Home and Community Care Digest December 2003: 0-0
IV antibiotic therapy at home works and costs less
AbstractDespite widespread adoption of intravenous (IV) home treatment over recent years, few clinical trials have evaluated the effectiveness of IV antibiotic therapy at home versus in hospital. This randomized clinical trial determined that IV antibiotic therapy is a feasible, safe and cost effective alternative to in-hospital treatment among those with a broad range of infections. Background: Few clinical trials have evaluated the effectiveness of intravenous (IV) antibiotic therapy at home versus in hospital despite widespread adoption of IV home treatment over the last decade. Although home IV treatment strategies are widely considered to be cost effective and preferable to the health care sector, there is a paucity of evidence to support these assumptions. The purpose of this study was to determine if home IV antibiotic therapy is a cost-effective alternative to in-hospital treatment among those with a broad range of infections.
Method: This study examined the impact of home versus hospital IV therapy on health related quality of life (HRQOL), incidence of adverse events, and cost for those with divergent infections requiring immediate treatment. Eighty-two consenting adult patients at 2 hospitals in Brisbane Australia were randomized to either home or hospital IV antibiotic therapy. Those included in the study confirmed the presence of family support and suitable facilities for IV therapy (e.g. telephone) in the home prior to enrolment. Excluded were those with (a) unstable disease, (b) past history of non-compliance with medications, and/or (c) history of substance abuse. Choice and duration of antibiotic therapy were the decision of the treating physician, in accordance with usual care for the particular infection of each participant (e.g. urinary tract infection, cellulitis, pneumonia).
Findings: No differences were found in HRQOL scores between the two groups after treatment. Treatment duration median was 11.5 days and 11 days for home and hospital groups respectively. Home therapy total costs--including costs pertaining to family, diagnostic-related group (DRG), hospital stay, home stay, home devices, and other services--were approximately half that of hospital therapy. For those requiring readmission to hospital after discharge, time to readmission was longer for those who received in hospital therapy.
Conclusions: Home IV antibiotic therapy is well tolerated by selected patients with divergent infections requiring immediate treatment. Home IV therapy is more cost effective, and is not associated with any major decline in quality of life or clinical outcomes as compared to hospital therapy.
Reference: Walter JM, Cagney RA, McCormack JG. A randomized trial of home vs hospital intravenous antibiotic therapy in adults with infectious diseases. Journal of Infection 2003 (in press).
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