delivery models.

Why is this important?

An estimated one in three hospital patients in the UK will receive an antimicrobial medication, often intravenously, to treat a serious infection. Intravenous antimicrobial therapy was once considered a barrier to hospital discharge, but patients can now complete their antimicrobial therapy as part of an OPAT service. Delivery of OPAT in the outpatient or community setting has many potential benefits including reduced risk of hospital-acquired infections, resource savings through reduced bed use, increased patient satisfaction, and care closer to home. A shift towards increased intravenous antimicrobial provision closer to the patients’ home also reduces the number of patients visiting or staying in hospitals during the current COVID-19 pandemic.

Referred by

The Scottish Antimicrobial Prescribing Group and British Society for Antimicrobial Therapy